Why the ‘Nocebo’ effect isn’t soothing
Everyone knows of the placebo effect, tellingly illustrated by the case of the surgeon incapacitated by acute sciatica midway through a difficult operation. Could one of the nursing staff, he requested, kindly give him a shot of morphine? This had the desired result, and it was only when his patient was heading for the recovery room that he learnt he had been deceived – the injection had contained not morphine but sterile water.
This potency of the placebo raises a whole series of interesting questions, much discussed, not least as to how doctors can be certain the drugs they prescribe work in the way supposed. Still, its consequences are invariably benign. The patient feels better and that is all that really matters.
Not so its supposed antithesis, the “nocebo effect” – with the bold claim reported in this newspaper last week that in most instances, the sideeffects of drugs are not due to their pharmacological effect in causing muscle pains, fatigue, bowel disturbances, general decrepitude, etc – but rather to the patient’s belief that they can be harmful.
This cannot possibly be true, while the potential implications – that doctors should doubt the validity of their patients’ account of their drug-induced symptoms – could scarcely be more serious. It is thus necessary to scrutinise closely the relevant study, involving 60 patients, on which this claim is based. A rather small number, one might think, and rightly so for concealed within a supplementary appendix – only available online – I discovered that 80 per cent of the original cohort (of more than 300 patients) had been excluded, declined to participate or failed to complete the study. This, then, is a classic instance of the “unrepresentative sample” – so limited and self-selected as to render any conclusions meaningless. Still, Big Pharma will be happy.
Open your windows
While we await, with guarded optimism, the much-heralded Covid-19 vaccine, simpler (and much cheaper) protective measures should not be neglected. Hence the concern expressed by Professor Edward Lynch in this paper last week after noting the windows were closed in 78 out of the 80 buses he recently observed passing Waterloo Station. “Good ventilation is extremely important,” he writes, a view echoed in an article in the Journal of Hospital Infection describing the role of fresh air in combating infectious illnesses prior to the discovery of antibiotics.
The twin goals of promoting recovery while also preventing cross-infection and reinfection were addressed, writes Dr Richard Hobday, by nursing patients next to an open window or placing them in their beds outside. He cites too the experience of the Camp Brooks Open Air Hospital near Boston, built at short notice at the height of the devastating 1918-19 Spanish flu pandemic. In good weather, patients spent virtually all their time outdoors, kept warm in their beds at night by hot water bottles and extra blankets. The survival rate was almost twice that of conventional hospitals while just two out of the 150 staff contracted the highly contagious virus.
Subsequently, Dr Hobday reports that scientists in the Sixties identified an “open-air factor” in fresh air that is specifically lethal to
most bacteria and viruses, and which loses its potency when outdoor air is enclosed. So, open those windows – and for those lucky enough to have a garden, a firepit – sales of which are booming – should hopefully see them through the winter months unscathed.
Moods and muscles
This week’s medical query comes courtesy of Mrs C B from Bristol, intermittently troubled by spasms of the neck muscles associated with sudden changes in mood. “I can spend the whole day feeling utterly miserable, very detached and foggy,” she writes. But the site of the spasm only needs to shift a fraction and “within seconds I feel released and life returns to normal”. She has tried, variously, physiotherapy, acupuncture, aromatherapy and bought a specially shaped pillow, but the mood changes persist much as before. Might anyone, she wonders, be able to advise how best to deal with them?
Fresh air is lethal to most viruses... and loses its potency when outdoor air is enclosed