Nocebo, now available without a prescription

New, from the makers of Maximum Strength Placebo, it's Nocebo, the product you will almost certainly regret."

Now for the first time, Nocebo is available for sale direct to the general public! Despite containing no active ingredients whatsoever, Nocebo can cause a wide range of undesirable effects, from nausea to diarrhea, that is because it's potency lies entirely inside the human brain! Nocebo merely suggests that it is bad for you, your brain and body does the rest!

Buy Nocebo, only £5.99 GBP!

Via Steve Silberman

Warning labels can act as nocebos

Remember the nocebo effect? It's the flip side of placebos. Placebos can make people feel better or even relieve pain (to a certain extent). Nocebo happens when a placebo causes negative side-effects—nausea, racing heart, dizziness, etc. And here's one more weird thing to add to this veritable bonfire of weirdness: When we tell people about the possible negative side-effects of a real drug, that might make them more likely to experience those side-effects.

In one study, 50 patients with chronic back pain were randomly divided into two groups before a leg flexion test. One group was informed that the test could lead to a slight increase in pain, while the other group was instructed that the test would have no effect. Guess which group reported more pain and was able to perform significantly fewer leg flexions?

Another example from the report: Patients undergoing chemotherapy for cancer treatment who expect these drugs to trigger intense nausea and vomiting suffer far more after receiving the drugs than patients who don’t.

And, like placebos and classic nocebos, this isn't just "all in their head"—at least, not in the sense that they're making it up or deluding themselves. There are measurable physical effects to this stuff.

As science writer Steve Silberman says in the article I've quoted from above, what we're learning here is that the feedback we get from other people ("That might make you feel yucky" or "You look tired today") has a physical effect on us. It's a little insane. It's also worth thinking about when we talk about medical ethics. Full disclosure of what treatments you're getting and what the risks and benefits are is generally regarded as the ethically right way to practice medicine. And that's probably correct. But how do you balance that with what we know about placebo/nocebo? What happens when transparency keeps you from using a harmless placebo as a treatment? What happens when transparency makes you more likely to experience negative health outcomes? It's a strange, strange world and it's not always easy to make the right ethical choices.

Read Steve Silberman's full story on the nocebo effect

Killed by something that doesn't exist

Placebos have no repeatable physical effect that can be broadly demonstrated to exist. But, if people believe the placebo can help them, it often does—especially for inherently subjective issues like pain relief.

Nocebos are what happens when a placebo (again, something that technically has no physical effect on the body) causes a negative side-effect, simply because the person believes that such side-effects are likely to happen to them.

There is a lot we don't understand about both of these effects. After all, running really detailed tests would inherently involve unethical behavior—intentionally not treating patients or intentionally trying to induce a negative reaction in them. But that doesn't mean you can ignore these phenomena.

A great example comes in a recent column by Alexis Madrigal on The Atlantic. You're probably familiar with the idea of sleep paralysis—the experience of waking up, being mentally awake, but still physically paralyzed. This happens to people all over the world. And, all over the world, it's long been explained in folklore as the work of demons and evil spirits. (The fact that sleep paralysis is often accompanied by feelings of terror, and the sensation of something sitting on your chest doesn't hurt in that regard.) Normally, sleep paralysis brings a few minutes of terror, but no lasting harm. In the mid-1980s, however, it suddenly became capable of killing. The catch, the men it killed were all recent Hmong immigrants, living in the United States. Researcher Shelley Adler thinks it was actually a nocebo effect that killed these men—they believed themselves into an early grave.

[In America] some Hmong felt that they had not properly honored the memories of their ancestors, which was a known risk factor among the Hmong for being visited by the tsog tsuam. Once the night-mare visitations began, a shaman was often needed to set things right. And in the scattered communities of Hmong across the country, they might not have access to the right person. Without access to traditional rituals, shamans, and geographies, the Hmong were unable to provide themselves psychic protection from the spirits of their sleep.

Drawing on all this evidence, Adler makes the provocative claim that the Laotian immigrants of the 1980s were in some sense killed by their powerful cultural belief in night spirits. It was not a simple process.

"It is my contention that in the context of severe and ongoing stress related to cultural disruption and national resettlement (exacerbated by intense feelings of powerlessness about existence in the United States), and from the perspective of a belief system in which evil spirits have the power to kill men who do not fulfill their religious obligations," Adler writes, "the solitary Hmong man confronted by the numinous terror of the night-mare (and aware of its murderous intent) can die of SUNDS."

Via Christopher Ryan