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Placebo, Nocebo — Worried Sick.

It was the gluten.

It was the gluten.

A few months ago, I was experiencing some intestinal problems. (I’ll spare you the details). Suellen suggested that I cut back on my gluten consumption. I did and my symptoms abated.

Was it gluten? Or was it nocebo?

As I study up on happiness, I frequently run across the placebo effect. The idea is simple: if you expect a treatment to make you feel better, … well, then you’ll feel better, even if the treatment is useless. It’s the power of positive thinking.

What about the opposite? Can you think yourself into a bad mood? Well, … duh … of course you can. Our thinking affects our mood (and vice versa). But can negative thinking affect our health? Even if we don’t know we’re thinking negatively?

Welcome to nocebo. Nocebo (Latin for I will harm) is essentially the opposite of placebo (Latin for I will please). In both cases, the effects are real. Things actually do change in your body. But the treatment doesn’t cause the changes. The mind does.

The nocebo effect often pops up during pharmaceutical testing. Researchers randomly assign people to experimental and control groups. The experimental group receives the treatment. The control group receives an inert treatment, often described as sugar pills.

In the best tests — the double blind – neither the subjects nor the researchers know which person is in which group. All the procedures – except the actual treatment — are exactly the same.

The researchers read the same warnings to both groups. Typically these include warnings about side effects. In many such studies, some of the people in the control group experience the side effects they were warned about. Their minds create the nocebo effect.

The nocebo effect can disrupt important pharmaceutical studies. But it doesn’t stop there. As pointed out in several articles, (here, here, and here) we can literally worry ourselves sick. People living near wind farms may report various forms of sickness and insomnia. Mobile phone users may report headaches (and fear much worse). People near wi-fi signals may report “…headaches, nausea, exhaustion, tingling, trouble concentrating, and gastrointestinal distress, among other symptoms.

When researchers closely study these phenomena, however, they find no link between the supposed cause and the effect. The mind is filling the gap and causing the effect. As various researchers have found, all it takes is a little gossip or a few media reports.

Can we suppress the nocebo effect by not warning people of the dangers of various modern technologies? That would certainly raise ethical questions. It may also have practical limits. We normally assume that the placebo and nocebo effects occur because we don’t know certain things. We don’t know that we’re getting an inert treatment and, therefore, our symptoms either get better (placebo) or worse (nocebo) based on our expectations. Our minds are deceiving us.

But one study found that even when people knew they were getting an inert treatment, they still got better. Titled “Placebos Without Deception”, the study told people with irritable bowel syndrome (IBS) that they would receive “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes”. The result: symptoms improved. The placebo worked, even without the benefit of deception. If placebos work without deception, might nocebos work the same way?

So, did gluten cause my intestinal distress? Hard to say. I’ve heard so much about gluten intolerance lately, that I may just have thought myself into intestinal problems. It may well be time to heed the BBC’s advice: “Beware the scaremongers. Like a witch doctor’s spell, their words might be spreading modern plagues.”

One Response to Placebo, Nocebo — Worried Sick.

  • I shake my head (at myself) every time I take ibuprofin for a headache and somehow begin feeling the headache abate long before the medicine really has time to have any real effect. The fastcebo effect at play. 🙂

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