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Thursday Complexity PostJuly 25, 2013


The Nocebo-The Placebo's Evil Twin


Honesty is harder when the truth risks harm.


People taking sugar pills and other faux medications with inert ingredients for such symptoms as pain, dizziness, headache, and depressed mood often experience relief. The placebo effect is well known. The placebo's evil twin is the nocebo-it comes from a Latin word meaning I will harm-and it has recently gotten more attention from researchers. The Harvard Mental Health Letter reports 20 percent patients taking sugar pills in clinical drug trials spontaneously report unpleasant side effects-and even more describe unpleasant effects if they are asked.


Expectations matter. If we expect help, we may feel better. If we expect distress we may feel it. And these physical manifestations are real, not imaginary. The Harvard letter reports on an experiment in which volunteers were told a mild electric current would be passed through their heads and that they might experience headaches. There was no current, but two thirds of the volunteers got headaches.


A New Yorker story by Gareth Cook reports that people involved in clinical drug trials often experience the symptoms they are warned about even when they are taking placebos. In research on fibromyalgia treatments, the story says, eleven percent of the people taking sugar pills dropped out of the trial because of debilitating side effects.


People also experience the nocebo effect as a result of disasters and scary information, alarming news and rumor. After the 1995 saran gas attack in a Tokyo subway many people who had actually not been exposed to the nerve gas suffered the highly publicized symptoms of dizziness and nausea. A New York Times story by Paul Enck and Winifred Hauser tells of a participant in a clinical trial for an antidepressant drug who attempted suicide by swallowing 26 pills. The person's blood pressure plunged dangerously even though the pills swallowed were harmless.


Sometimes the same treatment can be both placebo and nocebo. The Harvard letter tells of volunteers who experienced symptoms when told an injection contained an allergen, and relief when told an injection would neutralize the symptom. In both cases the injection contained only salt water.


Informed consent is a powerful doctrine that obligates physicians to tell patients all the risks of treatments. But what if all that information is detrimental to the patient? A Boston Globe story by Chris Berdik reports some reflections by doctors, all of whom urge honesty combined with the kind of thoughtful and skilled communication that takes some time with the patient. Dr. Luana Colloca, a researcher at NIH who studies placebos and nocebos, describes positive framing-you can say that two percent of the people on this treatment had nasty side effects, or that 98 percent did not. The Times story emphasizes that a doctor's choice of words is important. The story quotes the cardiologist Dr. Bernard Lown who once said, "Words are the most powerful tool a doctor possesses, but words, like a two-edged sword. can main as well as heal."



Remember PlexusCalls!


Friday, August 9, 2013 - 1-2 PM ET  
Register to receive your call-in number and pin:  
How Our Schools Can Inspire Emergence of Community Builders  
Guest: Ward Mailliard and Lisa Kimball   

Ward Mailliard is one of the founders of the Mount Madonna Center in Watsonville,  CA, and a member of the executive board of the Mount Madonna School, which educates children from pre-school through high school. An educator for more than 25 years, Mailliard helped create the "Values in World Thought" curriculum, which includes taking students to interview government and non-government leaders in Washington DC and other countries. Read his complete bio.


Lisa Kimball, PhD--In addition to serving on the Board, Lisa served as Plexus' President for 3 years. She continues to serve Plexus as Chair, Learning Programs. She is an entrepreneur with more than 30 years experience as an organizational consultant with business, government and non profit organizations. She earned her doctorate in educational psychology, cognition and learning conducting research on how senior executives use system thinking.


Healthcare PlexusCalls 
Wednesday, August 21, 2013 - 1-2 PM ET  
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Robot + Cooperation Between Hospitals = Better Care for Stroke Patients  
Guest: Dean Gushee     

When someone has a stroke, time is of the essence. Faster diagnosis and immediate treatment can often reduce or eliminate the debilitating effects of a stroke. At Mason General Hospital, a community hospital in southwest Washington State, emergency-room physicians are board-certified in emergency medicine, and trained in stroke diagnosis and treatment. And thanks to St. Peter Hospital, twenty minutes away, there is now a neurologist in the room when needed 24/7, via two-way video and a remote telehealth robot. Dean Gushee, medical director for the emergency department and medical director for the hospital, will join the call to talk about the resources that provide better care for stroke patients-and the cultural changes that were needed to allow separate hospitals, with differing policies and practices, to learn to work together. Read his complete bio.


Visit the Plexus Institute Calendar for a detailed schedule of PlexusCalls, Healthcare PlexusCalls, Nursing Network PlexusCalls and other upcoming events from Plexus Institute and others.  


Audio from all PlexusCall series are available by searching the iTunes store for plexuscalls. Or, visit under Resources/Call Series. 


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