The nocebo effect

Food for thought:

From the New Scientist the first page of a three page article:

Late one night in a small Alabama cemetery, Vance Vanders had a run-in with the local witch doctor, who wafted a bottle of unpleasant-smelling liquid in front of his face, and told him he was about to die and that no one could save him.

Back home, Vanders took to his bed and began to deteriorate. Some weeks later, emaciated and near death, he was admitted to the local hospital, where doctors were unable to find a cause for his symptoms or slow his decline. Only then did his wife tell one of the doctors, Drayton Doherty, of the hex.

Doherty thought long and hard. The next morning, he called Vanders’s family to his bedside. He told them that the previous night he had lured the witch doctor back to the cemetery, where he had choked him against a tree until he explained how the curse worked. The medicine man had, he said, rubbed lizard eggs into Vanders’s stomach, which had hatched inside his body. One reptile remained, which was eating Vanders from the inside out.

Great ceremony
Doherty then summoned a nurse who had, by prior arrangement, filled a large syringe with a powerful emetic. With great ceremony, he inspected the instrument and injected its contents into Vanders’ arm. A few minutes later, Vanders began to gag and vomit uncontrollably. In the midst of it all, unnoticed by everyone in the room, Doherty produced his pièce de résistance – a green lizard he had stashed in his black bag. “Look what has come out of you Vance,” he cried. “The voodoo curse is lifted.”

Vanders did a double take, lurched backwards to the head of the bed, then drifted into a deep sleep. When he woke next day he was alert and ravenous. He quickly regained his strength and was discharged a week later.

The facts of this case from 80 years ago were corroborated by four medical professionals. Perhaps the most remarkable thing about it is that Vanders survived. There are numerous documented instances from many parts of the globe of people dying after being cursed.

With no medical records and no autopsy results, there’s no way to be sure exactly how these people met their end. The common thread in these cases, however, is that a respected figure puts a curse on someone, perhaps by chanting or pointing a bone at them. Soon afterwards, the victim dies, apparently of natural causes.

Voodoo nouveau
You might think this sort of thing is increasingly rare, and limited to remote tribes. But according to Clifton Meador, a doctor at Vanderbilt School of Medicine in Nashville, Tennessee, who has documented cases like Vanders, the curse has taken on a new form.

Take Sam Shoeman, who was diagnosed with end-stage liver cancer in the 1970s and given just months to live. Shoeman duly died in the allotted time frame – yet the autopsy revealed that his doctors had got it wrong. The tumour was tiny and had not spread. “He didn’t die from cancer, but from believing he was dying of cancer,” says Meador. “If everyone treats you as if you are dying, you buy into it. Everything in your whole being becomes about dying.”
He didn’t die from cancer but from believing he was dying of cancer

Cases such as Shoeman’s may be extreme examples of a far more widespread phenomenon. Many patients who suffer harmful side effects, for instance, may do so only because they have been told to expect them. What’s more, people who believe they have a high risk of certain diseases are more likely to get them than people with the same risk factors who believe they have a low risk. It seems modern witch doctors wear white coats and carry stethoscopes.

The nocebo effect
The idea that believing you are ill can make you ill may seem far-fetched, yet rigorous trials have established beyond doubt that the converse is true – that the power of suggestion can improve health. This is the well-known placebo effect. Placebos cannot produce miracles, but they do produce measurable physical effects.

The placebo effect has an evil twin: the nocebo effect, in which dummy pills and negative expectations can produce harmful effects. The term “nocebo”, which means “I will harm”, was not coined until the 1960s, and the phenomenon has been far less studied than the placebo effect. It’s not easy, after all, to get ethical approval for studies designed to make people feel worse.

What we do know suggests the impact of nocebo is far-reaching. “Voodoo death, if it exists, may represent an extreme form of the nocebo phenomenon,” says anthropologist Robert Hahn of the US Centers for Disease Control and Prevention in Atlanta, Georgia, who has studied the nocebo effect. (read the rest here)