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Is Ignorance Really Bliss? What Is the ‘Nocebo’ Effect?

A weird, tricky ethical dilemma: Your chances of experiencing a drug's side effects go up if your doctor tells you they exist.

by
Theodore Dalrymple

Bio

July 27, 2014 - 9:00 am
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One of my first medical publications was on the nocebo effect, the unpleasant symptoms patients may suffer as a result of being made aware of potential side effects of a treatment they are about to receive or a procedure they are to undergo. Thus patients who were having a lumbar puncture were either told or not told they might suffer a headache afterwards; and lo and behold, those who were told that they might get headaches duly got headaches while those who were not told didn’t.

On the whole, as an article in a recent edition of the Journal of the American Medical Association points out, doctors are well aware of the placebo effect, that is to say the good that their treatment may do patients by means of mere suggestion, but have little awareness of the opposite nocebo effect, the harm that their treatment may do their patients by mere suggestion.

The nocebo effect poses an ethical dilemma for doctors, say authors of the article. On the one hand, doctors are supposed to do their patients no harm; on the other, they are supposed to be open and honest with their patients about the potential harms of drugs and other treatments. The dilemma is this: foreknowledge of those harms can harm some patients. Should the need for honesty trump the ethical injunction to do no harm?

All Comments   (5)
All Comments   (5)
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Bah humbug, here's the real nocebo effect: a doctor is more likely to take a patient report seriously, if the *doctor* has already read it in the side-effects.

I very heavily discount any claims of "placebo" or "nocebo" as almost always being "side-effects" of bad methodology, and the continuing medical tradition of treating patients as best kept ignorant. The next step after that is having the doctor yelling at a patient for not getting better - something I have actually experienced.

If you're a practitioner of western medicine, focus on the objective and causal, and leave the voodoo to others.

(yes, yes, I'm sure you can find some placebo effects and nocebo effects and even real scientific rationalizations for why that is, but the objective truth of the matter is that these are dwarfed by real science, they must have taught you guys *something* in medical school besides tut-tutting your patients back to health)
8 weeks ago
8 weeks ago Link To Comment
A potential silver lining to the Nocebo effect is that it may discourage people from utilizing the ever-increasing plethora of medical services that are of dubious or borderline benefit.
The incentives and medico-legal concerns of our system are such that complications from over-utilization of drugs and procedures is a growing public health threat.
8 weeks ago
8 weeks ago Link To Comment
My husband assiduously reads the information given about risks and side effects. He's fascinated by the list of mostly obscure reactions. It's unreasonable to expect every doctor who prescribes a medication to be able to recite every possible side effect, but the most likely should be mentioned along with a reminder that were the drug not safe, it would not have been approved by the FDA and considered suitable after all other medications and health issues the patient has are weighed. Is that too much to ask?
8 weeks ago
8 weeks ago Link To Comment
As a patient, I'd want to know about possible complications that might do lasting damage, especially if that can be mitigated by noticing and reporting their onset, or avoided by changes in diet etc. On the other hand, I don't feel the need to be told about trivial side effects, especially if they are in a booklet I've already been handed and could read if I wanted to do so.
9 weeks ago
9 weeks ago Link To Comment
The authors suggest that, to counteract the nocebo effect, doctors always append information about the potential harmful effects of their treatment with information about the good it will do.

I suggest instead a simple explanation of the nocebo effect.

The handful of pills in the young lady's hand makes it appear she is contemplating suicide.
9 weeks ago
9 weeks ago Link To Comment
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