Search Salon

- - - - - - - - - - - -

Recently in Salon Health & Body

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

Urge
Episode 2: The just-in-time orgasm
When love is your business, pleasure takes a serious toll.
By Tracy Quan
[07/15/99]

A thing of beauty
Should we flush our colons or leave them alone?
By Jon Bowen
[07/14/99]

Column
The cost of free love
After Helen's libertine days turned sour, she began to wonder: Was it about desire or just another way to conform?
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]

Complete archives for Health & Body

- - - - - - - - - - - -

- - - - - - - - - - - -

A possible example of nocebo effect on coronary disease has been teased out of the famous Framingham study (a massive longitudinal study that began in 1948). Elaine Eaker and her colleagues found that women who said they were more likely than other women their age to develop heart disease were in fact twice as likely (over a 20-year period) to experience myocardial infarction or coronary death, even when the results were controlled for variables like smoking, high blood pressure and high cholesterol. Sometimes it's no comfort to be right. It also appears that women who felt they had little control over their lives and who were lonely and who didn't get to take many vacations had a higher rate of coronary disease, a discouraging finding. The meek will inherit the earth, but they may be too sick to have fun with it.

I suppose this means that you can hearten depressed people by telling them that they must look on the bright side or risk damaging their health, maybe even fatally. "Cheer up or die!" you can tell them. No doubt they will thank you some day.

Other much-written-about forms of the nocebo effect are sociogenic illness, psychogenic illness or mass hysteria. "Knowledge of sickness in others fosters an expectation that one may also be subject to the same condition," writes Robert Hahn, perhaps the foremost scholar of nocebo. In cases like these, groups of people complain of symptoms like nausea, dizziness, shortness of breath, numbness, and coughing. Typically they have been made aware that someone else has gotten inexplicably sick, that there is a strange smell in their workplace or that something else worrisome is going on. Gradually more and more people display symptoms, making it seem all the more certain that something is terribly wrong.

Doctors may tread warily in linking the nocebo effect with terms like "mass hysteria," because almost all doctors have experienced this themselves in the form of MSD -- medical student's disease. The medical student, assumed to be a reasonably intelligent, level-headed person, reads about various unpleasant conditions with diffuse or common symptoms and becomes convinced that he or she has the disease. "Look at this checklist! Headaches: yes, I have headaches. Dizziness: I felt dizzy yesterday in the revolving door. Insomnia: I hardly got any sleep last night. Nervousness: totally! Oh my God, I have a brain tumor. Probably inoperable. It is both tragic and ironic. Wait, read these symptoms of tetanus! Headaches, dizziness, agitation ..."

Why, I understand that it is not unusual for medical students to read about rabies, look in the mirror and see themselves beginning to foam at the mouth, and rush out into the street barking and biting people. Most doctors remember this period in their career with some embarrassment, naturally, but perhaps it gives them a little sympathy for other victims of the nocebo effect.

Sociogenic factors like these are used by some to explain phenomena like Gulf War syndrome or illness following breast implants. Naturally such explanations are extremely controversial.

In cases of sociogenic illness, anthropologist Dan Moerman says, "The kinds of symptoms are always pretty much the same. They're sleepless, and they have achy joints and there's nothing ever very specific."

Moerman describes an incident in Michigan in the mid-1970s in which a large amount of animal feed became contaminated with compounds meant for fireproofing pajamas -- PBBs (polybrominated biphenyls). Contaminated feed sickened and killed a number of cattle. (However, they did not catch fire in their beds.) Because the effects of PBBs were little known (but people knew that the related polychlorinated biphenyls, or PCBs, are dangerous), and because it was unclear how many farms had gotten contaminated feed, there was widespread alarm on Michigan farms. Many farmers were frightened to find themselves experiencing mysterious symptoms.

"Guess what their symptoms were?" asks Moerman. "They had sore knees, and they couldn't sleep and they were distracted." Now, nearly 25 years later, epidemiological studies have looked at the health of those farmers, and compared them to Wisconsin farmers without PBB exposure. "They studied these people from pillar to post," says Moerman. "There was no difference. Zero. No mortality difference, no cancer difference. But the Michigan farmers who say they were afflicted, were afflicted. They were sick! They were not sick with anything that anyone could measure, but they were sick."

To Moerman, the most intriguing part of the PBB episode may come from the cows. He recently charted milk production in Michigan cows in pounds of milk per cow per year ("I had never really realized how wonderful agricultural statistics are") and found a sharp drop in milk production in 1974. "It drops by 10 to 12 percent. It just goes 'kerchunk' and it drops. Ninety-nine percent of the cows never got any of this PBB, but their production of milk dropped anyway. Well, you know cows don't read the newspaper. But what do cows do?" Moerman asks. "Hang out with farmers?" I guess. "That's right. They hang out with farmers. I think we have a nocebo effect in domestic animals."

Next page | What to do if your doc tells you you're ugly