The reverse placebo effect is called. Placebo and nocebo: rules of self-healing

What do you know about the placebo effect? Most of us know that this is a dummy (for example, a pill that has no medicinal effect on the body), which helps a person recover from even the most serious illnesses. The patient “suggests” to himself that he is taking a truly real and mega-effective medicine. But can such treatment cause harm? Do you mean treatment with an empty tablet without medication? Yes, maybe this effect is called nocebo.

The disease is incurable

In medicine and psychology, there is the so-called nocebo effect - the deliberate suggestion of harm (yes, we focus on suggestion). American psychologists have called doctors who can deliberately harm their patients witches. Why? Because doctors, as we know, have enormous power (psychological) over a sick person. In simple words, if a person gets sick, he believes everything the doctor tells him. After all, who else can know better about how to treat, how and what the result will be?

If a doctor says to a sick person: “Your disease is incurable!”, then he will believe with a 90% probability. Few people really question anything that doctors say. Moreover, this rule works in both cases - if the diagnosis was made incorrectly or correctly.

Placebo effect

If we talk about the placebo effect, then you can come across a huge number of cases and situations where doctors “cured” severe oncological diseases, pathologies, and seemingly incurable diseases. It is enough to tell the person that you are getting better, everything will be fine, you will soon recover, and he will get better. There are cases where patients recovered in this way literally in a week or at most a month.

In 1970, a man was diagnosed with liver cancer at the last, most severe stage. The patient was told this sad and rather difficult news. According to doctors' forecasts, he had a few months to live or even less. A month later the patient died. It later turned out that the man had a harmless inflammation that could be eliminated with a course of antibiotics. After this incident, doctors began to talk about the so-called nocebo effect (the reverse of placebo). There are cases when even a common one (acute respiratory viral infection), accompanied by a cough, runny nose and fever, ended in death. The reason is the power of self-hypnosis.

For reference!

The effect translates as “I will cause harm.”

A negative effect from drug treatment can occur even if the patient reads the contraindications and side effects indicated on the drug. The power of thought is truly unique.

The nocebo effect is contagious

Medical practitioners and psychologists say that the people around you can infect the people around you with the nocebo effect. How? The negative influence of loved ones, friends, relatives under the guise that “here, you have fallen ill with a very serious illness,” “you feel bad now, but it could get even worse,” “you need to be examined more thoroughly, otherwise it threatens with serious consequences.” If a person who is at the stage of treatment hears a lot of such advice from his friends, he will begin to panic and attract not very favorable and positive thoughts. All this can end with real consequences or even tragically.

Answers to frequently asked questions

When exactly (under what circumstances) can the nocebo effect occur?

Most often, bad thoughts visit the head of a person (both sick and healthy) if he is in the hospital. In medical institutions, more than anywhere else, you can notice and listen (most importantly, not listen) to people complaining about illness, difficult life situations, pain, worries about death, etc. Unfortunately, it is almost impossible to avoid such oppressive people. But, you can listen to them less, constantly get distracted, read positive literature, or find those people who think in placebo terms (they believe only in a favorable outcome).

Can negative thoughts or a negative attitude harm a person?

If the patient is in a negative mood, then a number of physiological changes occur in his body, namely, the production of dopamine is sharply reduced.

For reference!

Dopamine is a substance produced by the brain. It controls pleasure processes in the body.

That is, when the level of dopamine sharply decreases, this leads to increased pain (even if it is minimal or practically non-existent). A person suffering from any disease, when negative thoughts arise, begins to become intensely nervous, worry and expect the worst events to occur (in matters of health).

Thought creates disease!

Convince yourself that you are sick

Right now you can convince yourself that you are sick. It is enough to think about bad things for several days in a row and they will immediately happen. Even an ordinary runny nose can sometimes kill if you try hard and really predict an unfavorable outcome in this case. Self-conviction about the disease, first of all, applies to those who are actually faced with a serious diagnosis, namely, malignant tumors.

Natalya, 50 years old: “My husband was told that the thyroid tumor discovered in him was very serious in its course, and the positive outcome for cure was minimal. Therefore, you need to be prepared for anything, in particular for the worst. We visited about 10 doctors and one of them said that my husband’s tumor was malignant and he could die (if we didn’t find an expensive medicine right now). We didn’t have any money at that time and we couldn’t find it or purchase the necessary medicine within a week. After 2 months, as the doctor indicated, the husband died. It turned out that my husband had a common one, which was eliminated by iodine replacement therapy. We are convinced that the nocebo effect exists."

Tatyana, 32 years old: “There was a case in my medical practice - one of the nurses mixed up patient blood tests for tumor markers. As a result, she told the patient with a benign tumor that she had stage 4 cancer; a patient with rapidly developing cancer was told that she was healthy, or rather, her tumor just required constant monitoring and that’s all. This is surprising, but still a fact - one of the patients died and, moreover, she was healthy (yes, it was the one who was affirmatively told that she had a fatal form of cancer who died).

Most of us know what the placebo effect is, you take a pill without the drug but you feel better. Unfortunately, the placebo effect has a lesser known antipode, the nocebo effect. This means that if we wait for illness, we can get sick without objective reasons.

Placebo is a treatment that helps with any disease, but not all. The placebo effect in medicine is generally accepted. Its essence is that if a person is confident in the effectiveness of a particular drug or procedure, then he can get the expected effect. Moreover, a positive result can be achieved even in the case of fictitious treatment. If you think that three tablets will help you better than two, or you are sure that capsules are more effective than tablets, then there is a high probability of finding confirmation of this from your own experience. And if you believe that expensive original drugs are better than cheap generics, then most likely your money will be well spent.

But placebo has an antipode - nocebo. Nocebo is a phenomenon much less studied than placebo and is much less common in clinical practice. The term nocebo comes from the Latin noceo - to harm. These terms denote something that has no real effect, but causes some kind of negative reaction in a person, even to the point of death.

There are many examples of nocebo action. Deaths have been reported in people who were misdiagnosed as fatal. Unfortunately, the error was discovered only at autopsy. Difficulties in studying the nocebo effect arise from ethical requirements that prohibit interventions that could cause harm to subjects. But still, scientists are studying this phenomenon. Thus, in one study on volunteers, the connection between mobile phone use and headaches was studied. Some of the subjects complained of headaches even when they were given an imitation phone instead of a telephone (without their knowledge).

We may well convince ourselves that we are sick. And actually get sick. This is the nocebo effect

Drugs can also play a nocebo role. Thus, patients sometimes report unexpected and uncharacteristic side effects for a given drug that cannot be explained by the mechanism of action of the drug. There are several factors associated with an increase in the number of side effects. These include: the patient's expectation of certain adverse reactions at the beginning of treatment, previous experience of treatment with these drugs and, especially, the patient's personal characteristics.

Despite the lack of knowledge about the physiological basis of nocebo action, some data are still available. Patients anticipating increased pain have been shown to experience increased anxiety. This leads to activation of cholecystokinia and increases pain. This response creates a vicious cycle of anxiety and pain, which may explain the nocebo effect. The dopaminergic and opioid systems also play a role in the development of the placebo or nocebo effect.

The nocebo effect has important implications for clinical practice. It is necessary to determine which patients are at risk of developing a nocebo effect. When communicating with such patients, you should especially carefully choose words and terms so as not to worsen their condition. And with the development of nonspecific side effects, one should keep in mind the possible nocebo effect and take this into account during further treatment.

Placebo and nocebo are two sides of the same coin. Which of them will manifest itself in each specific case depends on the person’s expectations, i.e. depends on what forecast he makes for himself. And the nature of this prognosis largely depends on the doctor’s literacy.
Reading drug labels that detail side effects can make people's condition worse. And even if there are no visible side effects, after taking the drug a person often complains of feeling unwell.

And those who consider themselves to be at high risk for a disease are much more likely to develop it than those who are at the same risk and do not know about it.

Word of mouth has a nocebo effect. “As soon as someone who has nothing to do with professional medicine spreads a rumor that a certain medicine has a negative effect, everyone immediately refuses it. Although they were often treated with it for many years and were quite satisfied with the result. Sometimes television plays the role of word of mouth. For example, once on TV they spread information that a French antidepressant was used by drug addicts. Immediately there was a wave of refusals, although the drug had excellent performance indicators and is used throughout Europe.”

The French writer and philosopher of the Renaissance Michel Montaigne made famous the saying of the ancient Latins: Fortis imaginatio generat casum - “a strong imagination gives rise to an event.” Montaigne did not mean illness, but the materialization of any strong faith. It was as if he was warning: you shouldn’t waste it expecting trouble.

Everything is material, even anxiety
Placebo and nocebo effects have very real manifestations in the human brain and are explained by material reasons. They were identified by Jon-Kar Zubieta* from the University of Michigan using positron emission tomography (PET). The scientist demonstrated that the nocebo effect is associated with a decrease in the production of the hormone dopamine, which is involved in the production of opioid peptides that have an analgesic effect. This explains why nocebo increases pain. At the same time, Fabrizio Benedetti** of the Faculty of Medicine at the University of Turin in Italy discovered that pain caused by the nocebo effect could be suppressed by using proglumide, a drug that blocks receptors for a hormone called cholecystokinin (CCK). After all, the anticipation of pain causes anxiety, and it activates CCK receptors, increasing pain.

Nocebo effect in men and women
Anxiety in the form of a nocebo effect occurs more often in women than in men. But men can also be anxious, and their problem is that they push their anxiety inside themselves and do not discuss suspicions with a doctor.
Paul Enck, a psychologist at the University Hospital of the University of Tübingen (Germany), as a result of many years of clinical practice, came to the conclusion that in men the development of the nocebo effect is more strongly influenced by the expectation of illness than by life experience and information about the illness. The opposite is true for women. Women rely more on past experience, while men are very reluctant to take the past into account when analyzing a specific situation.

Contagious psychosis
Perhaps the most striking example of the nocebo effect described in fiction is the reaction of the protagonist of Jerome K. Jerome's book "Three Men in a Boat" to a medical reference book in the British Museum library. “So I conscientiously went through all the letters of the alphabet, and the only disease that I did not find in myself was puerperal fever... I entered this reading room as a happy, healthy person. “I crawled out of there as a pathetic wreck,” the author describes the experiences of his hero, a master of negative self-hypnosis.

Large-scale deception
55% of doctors noted that they prescribe at least one placebo drug to their patients. Moreover, both active and passive placebos are used. 41% prescribe additional analgesics, 38% P vitamins, 13% P antibiotics, another 13% P sedatives. A real placebo - in the physiological sense of the word - is prescribed by only 5% of doctors: 3% are glucose tablets, 2% are salt tablets.
Among those who prescribe placebos to patients, 68% of doctors give their patients explanations such as “I will give you a pill that is not usually prescribed for your condition, but it will definitely help you.” 18% do not stand on ceremony and call it a medicine. 9% call it “a medicine with no known effects on your disease.” And only 5% call the placebo by its real name. True, it is not clear why they do this; in this case, it is unlikely that one can count on the desired reaction from the patient.

Film instructions for use
A classic case of nocebo is shown in Boris Rytsarev’s film “The Doctor’s Apprentice” (1983). A young man, pretending to be deaf and mute, became an apprentice to the court physician. The deception was revealed, but by that time the young man had already learned a lot from his mentor. He suggested that the king postpone his execution, which the old doctor insisted on, and arrange a kind of test for professional aptitude: a student and a teacher prepare their best poison, then give it to each other and save themselves by selecting an antidote according to their knowledge. The young man survived after a dose of poison, but the old doctor fell dead after drinking from a cup that his student brought to him. The young man explained to the angry king that he had given the court doctor only spring water, having finished the contents of the cup as proof. This is pure nocebo: the old doctor was expecting poison, but could not recognize it, and his body reacted accordingly.

Useful tips
Love of life. My advice to avoid the nocebo effect is to trust articles in the non-professional press less and love life more. Think that a new fine day is coming, you are surrounded by family and friends, you have an interesting job, and a party with friends awaits you on the weekend.
Changing worldview. A person always has a choice of what to do, what to think and feel. He can “drown” in negative emotions and, as a result of the nocebo effect, become drawn into an illness that he might not have had at all. In this case, you need to radically change your worldview and lifestyle.

We are more familiar with names such as "placebo" and "iatrogenic". Not so long ago I also read with pleasure about “nocebo,” which, I admit, I knew nothing about or simply didn’t remember the word “nocebo.”

All these definitions relate to the section of psychiatry, since placebo, iatrogenic and nocebo are associated with influence on the mental activity of the brain, through the secondary signaling system, that is, through our speech.

A placebo is a self-hypnosis effect. At first, the person was explained in great detail the effect of a certain medicine, which fantastically quickly and without complications removes the symptom of the disease that the patient currently has.
  Then, instead of medicine, they gave me, as we say, a “dummy” that does not contain any chemically significant substances. The patient, believing in the miraculous properties of the false medicine, began to take it and the symptom that bothered him went away.

It turns out that the patient mentally launched and supported the healing process. Of course, a change in the rhythm of life, the nature of nutrition and fluid intake, adequate physical activity, etc., which relate to the factors of a “healthy lifestyle”, what doctors usually recommend to their patients, played a role here.

Distributors of Western companies that have flooded into our country (Herbalife, New Ways, In-rich, etc. - I already wrote on this topic on the Forum) began to use this with success, with their dietary supplements - dummies.

Naturally, “specialists” were hired for such work, far from medicine, but with well-spoken tongues. Yes, and doctors cheated by selling dietary supplements at an appointment in a clinic or hospital, receiving an amount per month that significantly exceeded their salary. Unfortunately, there are a lot of dubious “clinics” selling dietary supplements, and nothing has changed yet.

You may ask: what about placebos? I will answer - calmly, but with caution. After all, there is no obvious harm to the body. The man felt better. This “experience” is remembered by the body, and in the future it will work faster.

However, this is only true if the disturbance in the functioning of the body concerns only the deviation of some function. If the disease has entered the stage of organic changes, then flirting with a placebo will lead to the erasure of symptoms that are very important for diagnosis, and, more importantly, a loss of time for organizing true and targeted treatment.
  That’s when the moment of truth comes, when even the services of a surgeon will be useless.

Iatrogenesis– this is a slightly different type of external influence on the patient. It is associated with careless and, sometimes, deliberate communication to the patient about the severity (often dubious) of the pathology that he has. These words sometimes sink into the patient’s soul so deeply that he constantly remembers them.
  And in this case, as in the placebo, the effect of suggestion begins to operate, but only in the reverse order, with a negative factor, further undermining the body already weakened by the disease.

However, this is not all about iatrogenics. It often happens that a healthy person, having received this kind of news, begins to experience symptoms of a non-existent disease. What can I talk about if I myself have found myself in similar situations more than once, but I’ll tell you about them another time.

To make it clear about the seriousness of the pathological influence of words on a person, especially a patient, who, as a rule, is 100% suggestible, I will give one phrase that I always say at the first seminar of the School.

Think about it, and you will understand how important and significant it is what we say:

“Just a few words spoken quietly, one might say in the ear, can make a person either very happy or endlessly unhappy, even to the point of suicide.”

What affected the person?
  Not intonation, and not volume, but INFORMATION that entered the body through the ears and affected the psycho-emotional center of the brain.

Isn’t that why people say: “The word is silver, silence is gold”, “The word is not a sparrow, if it flies out, you won’t catch it,” hinting to us that we need to think before speaking, and it is better to remain silent than to speak, and then repent (and sometimes pay) for what was said.

Especially this relevant in raising children. He is a good parent who talks to the child and is patient in dealing with him.

Now it's time to find out about NOCEBO.

Nocebo effect.
  “It has long been proven that the anticipation of illness can be as dangerous as the illness itself. For example, followers of the Voodoo cult often resort to suggestion if they need to harm someone.
  A voodooist makes a person believe in a disease, as a result he exhibits various symptoms, in some cases the victim literally kills himself. This phenomenon is known as the “nocebo effect” (Latin nocebo - “I will hurt”).

Scientists claim that beliefs that are dangerous to health can be transmitted from person to person and spread through the media.

To experience the nocebo effect for yourself, you don’t have to provoke some voodoo priest - just flip through a couple of newspapers or exchange gossip with work colleagues.

Remember, some time ago there was a rumor that cell phones have a detrimental effect on the brain, and although no one has yet provided scientific evidence of this, thousands of people around the world have said that cell phones have become a source of headaches for them, in the literal sense of the word.

Once upon a time, doctors conducted an experiment to identify the connection between headaches and cell phones, while some of its participants complained of malaise, even if they were “influenced” by dummies instead of real phones.

The nocebo effect can be so pronounced that it can turn a not-so-good joke into a real tragedy. As a striking example of harmful self-hypnosis, the famous German psychiatrist Erich Menninger von Lerchenthal cited the following story that happened to his students in Vienna. Wanting to teach one of the university employees a lesson, the students dragged him into a pre-prepared room, blindfolded him and announced that he would now be beheaded. The unfortunate man's head was placed on a wooden block, and then the pranksters hit him on the neck with a wet, cold towel. At the same moment, the victim of the cruel prank died.

Nocebo can influence not only a person’s well-being, but also physiological indicators. A case that occurred in 2007 is widely known in medical circles. The patient, who was being treated for depression, decided to take his own life and swallowed several dozen pills prescribed to him. The man collapsed lifeless right in the corridor of the clinic, his blood pressure dropped sharply and if not for the urgent measures taken by the doctors who arrived in time, he would not have been alive.

The most surprising thing is that the blood test did not reveal any potent substances in the body of the would-be suicide. The doctors who “recovered” him puzzled over the mysterious incident for some time, and only a few hours later, the patient’s attending physician explained that he had participated in an experiment to study the “placebo effect,” and almost died from an “overdose” of sweet “pacifiers.”

Of course, all this looks a little comical, but according to Fabrizio Benedetti, a neurophysiologist at the Medical School at the University of Turin, nocebo can really kill a person.

Anticipation and fear of illness directly affect the hypothalamus, pituitary gland and adrenal medulla, provoking a powerful hormonal explosion. By and large, the body doesn’t care whether the danger is real or whether the brain “created” it - if the fear of the threat is strong enough, there is a risk of death.

As mentioned earlier, the nocebo effect can be transmitted through gossip and rumors. The same Benedetti conducted the following experiment last year. He invited a group of more than a hundred students to hike in the mountains, to an altitude of about 3000 m and, a few days before the trip, he told one of them that the thin mountain air could cause migraines. The “initiate” conveyed the news to his comrades, and by the day of the hike, about a quarter of his participants complained of a severe headache. Moreover, their analyzes showed that the boys and girls had just returned from a mountain hike, where they breathed air with a low oxygen content. “The blood biochemistry of those ‘infected’ with rumors has changed,” notes the neurophysiologist.

In other words, the nocebo effect can spread like a kind of epidemic and cover quite large groups of people. At the same time, a person sometimes does not even understand what caused the malaise - according to some data, nocebo acts and is transmitted at the level of subconscious signals.

A few more examples of mysterious mass illnesses that can perhaps only be explained by outbreaks of the nocebo effect.

In July 1518, in the French city of Strasbourg, a woman was noticed on the street performing a strange dance that lasted several days. Other townspeople joined her and gradually the “flash mob” grew to almost 400 participants. By the end of the summer, several dozen participants in the “dance marathon” died of heart attacks or exhaustion. This tragic episode went down in history as the “Dancing Plague.”

In 1962, an unknown disease struck dozens of workers in an American textile factory. Symptoms included nausea, numbness of the limbs, and dizziness, but doctors were unable to diagnose any of the patients. The official version says that the culprit is mass hysteria associated with the closure of the factory and loss of work.

At the end of the 19th century, many users of a fashionable gadget called the “telephone” complained that after telephone conversations they felt dizzy and had a headache.

In general, fear of technological progress often generates a nocebo effect. For example, in Canada, the so-called “wind turbine syndrome” is quite common - Canadians living near wind power plants claim that they suffer from insomnia and illness and, of course, wind turbines are to blame for this.

Recently, in many countries around the world, complaints about vision problems due to watching 3D TV have become more frequent - doctors believe that the nocebo effect may also be to blame for this, but the study of the impact of 3D technologies on people's health is only gaining momentum.

How to stop epidemics of deadly rumors and beliefs? One of the measures may be to strengthen control over the activities of unscrupulous media that disseminate information that can provoke nocebo outbreaks. In addition, it is important to increase the level of education of people in every possible way, to explain to them that their gullibility can create a threat to their well-being.

“We must make patients understand what internal fear is and that it needs to be dealt with,” says Dimos Mitsikostas. He recognizes that with all the achievements of modern medical science, the connection between thinking and physical HEALTH cannot be ignored. For thousands of years, medicine has used the will of people to heal them.

Of course, the desire to get well is not enough to defeat the disease, but you can’t do without it,” the doctor adds.

  Attention! the information on the site does not constitute a medical diagnosis or a guide to action and is intended for informational purposes only.

Dr. Lissa Rankin at TEDx, It's never too late to calmly and carefully listen/watch/read in this text now. It describes, from a scientific point of view, the mechanisms of miraculous self-healing from any disease (including cancer at the last stage) or sudden death from the “evil eye”.

Zozhnik provides the text of this important speech by Lissa (with subheadings, editing, links and pictures).

Can consciousness heal the body? And if so, is there evidence to convince skeptical doctors like me? These questions have driven my research in recent years. And I made the discovery that the scientific community, the medical establishment over the last 50 years have proven that consciousness can heal the body. This is called the "placebo effect."

The Science of Self-Healing

We've been trying to outwit him for decades. The placebo effect is a thorn in the side of medical practice. This is the unpleasant truth that stands between implementation
new types of treatment, new surgical methods in medical practice.

But I think this is rather good news because it is ironclad proof that the body contains internal repair mechanisms that allow the unthinkable to happen to the body.

If you find this surprising and find it hard to believe in self-healing,
you should check out The Spontaneous Remission Project, a database compiled by the Institute of Noetic Sciences. These are more than 3,500 cases described in the medical literature of patients who recovered from so-called “incurable” diseases.

You will be shocked if you look at this database. It contains everything: the fourth stage of cancer disappeared without treatment, HIV-positive patients became HIV-negative, heart and kidney failure, diabetes, hypertension, thyroid diseases, autoimmune diseases disappeared.

The case of “Mr. Wright”

This is a famous case studied in 1957, which you may have probably encountered on the Russian-language Internet. The patient, the so-called “Mr. Wright” ( Judging by the sources, the patient’s name is provisional, - approx. Zozhnik) was an advanced form of lymphosarcoma. The patient was not doing very well, he had little time left: tumors the size of oranges in the armpits, on the neck, in the chest and abdominal cavities. His liver and spleen were enlarged, his lungs took on 2 liters of cloudy fluid every day and had to be drained so he could breathe.

But Mr. Wright did not lose hope. He learned about the wonderful drug Krebiozen and begged his doctor: “Please give me Krebiozen and everything will be fine.”
His attending physician, Dr. West, could not do this due to the novelty and insufficient study of the new drug. But Mr. Wright was persistent and did not give up, he continued to beg for medicine until the doctor agreed to prescribe Krebiozen.

Demonstration for the speedy distribution of a new wonderful cancer drug - Krebiozen, which turned out to be a dummy after testing.

He scheduled the dose for Friday of the following week. Hoping Mr. Wright doesn't make it to Monday. But by the appointed hour he was on his feet and even walking around the ward. I had to give him medicine.

After 10 days, Wright's tumors had shrunk to half their previous size. A couple more weeks passed after I started taking Krebiozen and they completely disappeared. Wright danced with joy like crazy and believed that Krebiozen was a miracle drug that cured him!

This went on for two whole months until a full medical report on Krebiozen was released, which stated that the therapeutic effect of this drug had not been proven. Mr. Wright became depressed and the cancer returned.

Dr. West decided to cheat and explained to his patient: “That Krebiozen was not purified well enough. It was of poor quality. But now we have ultra-pure, concentrated Krebiozen. And that’s what we need!”

Wright was then given a placebo injection. And his tumors disappeared again, and the fluid from his lungs went away. The patient began to have fun again. All 2 months until the Medical Association of America ruined everything by releasing a national report that definitely proved that Krebiozen was useless.

Two days after Wright heard the news, he died. He died despite the fact that a week before his death he was flying his own light aircraft!

"Nocebo" - the opposite of placebo

Here is another case known to medicine that looks like a fairy tale. Three girls were born. The birth was attended by a midwife on Friday the 13th and she began to claim that all children born on that day were susceptible to spoilage. “The first one,” she said, “will die before her 16th birthday. The second is up to 21 years old. The third is up to 23 years old.”

And, as it turned out later, the first girl died the day before her 16th birthday, the second - before she turned 21. And the third, knowing what happened to the previous two, the day before her 23rd birthday, was admitted to the hospital with hyperventilation syndrome and asked the doctors: “I’ll survive, right?” She died that night.

These two cases from the medical literature are excellent examples of the placebo effect and its opposite, nocebo.

When Mr. Wright was cured by distilled water, this is a good example of the placebo effect. You are offered inert therapy - and somehow it works, although no one can explain it.

The nocebo effect is the opposite. These three girls who were “jinxed” are a prime example of this. When the mind believes that something bad can happen, it becomes a reality.

Measurable Placebo Effects

Medical publications, journals, the New England Journal of Medicine, the Journal of the Medical Association of America are all full of evidence of the placebo effect.

When people are told they are being given an effective drug, but instead are given saline injections or regular sugar pills, this is often even more effective than actual surgery. In 18-80% of cases people recover!

And it's not just that they think they feel better. They actually feel better and it's measurable. With modern instruments, we can observe what happens in the bodies of patients who take a placebo. Their ulcers heal, the symptoms of intestinal inflammation decrease, the bronchial tubes expand, and the cells begin to look different under a microscope. It is easy to confirm that this is happening.

I love Rogaine's research. There's a group of bald guys, you give them a placebo and their hair starts growing.

Or the opposite effect. You give them a placebo, call it chemotherapy, and people start vomiting and their hair falls out!

The doctor and health workers are also a placebo (or nocebo)

But is it really just the power of positive thinking that produces these results? No, says Harvard scientist Ted Kaptchuk. He believes that the most important thing is that the care and concern provided by a health worker is more influential than positive thinking. Some studies say that the doctor is actually a placebo.

Ted Kaptchuk observed patients who received placebo as a therapeutic therapy. And he told them: “This is a placebo and there is nothing in it, no active substance.” But they still recovered. The majority, as Kaptchuk admitted, thanks to care and care, they wanted and they did something and felt that they were cared for.

The body has a natural internal healing mechanism, but science shows that it requires the care and attention of a health professional, such as a healer, to facilitate the process.

It is not easy to cope with an illness alone and it makes a big difference when someone supports that confidence. But The problem is that the doctor can be either a placebo or a nocebo.

What do patients need from us healthcare workers? They need us to be a force of healing, not fear or pessimism. Therefore, when the doctor says: “You have an incurable disease, you are doomed to take these drugs for the rest of your life.” Or “You have cancer. You have 5 years left to live." It's like that midwife telling those three newborns that they were jinxed.

As doctors, we want to be realistic, you know? When we give people information that we think they should know, but in reality we can do harm.

Instead, doctors should be like Dr. West and give distilled water. "Mr. Wright, I promise this will help you."

Health Pyramid

What do placebo and nocebo effects in their pure form indicate? Can we do anything without clinical trials?

My hypothesis says that to heal ourselves, to be optimally healthy, we need more than just a good diet, regular exercise, getting enough sleep, taking vitamins, following doctor's orders. This is all good, critical and important.

But I also became convinced that we need healthy relationships, a healthy work environment and creative life, a healthy spiritual life, a healthy sex life, financial health, the environment. Finally, we need a healthy mind.

I wanted to prove this so badly that I found literature and extensive data that proved that all of this was significant and changed my mind. I've collected them in my upcoming book, Mind Over Medicine: Scientists Prove You Heal Yourself.
I want to introduce you to the key aspects of this. As you can see from this entire pyramid of health, all edges are built on a foundation that I called the inner wick.

What is important to me is the authentic part of you that knows what is true for you. This desire to bring the truth to you may not apply to your life, and the stones in the pyramid of your health may not be balanced.

I placed body and physical health at the top of the pyramid. Because it is the most fragile, the most shaky, the most easily destroyed if something goes wrong in your life. From medical data, I have found that relationships matter. People with strong social networks have half the risk of heart disease compared to those who are lonely.

Married couples are twice as likely to live longer than those who are not married. Healing your loneliness is the most important preventative measure you can take for your body. This is more effective than quitting smoking or doing exercises.

Spiritual Life Matters. Church members live an average of 14 years longer.

Work matters. You can work yourself to death. In Japan it is called karoshi. Death from overwork at work. Survivors of karoshi can file a claim for damages. And not only in Japan, this happens very often in the USA, but we do not receive compensation for it. According to a study, people who don't take vacations are 3 times more likely to suffer from heart disease.

Happy people live 7-10 years longer than the unhappy ones, and the optimist is 77% less likely to have heart disease than the optimist.

How does this work?

What happens in the brain that changes the body? This is what amazes me. I discovered that the brain communicates with the cells of the body through hormones and neurotransmitters. For example, the brain identifies negative thoughts and beliefs as a threat.

You are lonely or a pessimist, something is wrong at work, a problematic relationship and the amygdala screams: “Threat! Threat!" The hypothalamus turns on, then the pituitary gland, which communicates with the adrenal glands, which begin to splash out stress hormones - cortisol, norepinephrine, adrenaline. What comes into play is what Walter Kennett of Harvard calls the stress reaction. Which turns on the sympathetic nervous system, putting you in a "fight or flight" state, which is protective if you're running from a mountain lion.
But in everyday life, in the event of a threat, that quick stress reaction arises, which should be turned off when the danger has passed. But in our case this does not happen.

Fortunately, there is a counterbalance to the relaxation mechanism described by Herbert Benson of Harvard University. And when the direction changes, the stress response turns off and the parasympathetic nervous system turns on, healing hormones such as oxytocin, dopamine, nitric oxide, endorphins, flood the body and cleanse every cell.

Most surprisingly, the natural self-healing mechanism is activated only when the nervous system is relaxed. Therefore, in a stressful situation, all self-defense mechanisms are not activated. The body is too busy trying to fight or flee rather than heal.

When you think about it, you ask yourself: How can I change the balance of my body?

One report shows that on average we experience more than 50 stressful situations every day. If you're lonely, depressed, unhappy in your job, or have a bad relationship with your partner, the number at least doubles.

Therefore, the relaxation response is believed by researchers to explain the placebo effect. So when you take a new wonder drug, you don't know whether it's a placebo or not. The tablet triggers a relaxation mechanism; the combination of a positive attitude and proper care from a health professional relaxes the nervous system.

And then that natural self-healing mechanism turns on. Luckily, you don't have to participate in a clinical trial to enable relaxation. There are many simple and enjoyable ways to kick-start your relaxation mechanism. And this is proven by research.

• meditate,
• express yourself creatively,
• give a massage,
• do yoga or tai chi,
• go out for a walk with friends,
• do what you love,
• sex,
• you can laugh,
• do exercises
• play with animals.

I ask you to consider your own health pyramid. What bricks are not balanced in it? Each of the bricks can be a factor creating a stressful situation or relaxation. How to increase the amount of relaxation in your body?

And most importantly: what does your body need to heal itself? What prescription do you need? Do you have the courage to admit the truth that your inner source already knows?

I think our healthcare system is in terrible shape, mainly because we have forgotten the body's ability to heal. The medical establishment is too arrogant. We are used to thinking that with all modern technology, all the knowledge of past centuries, we have mastered nature and refuse to think that nature can sometimes be better than our medicine.

We must take responsibility for our body, your consciousness has enormous power, interact with the body and heal it. It all starts with you.
Be the love you want to see in healthcare.

And I believe miracles will happen. Once you do this, oxytocin, dopamine are released, and self-healing begins.

Nobody knows how it works, but everyone uses it. Scientific conclusions about the effectiveness of drugs are based on it. It itself can sometimes act as medicine and successfully replace them. Incomprehensible, like human nature itself, mysterious and contradictory, like everything in medicine - a placebo.

Alexey Vodovozov

Since ancient times, doctors have treated patients not only with medicines, but also with “a kind word and a gentle look.” However, the first written mention of placebo in a medical context dates back to the 18th century—a 1785 work described placebo as “a common method of treatment,” and Quincy’s Lexicon-Medicum (1811) provided the first definition: “An epithet applied to any treatment that directed more to the patient's pleasure than to his benefit."

The modern history of placebos dates back to 1946, when Cornell University, one of the largest and most famous universities in the United States, part of the elite Ivy League, held the first symposium on the effects of placebos on patients. And in 1955, Boston physician Henry Beecher published an article in the Journal of the American Medical Association, “The Almighty Placebo,” about the results of a clinical trial in which it was found that about a third of patients received a noticeable improvement from pacifiers. Beecher called this phenomenon the “placebo effect.” This is how the final separation of concepts occurred in medicine. The term “placebo” began to refer directly to a dummy drug. This role is usually played by a physiologically inert substance, for example the milk sugar lactose. And the placebo effect (or placebo effect) began to be called the consequences of using a placebo in patients. The trigger can be not only a pacifier, but, for example, irradiation (sometimes they use various “flashing” devices with “neons”), an injection of saline solution, and even a banal measurement of body temperature. However, in particularly advanced cases one has to resort to a completely non-placebo placebo. Such as surgical operations that are carried out according to the “cut and sew up” principle.

Lost in translation

The term “placebo” has a very interesting fate. Disputes about it do not subside among linguists and historians. The most common version is a translator error. When Blessed Jerome (342−420) translated the Bible into Latin, he used a translation from Hebrew into ancient Greek, the famous Septuagint, or “translation of the seventy-two elders.” Thus, in Psalm 116:9 the phrase “Placebo Domino in regione vivorum” (“I will give thanks to the Lord in the land of the living”) appeared. Researchers believe that this phrase is a direct translation from ancient Greek, without taking into account discrepancies in the Hebrew original. And this discrepancy concerned precisely the word that Jerome translated with the verb placebo. In meaning and context, the phrase should have sounded like “I will follow”, in the literal sense - as if stepping foot after footstep. In the second and third editions of the Vulgate (the Latin text of the Bible, in the compilation of which Jerome took an active part), the phrase sounded different. However, the church recognized only the first translation of the Psalter as canonical, and the erroneous verb stuck. The funeral service began with this psalm, a phrase often repeated as a refrain. Beggars and beggars, seeing the funeral procession, began to sing it, hoping that they would receive something from the generosity of the relatives of the deceased. This is how the expression “singing placebo” appeared, that is, begging, trying to make money on someone else’s grief. A little later, the word “placebo” became synonymous with hypocrisy and flattery. And only much later the term began to be used in medicine.

We're waiting, sir.

What is the placebo effect associated with? With a positive unconscious psychological expectation of the patient, scientists say. Psychology plays a huge role in our lives, in the work of all organs and systems. First of all, of course, the brain, and from there, indirectly through various biological substances, the body as a whole. In the famous medical joke “All diseases are from nerves, and only syphilis is from pleasure,” there is much more truth than irony. Hypochondria, a mass of psychosomatic diseases, when a person simply “winds up” himself into organic pathology, is the best proof of this. Well, since you can get sick from suggestion, you can also be cured by suggestion. And this is widely used in medicine.

Firstly, as a way to get rid of “professional” patients. This group is not so small that it can be ignored. Such patients take up time both from the doctor and from other truly sick people. In a good way, they need the help of a psychotherapist or psychoanalyst, but this institute is not yet so developed in our country. And not everyone wants to admit that they have psychological (or even mental) problems.

“This rare, patented remedy, just delivered yesterday by ship from Rio de Zhitomir,” can come to the rescue. On the one hand, no actual active substances enter the patient’s body. That is, there is no harm. On the other hand, the person calmed down, they paid attention to him, and even gave him a unique drug. The therapeutic effect has been achieved.

Secondly, placebos are used in the treatment of certain diseases, such as chronic alcoholism. This is a serious disease of pathological dependence, incurable if physical addiction to ethanol occurs. But you can put it into long-term remission, which will last as long as the person can abstain from alcohol. Without the patient's desire, the doctor will not be able to force him to give up alcohol. Need motivation. Some people realize their weakness before drinking and ask to be “coded” for them.

Indeed, there are drugs, for example disulfiram, which in combination with alcohol cause severe poisoning, even death is possible. It is clear that in the vast majority of cases no one will needlessly risk the patient’s life. It’s one thing if he is in a hospital under the supervision of a doctor, and quite another thing if he is “free.” In this case, narcologists sometimes use a placebo - the patient is injected with a supposedly “coding” drug, then a provocative test with ethanol is carried out (in this case, a negative reaction of the body is simulated with medication, most often nausea and vomiting). Sometimes this is enough, especially if the person himself wants it. If the “coded” person immediately runs to the kiosk to once again check the strength of the “code,” then medicine is already powerless. Thirdly, the placebo effect is widely used in the methods of “complementary” or even frankly alternative medicine. Suffice it to recall homeopathy or “miracle drugs”, which are actively advertised and sold on almost every corner.

Large-scale deception

55% of doctors noted that they prescribe at least one placebo drug to their patients. Moreover, both active and passive placebos are used. 41% prescribe additional analgesics, 38% - vitamins, 13% - antibiotics, another 13% - sedatives. A real placebo - in the physiological sense of the word - is prescribed by only 5% of doctors: 3% are glucose tablets, 2% are salt tablets. Among those who prescribe placebos to patients, 68% of doctors give their patients explanations such as “I will give you a pill that is not usually prescribed for your condition, but it will definitely help you.” 18% do not stand on ceremony and call it a medicine. 9% call it “a medicine with no known effects on your disease.” And only 5% call the placebo by its real name. True, it is not clear why they do this; in this case, it is unlikely that one can count on the desired reaction from the patient.

What is your evidence?

But perhaps the most widespread use for placebos is in clinical trials. It was on the comparison of the effect of the drug being studied with a placebo that what we now call evidence-based medicine grew. The idea is simple: we take two tablets of the same color and shape, but one of them contains the active substance, and the other is a pacifier. And we compare how people with the same disease react to them. If it’s the same, it means the medicine is no good. Ideally, a study that meets the principles of evidence-based medicine should be double-blind, randomized, placebo-controlled, and multicenter. What does this mean?

Placebo control is the use of a passive or active placebo in a control group. An active placebo is preferable in this case, since in this case it is more likely that a trick with the dummy will not even be suspected.

Randomization is the random assignment of patients to an experimental or control group so that they have equal opportunity to receive either the study drug or a placebo.

“Blindness” in this case means that all patients remain unaware of what exactly they are drinking, whether it is a drug or not. The placebo effect of treatment will still appear in both groups, but when comparing the results it can be neglected.

Double blindness also excludes medical knowledge. Only the person who ordered the study knows which group is using what. Nurses, doctors and even clinic management know nothing about the study design. And this is done for a reason. There is a known case when one medical journal published the results of two studies in which, under the guise of amphetamine stimulants, subjects were offered a placebo. In one study there was no effect, but in the other there were not only subjective, but also objective data: the participants’ heart rate, breathing, blood pressure changed, and changes in the encephalogram were recorded. When they began to look into it, it turned out that the author recruited participants for the second study among his students and they really wanted the professor to do everything right.

A multicenter study is conducted in several clinics that are not aware of each other's participation. It is better if these are clinics in different cities, ideally in different countries.

This eliminates the influence of both psychological and as yet unknown factors on the results. However, returning to the issue of patient rights, it should be said that at present people are still informed that they are participating in trials where some of the subjects receive a placebo instead of a drug and no one knows which group they are in. In addition, the patient has the right to refuse to participate in research at any time. Scientists are confident that this affects reliability, but not so much as to neglect the norms of modern medical ethics. When known drugs and methods began to be “run” through such studies, many surprises were discovered, mostly unpleasant. Many popular remedies, which both patients and doctors considered effective, worked on pure psychology. And entire groups of medicines began to lose their status. Thus, in the USA,... nootropics were transferred to the category of biologically active food additives. The same drugs that boomed in popularity in the 1980s and 1990s. They were followed by drugs from the group of hepatoprotectors (“liver protectors”), which were considered extremely effective and terribly in short supply during Soviet times. And with chondroprotectors, drugs that supposedly restore the cartilage tissue of joints, and therefore reduce pain from arthrosis and arthritis, it somehow turned out to be inconvenient. The studies revealed that the placebo ultimately turned out to be more effective than all glucosamines and chondroitins combined. Magnetic therapy, a popular physiotherapeutic method, also did not show effectiveness different from placebo. And this list is constantly growing.

Reverse of the medal

As you know, for every Dr. Jekyll there is a Mr. Hyde. Placebos also have it. If there are positive psychological expectations, why not be negative? The term "nocebo" was coined in 1961 by Walter Kennedy. Nocebo comes from the Latin noceo - “to harm” and is an integral part of the placebo phenomenon, its twin and antithesis.

It is quite logical: if you believe in the treatment, its effectiveness will increase. If you don’t believe, even a remedy tested by evidence-based medicine will not work. And if you wait for side effects, they will definitely appear.

As happened, for example, in the study of small doses of acetylsalicylic acid as a prevention of recurrent heart attacks. Some patients were warned about a possible side effect in the form of pain in the stomach, while others were not. Those who were warned complained of precisely such pain three times more often than those who were not warned. Meanwhile, during an objective study, the frequency of erosive and ulcerative complications was the same in both.

Film instructions for use

A classic case of nocebo is shown in Boris Rytsarev’s film “The Doctor’s Apprentice” (1983). A young man, pretending to be deaf and mute, became an apprentice to the court physician. The deception was revealed, but by that time the young man had already learned a lot from his mentor. He suggested that the king postpone his execution, which the old doctor insisted on, and arrange a kind of test for professional aptitude: a student and a teacher prepare their best poison, then give it to each other and save themselves by selecting an antidote according to their knowledge. The young man survived after a dose of poison, but the old doctor fell dead after drinking from a cup that his student brought to him. The young man explained to the angry king that he had given the court doctor only spring water, having finished the contents of the cup as proof. This is pure nocebo: the old doctor was expecting poison, but could not recognize it, and his body reacted accordingly.

It is also known that in people who are opposed to vaccinations, even the injection of a harmless saline solution causes itching and redness at the injection site; in some, the temperature even rises to low-grade (37.1-37.5°C).

There are also very sad cases. They occur when patients lose faith in a cure, in a successful outcome of the operation. And then the person “leaves” with a history of not very serious illness, despite all the efforts of doctors. “There are patients who almost dream of death in order to be reunited with previously deceased loved ones. Almost all of them really die,” Professor Herbert Benson from Boston shares his sad experience.

But why?

Science does not yet know why the placebo or nocebo effect occurs and how to predict it in a particular patient. The best studied analgesic is placebo. Our brain has its own drugs - endorphins. Their purpose is to eliminate pain, and the action, as the name suggests, is similar to the action of morphine.

If a placebo is given instead of an analgesic in a study, it becomes a signal to increase the synthesis of endorphins. If a person is given the drug naloxone, which blocks specific receptors in the brain that endorphins bind to, placebo pain relief becomes much less effective. But it still doesn't disappear at all.

Why this happens, explained German scientists from the Medical Center of the University of Hamburg. Their work was published by one of the most authoritative scientific journals in the world, Science. The researchers applied a completely neutral cream to both hands of 15 healthy volunteers. Participants in the experiment were informed that on one hand they had a pharmacologically inactive substance, and on the other, it contained an experimental painkiller. After this, the volunteers received “injections” with a laser into the treated skin of the hand. The activity of the spinal cord structures that conduct pain signals was assessed using functional magnetic resonance imaging (fMRI).

When experiment participants believed that their arm was pain-free, their pain sensations decreased by about a quarter. At the same time, the activity of the pain pathways of the spinal cord decreased significantly. This study showed that placebos also act at lower levels, like actual narcotic analgesics. And it once again emphasized that we still know practically nothing about such a widespread and widely used method in medicine. Scientists still have to study and study both placebo and nocebo.