The Nocebo Response

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Tags: belief, effect, expectation, healing, nocebo, placebo

2 comments

Bruce on June 16, 2008 at 12:20 am

I read about the nocebo effect recently in a scientific paper reviewing all the popular low-carb diet books. Two examples were given of studies comparing low-fat to low-carb diets. All subjects met with a dietitian several times, who probably reinforced the low-fat diet (placebo effect) and discouraged the low carb dieters (nocebo effect). This variable needs to be controlled. All subjects should be given reinforcement or none of them should.

http://www.scientificexploration.org/jse/articles/pdf/18.1_kauffman.pdf
admin on June 16, 2008 at 10:04 am

Thanks for your comment, Bruce. I couldn’t agree more that trials need better controls for both the placebo and nocebo effect.

Some have argued (rightly, I believe) that an inert placebo control isn’t enough, however, to guarantee a double-blind trial. Patients taking the active drug in a study often experience side effects, which of course leads them to suspect they are taking the drug and not the placebo and ruins the blind.

A more accurate alternative would be an “active placebo”, which is a substance that does not address the disease in question but has some relatively benign physiological effects like producing dry mouth or stimulation (like a caffeine pill, perhaps). In studies done with active placebos, the difference between the efficacy of antidepressants and placebo was virtually nil.