Nocebos: The Murphy's Law of Medicine

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“Anything that can go wrong, will go wrong.” Law or not, the old adage points to the negative expectations we sometime fall victim to whether merited or not. In medicine it might be called the nocebo effect.

We've all heard about the positive influence of placebos: take a pill with no active ingredients whatsoever and a healing response ensues anyway. A nocebo is an ill effect caused by the suggestion or belief that something is harmful. Think of it as the placebo's sinister counterpart.

Researching the influence of nocebos on an individual’s health has lagged behind the study of placebos. Experts are just beginning to understand their importance through clinical studies. These investigations point to a robust mental component when taking into account health maintenance and outcomes.

"For better or worse, our minds are as much a part of treatment as the pills and therapies we receive," according to Matthew D. Erlich, M.D. and Lloyd I. Sederer, M.D. in, Should HealthCare Providers Be Afraid of the 'Nocebo' Effect?, published in the Huffington Post.

Expecting the worst after a treatment (which seems to be a common response) can actually make the patient feel worse. Thus, doctors, nurses and other hospital staff are increasing their commitment to helping patients avoid the nocebo effect.

Case in point: the findings of researchers from Oxford University studying pain levels in patients. Simply telling a patient the painkiller he had been given had worn off increased the person's pain to the same levels before the drug was administered, according to a study by Irene Tracey and her associates.

Penny Sarchet discusses these findings in her winning essay, The nocebo effect: Wellcome Trust science writing prize. From these results she concludes, "That a patient's negative expectations have the power to undermine the effectiveness of a treatment, and suggests that doctors would do well to treat the beliefs of their patients, not just their physical symptoms."

Sarchet points out an interesting dichotomy. Doctors have a moral and legal responsibility to disclose the numerous side effects of the treatments they prescribe. However, in doing so, they could be negating the very benefits they hope to confer due to the negative expectations brought on by divulging the side effects to the patient. It's a catch-22.

With the proliferation of sickly symptoms and so many new illnesses coming to the attention of the public, one has to wonder to what extent nocebo-induced conditions are swaying an individual's health.

I recall once being told I looked tired. Although I felt fine the comment bothered me to the point I soon began to feel limp and listless.

Looking back at that experience, I see the effect my thinking had over how I was feeling. My expectation – and how I felt - changed due to the negative comment. But other experiences and my own spiritual practice tell me we don't have to submit to “Murphy’s law” thinking.

“I’d say you’ll do best by filling your minds and meditating on things true, noble, reputable, authentic, compelling, gracious—the best, not the worst; the beautiful, not the ugly; things to praise, not things to curse,” says Paul, Bible hero and healer.

That's how I start my prayer - which helps to improve my mental outlook and my physical health.

Attitude, expectation and anxiety: these mental qualities do have sway over how you feel. When worry, dread, and apprehension are troubling you it’s time to eliminate “Murphy’s law” of negatives from your thinking.


Steve Salt is a syndicated health blogger and a Christian Science teacher and practitioner. This post was originally published on the Cleveland Plain Dealer. Follow him on twitter @saltseasoned.

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