By Lili Feng, MD. Department of Medicine, Baylor College of Medicine

(Clearwisdom.net) The placebo (from Latin "I will please") effect is a phenomenon that patients feel better after they've been treated with control pills (e.g. sugar pills). This phenomenon has been observed throughout the field of medicine and few physicians would challenge it.^1-5 Recently, a study finds that common knee surgery is no better than placebo.⁶ The nocebo (from Latin "I will harm") effect is the opposite of the placebo effect, and this phenomenon suggests negative expectation can affect subjects negatively.^7-10 The placebo/nocebo effect indicates that the human mind can play an important role in shaping a patient's response to illness and medical treatments. The nocebo effect creates negative expectations about symptoms and can have devastating influence on patient recovery. Just as the placebo effect works by making patients believe they will get better, the nocebo effect can serve to make patients worse and even cause death.⁹ In one experiment, asthmatic patients breathed in a vapor that researchers told them was a chemical irritant or allergen. Nearly half of the patients experienced breathing problems, with a dozen developing full-blown attacks. When subjects were "treated" with a substance they believed to be a bronchodilating medicine, and recovered immediately. In actuality, both the "irritant" and the "medicine" were a nebulized saltwater solution. The bronchial constriction was caused - or cured by the patients' expectations alone.¹¹ The nocebo test is so unethical that very little research has been done in the medical history, because it severely violates the fundamental ethical principles of beneficence and nonmaleficence (do no harm).¹²

Therefore, the placebo effect cannot be separated from pharmacological benefits either since the patients' mind in a drug treatment group can also affect the patients' response to medical treatment. As a matter of fact, the placebo effect also plays an important role in complementary and alternative medicine (CAM) and it is impossible to rule out the placebo effect in the subjects who had positive response to CAM, such as Qigong, Yoga, musical therapies, meditation, and many other alternative therapeutic methods. Only when the nocebo effect is taken into account during a clinical trial, can the therapeutical effectiveness of a drug or any other treatments be confirmed. However, ethics and legitimacy challenge the use of nocebo test in clinical trials since the nocebo effect may be responsible for substantial variety of pathology throughout the world .¹³

It has been reported that Falun Gong has great potency in curing disease and keeping fit . We may presume that health-promoting phenotype may not result from the placebo effect (if we may consider Falun Gong practicing in human health as a clinical trial). Since in this "clinical trial," the crackdown on Falun Gong in China might be viewed as a very severe test to examine whether the potency of Falun Gong results from the placebo effect. A comprehensive, vicious suppression of Falun Dafa practitioners has been initiated since 1999. The Falun Gong practitioners have been arrested, beaten, sent to labor camps, sentenced to jail, and all radio stations, television stations, and the press have been used to create negative impression on Falun Gong nationwide and worldwide.¹⁴ Since 1999, at least 451 people have died as a result of police torture and brutality since the crackdown. Any potential good consequences that may result from the positive expectation (placebo effect) must have completely vanished in front of such an inhuman and cruel nocebo effect. Yet, in spite of the nocebo effect from the crackdown on Falun Gong, and in spite of initial negative thoughts and doubts among some Falun Gong practitioners and most have continued to practice their believing and have attained astonishing health promoting benefits in the process.^14,15

If we consider the effects of Falun Gong practice on human health, we would also conclude that, a) the Falun Gong's positive effects on human health has exceed many modalities used today in clinical practice, and b), as a clinical trial, it is the only study that has passed the most inhuman and stringent nocebo test. This is an outstanding result in medical history in light of the fact that 90% of clinical trials fail to show benefit due to the placebo effect.

1. Beecher H. The powerful placebo. JAMA 1955;159:1602-1606.

2. Shapiro AK. Placebo effects in medicine, psychotherapy, and psychoanalysis. In: Bergin A, Garfield S, editors. Handbook of psychotherapy and behavior change. New York: Wiley and Sons; 1971.

3. Benson H, Epstein MD. The placebo effect. A neglected asset in the care of patients. Jama 1975;232(12):1225-7.

4. Stefano GB, Fricchione GL, Slingsby BT, Benson H. The placebo effect and relaxation response: neural processes and their coupling to constitutive nitric oxide. Brain Res Brain Res Rev 2001;35(1):1-19.

5. Walsh BT, Seidman SN, Sysko R, Gould M. Placebo response in studies of major depression: variable, substantial, and growing. Jama 2002;287(14):1840-7.

6. Moseley JB, O'Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002;347(2):81-8.

7. Schweiger A, Parducci A. Nocebo: the psychologic induction of pain. Pavlov J Biol Sci 1981;16(3):140-3.

8. Spiegel H. Nocebo: the power of suggestibility. Prev Med 1997;26(5 Pt 1):616-21.

9. Benson H. The nocebo effect: history and physiology. Prev Med 1997;26(5 Pt 1):612-5.

10. Barsky AJ, Saintfort R, Rogers MP, Borus JF. Nonspecific medication side effects and the nocebo phenomenon. Jama 2002;287(5):622-7.

11. Morse G. The nocebo effect. Hippocrates 1999;13(10):http://www.hippocrates.com/archive/november1999/11departments/11integrative.html.

12. Beauchamp T, Childress J. Principles of biomedical ethics. 5th ed. New York: Oxford University Press; 2001.

13. Hahn RA. The nocebo phenomenon: concept, evidence, and implications for public health. Prev Med 1997;26(5 Pt 1):607-11.

14. http://www.clearwisdom.net.

15. http://www.faluninfo.net.

Posting date: 4/28/2003
Original article date: 4/28/2003
Category: Scientific Findings

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