A drug with no active ingredient can sometimes prove to be very effective … as long as patient is convinced of his efficacy. This is commonly referred to as placebo effect. The “Magic Kiss” given to children to relieve ir pain after a boo-boo is a good example. Homeopathy is anor. But re is also a dark side of placebo effect, less known to general public: Nocebo effect. It occurs when a person experiences side effects when he or she is given a drug with no active ingredient or condition is deteriorating because he or she doubts efficacy of his or her treatment.
Hypersensitivity to Pain
Studies on nocebo effect are still relatively rare. This is probably reason why work demonstrating that price of a drug could enhance its adverse effects was published on Friday in famous journal Science. This study, conducted by researchers from University Medical Center of Hamburg-Eppendorf, universities of Colorado and Cambridge, covers 49 patients, separated into two groups. Two identical creams supposed to relieve itching, but in reality devoid of active principle, were applied to each of two groups. Only price changed (as well as packaging and name, designed to enhance credibility of ir respective costs).
The researchers n took care to explain to each participant that product could induce hypersensitivity to pain. They n issued a small “flash” of heat on treated arm. The pain felt was, on average, twice as strong in patients who had benefited from most costly “treatment”. Better still, pain continued to increase in this group as test progressed, while it decreased in or group.
It is not just a matter of feeling. Functional MRI confirmed a more important activity in prefrontal cortex as well as in spinal cord: in short, patients who tested most expensive cream actually had more harm than ors. “This is an interesting and very well conducted study,” says Fabrizio Benedetti, professor of Neurosciences at Faculty of Medicine at University of Turin. We already knew that commercial parameters of a drug, such as Price, could have an influence on placebo effect. This had been demonstrated in a study of 2008 published in Jama (Waber et al.).
Little taught in faculty
But can such work be generalized? “It’s very complicated,” says Patrick Lemoine, psychiatrist and author of Mystery of Nocebo (published in 2011 at Odile Jacob editions). Many parameters must be taken into account in placebo effect, as in nocebo effect. The level of education, Professional category, cultural context, all of this can play a role. That was very poorly evaluated when we went to generics, for example. If you are a little Bobo, you find it well to reduce social security spending, re is less risk that effectiveness of generic decreases and that adverse effects increase. “It is not same when you are a senior who has been accustomed to your treatment for twenty years.”
The placebo and nocebo effects are still poorly taught in medical schools. “But it is fundamental,” assures Patrick Lemoine. The relationship between doctor and his patient is fundamental. More and better we explain efficacy of a treatment, more likely it is to walk. Pharmacists but also nurses also have a role to play: “If y draw too much attention to adverse effect of treatment, y will reinforce risk of seeing it happen,” explains Dr. Lemoine. The media also have a responsibility. “There is a fear that media hype around presumed risks of vaccination does not create much nocebo effect,” continues psychiatrist. The coverage of recent Levothyrox case has most likely also contributed to a multiplication of side effects.
