The power of negative thinking | Bleader

The power of negative thinking


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Last week I posted my idea of what placebo drug warnings would look like. Placebos are pills with no active ingredients—they're typically given to control groups, in clinical trials that are testing the efficacy of "real" drugs. But in several recent studies, placebos themselves have "performed as well as drugs that Americans spend millions on," the New Yorker reported earlier this month. They help people feel better who are told the pills will help—it's the power of positive thinking. A new institute at Harvard is exploring the idea that placebos might be given as medicine in clinical practice.

But there's also the power of negative thinking. "Expecting a placebo to do harm or cause pain makes people sicker," the New Yorker story noted. This is called the "nocebo effect."

The ill effects of negative thinking aren't confined to placebos, of course. That's what got me reflecting on drug warnings—the ominous tracts that accompany prescription medicines.

Around the time I read the New Yorker article, a doctor had written me a prescription for a drug he thought might alleviate my persistent back pain. Stints of physical therapy, massage, Pilates, and Rolfing have helped, but not enough.

The prescription was for Naproxen, a nonsteroidal anti-inflammatory drug. NSAIDs are among the most commonly prescribed medicines.

I've taken enough meds in my day to be inured to the fine-print cautions, so I usually skim the leaflet. But the placebo story had me thinking about drugs, so I read the entire sheet.

There weren't many ailments I might not suffer. The tablets in the bottle could increase my risk of a serious and sometimes fatal heart attack or stroke, and serious and sometimes fatal stomach ulcers. I was supposed to contact my doctor or an emergency room at once if I developed: severe stomach or back pain; black, tarry stools; unusual weight gain or swelling; chest pain; confusion; dark urine; depression; fainting; fast or irregular heartbeat; fever; chills; persistent sore throat; loss of appetite; mood changes; numbness of an arm or leg; one-sided weakness; red, swollen, blistered, or peeling skin; ringing in the ears; seizures; severe headaches; dizziness; vomiting; shortness of breath; swelling of hands, legs, or feet; unusual bruising or bleeding; unusual joint or muscle pain; unusual tiredness or weakness; vision or speech changes; or yellowing of the skin or eyes.

Or I might luck out with mere inconveniences—upset stomach, nausea, heartburn, gas, headache, diarrhea, constipation, drowsiness, stuffy nose.

"This is not a complete list of all side effects that may occur," the leaflet assured me.

I'm not particularly susceptible to such warnings—but my dad was. In his 80s he was homebound, and I picked up his prescriptions for him when I shopped for his groceries. He always read the warnings meticulously and would begin developing side-effects almost as soon as he swallowed his first dose—which often made him balk at further doses. He had heart disease and an enlarged prostate, conditions I felt the drugs his doctors prescribed would mitigate; so we fought often over his meds regimen, with the warnings tract at the center of our fights. Sometimes that troublesome leaflet would be mysteriously missing from the bag of medicine I delivered to my dad.

I wondered back then, and I wonder even more today, about the benefits of the warnings. Surely some cautions are necessary—but must they be exhaustive? Aren't the guides written that way mainly to ward off lawsuits? If they scare people out of taking medicine that would help them, are they doing more harm than good? Don't the admonishments actually make some people sicker? Should there be an additional leaflet, warning of the risks of the warnings?

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