The Nocebo Effect

If you ever read the label on your prescription drugs (or more likely the PI (Product Insert)), you will learn about all kinds of potential side effects ranging from mild things like headaches to much more serious but rarer conditions. The WSJ had an article earlier this week called “Power of Suggestion: When Drug Labels Make You Sick” which talks about the “nocebo effect” where knowing about potential risks makes you more likely to experience them.

“Women in the multi-decade Framingham Heart study who thought they were at risk for heart attacks were 3.7 times as likely to die of coronary conditions as women who didn’t have such fears – regardless of whether they smoked or had other risk factors.”

“In a 1960s test, when hospital patients were given sugar water and told it would make them vomit, 80% of them did.”

Richard Kradin, author of “The Placebo Response and the Power of Unconscious Healing” says that about 25% of people who get placebos (i.e., a sugar pill) complain about side effects in clinical trials.

The article tees up the question of what to do with this information. Should the information be for the physician only? [I don’t think so.] Should the physician walk the patient through the information and the key side effects? [I think they should for any serious effects or have some type of follow-up mechanism to see how the patient feels on any chronic medication.]

I guess part of the challenge is talking with the patient about normal symptoms they are having before taking the drug. Are you drowsy? Do you have frequent headaches? Then at least they might be able to understand if they are side effects or the “nocebo effect”.