Nocebo

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For the album, see Nocebo (album). For the film, see Nocebo (film).

A nocebo effect is said to occur when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have.[1][2] For example, when a patient anticipates a side effect of a medication, they can experience that effect even if the "medication" is actually an inert substance.[1] The complementary concept, the placebo effect, is said to occur when positive expectations improve an outcome. The nocebo effect is also said to occur in someone who falls ill owing to the erroneous belief that they were exposed to a toxin, e.g. a physical phenomenon they believe is harmful, such as EM radiation.[3]

Both placebo and nocebo effects are presumably psychogenic, but they can induce measurable changes in the body.[1] One article that reviewed 31 studies on nocebo effects reported a wide range of symptoms that could manifest as nocebo effects, including nausea, stomach pains, itching, bloating, depression, sleep problems, loss of appetite, sexual dysfunction, and severe hypotension.[1]

Etymology and usage

The term nocebo (

ringing in the ears caused by quinine.[6] That is not to say that the patient's psychologically induced response may not include physiological effects. For example, an expectation of pain may induce anxiety, which in turn causes the release of cholecystokinin, which facilitates pain transmission.[7]

Response

In the narrowest sense, a nocebo response occurs when a drug-trial subject's symptoms are worsened by the administration of an inert, sham,

pharmacological knowledge and the current understanding of cause and effect, a placebo contains no chemical (or any other agent) that could possibly cause any of the observed worsening in the subject's symptoms. Thus, any change for the worse must be due to some subjective factor. Adverse expectations can also cause the analgesic effects of anesthetic medications to disappear.[9]

The worsening of the subject's symptoms or reduction of beneficial effects is a direct consequence of their exposure to the placebo, but those symptoms have not been chemically generated by the placebo. Because this generation of symptoms entails a complex of "subject-internal" activities, in the strictest sense, we can never speak in terms of simulator-centered "nocebo effects", but only in terms of subject-centered "nocebo responses". Although some observers attribute nocebo responses (or placebo responses) to a subject's gullibility, there is no evidence that an individual who manifests a nocebo/placebo response to one treatment will manifest a nocebo/placebo response to any other treatment; i.e., there is no fixed nocebo/placebo-responding trait or propensity.[10]

McGlashan, Evans & Orne found no evidence in 1969 of what they termed a placebo personality.[11] Also, in a carefully designed study, Lasagna, Mosteller, von Felsinger and Beecher in 1954,[12] found that there was no way that any observer could determine, by testing or by interview, which subject would manifest a placebo reaction and which would not. Experiments have shown that no relationship exists between an individual's measured hypnotic susceptibility and their manifestation of nocebo or placebo responses.[13][14][15]

Based on a biosemiotic model (2022), Goli explains how harm and/or healing expectations lead to a multimodal image and form transient allostatic or homeostatic interoceptive feelings, demonstrating how repetitive experiences of a potential body induce epigenetic changes and form new attractors, such as nocebos and placeboes, in the actual body.[16]

Effects

Side effects of drugs

It has been shown that, due to the nocebo effect, warning patients about side effects of drugs can contribute to the causation of such effects, whether the drug is real or not.[17][18] This effect has been observed in clinical trials: according to a 2013 review, the dropout rate among placebo-treated patients in a meta-analysis of 41 clinical trials of Parkinson's disease treatments was 8.8%.[19] A 2013 review found that nearly 1 out of 20 patients receiving a placebo in clinical trials for depression dropped out due to adverse events, which were believed to have been caused by the nocebo effect.[20]

In January 2022, a systematic review and meta-analysis concluded that nocebo responses accounted for 72% of adverse effects after the first COVID-19 vaccine dose and 52% after the second dose.[21][22]

Many studies show that the formation of nocebo responses are influenced by inappropriate health education, media work, and other discourse makers who induce health anxiety and negative expectations.[23]

Electromagnetic hypersensitivity

Evidence suggests that the symptoms of electromagnetic hypersensitivity are caused by the nocebo effect.[24][25]

Pain

Verbal suggestion can cause hyperalgesia (increased sensitivity to pain) and allodynia (perception of a tactile stimulus as painful) as a result of the nocebo effect.[26] Nocebo hyperalgesia is believed to involve the activation of cholecystokinin receptors.[27]

Ambiguity of medical usage

Stewart-Williams and Podd argue that using the contrasting terms "placebo" and "nocebo" to label inert agents that produce pleasant, health-improving, or desirable outcomes versus unpleasant, health-diminishing, or undesirable outcomes (respectively), is extremely counterproductive.

analgesia and hyperalgesia, the first of which, from this definition, would be a placebo, and the second a nocebo.[29]

A second problem is that the same effect, such as

mutually exclusive ways (i.e., placebo and nocebo); and this is giving the false impression that the drug in question has produced two different phenomena.[28]

Ambiguity of anthropological usage

Some people maintain that belief kills (e.g.,

psychophysiological disorder which results in a psychogenic death. Rubel in 1964 spoke of "culture bound" syndromes, which were those "from which members of a particular group claim to suffer and for which their culture provides an etiology, diagnosis, preventive measures, and regimens of healing".[33]

Certain anthropologists, such as Robert Hahn and Arthur Kleinman, have extended the placebo/nocebo distinction into this realm in order to allow a distinction to be made between rituals, like faith healing, that are performed in order to heal, cure, or bring benefit (placebo rituals) and others, like "pointing the bone", that are performed in order to kill, injure or bring harm (nocebo rituals). As the meaning of the two inter-related and opposing terms has extended, we now find anthropologists speaking, in various contexts, of nocebo or placebo (harmful or helpful) rituals:[34]

  • that might entail nocebo or placebo (unpleasant or pleasant) procedures;
  • about which subjects might have nocebo or placebo (harmful or beneficial) beliefs;
  • that are delivered by operators that might have nocebo or placebo (pathogenic, disease-generating or salutogenic, health-promoting) expectations;
  • that are delivered to subjects that might have nocebo or placebo (negative, fearful, despairing or positive, hopeful, confident) expectations about the ritual;
  • which are delivered by operators who might have nocebo or placebo (malevolent or benevolent) intentions, in the hope that the rituals will generate nocebo or placebo (lethal, injurious, harmful or restorative, curative, healthy) outcomes; and, that all of this depends upon the operator's overall beliefs in the harmful nature of the nocebo ritual or the beneficial nature of the placebo ritual.

Yet it may become even more terminologically complex, for as Hahn and Kleinman indicate, there can also be cases where there are

unintended consequences).[34] Writing from his extensive experience of treating cancer (including more than 1,000 melanoma cases) at Sydney Hospital, Milton in 1973 warned of the impact of the delivery of a prognosis, and how many of his patients, upon receiving their prognosis, simply turned their face to the wall and died a premature death: "there is a small group of patients in whom the realization of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death. This problem of self-willed death is in some ways analogous to the death produced in primitive peoples by witchcraft ('pointing the bone')".[35]

Ethics

A number of researchers have pointed out that the harm caused by communicating with patients about potential treatment

framing effect[37]
and the authorized concealment.

See also

Notes

  1. ^ a b c d Häuser, Hansen & Enck 2012.
  2. ^ Enck & Häuser 2012.
  3. ISBN 978-3030407452
    .
  4. Perseus Project
    .
  5. Perseus Project
    .
  6. ^ a b Kennedy 1961.
  7. ^ Benedetti et al. 2007.
  8. ^ Miller 2003.
  9. ^ Bingel et al. 2011.
  10. PMID 25006673
    .
  11. ^ McGlashan, Evans & Orne 1969, p. 319.
  12. ^ Lasagna et al. 1954.
  13. ^ McGlashan, Evans & Orne 1969.
  14. ^ Stam 1982.
  15. ^ Stam & Spanos 1987.
  16. ISBN 978-3-031-17677-7
  17. ^ Colloca & Miller 2011.
  18. ^ Barsky et al. 2002.
  19. ^ Stathis et al. 2013.
  20. ^ Mitsikostas, Mantonakis & Chalarakis 2014.
  21. PMID 35040967
    .
  22. ^ Smith, Ian (19 January 2022). "'Nocebo effect' cause of most COVID vaccine side effects, study says". euronews.
  23. ISBN 978-3-319-35091-2
  24. ^ Rubin, Nieto-Hernandez & Wessely 2009.
  25. ^ Geary, James (4 March 2010). "The Man Who Was Allergic to Radio Waves". Popular Science. Retrieved 1 December 2014.
  26. S2CID 44220488
    .
  27. ^ Enck, Benedetti & Schedlowski 2008.
  28. ^ a b c d Stewart-Williams & Podd 2004.
  29. ^ Colloca & Benedetti 2007.
  30. ^ Cannon 1942.
  31. ^ Zusne & Jones 1989, p. 57.
  32. ^ Róheim 1925.
  33. ^ Rubel 1964.
  34. ^ a b Hahn & Kleinman 1983.
  35. ^ Milton 1973.
  36. S2CID 45271769
    .
  37. PMID 22318275
    .

References

External links

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