KATE FAASSE: I'd like to tell you the story of Mr A.
A young man who enrolled himself in a clinical
trial for a new antidepressant medication.
One day, after a huge fight with his girlfriend,
Mr A took all of the 29 pills that he'd been given for the trial.
Knowing he'd made a mistake, he asked his
neighbour to drive him to the hospital,
where he said, help me, I took all my pills, before collapsing.
The hospital staff raced into action.
Mr A was drowsy, pale, sweating, breathing rapidly,
and when they got him on monitoring equipment,
it became really clear that his heart rate was
very high and his blood pressure was very low.
He was showing concerning signs of an overdose.
So the care team got him on a saline drip
to try to stabilize his condition.
When the physician from the clinical trial arrived,
everyone in the room expected to be told that
Mr A had indeed taken anti-depressant pills.
What she revealed instead was that he'd taken 29 placebo pills,
sugar pills, containing no active ingredient at all.
Everyone was relieved and a little surprised at this news.
But sure enough, within 15 minutes, Mr A was sitting up, alert,
chatting and his blood pressure and heart rate had returned to normal.
So rather than a medication overdose, Mr A had taken a placebo overdose.
Now, most people have heard of the placebo effect where
sugar pills can cause healing or health improvement.
What Mr A experienced was a dramatic example of the nocebo effect,
the dark side of placebo,
where those same sugar pills can cause unpleasant
and sometimes serious side effects.
This is what we study in my lab, the nocebo effect.
We give people sugar pills, we warn them about possible side effects,
and we watch what happens.
We don't do this just because we like making people sick,
but because it's really important to understand how nocebo
effects form and what we can do to prevent them.
This is particularly important because while
nocebo effects can be caused by sugar pills,
like Mr A, they can also be caused by real medicines.
And lots of people take real medicines.
And lots of people experience nocebo effects from them.
In fact, anyone can experience a nocebo
effect given the right circumstances.
I want you to think about tiny bugs like
lice crawling through your hair,
down your face, your neck, your back, across your arms and your legs.
I want you to think about how itchy you are right now.
Perhaps you really want to scratch your head.
Maybe you have an itch on your leg.
Now I want you to think about how tired you are, how sleepy.
Perhaps it's been a long day, a long month, a long year.
Maybe your eyelids are starting to feel really heavy.
Perhaps you're just starting to feel the urge to.
Just paying attention to symptoms can actually cause them to happen.
And yes, it is all in your head.
But those symptoms are also very real.
If we'd looked at your brain activity while you were feeling itchy,
we'd have seen something very similar to somebody
who has an itchy rash or a mosquito bite.
Those same brain regions that activate when you're
itchy would have been active in your brain too.
This is part of the explanation for how nocebo effects occur.
We can literally think ourselves into experiencing side effects.
And now I want you to imagine you've been prescribed
a new medication by your doctor.
What's one of the first questions you might ask?
What are the side effects?
And so you start paying just a little bit
more attention to those side effects.
Expecting that they might occur.
The nocebo effect is really driven by
the power of negative expectations.
So expecting to experience a side effect can actually make it happen.
So how common is the nocebo effect?
Well, in a huge study involving more than half a million people,
taking a range of different drugs,
it was found that 76% of people reported side effects,
which wasn't particularly surprising.
What was surprising is that 73% of people taking placebo pills,
sugar pills, reported remarkably similar side effects,
which means that of all those side effects,
only 4% can be explained by the drugs themselves.
The rest can't.
Now, some of those are common everyday
symptoms that all of us experience.
But about 60% seem to be caused by the nocebo effect.
So most side effects, more than half,
are probably caused by the nocebo effect.
So the nocebo effect is common.
It can be very serious, and it can be caused really easily just by
warning people about the possible side effects of a medication.
So the first study to show us this happened by a lucky mistake.
There was a mix up with the consent forms,
and some participants were warned that the drug
they were taking might cause indigestion,
nausea, diarrhea and vomiting, and others weren't.
People who got these warnings were three times
more likely to experience these side effects
and almost six times more likely to quit
the study because they were so unpleasant.
These kinds of warnings have also caused problems for statins.
So statins are medications prescribed to
lower cholesterol and more importantly,
to reduce the risk of heart attack and stroke.
If you've heard of statins,
you've probably heard that statins cause muscle pain.
It's been in newspapers, it's been in television coverage.
It's one of the first things that pops up on an internet search.
Except, that's not what the data says.
What the data says is that people who are taking statins are just as
likely to experience muscle pain as people who are taking placebos.
Despite this, people taking statins are still warned
that muscle pain is a possible side effect.
And about 30% of them will experience muscle
pain not because of the statins,
but because of the nocebo effect.
And some of them will stop taking their
statins because of this nocebo effect.
Statins that were prescribed to reduce
the risk of heart attack and stroke.
So, why is muscle pain still listed as a statin side effect?
What happens is, in a clinical trial,
all reports of side effects get added to that list.
The catch is, it doesn't matter whether those side effects are reported
by people taking the real medicine or people taking a placebo.
They end up on the list either way.
So we end up in a vicious cycle.
People in clinical trials expect to experience side effects.
They report them, and those side effects end up on that list,
regardless of whether they're actually caused by the medication.
When the medications are approved, it's given to other people.
They're warned about those side effects,
including the ones that aren't actually caused by the medication,
but they still experience them, not because of the drug,
but because of the nocebo effect.
So how do we break the cycle?
How do we prevent or at least reduce the nocebo effect?
So, I think, you know the first answer.
Stop warning people about things that are not actually side effects.
Please know that if I was in charge,
we would already be working towards this.
But unfortunately, the system was designed by lawyers,
not by doctors, and certainly not by health psychologists.
And unfortunately, it's not that easy to change.
So we need to work within the system that we have to
develop strategies to reduce the nocebo effect.
And I'm gonna tell you about three.
The first is to change the way we talk about side effects.
So often we see information like, this drug may cause headache,
or 30% of people who take this drug will experience headache.
But what if we flip the script and focus on the positive?
70% of people who take this drug won't experience headache.
That certainly sounds better.
And it turns out that focusing on the positive,
on people who don't experience side effects,
can actually reduce the nocebo effect.
So this has been seen in studies with placebo pills,
but also in studies with flu vaccines and pain relieving medications.
The second strategy is to make people happy.
Now, this is very new research, but it looks
like putting people in a positive mood,
by having them do things like watching funny
videos before they get a treatment,
can actually stop the nocebo effect from forming.
The third strategy is teaching people about the nocebo effect,
much like we've been doing here for the past 10 minutes or so.
So as well as causing side effects,
this talk might actually prevent them because
people who are taught about the nocebo effect
are less likely to experience it.
Nine million Australians take prescribed medications every day.
If 76% of them experience side effects and 60%
of those are caused by the nocebo effect,
that could be something like four million
Australians experiencing nocebo effects.
In order to thrive in the 21st century,
we need to take the nocebo effect seriously.
It's causing unnecessary harm and suffering
to literally millions of people.
We have increasing knowledge about how to prevent
or at least reduce nocebo effects.
And it's time to put that knowledge into action.