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I removed from placebo effect the following text:

The reverse effect, sometimes called the nocebo effect, is the result of negative expectations by the patient. Some patients who believe that they should be ill can exhibit genuine symptoms.
The Nocebo Effect may or may not be distinguished from older concepts such as sociogenic illness or psychosomatic illness. In any case, distinguishing between these effects can be a difficult problem for medical semiotics, or the study of how to interpret the patient's description of their ailments.
The strictest definition would be the negative effect produced by an expectation that a medicine or treatment does not work in general or for the patient in particular. Sociogenic illness and psychosomatic illness might therefore be broader terms where a known or unknown cause with cultural or psychological factors is involved.
Example: I believe that cough medicine does not work. I suffer, therefore, from the Nocebo effect--the medicine is less effective for me than for a patient who believes the medicine actually prevents coughs.

Starting to integrate it now... Dbenbenn 18:59, 6 Jan 2005 (UTC)

David, your example is a combination of both nocebo and placebo effects. The pure nocebo effect would be: "the medicine is less effective for you than for a patient who is unsure if the medicine actually prevents coughs". Axl 20:58, 6 Jan 2005 (UTC)
Not my example. I simply moved the text from placebo effect. I agree that the text above and the text in the nocebo effect article proper, needs changes. Dbenbenn 21:05, 6 Jan 2005 (UTC)

... merged. I took out the example, which didn't seem to add much, and also the unsourced statement that the nocebo effect actually occurs. Dbenbenn 21:26, 6 Jan 2005 (UTC)


I suggest that Nocebo effect and Nocebo response be merged, and then moved to Nocebo. Tom Harrison Talk 15:29, 29 May 2006 (UTC)[reply]

Comment on Merge Proposal[edit]

I believe that it may be wrong to do this; for the simple reason -- as I have now described in the additions I have made today to the piece I deposited yesterday under nocebo response -- that the contrasting terms placebo and nocebo are galloping away into the distance and, to a large extent no longer mean anything, would have to be done very carefully.

A second point, in support of this, is to quote a piece from a recent paper stating that, at least in the domain of medicine, things had gone far too far:

Stewart-Williams, S. & Podd, J., "The Placebo Effect: Dissolving the Expectancy Versus Conditioning Debate", Psychological Bulletin, Vol.130, No.2, (March 2004), p.326:

Finally, it is sometimes argued that placebo effects are, by definition, desirable effects. After all, the word placebo comes from the Latin meaning “to please,” and the archetypal placebo event involves an improvement in health. The undesirable effects of inert agents have been dubbed nocebo effects, and the agents producing them nocebos (Hahn, 1997). Just as inert agents can produce analgesia, they can also produce hyperalgesia (Benedetti & Amanzio, 1997). In the latter case, the inert agent would be a nocebo and the hyperalgesia a nocebo effect. However, there are several problems with the placebo–nocebo distinction. Inert agents may sometimes simultaneously produce both desirable and undesirable symptoms. For example, the response may mimic not only the healing effects of drugs and other treatments, but also some of their side effects (Shapiro, Chassan, Morris, & Frick, 1974). In such instances, we would have to say that the agent in question is both a placebo and a nocebo. It would be more parsimonious to say that the same agent (a placebo) can simultaneously produce both desirable and undesirable effects. Another problem is that the same effect might be desirable for one person but undesirable for another. For instance, placebo immunosuppression may be undesirable to most people but desirable to people suffering an autoimmune disorder (Olness & Ader, 1992). In this case, we would have to say that the former group had taken nocebos but the latter placebos, and we could not know which we had administered until we had established whether the recipients considered the effects desirable or not. Furthermore, although the same effect was produced in both cases, and presumably through the same mechanisms, by labeling one a placebo effect and one a nocebo effect, we would in effect be treating it as two different phenomena, simply because it was desirable to one group but not the other. These considerations lead us to suggest that, despite the origin of the word placebo, the desirability of the effect should not be part of the definition [of the terms placebo and placebo effect].
Benedetti, F., & Amanzio, M. (1997). The neurobiology of placebo analgesia: From endogenous opioids to cholecystokinin. Progress in Neurobiology, 52, 109–125.
Hahn, R. A. (1997). The nocebo phenomenon: Scope and foundations. In A. Harrington (Ed.), The placebo effect: An interdisciplinary exploration (pp. 56–76). Cambridge, MA: Harvard University Press.
Olness, K., & Ader, R. (1992). Conditioning as an adjunct in the pharmacotherapy of lupus erythematosus. Journal of Developmental & Behavioral Pediatrics, 13, 124–125.
Shapiro, A. K., Chassan, J., Morris, L. A., & Frick, R. (1974). Placebo-induced side effects. Journal of Operational Psychiatry, 6, 43–46.

My third point is that the originator of the technical term was very certain that it was a subject-centred phenomenon; and, from my studies that notion seems to be so, so essential -- and so I would strongly oppose anything going under the very widely used, but totally incorrect, title of "nocebo effect".

My fourth point is that my strong desire to have it all located under nocebo response is for the technical reason that "nocebo response" or , more correctly. "nocebo reaction", was where the word "nocebo" first appeareed in English.

My fifth point is that, even though it may seem, at first glance, that it is sensible to place it all under the entry "nocebo" -- i.e., given that we would never have the concept of a "nocebo" if the meaning of the "placebo" being "a pleaser" had not emerged from somewhere, and caused so much trouble due to the superficial similarity of the two homynyms (simulator vs. pleaser) -- I am very certain that we need to have the following six entries in oorder to clearly disambiguate all of this mess:

(1) Placebo: describing the evolution of the term placebo, from the Septuagint version of the Psalms, as translated by Jerome into his first version of the Vulgate, and how this translation was used as the text for the Roman Catholic "Office of the Dead" ritual, etc.,etc. and how, following this thread, how the original term placebo has only one meaning: a simulator.

Then all of the applications of such a dummy simulator in medicine and pharmacology could be discussed.

A second section would also need to appear to detail the pejorative use of the term placebo -- in the period where modern scientific medicine was emerging from the morass of herbal medicine and traditional physic, and was atempting to dissociate itself from so-called "heroic medicine" -- to designate therpies that had once been thought efficacious, but were now found (per medium of this fore-runner of evidence based medicine) to be bereft of active ingredients.

A third section would need to appear to deal with the therapist-delivered placebo (essentially the legendary sugar pill) which embodied the notion that a placebo was a "pleaser".

(2) Placebo Effect: Stressing that this description ascribes agency to the drug. A short note stating that this was either the consequence of being given either a sugar pill, or of being given a dummy, inert, simulator (it didn't matter which) -- and, as a consequence, the administraion (in either case) of something which, both by definition, and by stipulation, contained no active substances, and therefore, could not logically be spoken of having any sort of substance-centred agency (as it was all subject-centred response).

(3) Placebo Response: Essentially a matching piece to that which I have written about "nocebo response" -- which I would be quite prepared to write and offer up for commment.

This would then lead us to

(4) Nocebo: a simple statement that this was created to be the counterpart of the sort of placebo that generated a pleasant response; the something that had generated an unpleasant reponse.

(5) Nocebo Effect: Stressing that this description ascribes agency to the drug. A short note stating that because this was, at least in the first instance, something which, both by definition, and by stipulation, contained no active substances, and therefore, could not logically be spoken of having any sort of substance-centred agency (as it was all subject-centred response).

(6) Nocebo Response: as it now apppears.

I suppose that my real point is this, that whatever goes on with the nocebo stuff, I believe that it would be far more productive for it to be symmmetrical with the various descriptions of the applications of the term placebo; and, because the issue of elaborating all of the considerably different aspects of placebo, requiring such a sort of exposition, I believe that everyone would be better served if the six sections I have suggested are the final form.

I eagerly await your views on this, and I willl delay writing the piece I intended on the "placebo response" until I have a better idea of what I am to do, based on the guidance and acquired wisdom of others far more experienced than myself. cogtrue 02:26, 30 May 2006 (UTC)[reply]