Skip to main content

Warning about drug side-effects often help create them

Funny as it might seem, patients who are warned too much of possible side-effects before being given a medication, seem to experience them more often. Describing this phenomenon as the NOCEBO effect, German researcher Winfried Hauser has recently shown that patients anticipating side-effects such as giddiness, headache, constipation or lack of concentration, experience them more often than those who take the drug without being told about them.

This new finding fits well with what physicians have suspected all along, that the body’s response to therapy often depends on the patient’s belief with which he takes it. Some of the benefits of medicine undoubtedly come from the positive anticipation that a particular drug will work as intended -- easing arthritis or relieving wheezing, for example – called the PLACEBO effect. On the flip side our belief in a drug’s side effects may actually cause us to suffer from them as well.

The role of suggestion and belief in obtaining a positive response from treatment is well known. Scientists have shown that PLACEBO medication, that is one which has no active ingredient but looks like a drug, such as an empty capsule, often produces remarkable benefit when taken with positive anticipation of relief.  As many as 50% of patients report benefit in headaches, abdominal pain, dyspepsia and sexual functions with dummy medicines consumed in good faith.

Dr Winfried, an expert in psychosomatic medicine, who has visited India two times, feels that imagination and fears of patients can have just the opposite effect. When cautioned that a drug may cause sexual dysfunction, for example, a larger number of patients taking it report experiencing it.

A lady who consulted me with the history of breaking into allergic hives on taking virtually every antibiotic had a similar reaction when administered a vitamin capsule that looked like an antibiotic. Her hives disappeared when she was told and assured that it was a vitamin and not an antibiotic.

Practitioners of alternative and indigenous systems of medicine bank more on faith and do not usually mention side-effects of their therapy. Patients too therefore consider these innocuous and harmless, and consequently do not report side effects with their use.

Is keeping patients in the dark about a drug’s potential side effects, then the only solution?  In modern times it would be clearly not ethical. What experts propose is “contextualized informed consent,” that takes into account the possible side effects, the patient being treated, and the disease involved. While it will be clearly important to caution against potentially dangerous side effects, such as drowsiness while prescribing anti-allergic drugs to a person who might drive a car for instance, mentioning lack of concentration with an anti-diarrheal to an exam-going student may cause unnecessary harm.


While modern medicine requires that all potential effects of therapy, beneficial as well as harmful, be placed on the table, which aspects to highlight and which ones to downplay remains a matter of the wise doctor’s discretion.

As published in HT City ( Hindustan Times) dated 19th August, 2012.

Comments

Popular posts from this blog

The Doctor’s Dress

The familiar white coat worn by physicians as their distinctive dress for over 100 years, has started generating  murmurs  of controversy. It is not uncommon to find the blood pressure to be higher when measured by a white-coat-wearing-doctor in the hospital or clinic than the readings obtained at home by relatives.  This is due to the anxiety that the white coat and the hospital setting evokes in patients, and has been termed “White Coat Hypertension”. Mature clinicians often routinely subtract a few points from these measurements when entering records in case charts or calculating the dose of anti-hypertensive medications to be prescribed. The white coat scares children too.  Kids often express their dislike for this dress by crying and screaming and by denying access to their bellies or chest for examination by paediatricians in this attire. Many pediatricians across the world have folded up their white coats and taken to informal colourful dressing to...

Food Fads in Liver Disorders

In an attempt at trying to do well to those they love, spouses and parents often enforce diets on patients of liver diseases that often turn out to be detrimental. The commonest food fad is pale insipid boiled cabbage being doled out to nauseous patients suffering from hepatitis that makes them puke even more.  The liver, in a way, is a buzzing manufacturing unit that requires lots of energy to keep its multiple functions going. And it derives all this from the food we eat. During disease, such as during an attack of jaundice, when many of the liver cells get killed, the liver attemptsdamage control by trying to regenerate quickly. For its cells to multiply however, it requires a generous supply of energy that comes from carbohydrates, and protein, the building block for its cells and tissues. Boiled green vegetables unfortunately have neither of these. Hence the situation often progresses to that of a starved liver unable to recuperate due to cut-off food suppl...

Teaching and Learning – is there a trick?

One of the big mistakes that we as parents and teachers often make, and that could stifle the mental development of our children, is to treat them as just small adults! In fact, it is this attitude of grown-ups that could be leading our next generation to become stereotyped conformists rather than original thinkers and innovators. And if we intend to drive home health messages and inculcate healthy habits we need to tailor our efforts to their cognitive potential. That children indeed think and discover the world differently was first noticed by a Swiss scientist Jean Piaget in the early 20th century. He studied his own three children grow and was intrigued by how they behaved, played games and learnt at different ages. With further observations and experiments, he propounded the theory of ‘cognitive development’, placed great importance on the education of children and is hailed even today, 30 years after his death, as a pioneer of the constructive theory of knowing.  He...