Author: Aldanova Aziza
Translated by: Merencova Anastasia
Copy editor: Issabayeva Madina
The placebo effect is considered universally recognized in medicine, since it has no pharmacological effect and gives a positive effect. Placebo is the only kind of effect, where we get the desired result due to its particular drug and procedure. But there is also a counterbalance - the nocebo effect. If a person believes that this drug will harm him, then he will harm - this is a nocebo philosophy. From the Latin “noceo” - harm, an undesirable phenomenon, in the absence of a connection between the drug and in the process of therapy. What causes the nocebo effect? How does it work? Nocebo and ethics, as well as who is more susceptible to adverse events?
For the first time, the term nocebo was invented and described by the doctor Walter Kennedy in 1960 in the International Journal of Clinical and Experimental Medicine. The human mind is designed so that it feels pain, and the nocebo effect is the occurrence or intensification of a symptom that a patient has. In physics, Bayesian theory describes the ability to make predictions based on incomplete data. Our brain is also arranged, we perceive all data fragmented, and the space between these information remains for conjecture, where it is replaced by the nocebo or placebo effect.
Both in clinical practice and in studies, nocebo-effect is a very common phenomenon. In 2012, Doctor of Medicine Professor Winfried Heyzer from the Department of Psychosomatic Medicine and Psychotherapy of the Technical University of Munich conducted a study on the nocebo phenomenon together with his colleagues Ernil Hansen (MD, professor from the University Medical Center Regensburg) and doctor of psychology, Professor Paul Enck (University Hospital Tübingen ) Having created an experimental group of 50 people with chronic back pain, scientists randomly divided the participants into two groups. One group was informed that the test would cause minor pain, and the second group was not told. At the end of the test, patients from the first group complained of excessive pain, rating from 48 on a 101 point scale, and productivity in bending the legs was low. A group with neutral instruction rated pains averaging 30 on a 101-point scale. This suggests that nocebo serves as a kind of preparation for a negative effect or phenomenon.
In accordance with the consequence of the nocebo effect in medical ethics, a dilemma arises: to inform the patient about the side effects of the drug or treatment complications, which can negatively affect the health and results of treatment, or adhering to the oath “not to harm” to hide details of information that could harm the patient, thereby infringing on the rights of the patient? Where the choice is not easy, no one wants to deceive the patient, and no one wants to initiate the nocebo effect. In September 2019, an experiment was conducted where the nocebo effect is experienced and from the side, not to mention doctors and patients, it was published in the journal The Clinical journal of Pain. During the experiment, volunteers were shown a video in which a woman experienced pain during the test. This test was conducted on volunteers of the experiment. At the end of the experiment, participants reported that they felt terrible pain, although pain was not said during the experiment. At the same time, if the woman on the video did not show feelings of pain, the participants did not feel it either. According to the researchers, people tend to feel pain after reading stories with similar illnesses on the Internet. This also applies not only to diseases, but also to diets, physical activity, everything that is subject to treatment and is painful in nature.
It is also known that some people are much more sensitive to the nocebo effect, which depends on their personal qualities. A group of Swiss scientists conducted a meta-analysis based on the database from 1997 to 2018. According to the study, people with an optimistic outlook on life are more likely to have a placebo effect, while people with a pessimistic mood and nervousness tend to be no-brain. Accordingly, the treatment for each person is selected individually, collecting information, talking and examining the patient, as claimed by a group of scientists.
Nocebo does not have any pharmacological effects, but it is quite capable of causing certain complications or a negative effect. But, Walter Kennedy himself described the phenomenon, saying that it is inherent in the person himself, rather than in medicine. It is worth agreeing with this, and the prevention of the nocebo effect is based on its deep study. Also, you should not avoid different medications to avoid the effect of nocebo, but try to clarify and convey to the patient, emphasizing the need for this treatment, rather than side effects.
