The nocebo effect

Here is a blog from last year … recycled. One point mentioned below is that there has been little research into utilising the placbo and nocebo effects. More on this topic in a day or two.

In the movie on Consciousness recently, there was one point most people probably missed. If the mind and body (Cartesian split) are distinct, they can’t interact. If they interact, they must have ground in common. A tricky concept, but one common in philosophy.

While many teachers, especially from the Abhidhamma tradition, claim that Buddhism entertains a mind and body distinction in fact this is not the case. The mind and body interact on many levels. And meditators can often relax their minds to high degrees, and experience sudden unfoldings in the body of deep seated tensions. Any tension of the mind will manifest in the body.

One area where the body/mind connection is seen is the Placebo effect. A very real lessening of physical symptoms of patients fed sugar pills with the claim it is medicine. Khun Morakot, who runs the monthly Kathmandu Meditation session and who has much experience with meditation for the sick (especially cancer patients), often points out that this placebo effect is not something to dismiss as lightly as the medical profession does. It needs to be investigated properly so that the effect can be enhanced.

Can meditation provide an amplified placebo effect in healing? We know from much peer reviewed investigation (from trials such as the MBSR program) that mindfulness meditation can reduce a whole array of stress hormones and markers such as blood pressure etc.

Which brings us to the nocebo effect – the negative side effects of a placebo pill (which people had been told might produce side-effects) . How much can a mental attitude be the cause of illness, just like the mental aspect of a placebo pill is a factor in healing? If the nocebo effect is as real as the placebo might one expect that meditators are more healthy. Possibly, though with many reservations….. in the mean time here is a section from a recent Guardian article :

Can a sugar pill have a side-effect? Interestingly, a paper published in the journal Pain next month looks at just this issue. It found every single placebo-controlled trial ever conducted on a migraine drug, and looked at the side-effects reported by the people in the control group, who received a dummy “placebo” sugar pill instead of the real drug. Not only were these side-effects common, they were also similar to those of whatever drug the patients thought they might be receiving.

This is nothing new. A study in 2006 sat 75 people in front of a rotating drum to make them feel nauseous, and gave them a placebo sugar pill: 25 were told it was a drug that would make the nausea worse. It did get worse, and they also exhibited more gastric tachyarrhythmia, the abnormal stomach activity that frequently accompanies nausea.

A paper in 2004 took 600 patients from three different specialist drug allergy clinics and gave them either the drug that was causing their adverse reactions, or a dummy pill with no ingredients: 27% of the patients experienced side-effects such as itching, malaise and headache from the placebo dummy pill.

And a classic paper from 1987 looked at the impact of listing side-effects on the treatment consent form. This was a large trial comparing aspirin against placebo, conducted in three different centres. In two, the form outlined various gastrointestinal side-effects, and in these centres there was a sixfold rise in the number of people reporting such symptoms and dropping out of the trial. This is the amazing world of the nocebo effect, where negative expectations can induce unpleasant symptoms, in the absence of a physical cause.