The Nocebo Effect: Censoring Your Consciousness
I talk with my patients a lot about the importance of words and the role they play in health and healing. Words have power, meaning, and the ability to change our perception, especially when they’re spoken by an authority figure we trust, like a doctor or issued from a large medical organization like the Centers for Disease Control and Prevention (CDC) or the American Medical Association (AMA). We take whatever is said at face value because they’re the experts, right?
Careless Commentary
While getting in the habit of thinking and speaking positive messages to our bodies during illness is essential, it’s astonishing how often physicians unconsciously undermine the patient’s efforts with words that are poorly chosen or don’t necessarily apply to their situation. My concern here is that patients hold physicians in such high regard that their misspoken words can be seen as definitive and negate much of the healing mental work they’ve been doing.Recently, a patient of mine was reviewing the results from a full blood panel with another physician. I’d ordered the test, so I already knew the results were excellent. In fact, I’d never seen triglycerides that low in my entire career. After reviewing the results with the other physician, who I know and respect, the doctor said, “This is all great, but if I had to mention anything, I’d say your HDL [good cholesterol] is on the low side. You know, they say you can tell how long you’re going to live if you multiply your HDL level with your—.“At that point, my patient politely interrupted by saying, “Save it. You know what? I don’t need that in my consciousness.” The doctor took no offense and obliged. While this “factoid” had nothing to do with why my patient was there, casual, off-handed comments like that have the potential of creating unnecessary fear and negating much of the positive mental work patients put toward healing.
Best Intentions Backfire
Aside from creating fear, a doctor that misspeaks can generate the nocebo effect. We’ve all heard of the placebo effect. That’s when an inert substance like a sugar pill actually relieves symptoms or cures an illness because the patient believes it will.
In Latin, “placebo” means I shall please. “Nocebo,” which means I shall harm, has the same power as placebo, but to the negative effect.
It can actually create symptoms or cause an illness. It’s important to know that a placebo or nocebo device can be anything, even words. Here’s a great example from a peer-reviewed medical journal.In 1957, “Mr. Wright” was suffering from advanced stage lymphoma and had less than three months to live. While his doctor had given up hope, Mr. Wright had not. When he learned that the Long Beach, California hospital he was staying in was part of a new cancer drug trial, he begged to be a part of the study. Although his short life expectancy disqualified him from participation, after relentless requests, his physician was able to acquire a single dose for him. Two days after the injection, Wright was smiling, had more energy and acted like a new man. By the third day, his tumors were half their original size. After ten days, Wright was sent home, completely cured. His doctor said the tumors “melted like snowballs on a hot stove.”Several months later, Wright heard a radio report that the drug trial had completed and that the supposed miracle injection was a complete failure and totally ineffective. As he emotionally embraced this devastating news, Wright’s cancer reappeared almost immediately. By now, his doctor suspected the placebo effect was in play and moved quickly. He told Wright that his injection was from a faulty batch and that he’d acquired a “double-strength” dose. After the injection, which was really distilled water, Wright’s tumors vanished in days. All was well until Wright heard the AMA announce on TV that the drug manufacturer was being indicted for fraud. The injection was nothing more than mineral water with some amino acids. Within days, Wright was dead. For Mr. Wright, it took a placebo in the form of a pill to ignite his faith and healing power. All it took to undo that was words.
Avoid Information Overload
Too often, doctors don’t feel like they’ve done their job if they didn’t find anything wrong with the patient or at least provided some health advice. This is where we, as physicians, can get into trouble with the nocebo effect, as nearly was the case with my patient in the earlier example. While we need to be forthright with our patients about their conditions, we must take care not to prognosticate about negative outcomes that may or may not be far into the future. A lot can change in three years, three weeks, or three days.Be wary of statistics, as well. Everyone likes to throw statistics into conversation because they sound so definitive and make us feel authoritative when we say things like, “Four out of five people _____." Statistics are commonly bent to fit the agenda of the agency sponsoring the study or survey. The best way you can prevent yourself from becoming a nocebo statistic is to stop listening to statistics. If your physician misspeaks, kindly ask him to refrain from predicting unnecessary doomsday scenarios. It takes courage to go against conventional medical “wisdom,” but healing often requires it.
Try to resist going online and researching your condition. While being informed is important, there is a great deal of medical misinformation on the internet with the potential of being a powerful nocebo.
If you don’t understand something your physician said during an appointment, never assume; always ask him or her for clarification. Remember, when it comes to your health, no words carry more power than the ones you think and speak.For more health insights from Dr. Sadeghi, please visit beingclarity.com to sign up for the monthly newsletter or check out his annual health and well-being journal, MegaZEN here. For daily messages of encouragement and humor, follow him on Instagram at @drhabibsadeghi.
