The Nocebo Effect

[jholden40]

Have only recently heard about the 'nocebo' effect as a subject of medical/psychological research - here's a link to an interesting little essay that appeared in UK press yesterday

The nocebo effect: Wellcome Trust science writing prize essay | Science | The Observer

[catyvid]

@jholden40, this is very interesting, thank you for posting this article. I'm not exactly sure how physicians will be able to convince patients that their condition is or is not serious enough to kill, disable or cause them pain. Considering the advent of readily available medical information on the Internet I think there are very few patients who do not research or second guess their physician on their individual diagnosis. What this means is that the relationship between doctor and patient is no longer a closed loop. All in all I think this is a good thing and the days of unquestioning trust of our health care professioals is a thing of the past, much like the beloved family physician and the house call which might not be a good thing.
I think that many doctors intuit the nocebo effect and are attempting to convince their patients that their chosen course of treatment is at times more effective than clinically proven. For example, I have had health care providers claim that low dose opiates or Nsaids were VERY strong medications and should eradicate all pain experienced when clearly the medication would barely touch a simple headache much less ease intense acute pain. On the other hand I agree that a terminal diagnosis could very well lead to a patient's demise when it might not be inevitable. It is interesting that in Japan a cancer patient is not informed of the diagnosis but rather the family is told the diagnosis and instructed to not tell the patient. I wonder what the cancer mortality rates are in the US as compared to those in Japan. Sorry for the long post, just thinking aloud.

[Lynx4]

@catyvid, Your last couple of sentences is something I've thought about for a while. My father went to a doctor, the doc said he had cancer and had 2 weeks to live and he died in 2 weeks. Now, he had been going along just fine, so what would have happened if he hadn't gone to the doctor? Would he have died so quickly? I don't think so.

My mother was told she had 3 weeks left and died in 2-1/2 weeks. Yet....a month before she had been at home, doing normal things that little old ladies do. They decided she needed in patient therapy to make her arms and legs stronger, she got very ill at this place and was taken to the hospital a WEEK after she exhibited strange behavior and they found out she had an infection that had spread through her body and then she died. If we had left her at home, shuffling around and doing odds and ends she would probably still be alive. Or if this Inpatient Rehab center had sent her to a hospital or had a doctor look at her when she started exhibiting behaviors not normal to her, she might be alive.

So I almost agree with not telling someone they are going to die. I only say almost because I believe that people who are going to die soon have the right to know so they can get Wills put together, tie up loose ends, apologize to someone they always meant to apologize to, etc.

Along the same lines but then not really....I've always been amused that doctors hide our charts from us and don't want us to read them. My pain doctor puts my chart right beside me and lets me read the whole thing, but he's the first and probably last doctor who will do that. I always wondered why I couldn't read about my life and my health problems. Doctors are strange people.