The duracebo effect
Placebo, nocebo and duracebo
We can say that there is a whole "industry" of fear. Streams of messages about the dangers of genetically modified foods, food additives, fast food, chewing gum and everything that, for the sake of horror stories, can be called scary for the average man in the street, but meaningless from the point of view of a specialist, the word "chemistry" are rushing from the TV, radio and the Internet.
They also write about the dangers of plastic, Teflon or aluminum dishes, meat, bread, kefir, soy, vaccinations, microwave ovens, cell phones, wireless networks, washing with soap and magnetic storms, from which only special foil caps save. Name the phenomenon, and I'm willing to bet that someone has already written about how it has a bad effect on human health, if not in the first, then at least in the third generation.
It is quite easy to convince people of the danger of anything, as the well-known story with dihydrogen monoxide shows, for example. Sometimes insanity comes to the point that these factors are attributed to the methods of destroying the people according to the directive adopted as part of another Masonic conspiracy. It is difficult to say what purpose people who replicate unfounded horror films pursue. Using Hanlon's razor ("never attribute to malicious intent something that can be explained by stupidity"), we will write it off to the fact that there are a sufficient number of idiots in the world.
You can deal with each of the horror stories for a long time and in detail, but within the framework of this article we will simply note that such horror films are usually based not on thorough scientific research, but on the speculation of incompetent people who will not be able to provide a link to a scientific article from PubMed in response to the question "how do you know this?". I think for those who are shaking at the slightest mention of the letter "E", the following picture will be useful.
At the same time, the danger of the media statements themselves about the ghostly threats surrounding us has recently found experimental confirmation – the nocebo effect. The nocebo effect is essentially the opposite of the more well-known placebo effect, which, together with erroneous diagnoses and spontaneous remissions, slightly more than fully explains the apparent effectiveness of homeopathic "medicines" and many other means of alternative "medicine".
Speaking about the "miracles" of alternative "medicine", along with the placebo effect, it is worth mentioning cases of incorrectly made (and sometimes specially invented by healers) diagnoses) and spontaneous remissions, i.e. cures without external interventions at the expense of the body itself (yes, we have an immune system formed by millions of years of evolution, which protects us from a huge number of sores). It is easy to illustrate this: a person got sick with a cold, was not treated, and is healthy after a week. Did the stump on which he sat during his illness help him? Or the banana he ate? It is impossible to determine this from a single observation. This does not prevent us from finding cause-and-effect relationships between unrelated events. Such remissions (or regressions) occur even in patients with very serious diseases, for example, cancer [8], although not so often. In other words, post hoc ergo propter hoc, "after this means because of this", is a typical logical mistake made by supporters of alternative medicine (and not only), attributing single cases of recovery to healers, pacifiers or prayer only on the grounds that these effects preceded improvement.
I mentioned "alternative medicine", but this term needs to be clarified. As Tim Minchin wittily pointed out, the medicine about which it is shown that it works is simply called: medicine. Alternative medicine is something about which it is known that it does not work, or it is not known for sure whether it works or not. This includes the activities of all kinds of healers, homeopaths, magicians, holy water treatment, dancing with tambourines, treatment of hemorrhoids with a cucumber not torn from the tops, and much more.
So what is the placebo effect? The placebo effect is called the phenomenon of improving a person's health or well-being due to the fact that he believes in the effectiveness of some effect, in fact neutral. In addition to taking the drug, such an effect may be, for example, the performance of certain procedures or exercises, the direct effect of which is not observed. In response to the expectation of an improvement in well-being, the patient's brain produces certain substances that cause this very improvement in well-being. This mechanism has been studied and described in some detail [1,2], but we will not dwell on it now.
Simplified scheme of the placebo effect [2]The fact that in some conditions it is the placebo effect that works, and not the therapy itself, is checked as follows: people are randomly divided into two groups, one turns out to be a supposed "medicine", and the other gets the appearance of a "medicine", for example, dummy pills, if a homeopathy remedy is checked, or pricking with special moving needles when checking acupuncture.
By all outward signs, the placebo should be similar to the "remedy", but the alleged key component in the placebo is missing. It turns out that the strength of the placebo effect depends on the way the placebo is provided. For example, injections with saline have a stronger effect than sugar tablets, the strength of the tablets depends on their color [3], as well as on the stated price of the tablets and in general the persuasiveness with which their usefulness is described [4, 5].
But do not assume that placebo can help with any diseases or that it can be compared with high-quality modern medicines in its effectiveness (in clinical trials of normal drugs, it is required that the drug performs better than placebo), but in some cases placebo has proven itself on the good side, for example, for pain relief.
It is quite interesting about the placebo effect described in the Daren Brown program "fear and faith", which shows a not very scientific, but very visual demonstration of the "super placebo" effect. So, in order to convince the participants of the experiment of the effectiveness of a certain drug that relieves people of fears (in fact, the drug is a dummy), a whole fake one-day institute was created, allegedly for the research and production of this non-existent drug. Inside the walls of the "institute", actors dressed in dressing gowns, with an intelligent look and a bunch of scientific terms read lectures to volunteer participants about the wonderful properties of the pseudo-means they were developing: everything was done in such a way as to create the illusion of seriousness, scientific, validity of the proposed treatment method. Of course, the super placebo gave a super noticeable result.
But back to the nocebo effect, the opposite effect. For the first time, the nocebo effect interested me after I read a study on the therapeutic effect of prayer on the number of complications in people who have undergone heart surgery [6]. The patients were randomly divided into three groups. Patients from the first group were informed that they might be prayed for (or they might not be) and they were prayed for. The patients of the second group were also informed that they might be prayed for, but they were not prayed for. The patients of the third group were told that they would definitely be prayed for, and they really were prayed for. The number of complications in patients was estimated. As expected, it turned out that prayer itself has no therapeutic effect: people from the first and second groups had approximately the same frequency of complications. But knowing that people would pray for you was associated with an increased risk of complications after surgery.
Perhaps the increased risk of complications was due to the fact that patients who were told that they would definitely be prayed for were in a state of stress ("everything is so bad that they have already started praying for me?").
More accurately, the nocebo effect was shown in an experiment that was published just the other day [7]. People were randomly divided into two groups. Participants from the first group were shown a film about how wireless WiFi networks are dangerous to health. Participants from the second group were shown a film about the fact that there is no proven danger of wireless WiFi networks. After that, the participants were subjected to 15 minutes of fake radiation (that is, they were told that they were being exposed to WiFi, but in fact there was no radiation). The nonexistent radiation made some participants feel so bad that they asked to interrupt the experiment. Most of the participants noted symptoms that they associated with non-existent WiFi exposure, and among those who watched a film about the dangers of WiFi, there was a greater proportion of participants who indicated the presence of symptoms caused by radiation. Thus, media materials telling about the horrors of the phenomena faced by ordinary people can negatively affect the well-being of the audience of these materials.
Will fans take note of this fact to scare with far-fetched horror stories about the harm of everything in the world? I doubt. I have often seen in the comments to posts about GMOs or food additives, user statements that someone has a stomach rumbling from GMOs in a special way, someone has indigestion from "chemistry", poor health after consuming glutamate or unpleasant sensations in the stomach after drinking Coca-Cola (like mercury with arsenic screwed up). I appeal to such commentators: have you excluded the nocebo effect? Of course, the media should report dangerous substances when the harm from these substances is scientifically proven and significantly exceeds the harm from the nocebo effect. But there is an additional reason to doubt the ethics of spreading rumors about the harmfulness of a particular phenomenon.
Literature:
- Zubieta JK, Stohler CS: Neurobiological mechanisms of placebo responses. Ann N Y Acad Sci 2009, 1156:198-210.
- Pacheco-Lopez et al.: Expectations and associations that heal: Immunomodulatory placebo effects and its neurobiology. Brain Behav Immun 2006, 20(5):430-446.
- de Craen et al.: Effect of colour of drugs: systematic review of perceived effect of drugs and of their effectiveness. BMJ 1996, 313(7072):1624-1626.
- Bjorkedal E, Flaten MA: Interaction between expectancies and drug effects: an experimental investigation of placebo analgesia with caffeine as an active placebo. Psychopharmacology (Berl) 2011, 215(3):537-548.
- Purves D AG, Fitzpatrick D: Neuroscience. 2001.
- Benson et al.: Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. Am Heart J 2006, 151(4):934-942.
- Witthoft M, Rubin GJ: Are media warnings about the adverse health effects of modern life self-fulfilling? An experimental study on idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). J Psychosom Res 2013, 74(3):206-212.
- Papac RJ: Spontaneous regression of cancer: possible mechanisms. In Vivo 1998, 12(6):571-578.
Portal "Eternal youth" http://vechnayamolodost.ru13.05.2013