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Overdiagnosis and Its Harms

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The Nocebo Effect

Abstract

The placebo effect refers to a therapeutic benefit arising as a rule from the expectation of benefit itself, not from the actual composition of a treatment. Thus patients who are told they are receiving a painkiller but actually get saline solution can still enjoy an analgesic effect owing to the evocative power of the medical ritual. Note that this model doesn’t entail that the benefit of the treatment is illusory. On the contrary, placebos can stimulate the release of the body’s opioids, an effect that can be blocked by the opioid antagonist, naloxone. Correspondingly, the nocebo effect refers to a harm arising from the expectation of harm, as when people led to believe they have suffered a toxic exposure fall ill. While the nocebo effect is ethically difficult to study and much of the knowledge about it derives from observation and accidental findings rather than experiment, both the placebo and nocebo effect appear to operate largely through the power of suggestive messages, enhanced in many cases by theatrical effects. Among the messages capable of springing to life in our minds and bodies are those that propel the process of medicalization. “Telling people they are sick undoubtedly has a strong negative placebo effect.”1

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Notes

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© 2015 Stewart Justman

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Justman, S. (2015). Overdiagnosis and Its Harms. In: The Nocebo Effect. Palgrave Macmillan, New York. https://doi.org/10.1057/9781137523297_4

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