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,
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
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.