Sunday, September 06, 2009

Big mystery: Why you feel sick when doctors tell you you are

Of New Scientist's Michael Brooks's 13 things that don't make sense, the thirteenth was the nocebo effect (02 September 2009).

In Latin, "nocebo" means "I will harm." It is the opposite of "placebo" which means "I will please." Practically, just as placebo means that the patient gets better because he has been told he will, nocebo means that a patient gets worse precisely because medics have predicted pain, debility, or death.

It was easy to dismiss accounts of voodoo death, but Brooks recounts the following case:
In the 1970s, for example, doctors diagnosed a man with end-stage liver cancer, and told him he had just a few months to live. Though the patient died in the predicted time, an autopsy showed the doctors had been mistaken. There was a tiny tumour, but it had not spread. It seemed the doctors' prognosis had been a death curse.
I am not clear why that doesn't make sense. A person who is informed by a credible source that he will die could surely have a heart attack or allow a chronic condition to overtake him. The placebo effect works very well indeed, so we should expect its evil twin to do likewise.

It is only a b ig mystery if you think that the mind is an illusion generated by the dance of neurons in the brain and has no causal power. Otherwise, the sense of mystery is completely absent.

Interestingly, the Criminal Code of Canada says two relevant things: After denying that deaths supposedly caused by “the influence of the mind alone” (= witchcraft, the "evil eye", etc.) are culpable homicide, the Code nonetheless adds this rider: “This section does not apply where a person causes the death of a child or sick person by willfully frightening him” (sec. 228). Now, the doctors mentioned in Brooks's account are not in the dock for this, because they honestly believed what they told that man. But should they have told him the news in that way?

I once interviewed a radiologist whose key job was "bad news from radiology." I asked her how she coped. She said, basically, my patients are usually in considerable pain and have been sick for a long time, and they know something is very wrong. Her method was, before telling them the results, to set up a further treatment plan. The plan usually amounted to palliative care. But, she said, they are never left alone, never abandoned. She seemed a wise lady to me.

And I think that, with her approach, if a patient's diagnosis turns out to be wrong, he won't deteriorate rapidly or die any time soon, so a new diagnosis will be sought. And the nocebo effect will be out looking for a job.

More on the nocebo effect at The Mindful Hack:

Evolutionary psychology: Misunderstanding superstition

Commentator Dinesh D'Souza on The Spiritual Brain: Including stuff he didn't know (No way is that his fault. The medical and parmaceutical community finds all these topics very difficult, and they discuss them only reluctantly.)

Prayer studies: From one-way skepticism, deliver us

Faith as one ofthe healing arts