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Worried Sick- the Nocebo Effect

A synthetic form of thyroxine called Eltroxin, chemically and biologically identical to natural thyroxine, has been in use for over forty years. It is used effectively to treat hypothyroidism which if left untreated can result in a range of symptoms up to and including heart disease. In 2007 GlaxoSmithKline moved its manufacture from Canada to Germany. At the same time they updated the actual tablet, changing its physical form but leaving the active ingredient the same.

Shortly thereafter in New Zealand a trickle of reports of adverse side effects not seen before were received by a health monitoring organization. After the new side effects began to show up in the press, reports of the new symptoms skyrocketed over a thousand fold even though the only difference was the appearance of the pills, not the chemistry.

A study by a team of Italian gastroenterologists involved patients who were lactose intolerant and a control group who weren’t. The subjects were told that the study involved examining the effects of lactose on the gut. Even though the subjects were given only a glucose tablet which can not cause symptoms, forty four percent of those intolerant and and 26 percent of those tolerant, reported gastrointestinal problems.

Many here in the US and overseas suffer from a so called WiFi syndrome. A range of symptoms including nausea, head aches, joint pain etc. occur when they know they are exposed to electromagnetic fields, but only if they know they are exposed. There is absolutely no evidence that the EMF can cause these symptoms.

These examples are only three of hundreds of examples of what is know as the nocebo effect, from latin for “I shall harm”. In years past this may have been referred to as a form of mass hysteria, now more benignly called a psychogenic illness. In some cases it has been shown that the mere suggestion of a possible symptom or side effect can cause a biochemical change in the body which results in the symptom, but only from the suggestion.

This was shown elegantly in an animal model using rats. They were trained by classical Pavlovian training to become asthmatic. First the experimenters gave the rats a natural substance, histamine, which causes an asthma reaction and paired that with the ringing of a bell. In subsequent trials just the bell ringing would cause the rats to release excess histamine into their blood, thus triggering an asthma attack. If rats can be trained to become asthmatic, shouldn’t it be true that people who have asthma reactions could be trained to not react?

The nocebo effect is the evil twin of the better known placebo effect, latin for “I shall please”.

nocebo and placebo

nocebo and placebo

Any benefits of homeopathic medicine, and much folk medicine are a result of the placebo effect, including modern day agents associated with Traditional Chinese Medicine, acupuncture, much of chiropractic, and over the counter medications called nutritional supplements.

The question as to whether society should allow profit from the sale of placebos is a moral one. Should some one make money by suggesting that a nostrum will do something, even if it only works for believers? It sure works for Madison Avenue. Ca-ching.

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