5 Lessons to Learn from the Nocebo Effect

Health care professionals have known about the nocebo effect for years, but it recently reared its head in headlines again.

As the darker counterpart to the placebo effect, the nocebo effect leads patients to experience adverse effects from an inactive substance.

This effect recently caught the media’s attention when a French woman won a court case that permits her to receive a disability allowance because of her “allergy” to Wi-Fi.

Marine Richard claimed that she had an allergy to electromagnetic radiation, which emanates from objects like cell phones and Wi-Fi routers, The Guardian reported.

The woman won the case despite the fact that this allergy is not recognized as a medical condition in most countries, including France. There is also no scientific evidence that electromagnetic exposure is linked to symptoms such as tingling, headaches, fatigue, nausea, or palpitations.

Some surmised that fears about harmful effects from Wi-Fi radiation catalyze the nocebo effect in these individuals.

In another recent incident, a consulting firm was called in to investigate claims that wind turbines were causing headaches, nausea, ringing in the ears, dizziness, and stress.

US and Canadian researchers from Intrinsik Environmental Sciences Inc published a report in 2014 that cited the nocebo effect and determined that wind turbines had no adverse effects on public health. The researchers said negative expectations stemming from the turbines could have played a role in causing the symptoms.

The nocebo effect may also be the culprit behind non-celiac gluten sensitivity (NCGS). A 2013 study tested various diets for 37 patients with NCGS and found no specific response to gluten.

“A high nocebo response was found regardless of known background dietary triggers being controlled, and reproducibility of symptom induction to a specific protein was poor,” the researchers concluded.

As the nocebo effect becomes more mainstream, here are 5 key points to keep in mind:

1. The nocebo effect can be dangerous.

In a 2007 clinical trial on antidepressants, one of the control subjects took 29 inert pills in a suicide attempt. While the pills should have had no effect because he was taking a placebo, the man experienced hypotension and required intravenous fluids to maintain adequate blood pressure.

When the patient was informed that he was taking a placebo, the nocebo effect lifted and his adverse effects “rapidly abated,” the researchers stated.

2. Language is important.

A 2012 study found that language can play a role in encouraging the nocebo effect.

Phrases such as “This medication may help” and “Let’s try this drug” may create a sense of uncertainty about whether or not the medication will work.

Health care professionals may also be inadvertently focusing on the negative when they say things like “That always hurts a lot” and “You are a high-risk patient.”

“Patients are highly receptive to negative suggestion, particularly in situations perceived as existentially threatening, such as impending surgery, acute severe illness, or an accident,” the study authors concluded.

3. Tolerability of medications should be emphasized.

That same 2012 study suggested that a few strategies could reduce the nocebo effect.

One of these strategies was to focus on how effective a medication can be. By framing the statement as “The great majority of patients tolerate this treatment very well,” the health care professional sets positive expectations.

The researchers found that fewer adverse effects were reported when patients were told how well a procedure or medication works, compared with patients who were told the percentage of people who experience adverse effects.

4. The nocebo effect may decrease medication adherence.

Patients are more likely to stop taking their medication when their medication switches from a brand-name drug to a generic and the color of the pills change, according to a 2012 study.

This study found that some patients link efficacy to pill appearance, so changing how the pill looks can lead patients to believe that the new pills will not be effective.

5. Communication is paramount.

Health care professionals will have to find a balance between informing patients of the risks of a medication and not creating negative expectations.

A New York Times opinion piece suggested that more communication training for health care providers could help curb the power of the nocebo effect.