What is the Nocebo Effect?

Placebo is from the Latin “I shall please” and in the contemporary vernacular placebo means a sugar pill with no active ingredient that relies up a patient’s state of mind to either work or not work. The placebo effect is well documented in medical research. People with a positive attitude toward who take a simple placebo sugar pill have been show to improve their medical conditions without any actual medical help via the medicine. Many people are familiar with the placebo effect, but did you know that there is an opposite effect known as the nocebo in which a negative attitude can produce potentially devastating results.

The classic case study of the nocebo effect took place in the 1950s with a man known as Wright. Mr. Wright was suffering from lymphatic cancer and tumors. Some of these tumors were the size of Brayburn apples. One day Mr. Wright beseeched his doctor to put him on a new drug called Krebiozen. Wright had heard of anecdotal evidence that Krebiozen was effective exactly against the kind of cancer from which he was suffering. Wright received an injection of Krebiozen and less than two weeks later his tumors were gone. It would seem as though a miracle drug had been created. If that was so, however, you are right to wonder why cancer patients today are not lining up to receive injections of Krebiozen.

A few weeks after his tumors disappeared, Mr. Wright happened to read a newspaper article about a medical study of Krebiozen. The article detailed how Krebiozen had failed to produce positive results in the latest medical study. Shortly thereafter, Wright’s tumor returned. The doctor immediately took note of the placebo effect that seemed to be at work in his patient’s case and brought Wright in to give him an injection of what he termed a more potent form of Krebiozen. In fact, what the doctor injected into Wright was nothing more potent that water. Sure enough, however, the tumors disappeared yet again.

Mr. Wright might well have gone on to live a long and tumor-free life—or at least a mostly tumor-free life—had he not come into contact with a study by the American Medical Association two months later. The AMA report was the definitive and final statement on Krebiozen and it explains why you have never heard of it. The AMA declared Krebiozen to be completely worthless as a drug to fight cancerous tumors. Two days after reading the study, Mr. Wright was dead.

The result of other cases of the nocebo effect—in which a negative state of mind or attitude can produce potentially disastrous effects—helped to produce a sea change not just in how medicine is delivered to patients, but in the relationship between a doctor and patient. It is more commonly known as bedside manner and there seems to be a strong indication that a patient will deal with a disease or illness more effectively and efficiently if he has a positive attitude toward his caregiver. A doctor who delivers devastating news about cancer with little emotional attachment may see his patient go downhill much faster than a doctor who delivers this news with empathy and genuine care.

Mr. Wright’s case is an extreme one delivering evidence of both the placebo and nocebo effect. The disappearance of the tumors seems to indicate an almost supernatural ability of a positive outlook to heal disease. But imagine if you only believed with half the strength of Wright while taking a medication that actually does have an active ingredient that works. If Mr. Wright could heal his tumors with nothing but water, imagine how much better you might be able to deal with migraines or depression or allergies if you totally committed yourself to believe that medicines commonly prescribed to treat these disorders actually worked.

Or imagine the consequences if you refused to believe in a miracle drug that has absolutely been proven to work 90% of the time.