"The placebo effect is a result of the patient's expectation that the treatment will help," wrote Paul Enck and Winfried Hauser in the New York Times. "But expectations can also do harm. When a patient anticipates a pill's possible side effects, he can suffer them even if the pill is fake."
The authors, the first a professor of psychology and the second a professor of psychosomatic medicine, advised doctors to be mindful of the dangers of the nocebo effect, "particularly when informing patients about a treatment's potential complications."
The article didn't speculate on possible implications of the nocebo effect, but imaginative readers certainly will. To begin with, it sounds like the beginning of the end for those hilariously appalling pharmaceutical ads that pervade contemporary TV. These are the ones offering 30 seconds of rejuvenated men and women gamboling through fields of daisies, followed by a 30-second rapid-fire recitation of reported side effects, sudden death always among them.
Now that we know simply hearing about these calamitous possibilities makes calamity all the more likely, Big Pharma will have to reckon with the possibility that its advertising could attract less business than it drives away. Ask your doctor about Cymbalta? You bet. We'll ask our doctor what other antidepressant they can prescribe instead, and even if it's also linked to dizziness, severe liver problems, and possibly life-threatening skin reactions, at least we'll be too ignorant to anticipate them.
The other thing about the nocebo effect is that it justifies the head-in-the-sand approach to terminal illness taken by people who would rather not know. When the time comes, don't tell me I'm dying, they insist; that would just make the end come even faster. If Enck and Hauser are on the money about how our minds work, ignorance helps us live longer and denial is the best medicine.