Ms. Anne Bramblett
Core 110: Effective Writing
April 3, 2008
Placebo’s Underrated Counterpart
For an extra few points in your psychology class, you participate in a blind study of the ability of electrical currents to cause headaches. You are seated between two electrodes for a period of 10 minutes, and as soon as the currents stop, you notice a dull throbbing in your forehead. Within minutes, this throbbing develops into a full-blown headache. You report these sensations to the experimenter, who now reveals the catch of the study: the currents didn’t actually exist. Amazingly, your belief in the adverse effects of the “electrical currents” essentially caused you to develop a headache. The physical consequences of such beliefs are not uncommon; however, many people are unaware of their scientific explanation.
You are probably quite familiar with the placebo effect, the theory that believing you will benefit from an inert treatment actually brings about a remedial result.
This theory’s name comes from the Latin word placebo, meaning “I will please.” Until recent years, this was the only widely accepted theory regarding the psychological effects on the physical body in experimental studies. Now, however, the placebo’s counterpart is gaining popularity: the “nocebo effect”. The nocebo effect is the theory that your belief in the unpleasant or harmful consequences of an inert treatment actually manifests those results. Its name appropriately originates from the Latin nocebo “I will harm.” Unfortunately, testing of the nocebo effect is rare due to the scientific community’s belief that it is largely unethical. I believe, however, that despite ethical concerns, there is ample evidence that the nocebo effect is just as valid a scientific theory as the placebo effect.
Perhaps the most well-known evidence for the nocebo effect involves a study just like the one described in the introduction. In an experiment from the early 1980s, 34 college students were told that an electric current passing through their heads would most likely produce a headache. Though not a single volt of current was used, nearly two thirds of the students reported developing a headache during the study (Reid 1). Because the students believed the currents existed and ultimately expected painful sensations in their heads, they unknowingly produced these sensations themselves. This is just one of the numerous experiments that provide evidence for the validity of the nocebo effect.
Another astonishing study that supports the nocebo theory involved cancer patients who believed they were receiving a new kind of chemotherapy. Although they were convinced they were undergoing a real treatment, they were actually given an inactive drug. The patients believed that their cancer would regress; but at the same time, they anticipated experiencing the usual side effects of chemotherapy, such as nausea and hair loss. At the end of the treatment period, doctors noted that the cancer had not spread in the majority of the patients, and several actually had fewer cancer cells than before the inactive treatment. This is a prime example of the placebo effect, as the patients psychologically brought about physical progress. On the flip side, 60% of the patients receiving the inactive drug reported experiencing nausea, and an amazing 31% actually lost some or all of their hair. The patients’ belief in the power of the chemotherapy they thought they were receiving caused their bodies to respond in the expected manner, whether it was positive, negative, or both (Worrell 1). Just as the placebo effect was observed in these patients, the nocebo effect was clearly also present, and thus deserves more attention from the scientific community.
Unfortunately, ethics play a major role in just how much attention the nocebo effect gets. Ethical standards have become much stricter over the years, making it difficult to conduct experiments that might possibly put the patient at risk for some sort of damage to their health. Many researchers believe it is unfair to consciously set their subjects up to experience pain, even if the patients bring it on themselves through their thoughts and beliefs. However, in the Journal of the Royal Society of Medicine, Franklin
G. Miller questions:
Why the moral discomfort experienced by clinician-investigators? [...] Any randomized controlled trial can be regarded as in breach of clinical ethics in that the aim is to answer questions about groups of patients rather than provide personalized care: the concealment of treatment allocation is justified by the potential value of the knowledge to be gained rather than the medical interests of these patients. (Miller 2)
Current ethical concerns should thus be reevaluated if the patients are willingly involving themselves in the experiment, as the knowledge we can gain far outweighs the temporary discomfort experienced by the subjects.
The opportunity to gain this knowledge about the human body cannot be ignored. Testing of the nocebo effect should be conducted more often in order to establish it better in the scientific world. Though this may not happen right away, doctors and scientists alike cannot deny the already existing evidence for the theory, nor the power of “mind over matter.”
Miller, Franklin G. “Sham Procedures and the Ethics of Clinical Trials.” The Journal of the Royal Society of Medicine Volume 97 Number 12 Pp. 576-578
Reid, Brian. “The Nocebo Effect: Placebo's Evil Twin” The Washington Post Online 30
April 2002 < http://www.washingtonpost.com/ac2/wp-dyn/A2709-2002Apr29>
Worrell, David. “The Placebo Effect: Why Various Techniques 'Work'.” Sustained
Action 20 Feb. 2007 <http://sustainedaction.org/Explorations/placebo_effect.htm>