When your mind is the one causing drug side effects
Fatigue, palpitations, shortness of breath ... and on it goes – the list of possible side effects in a medication package insert can be unsettling.

So can a preoperative consultation, when the surgeon informs you of all the risks.

The problem is that many patients become fixated on potential complications or adverse reactions, which then may occur for no physiological reason, but instead, because of negative expectations.

Doctors call this the nocebo effect – the reverse of the placebo effect, where expectation of a positive outcome increases the effectiveness of a medication or treatment.

The effects are apparently much greater than has long been thought, according to experts who gathered at the 4th International Conference of the Society for Interdisciplinary Placebo Studies (SIPS) in Duisburg, Germany.

Their findings may help to improve medical care by having doctors communicate differently with patients.

Very real effects

“Placebo and nocebo effects aren’t merely imagined.

“We know that very complex neurobiological phenomena occur,” says Germany’s Essen University Hospital Centre for Pain Medicine head and neurology professor Dr Ulrike Bingel.

For this reason, she says, preoperative consultations and medication package inserts focusing mainly on risks are problematic.

“A package insert is a three-page summary of ‘death and ruin’,” she says.

“But the therapeutic effects targeted in your special situation aren’t mentioned at all.”

In a study led by Australia’s University of Sydney School of Psychology head Prof Dr Ben Colagiuri, patients were informed about the possible side effects of chemotherapy.

One group was told that 30% of patients experienced nausea, and another that 70% didn’t.

The result?

Fewer patients in the second group developed nausea.

Drawing on placebo research, doctors can now be trained on how to bolster treatment by means of an empathetic bedside manner and positive communication, says the Netherlands’ Leiden University psychology professor Dr Andrea Evers.

“Taking the placebo and nocebo effects into account can be learned quickly,” she says.

When a medical worker says before giving you an injection, “This will only hurt for a moment”, then hurt it will indeed.

A few soothing words can make a big difference, according to Prof Evers.

“In this way, we can improve healthcare, help patients, and also reduce costs through more effective treatment.”

The personal touch

Use of the placebo effect in conventional medicine, researchers emphasise, should always be only a beneficial adjunct to scientifically-grounded treatment.

This adjunct aspect is what they see as conventional medicine’s key difference from homeopathy and other forms of alternative medicine.

Non-medical practitioners unquestionably do a lot of things right in how they deal with patients, e.g. take their time, incorporate rituals and inform well, acknowledges Prof Bingel.

“These are all areas where we’ve got to ask ourselves: Have we lost them in [conventional] medicine?”

However, she adds, “Homeopathy is based on a mechanism-of-action model that doesn’t exist in current scientific knowledge.

“Patients are deceived. And that’s something we definitely don’t want when we utilise the placebo effect in science-based medicine.”

She would like the right kind of communication with patients to be as integral a part of medical training as cardiopulmonary resuscitation (CPR).

Progress in this area is slow though, she says.

“It’s financially more advantageous for a doctor to do a further apparatus-based diagnostic procedure than to have an unhurried talk with a patient.”

This needs to change, she says.

With respect to medications, Prof Bingel recommends that the legally-required package insert be supplemented by a patient information leaflet explaining in clear language how the medication works, and most importantly, spelling out its benefits.

In the long term, she says, the placebo effect could be taken into account when medications are still in the development phase.

They ideally could be released with an individually-customisable information packet, including a notice saying the medication works best in conjunction with a doctor’s consultation. – By Marc Herwig/dpa
Mind,Drugs,side effects
The nocebo effect is where patients worry so much about a drug’s side effects that they actually cause them to occur.