How about a double fake

This is interesting:

Before getting their prescriptions, half of the men were told about a small risk of erectile dysfunction and other sexual side effects; none of the men had a history of such troubles. Of the men who got the warning, about 44 percent developed these symptoms. But among those kept in the dark, the rate was far lower: only about 15 percent.

It’s known as the nocebo effect: When patients are warned of possible pain and unpleasant side effects, it increases the likelihood that they’ll experience them. If the placebo effect—in which positive patient expectations can be therapeutic—is relatively famous and well explored, the nocebo effect is its little-known evil twin.

It is both encouraging and discouraging because it shows how much of healing is affected by the mind. It also shows the usual interplay of two or more ideas that are both thought to be good:

“There was a push in the field to tell patients every possible risk,” says Dr. Frank Chessa, associate director of the ethics and professionalism course at Tufts Medical School. “What do you need to tell the patient? You need to tell the patient everything.”

But what doctors say, it turns out, can have unintended health consequences. Even subjects who get a placebo in drug trials routinely experience precisely those side effects listed on the informed consent documents.

The easy solution would seem to be to not mention side effects unless it’s necessary but, as the article notes, that’s not easy:

side effects do occur independent of a nocebo effect, and many are “mild” only “as long as the patient stays in bed.” Even a small risk of drug-induced drowsiness is serious for a school bus driver, for instance.

From a legal perspective, then, telling a patient about every possible side effect is safer. There are other pragmatic concerns as well: Making nuanced decisions about contextual informed consent rather than routinely telling every patient everything takes time and more personal attention, in an era when doctors’ time per patient is on the decline. “It requires a collaborative relationship with the patient, to explain what the nocebo effect is,” says Dr. Wayne Altman, the director of student education in the department of family medicine at Tufts Medical School, who teaches the importance of encouraging positive thinking in conversations with patients. “Because if they don’t trust what I’m telling them, they can just go home and look it up online in two minutes.”

and thus we get to the really issue: part of being a good doctor is spending time with patients and that’s not allowed in our current system. If doctors were able to spend more time with their patients then this power of the mind could be, perhaps, be directed and reduce the need for strong medication and reduce the number of unwelcome side effects.

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