The 'nocebo effect': Is Googling your symptoms making them worse?

A new study looks at whether knowing about the potential side-effects of medications leaves you more likely to believe you're experiencing them. Not everyone is convinced it does, and this leaves doctors with ethical questions about how much information is too much.

Research suggests correlation between looking up potential side-effects and experiencing them

The research raises questions about whether disclosing information about side-effects could actually be harmful to patient health. (Shutterstock)
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When you feel unwell, could Googling your symptoms make you feel sicker? According to a new study, it might.

You have probably heard of the placebo effect: a patient or test subject is given a pill with no medicinal effect, but they end up feeling better because they believed, or were told, that it was a real treatment.

Well, it turns out the placebo effect has an evil twin. Researchers call it the nocebo effect.

"Nocebo is kind of the opposite" of placebo, Dr. Baiju Shah, a senior scientist at Sunnybrook Health Sciences Centre in Toronto, told The Current's Anna Maria Tremonti.

"[It's] where you have a medication that probably has benefits, but because you go in with preconceived notions that it might be harmful or cause you to have side-effects, you actually are more likely to experience those negative effects."

Shah is the lead investigator on a new study called "Does Googling Lead to Statin Intolerance?", which will be published in the International Journal of Cardiology this summer.

We see it clinically all the time, where patients come in talking about side-effects, but inevitably it's something that they read about on Google.- Dr.  Baiju  Shah

His team of researchers reviewed patient intolerance to statins — a common cholesterol-lowering drug — in 13 countries across five continents. They then compared the recorded intolerance rate to the availability of websites that discuss the adverse effects of statins, through each country's Google search engine.

Countries that had the largest number of websites about side-effects — the United States, United Kingdom, Canada and Australia — had the highest rate of statin intolerance compared to countries in Asia and Eastern Europe, where intolerance levels are lower.

Dr. James McCormack argued that patients with better access to information about side-effects could be more likely to report them. (Andrey Popov/Shutterstock)

"We see it clinically all the time, where patients come in talking about side-effects," he said, "but inevitably it's something that they read about on Google." 

That prompted Shah's team to investigate whether there was a link between the two.

 Not everyone is convinced that the abundance of medical information online is making people sick, however.

"This is not a causal relationship," argued Paul Enck, a professor of psychosomatic medicine at the University Hospital Tübingen in Germany.

"You don't know whether the number of websites is responsible for the perceived intolerance rates, or whether the intolerance rates causes the other one. You cannot interpret that."

Examining patient data on the side-effects of statins, researchers compared countries countries where information was widely available with countries where it was not. (CBC)

What should doctors say?

The nocebo effect raises some important questions for doctors wondering how much is too much when it comes to informing patients of potentially adverse side-effects.

"It surely gives anybody who is a medical practitioner some pause for thought," said Dr. Brian Goldman, an ER doctor in Toronto and host of CBC Radio's White Coat, Black Art.

"When I'm in the emergency department, do I say we're going to give you some local anesthetic and it's going to numb the area and you'll be comfortable," he asked Tremonti, "or do I say there it's going to feel like a bee sting, it's going to burn, burn, burn?"

Dr. Brian Goldman, host of CBC Radio's White Coat, Black Art, said the research would give doctors 'pause for thought.' (CBC Radio)

"I have to tell you that most of the time, I say the latter. And now I realise that there are studies that show if I tell somebody that the local anesthetic is going to hurt, it hurts … so maybe I have to change my spiel."

Dr. James McCormack, a professor in UBC's faculty of pharmaceutical sciences, argued that patients with better access to information about side-effects would be more likely to report them in genuine cases.

"What we have to do in medicine today is talk to the patient about side-effects, and we need to give them accurate information," he said.

The key is in how that information is conveyed. He said doctors should be trying to focus patients on the medical benefits of a treatment, rather than the potential side-effects.

Listen the full conversation near the top of this page.


This segment was produced by The Current's Julie Crysler, Pacinthe Mattar and Danielle Carr.

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