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Wednesday, November 7, 2007

With an impressive air of authority: The nocebo effect

Everyone has heard the expression "scared to death." But can the mind actually influence life and death — or at least our well-being? Medical science is asking the same question.

In 1974, a Nashville physician treated Sam Londe for cancer of the esophagus, which was then considered fatal. Sam died a few weeks later, though an autopsy revealed that his esophagus was fine. He had a few cancerous spots on his liver and one on his lung, but not enough to kill him.

Three decades later his doctor told the Discovery Health Channel: "He died with cancer, but not from cancer. ... I thought he had cancer. He thought he had cancer. Everybody around him thought he had cancer. Did I remove hope in some way?"

Sam could have fallen victim to the "nocebo" phenomenon. With a placebo, a harmless substance is given to patients in medical studies to test the efficacy of a drug. Patients normally expect a positive outcome. But with the nocebo effect, people expect something bad to occur, developing symptoms after learning about painful side effects of medication.

"People get worse because they believe they'll get worse," says Dr. Julio Licinio, chairman of the Department of Psychiatry and Behavioral Sciences at the University of Miami. "It's almost like a negative self-fulfilling prophecy." (Nocebo is Latin for "I will harm.")

An example: Women who were studied in the landmark Framingham Heart Study who believed they were prone to heart disease were nearly four times as likely to die as women with similar risk factors — high blood pressure, excessive weight, high cholesterol — who didn't believe.

When you expect bad things to happen, Dr. Licinio says, stress hormones rise, your heart beats faster and your immune system becomes suppressed. "It's similar to the feeling you'd get if you saw a car rushing toward you. It's good in an acute situation when you need to run away. It's not good when you're having surgery."

Neither is it good, apparently, when a priest administers last rites. In the 1997 report, "Nocebo: The Power of Suggestibility," Dr. Herbert Spiegel of Columbia University writes about a case in which a priest was summoned to administer last rites at a large American Roman Catholic hospital. "With an impressive air of authority and a brusque voice," Spiegel said, the priest gave last rites to the wrong patient. Within 15 minutes, that patient died, but the other one lived a few more days.

Advice to patients: Share this story with any downbeat family members.

Read a story about the power of hope, or read Desonta Holder's source story in the McClatchy Newspapers.

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