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Encyclopedia > Nocebo

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In its original application, "nocebo" had a very specific meaning in the medical domains of pharmacology, and nosology, and aetiology. Pharmacology (in Greek: pharmacon (φάρμακον) meaning drug, and logos (λόγος) meaning science) is the study of how substances interact with living organisms to produce a change in function. ... ... Etiology (alternately aetiology, aitiology) is the study of Greek words aitia = cause and logos = word/speech) is used in philosophy, physics and biology in reference to the causes of various phenomena. ...


It was a subject-oriented adjective that was used to label the harmful, injurious, unpleasant, or undesirable reactions (or responses) that a subject manifested (thus, "nocebo reactions" (or "nocebo responses") as a result administering an inert dummy drug, where these responses had not been chemically generated, and were entirely due to the subject's pessimistic belief and expectation that the inert drug would produce harmful, injurious, unpleasant, or undesirable consequences. An adjective is a part of speech that modifies a noun or a pronoun, usually by describing it or making its meaning more specific. ... In English, to be inert is to be in a state of doing little or nothing. ... It has been suggested that Placebo effect be merged into this article or section. ... Pessimism, generally, describes a belief that things are bad, and tend to become worse; or that looks to the eventual triumph of evil over good; it contrasts with optimism, the contrary belief in the goodness and betterment of things generally. ... Look up belief in Wiktionary, the free dictionary. ... expectation in the context of probability theory and statistics, see expected value. ...


In these cases, there is no "real" drug involved, but the actual harmful, injurious, unpleasant or undesirable biochemical, physiological, behavioural, emotional, and/or cognitive consequences of the administration of the inert drug are very real.



One severe example of nocebo effect is someone who dies of fright after being bitten by a non-poisonous snake. [1] A poisonous snake or venomous snake is a snake that uses venom delivered through two fangs in its mouth to kill its prey. ...


The term "nocebo"

The term nocebo Latin for ("I will harm") was chosen by Walter Kennedy, in 1961, to denote the counterpart of one of the more recent applications of the term "placebo" (= "I will please"); namely, that of a placebo being a drug that produced a beneficial, healthy, pleasant, or desirable consequence in a subject, as a direct result of that subject's beliefs and expectations. Latin is an ancient Indo-European language originally spoken in Latium, the region immediately surrounding Rome. ... // A placebo is a medicine or preparation which has no inherent pertinent pharmacologic activity but which is effective only by virtue of the factor of suggestion attendant upon its administration. ...


Today, in the same way that the term placebo (or "placebo drug") is often used wrongly in an agent-oriented way to denote an active drug that produces an entirely predictable, and intentionally sought after outcome that is experienced as pleasant or desirable (e.g., analgesia), the term nocebo (or nocebo drug) is often used wrongly to denote its counterpart, an active drug that produces an entirely predictable, and intentionally sought outcome that is experienced as unpleasant or undesirable (e.g., nausea). // A placebo is a medicine or preparation which has no inherent pertinent pharmacologic activity but which is effective only by virtue of the factor of suggestion attendant upon its administration. ... For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ... For other uses, see Nausea (disambiguation). ...


Houston may have been the first to have spoken of a doctor's deliberate application of harmful "placebo" procedures, as distinct from the other, harmless sort of "placebo" procedures a doctor might apply and whose "usefulness was in direct proportion to the faith that the doctor had and the faith that he was able to inspire in his patients". Houston (1938,p.1418) wrote:

... [and while the efficacy of the placebo procedure] is believed in by the doctor, [the placebo procedure itself] is no longer harmless but harmful, sometimes very dangerous. It would seem peculiarly contradictory to speak of the painful and dangerous placebo, yet men are so constituted that they feel the need in dire extremity of resorting to dread measures. Nervous patients in particular, feel that a certain standing and sanction is bestowed upon their maladies when violent therapeutic measures are used."

Houston spoke of three significantly different categories of placebo (pp.1417-1418): Efficacy is the ability to produce a desired amount of a desired effect. ...

  • the drug that the physician knows to be inert, but which the subject believes to be potent.
  • the drug which is believed to be potent by both subject and physician, but which later investigation proves to have been totally inert.
  • the drug which is believed to be potent by both subject and physician, but is actually harmful and dangerous, rather than being inert and harmless.

The term "nocebo response" originally only meant an unpredictable unintentional belief-generated injurious response to an inert procedure.


But there is an emerging practice of labelling drugs that produce unpleasant consequences as "nocebo drugs" means that the term "nocebo response" may be being used to label an intentional, entirely pharmacologically-generated and quite predictably injurious outcome that has ensued from the administration of an active (nocebo) drug.


Anthropologists use the term "nocebo ritual" to describe a procedure, or treatment, or ritual that has been performed (or a herbal remedy or medication that has been administered) with malicious intent, by contrast with a placebo procedure or treatment or ritual that is performed with a benevolent intent. Look up Procedure in Wiktionary, the free dictionary. ... Treatment may refer to: // Health Therapy - the act of remediation of a health problem. ... A ritual is a set of actions, performed mainly for their symbolic value, which is prescribed by a religion or by the traditions of a community. ... Dioscorides’ Materia Medica, c. ... Oral medication A medication is a licenced drug taken to cure or reduce symptoms of an illness or medical condition. ...


The nocebo effect

Because the original meaning of "nocebo" specifically referred to a subject's response to an inert drug, the term nocebo effect can really only refer to the consequences of the application of a "harm-producing" "nocebo drug" (however, the concept of a "harm-producing" "nocebo drug" is a much later concept than either that of a "nocebo response" or of a "nocebo reaction"). Effect can be used in several different ways: Cause and effect are the relata of causality In movies and other media, sound effects are artificially created or enhanced sounds. ...


The nocebo response

In the strictest sense, a nocebo response is where a drug-trial's subject's symptoms are worsened by the administration of an inert, sham,[1] or dummy (simulator) treatment, called a placebo. In English, to be inert is to be in a state of doing little or nothing. ... A simulation is an imitation of some real device or state of affairs. ... // A placebo is a medicine or preparation which has no inherent pertinent pharmacologic activity but which is effective only by virtue of the factor of suggestion attendant upon its administration. ...


According to current pharmacological knowledge and the current understanding of cause and effect, a placebo contains no chemical (or any other agent) that could possibly cause any of the observed worsening in the subject's symptoms. Thus, any change for the worse must be due to some subject-internal factor. Pharmacology (in Greek: pharmacon is drug, and logos is science) is the study of how chemical substances interfere with living systems. ... Cause and Effect is considered by many fans to be one of the best episodes of the series Star Trek: The Next Generation. ...


The worsening of the subject's symptoms is a direct consequence of their exposure to the placebo, but those symptoms have not been chemically generated by the placebo. Because this generation of symptoms entails a complex of "subject-internal" activities, in the strictest sense, we can never speak in terms of simulator-centred "nocebo effects", but only in terms of subject-centred "nocebo responses".


Although some attribute nocebo responses (or placebo responses) to a subject's gullibility, there is no evidence that an individual who manifests a nocebo/placebo response to one treatment will manifest a nocebo/placebo response to any other treatment; i.e., there is no fixed nocebo/placebo-responding trait or propensity. The term gullibility refers to the state of being easily deceived. ... Look up trait in Wiktionary, the free dictionary. ...

McGlashan, Evans & Orne (1969, p.319) found no evidence of what they termed a "placebo personality". Also, in a carefully designed study, Lasagna, Mosteller, von Felsinger & Beecher (1954), found that there was no way that any observer could determine, by testing or by interview, which subject would manifest a placebo reaction and which would not.

Experiments have shown that no relationship exists between an individual's measured hypnotic susceptibility and his/her manifestation of nocebo or placebo responses.[2] Hypnotic susceptibility is a measurement of how easily a person can be hypnotized. ...


Why a nocebo response?

The term "nocebo response" was coined in 1961 by Walter Kennedy (he actually spoke of a "nocebo reaction"). A response is the following: Often a response is the result of a stimulus. ... A reaction is the following: In physics, a reaction (physics) is defined by Newtons third law: For every action there is an equal and opposite reaction. The idea that any given force has a pair or opposite force. ...


He had observed that another, entirely different and unrelated, and far more recent meaning of the term placebo was emerging into far more common usage in the technical literature (see homonym); namely that a "placebo response" (or "placebo reaction") was a "pleasant" response to a real or sham/dummy treatment (this new and entirely different usage was based on the Latin meaning of the word placebo, "I shall please"). A homonym is one of a group of two or more words that have the same phonetic form (i. ...


Kennedy chose the Latin word nocebo ("I shall harm") because it was the opposite of the Latin word placebo ("I shall please"), and used it to denote the counterpart of the placebo response: namely, an "unpleasant" response to the application of real or sham treatment.


Kennedy very strongly emphasized that his specific usage of the term nocebo did not refer to "the iatrogenic action of drugs"[3]: in other words, according to Kennedy, there was no such thing as a "nocebo effect", there was only a "nocebo response". An iatrogenic (pronounced , IPA) condition is a state of ill health or adverse effect caused by medical treatment, usually due to mistakes made in treatment. ...


He insisted that a nocebo reaction was subject-centred, and he was emphatic that the term nocebo reaction specifically referred to "a quality inherent in the patient rather than in the remedy".[3]


Even more significantly, Kennedy also stated that whilst "nocebo reactions do occur [they should never be confused] with true pharmaceutical effects, such as the ringing in the ears caused by quinine".[3] Pharmacology (in Greek: pharmacon is drug, and logos is science) is the study of how chemical substances interfere with living systems. ... Quinine is a natural white crystalline alkaloid having antipyretic, anti-malarial with analgesic and anti-inflammatory properties and a bitter taste. ...


This is strong, clear and very persuasive evidence that Kennedy was precisely speaking of an outcome that had been totally generated by a subject's negative expectation of a drug or ritual's administration; which was the exact counterpart of a placebo response that would have been generated by a subject's positive expectation.


And, finally, and most definitely, Kennedy was not speaking of an active drug's unwanted, but pharmacologically predictable negative side-effects (something for which the term nocebo is being increasingly used in current literature). Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ...


Ambiguity of medical usage

In an important recent paper,[4] Stewart-Williams and Podd argue that using the contrasting terms "placebo" and "nocebo" to label inert agents that produce pleasant, health-improving or desirable outcomes, or unpleasant, health-diminishing, or undesirable outcomes (respectively), is extremely counterproductive.


For example, precisely the same inert agents can produce analgesia and hyperalgesia, the first of which, from this definition, would be a placebo, and the second a nocebo. For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ... Hyperalgesia is an extreme sensitivity to pain, which in one form is caused by damage to nociceptors in the bodys soft tissues. ...


A second problem is that precisely the same effect, such as immunosuppression, may be quite desirable for a subject with an autoimmune disorder, but be quite undesirable for most other subjects. Thus, in the first case, the effect would be a placebo, and in the second, a nocebo. Immunosuppression is the medical suppression of the immune system. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ...


A third problem is that the prescriber does not know whether the relevant subjects consider the effects that they experience to be subjectively desirable or undesirable until some time after the drugs have actually been administered.


A fourth problem is that, in cases such as this, precisely the same phenomena are being generated in all of the subjects, and these are being generated by precisely the same drug, which is acting in all of the subjects through precisely the same mechanism. Yet, just because the phenomena in question have been subjectively considered to be desirable to one group, but not the other, the phenomena are now being labelled in two mutually exclusive ways (i.e., placebo and nocebo); and this is giving the false impression that the drug in question has produced two entirely different phenomena. A phenomenon (plural: phenomena) is an observable event, especially something special (literally something that can be seen from the Greek word phainomenon = observable). ... In logic, two mutually exclusive (or mutual exclusive according to some sources) propositions are propositions that logically cannot both be true. ...


These sorts of argument produce a strong case that — despite the fact that, in some of its applications, the term "placebo" is used to denote something that pleases (compared with it denoting an inert sumulator) — the desirability (placeboic nature) or undesirability (noceboic nature) of the phenomena that have been manifested by a subject, after a drug has been administered, should never be part of the definition of what constitutes either "a placebo" or "a placebo response". A definition is a form of words which states the meaning of a term. ...


Ambiguity of anthropological usage

Some people maintain that belief kills (e.g., "voodoo death": Cannon (1942) describes a number of "voodoo deaths" from a variety of different cultures) and belief heals (e.g., faith healing). Faith healer redirects here. ...


A "self-willed" death (due to voodoo hex, evil eye, pointing the bone procedure,[5] etc.) is an extreme form of a culture-specific syndrome or sociogenic illness, that produces a particular form of psychosomatic or psychophysiological disorder, which results in a psychogenic death. See Vodou, also Voodoo (disambiguation). ... Look up Curse in Wiktionary, the free dictionary. ... John Phillip, The Evil Eye (1859), a self-portrait depicting the artist sketching a Spanish gypsy who thinks she is being given the evil eye The evil eye is a widely distributed element of folklore, in which it is believed that the envy elicited by the good luck of fortunate... In medicine and medical anthropology, a culture-specific syndrome or culture-bound syndrome is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. ... This article or section is in need of attention from an expert on the subject. ... A psychosomatic illness is one with physical manifestations and supposed psychological cause, often diagnosed when any known or identifiable physical cause was excluded by medical examination. ... Psychophysiology is the science of understanding the link between psychology and physiology. ...

There are many recorded instances of self-willed psychogenic death. For example, the death of Ananias, as recorded in Acts 5:1-6; see Ananias and Sapphira.
Rubel (1964) spoke of "culture bound" syndromes, which were those "from which members of a particular group claim to suffer and for which their culture provides an etiology, diagnosis, preventive measures, and regimens of healing” (p.268).

It is important to distinguish these "self-willed deaths" from other "self-imposed" sorts of death, such as: Ananias and his wife Sapphira were, according to the author of Acts of the Apostles, members of the Early Christian church. ...

  • the "self-inflicted deaths" of suicide, voluntary euthanasia, or the refusal of life-extending treatment;
  • the "heroic" "self-inflicted death" of a soldier who throws himself on a hand grenade to save his mates, or that of the Antarctic explorer Captain Lawrence Oates (“I am just going outside and may be some time”); or
  • the "religious self-inflicted death"' of the self-immolating suttee, or the mors voluntaria religiosa (= "voluntary religious death") of the aged person, who religious elders have permitted to voluntarily, peacefully, and slowly die by fasting.

Certain anthropologists, such as Robert Hahn and Arthur Kleinman have extended the placebo/nocebo distinction into this realm in order to allow a distinction to be made between rituals, like faith healing, that are performed in order to heal, cure, or bring benefit (placebo rituals) and others, like "pointing the bone", that are performed in order to kill, injure or bring harm (nocebo rituals). Suicide (from Latin sui caedere, to kill oneself) is the act of willfully ending ones own life. ... For the program to kill people with disabilities in Nazi Germany, see Action T4. ... For the alcoholic beverage sold in New Orleans, see hand grenade (drink). ... Lawrence Edward Grace Oates (March 17, 1880 – March 17, 1912) was a British Antarctic explorer. ... Suttee is an ancient Indian funeral practice in which the widow was immolated alive on her husband’s funeral pyre. ... Fasting is the act of willingly abstaining from some or all food and/or drink, for a period of time. ... Arthur Kleinman (b. ...


As the meaning of the two inter-related and opposing terms has extended, we now find anthropologists speaking, in various contexts, of nocebo or placebo (harmful or helpful) rituals:-

  • that might entail nocebo or placebo (unpleasant or pleasant) procedures,
  • about which subjects might have nocebo or placebo (harmful or beneficial) beliefs,
  • that are delivered by operators that might have nocebo or placebo (pathogenic, disease-generating or salutogenic, health-promoting) expectations,
  • that are delivered to subjects that might have nocebo or placebo (negative, fearful, despairing or positive, hopeful, confident) expectations about the ritual,
  • which are delivered by operators who might have nocebo or placebo (malevolent or benevolent) intentions, in the hope that the rituals will generate nocebo or placebo (lethal, injurious, harmful or restorative, curative, healthy) outcomes;

and, that all of this depends upon the operator's overall beliefs in the harmful nature of the nocebo ritual or the beneficial nature of the placebo ritual.


Yet, it may become even more terminologically complex; for, as Hahn and Kleinman indicate, there can also be cases where there are paradoxical nocebo outcomes from placebo rituals (e.g. the TGN1412 drug trial [2] [3]), as well as paradoxical placebo outcomes from nocebo rituals (see also unintended consequences). For other meanings of Paradox, see Paradox (disambiguation). ... TGN1412 (also known as CD28-SuperMAB®) is the working name of an immunomodulatory drug which was withdrawn from development, originally intended for the treatment of B cell chronic lymphocytic leukemia (B-CLL) and rheumatoid arthritis. ... Unintended consequences can be either positive, in which case we get serendipity or windfalls source of problems, according to the Murphys law definitively negative: perverse effect, which is the opposite result to the one intended The Law of Unintended Consequences holds that almost all human actions have at least...


Writing from his extensive experience of treating cancer (including more than 1,000 melanoma cases) at Sydney Hospital, Milton (1973) warned of the impact of the delivery of a prognosis, and how many of his patients, upon receiving their prognosis, simply turned their face to the wall and died an extremely premature death: "... there is a small group of patients in whom the realisation of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death. This problem of self-willed death is in some ways analogous to the death produced in primitive peoples by witchcraft (“Pointing the bone”)." (p.1435) Melanoma is a malignant tumor of melanocytes and, less frequently, of the eye (see uveal melanoma). ... This article needs cleanup. ... Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ... When normal cells are damaged or old they undergo apoptosis; cancer cells, however, avoid apoptosis. ...


See also

Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ... Anthropolology (from the Greek word , man or person+knowledge) consists of the study of humanity (see genus Homo). ... Autosuggestion (or autogenous training) is a process by which an individual trains the subconscious mind to believe something, or systematically schematizes the persons own mental associations, usually for a given purpose. ... Look up belief in Wiktionary, the free dictionary. ... Look up charm in Wiktionary, the free dictionary. ... In medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a type of research study. ... In medicine, a contraindication is a condition or factor that increases the risk involved in using a particular drug, carrying out a medical procedure or engaging in a particular activity. ... In medicine and medical anthropology, a culture-specific syndrome or culture-bound syndrome is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. ... Look up Curse in Wiktionary, the free dictionary. ... Oral medication Caffeine is one of the most widely used psychoactive substances in the world. ... Efficacy is the ability to produce a desired amount of a desired effect. ... John Phillip, The Evil Eye (1859), a self-portrait depicting the artist sketching a Spanish gypsy who thinks she is being given the evil eye The evil eye is a widely distributed element of folklore, in which it is believed that the envy elicited by the good luck of fortunate... expectation in the context of probability theory and statistics, see expected value. ... Hypnotic susceptibility is a measurement of how easily a person can be hypnotized. ... Ancient Greek painting in a vase, showing a physician (iatros) bleeding a patient. ... An agents intention in performing an action is their specific purpose in doing so, the end or goal they aim at, or intend to accomplish. ... Malice is a legal term referring to a partys intention to do injury to another party. ... Medical anthropology is a sub-branch of cultural anthropology that is concerned with the application of anthropological and social science theories and methods to questions about health, illness and healing. ... Oral medication A medication is a licenced drug taken to cure or reduce symptoms of an illness or medical condition. ... A miracle, derived from the old Latin word miraculum meaning something wonderful, is a striking interposition of divine intervention by God in the universe by which the ordinary course and operation of Nature is overruled, suspended, or modified. ... The motif of harmful sensation refers to the physical or mental damage that a person suffers merely by experiencing what should normally be a benign sensation. ... The observer-expectancy effect, in science, is a cognitive bias that occurs in science when a researcher expects a given result and therefore unconsciously manipulates an experiment or misinterprets data in order to find it. ... Pessimism, from the Latin pessimus (worst), denotes a belief that the experienced world is the worst possible. ... Pharmacology (in Greek: pharmacon (φάρμακον) meaning drug, and logos (λόγος) meaning science) is the study of how substances interact with living organisms to produce a change in function. ... // A placebo is a medicine or preparation which has no inherent pertinent pharmacologic activity but which is effective only by virtue of the factor of suggestion attendant upon its administration. ... Post hoc ergo propter hoc, Latin for after this, therefore because of this, is a logical fallacy which assumes or asserts that if one event happens after another, then the first must be the cause of the second. ... This article or section is in need of attention from an expert on the subject. ... Psychophysiology is the science of understanding the link between psychology and physiology. ... Purpose is the quality of one being determined to do or achieve a goal deliberately. ... A scientific control augments integrity in experiments by isolating variables as dictated by the scientific method in order to make a conclusion about such variables. ... A self-fulfilling prophecy is a prediction that, in being made, actually causes itself to become true. ... This article or section is in need of attention from an expert on the subject. ... The spell is a magical act intended to cause an effect on reality using supernatural means of liturgical or ritual nature. ... Francis of Assisi, an early stigmatic. ... The Subject-expectancy effect, in science, is a cognitive bias that occurs in science when a subject expects a given result and therefore unconsciously manipulates an experiment or reports the expected result. ... A person is deemed to be suggestible if they accept and act on suggestions by others. ... By the older British writers on. ... The Mad Gasser of Mattoon is the name given by local newspapers to a mysterious figure said to have plagued Mattoon, Illinois in August and September of 1944. ... A therapeutic effect is a consequence of a medical treatment, of any kind, the results of which are judged to be desirable and beneficial. ... The name Thomas theorem refers to a fundamental principle in sociology formulated by William I. Thomas. ... Unintended consequences can be either positive, in which case we get serendipity or windfalls source of problems, according to the Murphys law definitively negative: perverse effect, which is the opposite result to the one intended The Law of Unintended Consequences holds that almost all human actions have at least...

Notes

  1. ^ Miller (2003)
  2. ^ McGlashan, Evans & Orne (1969); Stam (1984); Stam & Spanos (1987).
  3. ^ a b c Kennedy (1961), p.204
  4. ^ Stewart-Williams & Podd (2004), p.326
  5. ^ Zusne & Jones (1989), p.57; Róheim (1925).

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External links

  • Nocebo and nocebo effect
  • The nocebo response
  • The Nocebo Effect: Placebo's Evil Twin
  • What modifies a healing response

  Results from FactBites:
 
Nocebo - Wikipedia, the free encyclopedia (2481 words)
Anthropologists also use the term nocebo ritual to describe a procedure, or treatment, or ritual that has been performed (or a herbal remedy or medication that has been administered) with malicious intent, by contrast with a placebo procedure or treatment or ritual that is performed with a benevolent intent.
The term nocebo response was coined in 1961 by Walter Kennedy (he actually spoke of a nocebo reaction).
He insisted that a nocebo reaction was subject-centred, and he was emphatic that the term nocebo reaction specifically referred to "to a quality inherent in the patient rather than in the remedy".
nocebo effect (707 words)
A nocebo effect is an ill effect caused by the suggestion or belief that something is harmful.
Prior to that, both pleasant and harmful effects thought to be due to the power of suggestion were usually referred to as being due to the placebo effect.
Thus, it is not unexpected that the nocebo effect is not well-established in the scientific literature.
  More results at FactBites »

 
 

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