Nocebo Effect‏ (致命的暗示)

Voodoo nouveau.......Sound Familiar

You might think this sort of thing is increasingly rare, and limited to remote tribes. But according to Clifton Meador, a doctor at Vanderbilt School of Medicine in Nashville, Tennessee, who has documented cases like Vanders, the curse has taken on a new form.

[Hex death: voodoo magic or persuasion?

Meador CK. http://www.ncbi.nlm.nih.gov/pubmed/1546347 

Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.

Hex death is one that follows a ritualized pronouncement of death by a powerful authority, a phenomenon not widely accepted by the Western medical community, despite scattered accounts witnessed by reputable observers. Case histories of two patients are presented. The first patient, a poorly educated man near death after a hex pronounced by a local voodoo priest, rapidly recovered after ingenious words and actions by his family physician. The second, who had a diagnosis of metastatic carcinoma of the esophagus, died believing he was dying of widespread cancer, as did his family and his physicians. At autopsy, only a 2 cm nodule of cancer in his liver was found. The cases raise several intriguing questions. Is death from hexing limited to ignorant and superstitious tribes, or is it part of some general phenomenon basic to many forms of human communication? Is hex death only a form of human persuasion? If we can cause death by what we say or do, then

Take Sam Shoeman, who was diagnosed with end-stage liver cancer in the 1970s and given just months to live. Shoeman duly died in the allotted time frame - yet the autopsy revealed that his doctors had got it wrong. The tumour was tiny and had not spread. "He didn't die from cancer, but from believing he was dying of cancer," says Meador. "If everyone treats you as if you are dying, you buy into it. Everything in your whole being becomes about dying."

Death of the autopsy http://www.newscientist.com/article/mg19225772.100-death-of-the-autopsy.html 

§                                 13 November 2006 by Michael Le Page 

§                                 Magazine issue 2577

A 49-year-old man is admitted to hospital in Japan with chest pains and a partially paralysed arm. Doctors diagnose a simultaneous heart attack and stroke and the patient seems to respond well to treatment. The next day, however, he has a cardiac arrest, and later dies. The autopsy reveals that all along he'd had an aortic dissection, a tear in the lining of the major artery from the heart.

In the US, a previously healthy and active 79-year-old man is found confused and incapacitated. He is diagnosed with pneumonia and dehydration, and after treatment seems to be recovering well. After three days he starts breathing rapidly and his condition declines. Six days after admission he dies. The autopsy reveals rampant TB.

He didn't die from cancer but from believing he was dying of cancer

Cases such as Shoeman's may be extreme examples of a far more widespread phenomenon. Many patients who suffer harmful side effects, for instance, may do so only because they have been told to expect them. What's more, people who believe they have a high risk of certain diseases are more likely to get them than people with the same risk factors who believe they have a low risk. It seems modern witch doctors wear white coats and carry stethoscopes. 

The nocebo effect

The idea that believing you are ill can make you ill may seem far-fetched, yet rigorous trials have established beyond doubt that the converse is true - that the power of suggestion can improve health. This is the well-known placebo effect. Placebos cannot produce miracles, but they do produce measurable physical effects. http://www.newscientist.com/article/mg19926700.300-the-power-of-the-placebo-effect.html 

The placebo effect has an evil twin: the nocebo effect, in which dummy pills and negative expectations can produce harmful effects. The term "nocebo", which means "I will harm", was not coined until the 1960s, and the phenomenon has been far less studied than the placebo effect. It's not easy, after all, to get ethical approval for studies designed to make people feel worse.

What we do know suggests the impact of nocebo is far-reaching. "Voodoo death, if it exists, may represent an extreme form of the nocebo phenomenon," says anthropologist Robert Hahn of the US Centers for Disease Control and Prevention in Atlanta, Georgia, who has studied the nocebo effect.

Life threatening

In clinical trials, around a quarter of patients in control groups - those given supposedly inert therapies - experience negative side effects. Barsky AJ, Saintfort R, Rogers MP, Borus JF. 

Department of Psychiatry, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. 

Patients taking active medications frequently experience adverse, nonspecific side effects that are not a direct result of the specific pharmacological action of the drug. Although this phenomenon is common, distressing, and costly, it is rarely studied and poorly understood. The nocebo phenomenon, in which placebos produce adverse side effects, offers some insight into nonspecific side effect reporting. We performed a focused review of the literature, which identified several factors that appear to be associated with the nocebo phenomenon and/or reporting of nonspecific side effects while taking active medication: the patient's expectations of adverse effects at the outset of treatment; a process of conditioning in which the patient learns from prior experiences to associate medication-taking with somatic symptoms; certain psychological characteristics such as anxiety, depression, and the tendency to somati 

The severity of these side effects sometimes matches those associated with real drugs. A retrospective study of 15 trials involving thousands of patients prescribed either beta blockers or a control showed that both groups reported comparable levels of side effects, including fatigue, depressive symptoms and sexual dysfunction. A similar number had to withdraw from the studies because of them.