The Nocebo Effect

Just knowing that a drug can have side effects may increase your risk of suffering them. This is the nocebo effect: the patient’s expectation that a drug will do harm. An excellent summary of this appears in the New York Times review pages.

Side effects from medications are real and can be harmful. Even so, the benefits may still outweigh the potential risks. A recent study confirmed that certain cholesterol medications might lead to diabetes in susceptible patients. However, the reduction in cardiovascular disease with lowering the blood cholesterol is real – and even more important in patients with diabetes. Certain patients (and we have a good idea who they might be) can have terrible effects from osteoporosis medications. This doesn’t mean that other patients at high risk for hip and vertebral fractures shouldn’t take them.

I believe that direct to consumer pharmaceutical advertisements do greater harm than good. Mind you, only expensive medications have the budgets needed to buy television commercials. The ads rarely get down and dirty to discuss the actual disease but show idyllic vacations scenes or silly cartoons, ending with a sonorous litany of terrible outcomes (rash, headache, liver failure, depression and/or death).

Starting a medication should be a shared decision. Usually the physician is more knowledgeable party but the patient is the one that actually decides whether to take the medicine. No decision is written in stone – treatment plans can be (and often are) revised. These discussions are best done face to face; the discussions are of a higher quality when the patient is prepared with questions and concerns.