Everyone knows what the placebo effect is; right? It is what happens when you tell someone that they ought to feel good and the result is that they actually do feel good. It is more than just an illusion, the health benefits can be physically substantiated. The nocebo effect is simply the flip side of that coin. Tell someone they ought to feel bad and the result is that they actually do feel bad. The nocebo effect is is equally valid and equally potent as the placebo effect, yet the word is seldom heard.

It is my theory that modern western society is bombarded by nocebos and that we suffer greatly and unnecessarily because we permit it. It is time to rebel and to declare war on nocebos.

Where do the nocebos come from? First and foremost from the media. Every media outlet from 60 minutes, to NPR thrives on stock pieces that scare us. They scare us about the food we eat, the air we breath, the cars we drive, the power lines overhead, vaccines, and now cell phones cancer. They scare us about anything and everything that comes across the news wires. Their motive is simple; scary stories gain high ratings.

The media isn't the only one. Schools scare our children, notably with doomsday stories about Global Warming. Scientists eager to receive grant money and fame, gladly pile on to say “we haven't yet proven it false.” Politicians wallow in demagoguery. Worst of all in my opinion, are the lawyers who scare clients in order to drum up business for contingency fee lawsuits, and doctors who drop thinly veiled doubts in the minds of patients to help convince them to approve expensive, but unnecessary, procedures.

Doctor Andrew Wakefield published a study claiming to show that vaccines cause autism in children. Wikipedia says that his work has been discredited since. He stands accused of not only being wrong, but fraudulent in intent. Nevertheless, he profited financially and professionally from the publicity. The public lapped up the scary news, and the media willingly fueled the fires.

To be clear, I don't accuse all those people of lying or fabricating. All they need to do instead is to cite a study, no matter how preliminary, that seems to discover some kind of risk. That way their reportage can be factually correct yet still irresponsible and misleading. Worst of all are those studies that fail to prove that a hypothetical risk does not exist. That's not the proper standard for worry.

I have no doubt that the producers scan the journal abstracts and titles for anything that sounds like it talks about a heretofore unknown risk that can form the basis of a juicy story. Then as media outlets A, B and C pick up the story, that validates it as a legitimate issue and outlets, D, E, F … feel obligated to report it too.

It's not just me who thinks this way. Doctor Dean Edell, had a radio health talk show from 1979 until 2010. He said, "The typical American school child during the 1990's shows more anxiety than child psychiatric patients during the 1950's.” Doctor Edell further said (I paraphrase) ”Never in history have people lived longer, healthier, and free from suffering. Yet, never in history have those same people fretted and worried so much about their health and felt that they must be unhealthy.

I believe in the first amendment just like everyone else. People and institutions may not be subject to prior legal restraints to what they say. However, I believe that when their speech proves to provide no benefit (because it is false or misleading) but it does harm people, then those people should be able to sue for damages. I call it the nocebo tort.

In my mind, the most egregious modern nocebo effect was perpetrated against women with silicone breast implants. A mass hysteria exposed countless women to scary stories of the ill effects of silicone in their bodies. Many of them suffered terribly and experienced terrible pain. The hysteria climaxed in 1992 resulting in huge class action settlements and the withdrawal of silicone breast implant products. Soon thereafter, a flood of carefully done medical studies demolished the evidence that silicone was the cause of the suffering. Today, silicone breast implants are back on the market and being applied safely.

I feel terribly sorry for those women. Their suffering was real. However, I believe that the cause of their pain was not the silicone, but rather the nocebo effect. It was the purveyors of fear who caused the pain that should be sued, not the doctors or manufacturers.

We normally think of class action lawsuits as being between a large class of plaintiffs, against a single defendant. However, this Wikipedia article says that in rare cases there can be a class of defendants. I would love to see a lawsuit with breast implant nocebo victims as plaintiff class, versus the class of defendants consisting of trial lawyers, media outlets, magazine and book authors who profited from their suffering. In reality, it would probably never happen, but if it did it would make one dilly of a lawsuit.

Beyond silicone, it might be very difficult to use the nocebo tort successfully. It would be harder still to use it to compensate for damage to public health. We would be talking about the mother of all lawsuits; all people who listen to stuff against all people who say (untrue) scary things. Lawyers would call it Everyone versus Everybody. I'm sure that is far too big to be certified as a class. Perhaps an attorney general could stand in as the plaintiff for the public.  Still, that doesn't mean that the nocebo tort can't have a big impact. A relatively small number of lawsuits have dramatically changed our behavior toward tobacco, alcohol and sexual harassment. Likewise, a small number of nocebo tort cases could have a widespread chilling effect on purveyors of scare stories.

Scary stories may be the low hanging fruit and the easy path to big ratings. However, if they carry the risk of nocebo lawsuits, producers and authors would think twice, and perhaps demand more evidence of truth before making those stories public. In my opinion, the public would benefit from that degree of chilling effect on free speech. Indeed, it sounds like a no-brainer – placebo stories should be encouraged, and nocebo stories discouraged. We should listen more to people like Doctor Dean Edell and less to people like Doctor Andrew Wakefield

Does this mean that only Pollyanna views should be heard? No. Libel laws do not eliminate rude comments, and fraud laws do not eliminate shady business practices. They merely shave off the peaks of abuse.

Note: Is the nocebo tort really a new idea? Probably not. In researching this article, I did find one scholarly paper by ANUP MALANI from Duke Law school, The paper directly addresses the question. However, it does so only within the context of regulation, such as by the FDA. Nevertheless, the paper said that ordinary torts could be applied in cases of nocebo caused damages. I'm not a lawyer so I'm not qualified to agree or disagree.

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