Nocebo effect

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The Nocebo effect was an old variation on the well-known Placebo effect. Just as a sugar pill - which, if believed to contain a powerful drug, can make sick people feel better, so the Nocebo effect of belief can make well-people feel ill.

This is a variation on a old theme. The psychological effects of having treatment of any sort is beneficial whether or not there are actual biomedical changes. Similarly, the Nocebo effect is said to make people feel ill because of the scare-mongering and sensationalisation of what may be innocuous pollutants or trivially degraded environmental conditions.

The Placebo and its inversion, the Nocebo phenomena are well known to scientists and have been for centuries, but the term Nocebo was not used (it was sometimes called a "negative placebo"). However the term 'Nocebo' jumped into prominence in the mid 1990s when chemical, nuclear and tobacco companies came under concerted attack for health and environmental transgressions -- and the scientific defenders (and their PR agencies) reacted by claiming in media releases and conferernces that the perceived problems were essentially hysterical.

According to those promoting 'Nocebo' for the tobacco industry, there was no possibility of harm from second-hand smoke, because the amount taken into the lungs of a non-smoke was trivial when compare to the inhalations of a smoker.

This resurrection of the 'Nocebo effect' had a novelty value to journalists -- especially if they were smokers (and most were in those days). The science-for-sale entrepreneurs who actively promoted Nocebo for their chemical/tobacco/etc. clients found that it was a good way to get their "No problems" message noticed.

Documents & Timeline

In the tobacco archives with 14 million documents there is no evidence of the word "Nocebo" before 1996. It then suddenly becomes the fashion term of the decade.

It is taken up by the ARISE group (Philip Morris front group) in 1997 [2]

1996 Jan 16 The Chicago Tribute article "How the Media and Lawyers Stir Up False Illness"by Michael Fumento, journalist, tobacco lobbyist and TASSC associate of Steve Milloy and George Carlo. He also promotes the Nocebo effect and the safety of breast implants.

A Nocebo is a negative placebo. That is, while a placebo pill makes you feel better though unbeknownst to you it's only made of sugar, a nocebo makes you feel bad though physiologically speaking it shouldn't be able to. Nocebos don't get talked about much, which is why the [Wynder's] American Health Foundation (AHF) recently called together a number of experts for a conference on the subject. For nocebos aren't just minor curiosities, but are wreaking havoc in America today.

Fumento identifies some Nocebo health scares:

  • Gulf War Syndrome
  • Love Canal dioxin and chemical contamination
  • Silicone Breast Implants

    "For 30 years women were satisfied with implants," Emory University gynecology and obstetrics professor Dr Elizabeth Connell (of TASSC) told me.
    Connell headed the FDA panel that investigated the implants. "Lot of studies at the [FDA] hearings and since then showed a very high level of pleasure and acceptance and gratitude." But then the media and the lawyers got in the act. Newspapers and magazines ran stories with titles like "Ticking Time Bombs," "Toxic Breasts," and "After Implants, Horror Began."
    Suddenly women with implants were suffering all sorts of strange illnesses and "realizing" that illnesses they already had must be related to their implants. "When you have women being told they have ticking timebombs in their breasts, what are they to think?" said Connell.

[If you've got a a suspicious mind you might guess that this article was funded by Dow Chemicals. If you know anything about Fumento -- you'd be certain of it. The article was also promoted at the website by Walter Olson who is Peter Huber's ("junk-science") associate at the Manhattan Institute. Fumento and Steven J Milloy are both associated with this think-tank also.][3]

1996 Mar 23 A Philip Morris strategy technology document (from a brainstorming session) lists numerous ideas for coordinating the wide range of activies of both domestic/international tobacco and food companies under the heading "Potential Areas for PM-wide Synergies"

This list includes a number of non-technology ideas...

  • Special topic leadership and sponsorship, e.g. use of epidemiology data and meta-analysis studies, risk assessment, the NOCEBO effect, etc.
    [This was a speciality of both George Carlo and Ernest Wynder]
  • Good/bad science. [Another Carlo speciality]
  • Nutrition and health. [A Wynder speciality]
  • Monitoring regulatory activity as it could impact our products/packages/ processes and the use of technologies e.g., genetic modification
  • Biotechnology strategies [4]

1996 Dec 2 - 4 George L Carlo and Ernest Wynder (of the American Health Foundation) have convinced Dr Wayne Jonas of the National Institutes of Health to join forces with them in promoting a 3-day conference on the 'Nocebo'. They are giving new currency to this old idea by using this catchy name-variation of 'Placebo'.

Nocebo, is the idea that people make themselves really ill because they believe something is harmful (when it actually isn't). It provides polluters and poisoning companies with a possible alternate 'causal' mechanism to deflect blame away from their products. Note the listed headings for the conference: "Mass Hysteria, Psychosomatic Illness, etc"

So even they use of the term has implications for tobacco, chemicals and the cellphones, and for many other industries with environmental and health problems. 'Nocebo' provides them with another line of defence... another way to create doubt about 'cause and effect' relationships between their products and the health problems they may (or may not) cause.

1997 Feb 18 Dr Wayne Jonas of the National Institutes of Health appears to have wisely dropped out of the Carlo-Wynder 'Nocebo' conference. It is now being promoted only as a one-day event for a cost of $295. It is being held at Georgetown University, but without the support of the NCI.

Carlo and Wynder have now enlisted disinformation journalist Michael Fumento (also of TASSC), along with Dr Richard Adamson from the National Soft-Drink Association (ex NCI Division of Cancer Epidemiology -- also on the AHF Board of Directors) as speakers.

[Other speakers are not believed to be dubious ... so much as gullible]