Why health warnings can be bad

[Guest guest]

Here seems to be a counter attack to poo-poo people with ES.

" Rubin has little doubt that the symptoms exhibited by

electrosensitives are real. “Something cognitive is going on –

something to do with the expectation is triggering the symptoms,” he

says. And the idea of a psychological basis to electrosensitivity is

supported by the fact that cognitive behavioural therapy can be an

effective treatment. "

Any body know of an effective " cog behav therapy? "

Full Transcript:

Why health warnings can be bad

By Stuart Blackman

Published: April 25 2009 01:27 | Last updated: April 28 2009 12:33

http://www.ft.com/cms/s/2/0d9499ec-2d75-11de-9eba

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It is perhaps surprising that scientists behind an experiment conducted

at the University of California 25 years ago were able to recruit any

volunteers. The researchers, purporting to study the effects of

electric currents on brain function, warned potential participants that

electrodes would be strapped to their temples, and could cause serious

headaches. Despite this, 34 students came forward. At the end of the

trial, two thirds of the volunteers did report headaches – despite the

electric current never having been turned on. Such is the power of the

“nocebo” effect, the real subject of the experiment. The current had

not been switched on because the scientists were investigating whether

expectation alone could make healthy people ill. Apparently it could.

In the 25 years since then, research has been accumulating that the

nocebo effect – the evil twin of the better-known placebo effect – is a

widespread phenomenon that affects many aspects of our lives and which

might contribute to a host of 21st-century ailments, from food

allergies to obesity, chronic fatigue, back pain and

electrosensitivity. Some experts are concerned that the situation is

being compounded by the efforts of health professionals to raise

awareness of threats. “When someone receives a placebo and they get

better, it’s because of a variety of self-healing processes in the body

that are cognition-related,” says , a psychologist at the

National University of Ireland, Galway, who specialises in how mental

stress affects physical health. “One expects to get healed and certain

symptoms go away.” In the case of the nocebo, it is negative

expectations that become self-fulfilling prophecies.

When we expect something to make us ill – electrodes wired to our

temples, for example, or, more routinely, a medicine with known

side-effects – we start looking for signs of illness. And we’ll

probably find some, says , even if the pill is a dummy one or the

electric field a sham. That is because unpleasant physical symptoms are

a normal part of life for perfectly healthy people. Headaches come and

go. Some nights it is hard to get much sleep, and some days it is

difficult to keep our eyes open. We might feel light-headed one moment

and in a bad mood another. These are all experiences that we would not

think twice about were we not looking for signs that things are wrong.

But when we are looking, it is easy to interpret a bad night’s sleep as

insomnia, tiredness as fatigue, light-headedness as dizzy spells or a

bad mood as depression – and then to reattribute those symptoms to

whatever it was that we expected to harm us. And once we start

believing that something is making us ill, we get anxious, which can

itself exacerbate existing symptoms or induce others. “Anxiety

generally leads to elevations in blood pressure and immune deficiency,”

says . And more symptoms mean more anxiety.

Everyday expressions such as “worried sick” or “scared to death”

suggest that the link between negative emotions and ill-health was made

long before the phenomenon was given a medical label. But once in the

realm of scientific investigation, the nocebo effect started turning up

with surprising frequency. It is now recognised as a regular occurrence

in double-blind clinical trials of new medicines, where people taking

an inert, placebo control pill develop side-effects of the drug being

tested – if they are warned about them beforehand. If the nocebo effect

can make us ill in clinical trials, it can also do so in real life.

Placebo and Nocebo effects Rubin, researcher at King’s College

London, has been following up the early Californian experiments to

investigate the role of the nocebo effect in a debilitating condition

that afflicts increasing numbers of westerners, including, reportedly,

one in every 20 Swedes. Electrosensitivity is supposedly caused by

exposure to the electromagnetic fields given off by power lines, mobile

phone handsets and masts, wi-fi and other electrical appliances.

Sufferers report a range of symptoms, including headaches, tingling

skin, dry throat, eye irritations, problems with memory and

concentration, dizziness, inflammation and muscle and joint pains.

Crucially, Rubin’s research provides little reason to think that the

reported symptoms are caused by the electromagnetic fields. “There is

no robust evidence that there is a direct link, and there is reasonably

robust evidence that there is no link,” he says. Experiments show that

electrosensitive people are no better than anybody else at identifying

when they are being exposed to an electric field. And when they are

exposed, sufferers report more symptoms only if they have been told

that they are being exposed. It is this sort of evidence that has led

to the failure of court cases brought against mobile phone companies by

people who believe their symptoms to be caused by their handsets. Rubin

has little doubt that the symptoms exhibited by electrosensitives are

real. “Something cognitive is going on – something to do with the

expectation is triggering the symptoms,” he says. And the idea of a

psychological basis to electrosensitivity is supported by the fact that

cognitive behavioural therapy can be an effective treatment.

Even non-specific worries about the state of the world in general can

be enough to make us ill, according to research from the University of

Auckland. Prior to a huge pesticide-spraying programme in New Zealand,

people were asked about their attitudes towards new technologies and

environmental threats. After the spraying, those who were most

concerned about the health risks reported the greatest number of

symptoms.

If negative expectations generate symptoms, what generates the negative

expectations? , professor emeritus at University College

London and an expert on risk, says there is a current fashion among

health professionals and other authorities for issuing precautionary

advice concerning the health risks posed by new medicines and

technologies. And that, he says, is a major contributing factor.

Despite finding a dearth of evidence for a risk to health from mobile

phones, The Report, published in 2000 by the Independent Expert

Group on Mobile Telephones and Health (and named after the group’s

chairman, Sir ), recommended that people limit their use

of the technology, just in case. says that such an ambiguous

message is an example of just the sort of thing that can encourage

people to keep an eye out for signs of illness.

A similar message accompanied the UK Health Protection Agency’s 2004

report on the dangers of exposure to electromagnetic fields. “The

report found no evidence of an aetiological connection between the

fields and the symptoms,” says . “And yet at the press conference

that launched it, they went beyond that and said that people who

believe they are sensitive should stay away from electromagnetic

radiation.” Hence the ensuing headline from the Daily Mail: “Household

appliances such as kettles, computers and microwaves could be health

hazards, a government expert suggested yesterday.” The Swedish

government has issued similarly precautionary advice.

“This process is more general than just taking a pill,” says Arthur

Barsky, professor of psychiatry at Harvard Medical School. “However you

induce negative expectations – whether it’s through a pill, a health

warning or advertising by a drug company – you set in motion the same

process of symptom reattribution, which then amplifies the symptom,

which further solidifies the reattribution.” Wainwright, a

sociologist at the University of Bath, agrees that health warnings

issued for precautionary reasons can be bad for our health: “It’s a bit

like flicking through a medical encyclopaedia and imagining you’ve got

symptoms of disease X, Y and Z. But this effect has a lot more potency

when it’s a health professional telling you this stuff.”

Not even health professionals are immune. Medical students, who flick

through more than their fair share of medical encyclopaedias, are

themselves susceptible to a phenomenon known as “medical students’

disease”, whereby they develop symptoms of whatever condition they

happen to be studying. Research has shown that medics display more

signs of hypochondria than their peers studying law. Today, the

“worried well” are more likely to go online than to a library to

self-diagnose, in which case patient websites such as Medinfo or

NetDoctor could be exacerbating symptoms at the same time as raising

awareness of them. No research has yet been conducted that directly

addresses internet health sites and the nocebo effect.

But research published last year by psychologists at Harvard and Yale

universities raises the possibility that even our weight is susceptible

to the power of suggestion. The study looked at the health of hotel

chambermaids over a four-week period. Half of subjects were told at the

start that their work counted as good exercise that satisfied the

recommendations of the US surgeon-general. A month later, they had lost

weight and gained other health benefits such as lower blood pressure.

Their uninformed colleagues showed no change.

This puzzling finding does not seem to be explained by extra exercise

prompted by the briefing: this was weight-loss by placebo effect. And

where there is a placebo effect, nocebo is often lurking in the

shadows. In an age when health professionals and governments are

inclined to talk of obesity as an epidemic, of the entire population as

unhealthy and to demand that we exercise more, such pronouncements

might be doing more harm than good. “I very much believe that health

warnings can be adversely effective via a nocebo effect,” says Alia

Crum, one of the chambermaid study’s authors. “Whether or not this

overrides the benefit of getting the message out there is another

story.” Her current research attempts to tease apart these conflicting

effects.

Not all health warnings are likely to cause what they are intended to

prevent. Warnings on cigarette packets don’t give anyone cancer, for

example; in fact, no rigorous research has turned up evidence that

cancer, or any other serious, fatal disease, can be caused or cured by

the power of negative or positive thinking – although both might well

influence the strength of the symptoms. But it is not the cancer

statistics that many of these scientists fret over. Their concern is

the rise of conditions such as back pain, fibromyalgia (chronic fatigue

syndrome) and food allergies, which are characterised by the symptoms

expressed rather than by the underlying biology. These symptoms may

have a biological basis in some individuals and a psychological one in

others. So, while rare and tragic deaths resulting from extreme food

allergies can be attributed to physiological anaphylactic shock, health

warnings on food that “may contain nuts” might be contributing to the

rise of food allergies in general, and to the statistics that less than

20 per cent of teenagers who believe they have a food allergy actually

test positive.

“It’s quite remarkable how the illnesses that are increasing at the

moment are not the big, killer diseases, grounded in real, physical

pathology,” says Wainwright. “It’s the subjective problems of

everyday life that are becoming medicalised, where there’s no actual

evidence of any physical illness. “Even hassles at work are interpreted

through the medicalised category of work stress rather than political

or industrial relations issues” – a practice that Wainwright says is

promoted by government agencies. “Health policy is promoting this

belief that we’re all at risk from absolutely everything we come into

contact with, and that just encourages us to feel more vulnerable and

to interpret our normal experiences as health problems. It’s all just

amplifying this epidemic of non-specific illness, which has incredibly

disabling effects on people.”

Certain changes in doctors’ bedside manner might have been

counter-productive. “Doctors feel more and more bound to warn patients

about any possible consequences of taking a drug,” says Arthur Barsky

of Harvard, which can mean reeling off a long list of possible, albeit

unlikely side-effects. “There’s clearly a fundamental reason for

putting out health information,” he says, “but I think it’s become a

kind of hysteria.” If that hysteria means that more patients stop

taking a medicine, having been put off by possible side-effects, then

both the effectiveness of medical treatments and people’s confidence in

conventional medicine is undermined. It is one reason, says Barsky,

that people are putting increasing faith in alternative therapies. And

a loss of confidence in conventional medicine and its practitioners

might itself induce a nocebo effect that detracts further from its

efficacy.

We are actually freer from serious illness than our grandparents were,

and yet we worry about our health more than they did. Barsky calls this

the “paradox of health”: dramatic improvements in our clinical

well-being, accompanied by a rise in dissatisfaction with our health

and a tendency to report more symptoms. He suspects that excessive

awareness-raising is at least partly to blame.

at UCL has coined a phrase for the overemphasis on possible

negative outcomes by health professionals and their political masters:

compulsive risk assessment psychosis, or more succinctly, Crap. The

phenomenon has emerged, he says, from a climate of low and declining

trust, in which the health professions practise defensively. “The

doctors aren’t trusting their patients not to sue them. There’s all

this ass-covering going on all over the place.”

But if they don’t look out, health professionals and policymakers might

find that this strategy has left them dangerously exposed to attack

from other directions. Legal cases brought against mobile phone

companies by people who believe that the electromagnetic radiation

given off by their handsets is making them ill might have failed, but

cases brought against those who issue health warnings, on the grounds

that it exacerbates illness through the nocebo effect, might prove more

successful. At least they would have some scientific evidence to

support their claims.

Stuart Blackman is a freelance writer with a focus on science and the

environment

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