Life Etc: Mind: A Bitter Pill; Can’t Eat Wheat or Dairy?

In the run up to last year’s Olympics, researchers at Southern Cross University, in Australia, put steroids through their paces. In a double-blind, clinically controlled study, they set out to find out how effective steroids are. They found few work as well as users think, and some of the extra boost isn’t down to the drugs themselves, but from their placebo effect. But surprisingly, what they also found was that those given a placebo were convinced they experienced typical steroid side-effects of acne and "roid rage".

Dummy pills have cured many ills but that they can lead people to experience the extreme moodiness and irritability common to roid rage is also testament to the power of mind over non-medicine. The attribution of acne – a far more objective occurrence – to a placebo was even more significant. "A number of placebo subjects felt their acne could be due to steroids," says Professor Robert Weatherby, who conducted the study. "And one subject was `absolutely positive’ his acne was down to steroids. when in fact he was on a placebo."

Doctors call it the "nocebo effect"; placebo’s "evil twin". With the placebo effect the expectation that something will make us better means that it does, but with the nocebo effect, the expectation that something will make us ill actually does make us poorly.

A recent study in Naples found that 27 per cent of patients given an inert substance experienced side-effects such as itching, malaise and headaches. Eighteen years ago, researchers studying the blood thinning capacity of aspirin came up with a similar incidence: they found that patients who were warned about gastrointestinal problems when given the drug, were three times as likely to suffer from them.

"It’s hard to quantify but we think it’s common," says Dr Jim Kennedy, prescribing spokesperson for the Royal College of General Practitioners. Millions of pounds are spent on changing drug prescriptions every year and at least some of this is down to the nocebo effect. And there are other problems – people coming off drugs before they have time to work, or getting prescribed more drugs to deal with the "side-effects".

It’s a syndrome that isn’t confined to the doctor’s surgery. A few years back, not many of us had problems eating bread or cheese products but now an astonishing one in five of us believe that eating wheat or dairy makes us feel tired or bloated. But is bread and wheat always responsible for such reactions?

"In one study, a nutritionist fed people their `allergic foods’ and told them what they were eating and they all said they felt ill," says John Naish, author of The Hypochondriac’s Handbook. "But when researchers fed them the same substances through a tube in their stomachs, so they didn’t know what they were getting, only 2 per cent of people reported problems."

Most often the nocebo effect is the result of hyper-vigilance. Feeling tired or bloated is common, but if primed, as we are these days, it’s easy to attribute such sensations to a fashionable illness such as irritable- bowel syndrome, seasonal affective disorder, chronic fatigue syndrome – rather than an innocuous ailment.

"We need to be reasonable about how we expect our bodies to behave," says Kennedy. "Our bodies perform some days better than others, and that doesn’t mean something has gone drastically wrong. But we have a climate of not trusting science or medicine which makes people more likely to not trust drugs and more likely to think they have symptoms that they don’t."

Studies on anti-depressants have found women are more likely to suffer the nocebo effect than men and susceptibility may also be personality based. People who have a heightened awareness of their own bodies are more prone to nocebo symptoms. Prior experience can have a big effect too: if you have had good dealings with doctors you’re less likely to get side-effects.

According to Professor Arthur Barsky from the Harvard Medical School, roughly three quarters of medics are unaware of the phenomenon. But those who are, are learning that it’s as much about the way the message is delivered as the message itself. "If you say `You have to be careful of these, you get all sorts of side- effects’ it’s more likely to cause nocebo effects than if you say `Our experience is that there’s a small chance of these things happening,’ says Kennedy.

Just as doctors learn to package information for us, we might want to think about how we package information ourselves. What the mind expects, it often gets, and with drugs – as with the rest of life – low expectations tend to be met. n