Later On

A blog written for those whose interests more or less match mine.

Nocebos are just as powerful as placebos

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Nocebos exercise their noxious effects on the body by stimulating worry, fear, and stress. Megan Scudellari reports in The Scientist:

Something strange was happening in New Zealand. In the fall of 2007, pharmacies across the country had begun dispensing a new formulation of Eltroxin—the only thyroid hormone replacement drug approved and paid for by the government and used by tens of thousands of New Zealanders since 1973. Within months, reports of side effects began trickling in to the government’s health-care monitoring agency. These included known side effects of the drug, such as lethargy, joint pain, and depression, as well as symptoms not normally associated with the drug or disease, including eye pain, itching, and nausea. Then, the following summer, the floodgates opened: in the 18 months following the release of the new tablets, the rate of Eltroxin adverse event reporting rose nearly 2,000-fold.1

The strange thing was, the active ingredient in the drug, thyroxine, was exactly the same. Laboratory testing proved that the new formulation was bioequivalent to the old one. The only change was that the drugmaker, GlaxoSmithKline, had moved its manufacturing process from Canada to Germany, and in the process altered the drug’s inert qualities, including the tablets’ size, color, and markings.

So why were people getting sick? In June, it turned out, newspapers and TV stations around the country had begun to directly attribute the reported adverse effects to the changes in the drug. Following widespread coverage of the issue, more and more patients reported adverse events to the government. And the areas of the country with the most intense media coverage had the highest rates of reported ill effects, suggesting that perhaps a little social persuasion was at play.

But Eltroxin takers were not making up their symptoms. The feelings were real, but in the vast majority of cases they could not be attributed to the drug’s pharmacological properties. The patients were victims of the nocebo effect.“Nocebo” (meaning “I shall harm”) is the dastardly sibling of placebo (“I shall please”). In a placebo response, a sham medication or procedure has a beneficial health effect as a result of a patient’s expectation. Sugar pills, for example, can powerfully improve depression when the patient believes them to be antidepressants. But, researchers are learning, the reverse phenomenon is also common: negative expectations can actually cause harm.

When Parkinson’s patients undergoing deep brain stimulation were told that their brain pacemaker was going to be turned off, symptoms of their illness became more pronounced, even when the pacemaker was left on.2 When people with and without lactose intolerance were asked to ingest lactose, but were actually given glucose, 44 percent of those with lactose intolerance and 26 percent of those without it still complained of stomach pain.3 And men treated for an enlarged prostate with a commonly prescribed drug and told that the drug “may cause erectile dysfunction, decreased libido, [and] problems of ejaculation,” but that these effects were “uncommon,” were more than twice as likely to experience impotence as those who were not so informed.4

On paper, it sounds like psychobabble—a negative effect caused by a sham treatment based on a patient’s expectations—but it is a real biochemical and physiological process, involving pain and stress pathways in the brain. And mounting evidence suggests that the nocebo effect is having a substantial negative impact on clinical research, medicine, and health.

“Nocebo is at least as important as the placebo effect and may be more widespread,” says Ted Kaptchuk, director of Harvard’s Program in Placebo Studies at Beth Israel Deaconess Medical Center in Boston, Massachusetts.

Now that this pernicious phenomenon is starting to receive the recognition it deserves, the question is: What exactly can be done about it? . . .

Continue reading.

Somehow I am reminded of the Salem “witches.”

Written by Leisureguy

10 July 2013 at 10:53 am

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