Health worries

An interesting item in the Financial Times from a few days ago about the “nocebo” effect. This is the negative twin of the placebo effect: instead of making people feel better under the expectation that they are being treated it results in people feeling worse when they are led to expect to. As with the placebo effect it is hard to tell in any given case whether the effect is really all in the mind or not, but there appears to be growing evidence that people really are susceptible to negative suggestions.

When we expect something to make us ill – electrodes wired to our temples, for example, or, more routinely, a medicine with known side-effects – we start looking for signs of illness. And we’ll probably find some, says [psychologist Brian] Hughes, even if the pill is a dummy one or the electric field a sham. That is because unpleasant physical symptoms are a normal part of life for perfectly healthy people. Headaches come and go. Some nights it is hard to get much sleep, and some days it is difficult to keep our eyes open. We might feel light-headed one moment and in a bad mood another. These are all experiences that we would not think twice about were we not looking for signs that things are wrong. But when we are looking, it is easy to interpret a bad night’s sleep as insomnia, tiredness as fatigue, light-headedness as dizzy spells or a bad mood as depression – and then to reattribute those symptoms to whatever it was that we expected to harm us. And once we start believing that something is making us ill, we get anxious, which can itself exacerbate existing symptoms or induce others. “Anxiety generally leads to elevations in blood pressure and immune deficiency,” says Hughes. And more symptoms mean more anxiety.
A telltale sign is that the symptoms produced by any particular alleged cause are often manifold, so electrosensitivity, for instance, may result in headaches, insomnia, nausea or depression in different people; but then the whole symptom cluster is reproduced by multiple different causes: electromagnetic fields, chemicals, allergens, dietary imbalances, chronic fatigue viruses and so on all produce the same symptom cloud. (The usual list pops up again, for example, in this story about wind farms). On the other hand, measurable physical symptoms don’t seem to be produced with any regularity.

This is not to say that these kinds of unspecific symptoms never have an objective cause. Just that this is not the case anything like as often as claimed. The odds are that the well-publicized concerns of the worried well (in the developed world) about the ubiquitous wellsprings of toxicity are themselves the source of real distress and suffering on a wide scale. This also suggests that the alternative health industry, which specializes in treating the cases which flummox conventional medicine, is, by focussing people’s attention even more on their nocebic suffering, actively helping to make things worse.