It’s long been know that “set and setting” affects the experience of those using psychotropic drugs. “Users who are in a poor mental state or a highly structured environment are more likely to have a bad trip, which is when you feel paranoid, anxious, nervous or even terrified instead of euphoric. (Science.HowStuffWorks.com)” So why should the effects of human consciousness on the experience of pharmaceutical drugs be so different.
As the stories quoted below show, how you think a drug will affect you, does play a role in how the drug does affect you. So what about raw milk? Do the positive effects people report from drinking raw milk attributable to a placebo effect. And would warning labels on raw milk actually trigger a “nocebo” effect, causing at least some people to experience the dangers being warned about?
Do Warnings about Side Effects Make Us Sick?
“Your doctor doesn’t like what’s going on with your blood pressure. You’ve been taking medication for it, but he wants to put you on a new drug, and you’re fine with that. Then he leans in close and says in his most reassuring, man-to-man voice, “I should tell you that a small number of my patients have experienced some minor sexual dysfunction on this drug. It’s nothing to be ashamed of, and the good news is that this side effect is totally reversible. If you have any ‘issues’ in the bedroom, don’t hesitate to call, and we’ll switch you to another type of drug called an ACE inhibitor.” OK, you say, you’ll keep that in mind.
Three months later, your spouse is on edge. She wants to know if there’s anything she can “do” (wink, wink) to reignite the spark in your marriage. She’s been checking out websites advertising romantic getaways. No, no, you reassure her,it’s not you! It’s that new drug the doctor put me on, and I hate it. When you finally make the call, your doctor switches you over to a widely prescribed ACE inhibitor called Ramipril.
“Now, Ramipril is just a great drug,” he tells you, “but a very few patients who react badly to it find they develop a persistent cough…” Your throat starts to itch even before you fetch the new prescription. Later in the week, you’re telling your buddy at the office that you “must have swallowed wrong” — for the second day in a row. When you type the words ACE inhibitor cough into Google, the text string auto-completes, because so many other people have run the same search, desperately sucking on herbal lozenges between breathless sips of water.
In other words, you’re doomed. Cough, cough!
What’s going on here? Just medicine-as-usual in a world where valuable drugs have annoying side effects and conscientious health professionals do their best to protect their patients from unpleasant (and potentially litigious) surprises? Sure. But a provocative new report by Winfried Häuser, Ernil Hansen, and Paul Enck in the journal of the German Medical Association suggests that the side effects of some drugs, and the discomfort of certain medical procedures, may be inadvertently intensified by doctors and nurses trying to keep patients fully informed of the consequences of their medical care. The culprit behind this phenomenon is the nocebo effect.
You can think of the nocebo effect as the evil twin of the placebo effect — the body’s healing response to the act of taking a pill or receiving medical care, even if the pill itself is inert. The most familiar example of the placebo effect is what happens in trials of experimental drugs. One group of volunteers is randomly assigned to take the drug in question; another group is assigned to take placebo — a fake drug designed to look just like the real one. Neither the volunteers nor the staff know which group is which. If the drug group improves significantly more than the placebo group, the drug is judged to be effective. This kind of test — the double-blind, placebo-controlled trial — has been the gold standard of drug development in medicine for half a century.
In real life, gauging the effectiveness of a new medication is not quite that easy. In 2009, I wrote a widely-circulated article in Wired magazine about a mysterious increase in placebo effects in trials in recent years that is making it harder for Big Pharma to bring new drugs to market. I explored some of the reasons that might be happening in the article….”
“The Dark Side of the Placebo Effect: When Intense Belief Kills
They died in their sleep one by one, thousands of miles from home. Their median age was 33. All but one — 116 of the 117 — were healthy men. Immigrants from southeast Asia, you could count the time most had spent on American soil in just months. At the peak of the deaths in the early 1980s, the death rate from this mysterious problem among the Hmong ethnic group was equivalent to the top five natural causes of death for other American men in their age group.
Something was killing Hmong men in their sleep, and no one could figure out what it was. There was no obvious cause of death. None of them had been sick, physically. The men weren’t clustered all that tightly, geographically speaking. They were united by dislocation from Laos and a shared culture, but little else. Even House would have been stumped.
Doctors gave the problem a name, the kind that reeks of defeat, a dragon label on the edge of the known medical world: Sudden Unexpected Nocturnal Death Syndrome. SUNDS. It didn’t do much in terms of diagnosis or treatment, but it was easier to track the periodic conferences dedicated to understanding the problem.
Twenty-five years later, Shelley Adler’s new book pieces together what happened, drawing on interviews with the Hmong population and analyzing the extant scientific literature. Sleep Paralysis: Night-mares, Nocebos, and the Mind Body Connection is a mind-bending exploration of how what you believe interacts with how your body works. Adler, a professor at the University of California, San Francisco, comes to a stunning conclusion: In a sense, the Hmong were killed by their beliefs in the spirit world, even if the mechanism of their deaths was likely an obscure genetic cardiac arrhythmia that is prevalent in southeast Asia….”
“….Her argument amounts to a stirring and chilling case for the power of the nocebo, the flipside to the placebo effect. While placebo studies have grown in importance, the nocebo effect has not been studied well in scientific literature, in part because of the ethical issues involved in deliberately doing something that might harm people. Limited studies suggest that it is real and it is powerful. For example, doctors have found thatpatients made to feel anxious need larger amounts of opiates after surgery than other people. They’ve found that pretending to expose people who say they are sensitive to electromagnetic radiation to cell phone signals can give them debilitating headaches. Even patients’ level of side effects from arthritis medication seem determined by those patients’ beliefs about those medicines. Logically speaking, if the evidence shows the upside of belief, why wouldn’t we believe in the downside, too? And why wouldn’t we believe that the intensity of the downside would vary with the intensity of the belief, even if those beliefs were about something unscientific, like spirits or astrology?
If you’re still unsure that the nocebo effect could actually lead to premature death, Adler cites one stunning example of the effect from China. A team of researchers found that Chinese Americans die younger than expected “if they have a combination of disease and birth year which Chinese astrology and medicine considers ill-fated.” That is to say, if they were born in a year that was astrologically linked to poor lung health, they would die an average of five years earlier from lung-related disease than someone born in some other year with the same disease. Similar effects were not found in the white populations around them. And how much sooner you died depended on the people’s “strength of commitment to traditional Chinese culture.”
Think about that for a minute. If you were born under a bad sign, you died five years younger from the same diseases as people born under good signs. But only if you believed in Chinese astrology.
Results like these seem improbable, or anti-reason, or something. But Adler’s book is an attack on the “Oh, come on!” form of argument. She uses her understanding of both science and traditional belief structures to argue for what she calls “local biology.”….”
Placebos are getting more effective; drug makers desperate to know why
“Merck was in trouble. In 2002, the pharmaceutical giant was falling behind its rivals in sales. Even worse, patents on five blockbuster drugs were about to expire, which would allow cheaper generics to flood the market. The company hadn’t introduced a truly new product in three years, and its stock price was plummeting.
In interviews with the press, Edward Scolnick, Merck’s research director, laid out his battle plan to restore the firm to preeminence. Key to his strategy was expanding the company’s reach into the antidepressant market, where Merck had lagged while competitors like Pfizer and GlaxoSmithKline created some of the best-selling drugs in the world. “To remain dominant in the future,” he toldForbes, “we need to dominate the central nervous system.”
His plan hinged on the success of an experimental antidepressant codenamed MK-869. Still in clinical trials, it looked like every pharma executive’s dream: a new kind of medication that exploited brain chemistry in innovative ways to promote feelings of well-being. The drug tested brilliantly early on, with minimal side effects, and Merck touted its game-changing potential at a meeting of 300 securities analysts.
Behind the scenes, however, MK-869 was starting to unravel. True, many test subjects treated with the medication felt their hopelessness and anxiety lift. But so did nearly the same number who took a placebo, a look-alike pill made of milk sugar or another inert substance given to groups of volunteers in clinical trials to gauge how much more effective the real drug is by comparison. The fact that taking a faux drug can powerfully improve some people’s health—the so-called placebo effect—has long been considered an embarrassment to the serious practice of pharmacology.
Ultimately, Merck’s foray into the antidepressant market failed. In subsequent tests, MK-869 turned out to be no more effective than a placebo. In the jargon of the industry, the trials crossed the futility boundary….”