Tuesday, 5 February 2013

Nocebo Or Placebo?

The Placebo effect is a largely known about phenomenon within society despite our little scientific understanding of it. (I wrote this piece a while ago about it.) Though its reversal the ‘Nocebo effect’ is not widely known about. Nocebo comes from the Latin of ‘I will harm,’ the general principle behind it is there can be undesirable or harmful effects when a patient takes a ‘placebo’ pill, one with no active ingredients.

In some cases taking inert drugs can have a negative consequence, a common example is when a doctor states side-effects (for a placebo) you can actually feel the effects, not because the inert drug has actually caused it but because somehow by believing that you will suffer from it, you do. This poses huge ethical questions; based purely on this, it is surely better to not tell patients of side-effects, but then is this not going against the basic rights of a patient? It seems that we should not be told about unpleasant side-effects because it can reduce our pain and suffering however we are being denied the knowledge that the doctor by law is meant to tell us. 

A possible extreme case of the Nocebo effect is death, in 1992 the Southern Medical Journal reported the case of a man who had been diagnosed with cancer and was given a several month life expectancy. His autopsy showed the tumour in his liver had not grown; a member of staff working with his autopsy said “I do not know the pathologic cause of his death.” It has been suggested that his death could be the cause of the Nocebo effect. It is only a suggested theory and still remains highly unclear- this medical case happened in 1973, and perhaps with our improved medical knowledge a cause would have been established had it happened in the present day. 

Who knows? Maybe the extents of the Nocebo effect can sometimes be that extreme. I find it a refreshing thought that we still have much to learn about the medical science of humans and how the mind interacts with our body. 

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