Thursday, June 11, 2009

Placebos and Nocebos

A direct link to the above video is at

Last weekend I had a great time watching a new movie from Sam Raimi: "Drag Me to Hell". Like some of Mr. Raimi's early work (Evil Dead II being the classic example), this is a film that successfully walks the line between horror and very black comedy. We've talked before about empathy, audiences, and comedy and in entries like The Comedian and The Musician, we're connecting to that idea somewhat here as well.

Coincidentally, Raimi's film can be related to a word I just learned a few days ago: the word is "nocebo", which is the opposite of "placebo". In entries like The Placebo Effect, Crossing Your Arms to Change Your Trajectory, and Evolution's Fast Lane, we've talked about the surprising scientific evidence that a person's attitude can affect their own health right down to the expression of their genes, and in The Biocentric Universe we talked about the even more remarkable information that this can affect what genes they pass on to their offspring! A placebo, then, can actually confuse the results of a study testing a new drug, because some of the people receiving the placebo (which should have no effect at all) will experience an improvement in their condition because they believe they are being given a drug that will help them. As it turns out, it's their own attitude which is effecting the positive change they experience.

How does a nocebo work, then? Let's say a doctor gives a patient a harmless placebo as part of a test for a new drug, but warns the patient of possible side effects. What does it mean if the patient then develops those side effects? They didn't take the drug, all they got was the sugar pill, and now their hair is falling out because the doctor warned that this was a possible side effect? In the same way that the placebo effect tells us that people can improve their health simply by changing their attitude, the nocebo effect shows us that a person can make themselves ill by the same process.

In Drag Me to Hell, the main character is cursed by a gypsy woman, and told that she has three days to live. How different would that story be if we replaced the gypsy woman with a cancer specialist, who then told the main character they had three months to live? If we are to believe an article published recently in New Scientist magazine, the answer is that both scenarios may be more similar than we realize. Here's a quote from that article, written by Helen Pilcher:

Take Sam Shoeman, who was diagnosed with end-stage liver cancer in the 1970s and given just months to live. Shoeman duly died in the allotted time frame - yet the autopsy revealed that his doctors had got it wrong. The tumour was tiny and had not spread. "He didn't die from cancer, but from believing he was dying of cancer," says Meador. "If everyone treats you as if you are dying, you buy into it. Everything in your whole being becomes about dying."

Cases such as Shoeman's may be extreme examples of a far more widespread phenomenon. Many patients who suffer harmful side effects, for instance, may do so only because they have been told to expect them. What's more, people who believe they have a high risk of certain diseases are more likely to get them than people with the same risk factors who believe they have a low risk. It seems modern witch doctors wear white coats and carry stethoscopes.

The idea that believing you are ill can make you ill may seem far-fetched, yet rigorous trials have established beyond doubt that the converse is true - that the power of suggestion can improve health. This is the well-known placebo effect. Placebos cannot produce miracles, but they do produce measurable physical effects.

Ideas telling us that we live in troubled times, where there is little hope for the future, that environmental toxins are slowly killing us, or secret government agencies are deliberately poisoning us, then, take on a whole new significance. Could modern society be creating a dangerously poisonous environment with a constant influx of fear-based input? Could it really be so simple as avoiding entertainment and news that are designed to scare us, and we'll become a healthier society? Here's another few paragraphs from that New Scientist article:

Alarmingly, the nocebo effect can even be catching. Cases where symptoms without an identifiable cause spread through groups of people have been around for centuries, a phenomenon known as mass psychogenic illness. One outbreak (see "It's catching") inspired a recent study by psychologists Irving Kirsch and Giuliana Mazzoni of the University of Hull in the UK.

They asked some of a group of students to inhale a sample of normal air, which all participants were told contained "a suspected environmental toxin" linked to headache, nausea, itchy skin and drowsiness. Half of the participants also watched a woman inhale the sample and apparently develop these symptoms. Students who inhaled were more likely to report these symptoms than those who did not. Symptoms were also more pronounced in women, particularly those who had seen another apparently become ill - a bias also seen in mass psychogenic illness.

The study shows that if you hear of or observe a possible side effect, you are more likely to develop it yourself. That puts doctors in a tricky situation. "On the one hand people have the right to be informed about what to expect, but this makes it more likely they will experience these effects," says Mazzoni.

How many people thought they might have caught the H1N1 virus in the last month or two but were actually fine? How can we protect ourselves from the nocebo effect when we are bombarded with information about how sick we are about to get? If we really are all connected together in ways unseen, then we have to get better together. Certainly, laughing at to the boogeyman can help (another reason I bring up black comedies like Drag Me to Hell), but clearly there really are things that make us sick, and recognizing which is the nocebo effect and which is a real danger to our health and our future requires us to not bury our heads in the sand.

As another coincidence, I just started listening to an audiobook called Spontaneous Evolution, by Bruce Lipton and Steve Bhaerman, and not far into the very first CD it too mentions the nocebo effect. Here's what they have to say about it: ultimately, knowing about nocebos should be no different than knowing about placebos - in both cases, we are shown that we have more control over our own lives than we've been led to believe, and all we have to do is recognize the patterns that make us the way we are now, and find ways to change the patterns that we don't like. Lipton and Bhaerman caution us, though, that some of these patterns are so deeply ingrained from a very early age that it can be hard for us to even recognize which patterns are limiting us: as with most of what we've been talking about here, it's our need to move beyond the "now" of our limited position within spacetime, and embrace the much larger "everything" that is timelessness, that will help us to find the way to a better version of ourselves and our universe.

To finish, here's a video for my song about using the power of the mind, imagination, or meditation to get to a safe and healing place: "Turquoise and White".

A direct link to the above video is at

Enjoy the journey!

Rob Bryanton

Next: Surveillance


C. Om said...

Placebos and nocebos the same phenomenon which can be likened to the observer collapsing a field of possibilities to a preconceived point of reality. Great post as usual.

And thank you Rob, for the mention of my blog in the video. :-)

Mariana Soffer said...

Very intrestinng information, thanks.
Do you want to know another casuality?
go to my web and check what the last post is about:placebo
The entry is pretty short compared to yours but anyway let me know what you think if you do not mind by adding some informative comment to it.
I think we are talking in another dimension, who knows.
Take Care

Marcel Lamothe said...

Great stuff as always - You just made my morning!

paul skillman said...

This is how voodu works. The power of suggestion.

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