review of This book may cause side effects: Why our minds make us sick Written by Helen Pilcher.
IIn the early days of Viagra, the “little blue pill” that caused so much excitement about its sexual effects on men, I read a story about a woman who decided to try it for herself, thinking that what was good for geese might be good for geese as well. (Answer: Not always.) She took the little blue pill and described the exhilarating night of sex that followed. The best sex she’s ever had! God of pleasure! When she woke up in the morning, she discovered that the blue pill she had swallowed was Aleve (naproxen). At least she didn’t have a headache.
Most people know about placebos. This is an inert “sugar pill” that is administered to a control group in a clinical trial while the experimental group receives the active drug. This method allows researchers to rule out the influence, if any, of expectations on the medical benefits of a new drug. (Placebo-controlled trials of Viagra for Women found that women fared slightly better on the placebo, ending Pfizer’s efforts to double the market.) Hopes can be powerful. The larger the biologically inert placebo (a larger pill or larger injection) or the more complex the intervention (even a sham surgery), the greater the benefit. Placebos have been used in many settings, most dramatically on the battlefield, where suffering, dying soldiers beg for morphine, which has long been in short supply. You will be given saline and told that it is a powerful painkiller and the pain will go away.
Wherever placebos go, are nocebos likely to fall far behind? This book may cause side effectsHelen Pilcher, a science writer and television host with a PhD in cell biology, delves into the “evil twin” of placebos: the myriad ways they threaten our lives. negative Expectations influence us. If you have chills, fatigue or a headache after getting a coronavirus vaccination, it’s likely because you were told they were frequent “side effects,” she wrote. If you read a list of symptoms that a newly prescribed drug “may” cause, you will likely experience one or more of them and may decide not to take the drug after all. “If the mere thought of eating a certain food makes you feel sick, it’s very likely that the evil twin of the placebo has struck again. In fact, for many people who believe they are intolerant to certain ingredients, such as lactose or gluten, their misery may be due to psychological rather than physical processes,” she writes. When people who self-report as “gluten intolerant” are given gluten-free bread but are told that the bread contains gluten, they very often develop gastrointestinal symptoms. “And if someone is gluten intolerant, People are secretly given regular bread but told it is gluten-free. “They don’t have symptoms; it’s the way they think about gluten, not the protein itself, that they’re intolerant to,” Pilcher writes.
The combination of “sometimes” and dramatic anecdotes undermines her claim that nocebos affect all diseases.
Pilcher argues for Nocebo’s malicious antics in Chapter 12, from death from hexes to “psychogenic” deaths with no apparent physiological cause, to the downside of labeling them as mental and physical illnesses and thereby creating more cases. “The nocebo effect can cause blindness and paralysis, seizures, vomiting, and asthma attacks. Even if no brain damage is seen, it can cause symptoms of a concussion. In the absence of an allergen, it can cause hallmarks of an allergic reaction, such as watery eyes, a runny nose, and an itchy rash, which are indistinguishable from alternative symptoms caused by more common pollens.”
There’s really no scientific reason to differentiate between a placebo and a nocebo. Because both terms describe the effects that beliefs, expectations, and fears have on our bodies. But nocebos are hot. “The nocebo effect has been elevated from academic footnote to geeky hot potato,” she notes, and Pilcher makes the most of its spiciness. Nocebos are “much more prevalent and powerful than most people realized,” she writes. “Every symptom, every disease, and every disease is [sic] We can be negatively affected by the thoughts swirling around in our heads. ” all disease? Yes: “This phenomenon, hidden in plain sight, is part of every disease and makes us worse than we need to be.” Does she mean literally “everything” or does every disease simply have a “potential” to be affected?
That vagueness undermines her reporting. Admittedly, detailing all of the many studies she describes can be confusing. However, the strength of this finding cannot be assessed because it does not indicate the actual number or percentage of people affected by nocebos in the experiment, and vaguely states that it is “likely” that “most” or “some” people die. For example, she found that in one study, “people who were erroneously ‘diagnosed’ as having a ‘bad’ version… [of a fictitious gene that allegedly influences their response to exercise] I’ve done worse. They had decreased endurance and decreased lung capacity. ” “People”? All? One tenth? How many people? 3? 30? How much has your lung capacity “decreased”? How long did that decline last after returning home? Or, noting that “some” people die from the stress of bereavement or surviving a plane crash, he added: “That doesn’t mean by any means that severe stress will kill us all.” Such deaths are rare. It’s much more likely to move on through hardship than to die from life’s major stressors, but sometimes it happens. “Sometimes” combined with a dramatic anecdote (Johnny Cash died four months after his wife June) weakens her claim that nocebos are an influence. all disease. Did he die of a broken heart? Or is it a complication such as diabetes, respiratory failure, autonomic neuropathy, or pneumonia?
Ninety percent of the symptoms reported while taking statins were the same as those experienced while taking a placebo.
Even more worrying is Pilcher’s enthusiastic support of long-discredited and unreplicated experiments, such as Robert Rosenthal’s Pygmalion research. In the experiment, teachers allegedly raised the IQs of randomly selected students who had been told that they would develop intellectually that year, simply through the power of expectation. And Ms. Pilcher was so excited to meet Ellen Langer, the Harvard psychology professor who became famous for her decades-long work on “The Handmaiden” and “Counterclockwise,” that she suspended her skepticism and didn’t even do a quick Google search to uncover what was wrong with those studies. In the former, hotel maids are said to have lost weight and lowered their blood pressure simply by being told that their activity was “exercise” rather than “work.” However, because the experimenters relied on the women’s subjective self-reports, they could not rule out whether the women actually consciously or unconsciously increased their activity or changed their diet. And the 1979 “Counterclockwise” study, which purportedly showed that forcing eight men in their 70s to live in a simulated 1959 environment for a week physically reversed their frailty and other signs of aging, was never published in a peer-reviewed journal or replicated. (This later became a made-for-TV stunt using celebrities.) In fact, Langer told participants, “If we pull this off, there’s every reason to believe we’re going to feel like we did in 1959.” There’s no prejudice there.
Although these blunders provide a temporary hiatus, Pilcher provides details of other studies that rise to the level of “wow.” In one case, 60 patients who had stopped taking statins due to intolerable side effects were persuaded to take them again. They were given 12 pills, four of which contained statins. Four contain identical-looking placebo pills. And four empty bottles. Patients used one bottle per month in a randomly prescribed order for one year and recorded their daily symptoms on their smartphones. The study was double-blind, so neither the patients nor the doctors knew which pills (or none) the participants were taking. Researchers found that 90% of the symptoms reported while taking statins were the same as those experienced while taking a placebo. This means that most of the side effects of statins are caused by expectations rather than the contents of the pill.
You have nothing to lose and a world of delicious bread could be gained.
In the final chapter, Pilcher suggests ways to counter, if not overcome, the effects of nocebos. Please reconsider the after-effects of an injection as evidence that the medicine is working, rather than as a painful “side effect.” If you need medication, remember that 20 percent of people taking it experience headaches, and focus on the 80 percent who don’t. Additionally, if you have been diagnosed with a serious illness, you can request “individual informed consent” from your doctor. This means you can tell about serious symptoms that may require medical attention, but not the mild symptoms that are more likely to be caused by nocebos. And if you’re one of the thousands of people who think you’re allergic to gluten, unlike people with celiac disease, you definitely are, then why not ask a friend or partner to do a nice double-blind experiment? You have nothing to lose and a world of delicious bread could be gained.
