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Nancy Chan: Diary of a Manhattan call girl
About the story and list of characters.
By Tracy Quan
[07/15/99]

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The cost of free love
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By Virginia Vitzthum
[07/13/99]

Ginkgo below
Chinese herbalists consider ginkgo an aphrodisiac. So does at least one man in Dallas.
By Stephen G. Michaud
[07/12/99]

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By Susan McCarthy

July 15, 1999 | In one classic joke a doctor gives a patient bad news: "You have three months to live." "I want a second opinion!" snarls the patient. "OK. I also think you're ugly." This is the bedside manner of Dr. Nocebo, and it's probably not good for you.

Most people have heard of the placebo effect, but relatively few -- including physicians -- have heard of nocebo, which was only named in 1961. This is starting to change, with an increasing number of academic articles about nocebo, with a nocebo conference being given and with an odd array of non-medical groups getting interested.

The nocebo effect is the little-known evil twin of the placebo effect. In the placebo effect a sick person feels better because he believes he's being treated, often with a sugar pill or some other inert substance or intrinsically meaningless therapy. Placebo effects can be quite powerful, and a surprisingly large part of medicine, both ancient and modern, consists of placebo effects, whether physicians and patients realize it or not.

The nocebo effect comes into play in several situations: the one- to-one interaction of doctor and patient, each with his or her expectations; people's general beliefs and expectations outside the therapeutic situation; and expectations created in groups of people.

In a sickeningly simple example of doctor-to-patient nocebo effect, hospital patients were given sugar water and were told that it was an emetic. Eighty percent of them vomited. Thanks, Doc! This may provide one hint as to why there aren't more nocebo experiments. In another experiment I'm glad I didn't volunteer for, asthmatics inhaled a nebulized saline solution, which would have been inert except that they were told it was an irritant solution. Accordingly, they experienced breathing problems, and some had full-blown asthma attacks. They were then given the same saline spray, but this time they were told it was a helpful medicine -- and they recovered. Note that the patients didn't just think their airways were constricting -- they really were.

The extreme case of doctor-to-patient nocebo effect is voodoo death, in which, as we have all read, the shaman or witch doctor of the tribe pronounces the curse of death on some hapless person, who then dies. Sometimes they are said to die of fear, sometimes out of sheer conviction.

Unfortunately for the impressiveness of this evidence, it probably isn't true. Most accounts of voodoo death turn out to be the fantasies of excitable explorers and anthropologists. Others turn out to be retrospective. Say I notice that I am really, really sick and suspect that I'm going to die. I try to figure out why and it occurs to me that someone must have cursed me. (Perhaps that nasty editor at a certain alternative weekly who was so snippy about paying me! I'm sure he wants me dead, especially after I threatened to take him to tiny claims court.) Or perhaps someone else notices that I'm unwell and decides to claim the credit: "I cursed her! She crossed me and now she'll die. And the rest of you uppity freelancers better watch out."

One anthropologist has argued that some cases of voodoo death among the Yolngu people of Australia's East Arnhem Land are really cases of dehydration -- the patient and the patient's family figure it's pointless to waste water on someone who's doomed, so they don't, and eventually the person dries up and dies. Other anthropologists deny it hotly, saying that, 1) the Yolngu people actually take excellent care of sick people, not omitting the annoying insistence on just having a little sip of tea, come on, drink it for me; and, 2) there aren't any voodoo deaths in East Arnhem Land anyway, except for a few that get diagnosed in retrospect. I think this must be true, because I have crossed some pretty scary editors and publishers, yet I am still alive.

Next page | It's not unusual for med students to read about rabies and then start foaming at the mouth!