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The nocebo effect

Penny Sarchet discusses research on the ‘nocebo’ effect in her winning essay for the Wellcome Trust science writing prize

Can just telling a man he has cancer kill him? In 1992 the Southern Medical Journal reported the case of a man who in 1973 had been diagnosed with cancer and given just months to live. After his death, however, his autopsy showed that the tumour in his liver had not grown. His intern Clifton Meador didn’t believe he’d died of cancer: “I do not know the pathologic cause of his death,” he wrote. Could it be that, instead of the cancer, it was his expectation of death that killed him?

…The findings … not only offer the first glimpses into the neurology underlying the nocebo effect, but also have very real medical implications. Benedetti’s work on blocking cholecystokinin could pave the way for techniques that remove nocebo outcomes from medical procedures, as well as hinting at more general treatments for both pain and anxiety. The findings of Tracey’s team carry startling implications for the way we practise modern medicine. By monitoring pain levels in volunteers who had been given a strong opioid painkiller, they found that telling a volunteer the drug had now worn off was enough for a person’s pain to return to the levels it was at before they were given the drug. This indicates that a patient’s negative expectations have the power to undermine the effectiveness of a treatment, and suggests that doctors would do well to treat the beliefs of their patients, not just their physical symptoms.

This places a spotlight on doctor-patient relationships. Today’s society is litigious and sceptical, and if doctors overemphasise side-effects to their patients to avoid being sued, or patients mistrust their doctor’s chosen course of action, the nocebo effect can cause a treatment to fail before it has begun. It also introduces a paradox – we must believe in our doctors if we are to gain the full benefits of their prescribed treatments, but if we trust in them too strongly, we can die from their pronouncements.

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