Terrorized by Nocebos, blinded by Sunnydale Syndrome

June 24, 2011 | By | 1 Reply More

I had once read of “nocebos” before, but I was recently reminded of nocebos. What are they? The following is from Wikipedia:

In medicine, a nocebo reaction or response refers to harmful, unpleasant, or undesirable effects a subject manifests after receiving an inert dummy drug or placebo. Nocebo responses are not chemically generated and are due only to the subject’s pessimistic belief and expectation that the inert drug will produce negative consequences. In these cases, there is no “real” drug involved, but the actual negative consequences of the administration of the inert drug, which may be physiological, behavioural, emotional, and/or cognitive, are nonetheless real.

How powerful can a nocebo be? Wikipedia offers this example:

Writing from his extensive experience of treating cancer (including more than 1,000 melanoma cases) at Sydney Hospital, Milton (1973) warned of the impact of the delivery of a prognosis, and how many of his patients, upon receiving their prognosis, simply turned their face to the wall and died an extremely premature death: “… there is a small group of patients in whom the realisation of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death.

The existence of well-documented nocebos raise some interesting questions for me.  For instance, is it the incessantly spread media claims that terrorists lurk around every corner that is causing Americans to ignore the federal government’s wild growth of warmongering, spying and homeland security budgets (and perhaps these things serve as placebos for the disease of terrorism)?   Does the nocebo of ubiquitous terrorism cause us to ignore that our government tortures, spies on us and fights illegal wars?  Perhaps the fear of “terrorism” causes us, metaphorically speaking, to curl up in the fetal position, unable to see beyond our own little lives.  My question is whether we are entire country afflicted by nocebo-inflicted stupidity?   Bruce Schneier offers an excellent rundown of the real risks that face Americans (and don’t miss the many excellent comments too):

Consider that on this very day about 6,700 Americans will die…. Consider then that around 1,900 of the Americans who die today will be less than 65, and that indeed about 140 will be children. Approximately 50 Americans will be murdered today, including several women killed by their husbands or boyfriends, and several children who will die from abuse and neglect. Around 85 of us will commit suicide, and another 120 will die in traffic accidents.

[…]

Indeed, if one does not utter the magic word “terrorism,” the notion that it is actually in the best interests of the country for the government to do everything possible to keep its citizens safe becomes self-evident nonsense.

He offers a lot more compelling statistics too, I’d highly recommend his article.   The illustration that stands out is that we don’t do everything we can to prevent deaths generally, only potential death by terrorism.  “[W]e seem to consider 43,000 traffic deaths per year an acceptable cost to pay for driving big fast cars.”  Here’s another excellent recap of the relative dangers of terrorism and other–much greater–dangers, at least between 2000 and 2006.  And here’s what you should really be concerned about — the top ten causes of death in the United States

We are freaked out and made socially dysfunctional by the thought of terrorism. We destroy our education, health care and infrastructure budgets to attempt a “perfect” shield against something that will hurt almost none of us.

What is the real risk of terrorism?  Consider this, from a 2006 article titled “Don’t be Terrorized,” at Reason:

[I]f terrorists were to destroy entirely one of America’s 40,000 shopping malls per week, your chances of being there at the wrong time would be about one in one million or more. [Former Business Professor Michael] Rothschild also estimated that if terrorists hijacked and crashed one of America’s 18,000 commercial flights per week that your chance of being on the crashed plane would be one in 135,000. Even if terrorists were able to pull off one attack per year on the scale of the 9/11 atrocity, that would mean your one-year risk would be one in 100,000 and your lifetime risk would be about one in 1300.

I learned another interesting term today:  “Sunnydale Syndrome.”   This term, associated with the television series “Buffy: the Vampire Slayer,”  refers to the fact that many people overlook real (not terrorism) crushing and surreal social dysfunction and, instead, tend to their mundane lives.  We wake up and see the sunshine, we hear the birds, a car drives by and a neighbor says hello. Focusing on these sorts of occurrences causes many people to overlook the many dramatic problems our country faces, such as oil depletion, chemical toxins in the environment, global warming or the fact that big businesses almost completely owns Congress.

Dr. Who summarized this situation:  “Your species has the most amazing capacity for self-deception matched only by its ingenuity when trying to destroy itself.”

— The Seventh DoctorDoctor Who

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Category: Statistics

About the Author ()

Erich Vieth is an attorney focusing on consumer law litigation and appellate practice. He is also a working musician and a writer, having founded Dangerous Intersection in 2006. Erich lives in the Shaw Neighborhood of St. Louis, Missouri, where he lives half-time with his two extraordinary daughters.

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  1. Erich Vieth says:

    I just received another link to a NYT article on nocebos from a friend, along with this comment:

    We go to great lengths to require disclaimers on advertising about the potential risks of medications; yet these warnings might be causing harm. I obviously don’t think that scaling back that information is the answer, but it’s always interesting when both forks in the road have potentially serious negatives.

    Here’s an excerpt from the NYT article illustrating the powerful effect of nocebos:

    Consider the number of people in medical trials who, though receiving placebos, stop participating because of side effects. We found that 11 percent of people in fibromyalgia drug trials who were taking fake medication dropped out of the studies because of side effects like dizziness or nausea. Other researchers reported that the discontinuation rates because of side effects in placebo groups in migraine or tension drug trials were as much as 5 percent. Discontinuation rates in trials for statins ranged from 4 percent to 26 percent.

    In a curious study, a team of Italian gastroenterologists asked people with and without diagnosed lactose intolerance to take lactose for an experiment on its effects on bowel symptoms. But in reality the participants received glucose, which does not harm the gut. Nonetheless, 44 percent of people with known lactose intolerance and 26 percent of those without lactose intolerance complained of gastrointestinal symptoms.

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