Nocebo Effect

Funny as it might seem, patients who are warned too much of possible side-effects before being given a medication, seem to experience them more often. Describing this phenomenon as the NOCEBO effect, German researcher Winfried Hauser has recently shown that patients anticipating side-effects such as giddiness, headache, constipation or lack of concentration, experience them more often than those who take the drug without being told about them.

This new finding fits well with what physicians have suspected all along, that the body’s response to therapy often depends on the patient’s belief with which he takes it. Some of the benefits of medicine undoubtedly come from the positive anticipation that a particular drug will work as intended — easing arthritis or relieving wheezing, for example – called the PLACEBO effect. On the flip side our belief in a drug’s side effects may actually cause us to suffer from them as well.

The role of suggestion and belief in obtaining a positive response from treatment is well known. Scientists have shown that PLACEBO medication, that is one which has no active ingredient but looks like a drug, such as an empty capsule, often produces remarkable benefit when taken with positive anticipation of relief. As many as 50 percent of patients report benefit in headaches, abdominal pain, dyspepsia and sexual functions with dummy medicines consumed in good faith.

Dr Winfried, an expert in psychosomatic medicine, who has visted India two times, feels that imagination and fears of patients can have just the opposite effect. When cautioned that a drug may cause sexual dysfunction, for example, a larger number of patients taking it report experiencing it.

A lady who consulted me with the history of breaking into allergic hives on taking virtually every antibiotic had a similar reaction when administered a vitamin capsule that looked like an antibiotic. Her hives disappeared when she was told and assured that it was a vitamin and not an antibiotic.

Practitioners of alternative and indegenous systems of medicine bank more on faith and do not usually mention side-effects of their therapy. Patients too therefore consider these innocuous and harmless, and consequently do not report side effects with their use.

Is keeping patients in the dark about a drug’s potential side effects, then the only solution?  In modern times it would be clearly not ethical. What experts propose is “contextualized informed consent,” that takes into account the possible side effects, the patient being treated, and the disease involved. While it will be clearly important to caution against potentially dangerous side effects, such as drowsiness while prescribing anti-allergic drugs to a person who might drive a car for instance, mentioning lack of concentration with an anti-diarrheal to an exam-going student may cause unnecessary harm.

While modern medicine requires that all potential effects of therapy, beneficial as well as harmful, be placed on the table, which aspects to highlight and which ones to downplay remains a matter of the wise doctor’s discretion.