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The Nocebo Effect

I read an interesting strategy from a tech guy: he announces each systems upgrade two weeks before he implements it. Then, if a problem gets reported in those two weeks, he knows that the upgrade didn't cause it.

Psi Baba said:
How about the sleep-aid commercials that warn as a possible side effect, "may cause drowsiness." I should friggin' hope so!
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Why I really don't understand are the ones where they claim that they are "non-narcotic". Isn't a sleep-aid by definition a narcotic?
 
skeptigirl said:
So patients and research subjects don't recall all the headaches they had without the drug or placebo, instead, they conclude this headache is different and caused by the coincident event.
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This is, not surprisingly, why this is referred to as "recall bias" and is very problematic in all types of clinical trials. This is also why we use placebo control arms to "cancel out" this type of bias, if the trial is designed and statistically powered appropriately. The new FDA package labeling guidelines only require that manufacturers report in a table those non-serious adverse events that have a greater than 2% rate over the placebo/control arm.

As far as the placebo/"nocebo" concern, if you give consideration to the above known study confounder you have to conclude that there actually isn't any direct physiological harm being done by a non-medication. Recall bias helps explain the belief that the medicine had an effect - positive or negative. The only potential harm, on a more philosophical level, is the then subsequent belief by the person taking the medication that ALL medication is either dangerous or ineffective.

-Dr. Imago
 
Art Vandelay said:
Why I really don't understand are the ones where they claim that they are "non-narcotic". Isn't a sleep-aid by definition a narcotic?
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heh

You would think so, but narcotic comes from the Greek narke, which meant - numbness or stupor, not sleep.
 
Googles says it's "Inducing sleep or stupor; causing narcosis." Isn't sleep an extreme form of stupor?
 
I mentioned this in a Community thread, as well, but I think it bears repeating: those warnings about erections lasting more than 4 hours are serious. Priapism also can happen even without taking ED drugs.

If you value your ability to get an erection ever again, you really want to get it seen to. Don't wait. Time is a factor.

In fact, all you gents probably ought to look up priapism and penile fracture; on the off chance either ever happens, maybe solid facts could help counter any feelings of embarrassment that might prevent you from seeking the doctor ASAP.

[end urology derail/buzzkill, apologies to the Nocebo folks!]
 
Psi Baba said:
How about the sleep-aid commercials that warn as a possible side effect, "may cause drowsiness." I should friggin' hope so!
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My favourite was the medication for social anxiety that warned of an inability to control loose bowel movements. If that doesn't make you anxious while you're out and about...
 
Beausoleil said:
My favourite was the medication for social anxiety that warned of an inability to control loose bowel movements. If that doesn't make you anxious while you're out and about...
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Yeah, but that is a real effect, not a Nocebo effect.

Nonspecific Medication Side Effects and the Nocebo Phenomenon

Arthur J. Barsky, MD; Ralph Saintfort, MD; Malcolm P. Rogers, MD; Jonathan F. Borus, MD

JAMA. 2002;287:622-627.

Patients taking active medications frequently experience adverse, nonspecific side effects that are not a direct result of the specific pharmacological action of the drug. Although this phenomenon is common, distressing, and costly, it is rarely studied and poorly understood. The nocebo phenomenon, in which placebos produce adverse side effects, offers some insight into nonspecific side effect reporting. We performed a focused review of the literature, which identified several factors that appear to be associated with the nocebo phenomenon and/or reporting of nonspecific side effects while taking active medication: the patient's expectations of adverse effects at the outset of treatment; a process of conditioning in which the patient learns from prior experiences to associate medication-taking with somatic symptoms; certain psychological characteristics such as anxiety, depression, and the tendency to somatize; and situational and contextual factors.
 
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I killed my own thread. Damn those facts. Maybe I should post some woo stuff. That always gets a thread going.
 
robinson said:
Nonspecific Medication Side Effects and the Nocebo Phenomenon

Arthur J. Barsky, MD; Ralph Saintfort, MD; Malcolm P. Rogers, MD; Jonathan F. Borus, MD

JAMA. 2002;287:622-627.

Patients taking active medications frequently experience adverse, nonspecific side effects that are not a direct result of the specific pharmacological action of the drug. Although this phenomenon is common, distressing, and costly, it is rarely studied and poorly understood. The nocebo phenomenon, in which placebos produce adverse side effects, offers some insight into nonspecific side effect reporting. We performed a focused review of the literature, which identified several factors that appear to be associated with the nocebo phenomenon and/or reporting of nonspecific side effects while taking active medication: the patient's expectations of adverse effects at the outset of treatment; a process of conditioning in which the patient learns from prior experiences to associate medication-taking with somatic symptoms; certain psychological characteristics such as anxiety, depression, and the tendency to somatize; and situational and contextual factors.
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Fascinating! I had never head of this before.

And you revived this yesterday? weird. I just stumbled across this from a search on google after trying to find some info on this effect, and was going to revive it myself when I started reading it, only to realize you just did yesterday.

The placebo's evil twin :) I had heard of people recovering from illness due to what they think via the placebo effect, but I never considered that negative thoughts could cause the opposite effect on your health. I'll have to have another look at this when I have more time. Cool thread. :thumbsup:

http://www.washingtonpost.com/ac2/wp-dyn/A2709-2002Apr29
Ten years ago, researchers stumbled onto a striking finding: Women who believed that they were prone to heart disease were nearly four times as likely to die as women with similar risk factors who didn't hold such fatalistic views.

The higher risk of death, in other words, had nothing to with the usual heart disease culprits -- age, blood pressure, cholesterol, weight. Instead, it tracked closely with belief. Think sick, be sick.
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Obsequious said:
I mentioned this in a Community thread, as well, but I think it bears repeating: those warnings about erections lasting more than 4 hours are serious. Priapism also can happen even without taking ED drugs.
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Maybe they should include a 4-hour egg timer as a marketing gimmick.
 
I think one important thing to consider with placebo/nocebo effects is the clinical relevance. There's a lot of fascinating exploration of the effects from a psychology angle and I endorse its continuance, but at the end of the day, they do not seem to have any practical medical value, except for a selection of psychiatric patients (ie: somatization disorders where people believe they have an 'allergy' or 'sensitivity' to some materials or phenomena).

That should be the take-away message.
 
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