The nocebo effect is evil twin brother of the placebo effect

DEAR DR. ROACH » Over the past year, I have taken three different statins, all with disastrous side effects. I am currently getting a month off before my doctor tries another one. I have talked to everyone I know or meet about these drugs. My decidedly unscientific survey results are that about a third of the people take them without problems, a third cannot take them because of side effects, and the last third tell their doctors they take them but they actually don’t. Are the reported side-effect statistics somehow being manipulated? — J.T.

DEAR READER »

Deciding what to do for an individual like you is difficult, as one can never know in an individual whether the effects are “real” or nocebo. Statins are the most effective class of drug to reduce heart disease risk, so on the one hand, you don’t want to withhold medication that is likely to improve and extend someone’s life. On the other hand, you don’t want the risk of “disastrous” side effects. Waiting four weeks and trying a different statin (fluvastatin and pravastatin tend to be tolerated best, but rosuvastatin and atorvastatin have been shown to be useful in people who haven’t tolerated other statins) is one approach; CoQ10 supplementation (itself largely, but not entirely, a placebo) also has helped. Finally, a healthy diet may reduce the dose of statin needed, or even eliminate the need entirely in some people. People with known blockages should be on a statin if possible.

READERS » The booklet on vertigo explains this disruptive condition in detail and outlines its treatment. Readers can order a copy by writing: Dr. Roach Book No. 801 628 Virginia Dr. Orlando, FL 32803 Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.