Wednesday, January 25, 2012


Recently a ER+ positive BC survivor was told by her new oncologist that she should switch from taking tamoxifen to the newer aromatase inhibitors (AIs) due to her decreasing bone density and presumably better survival with the AIs. I asked what did he tell her about the side effects of the  AIs?
Many women report crippling joint and bone pain from AIs (many of these women are my readers). This is a well known and very common side effect. Why wouldn't he have mentioned that to her? Certainly he knows..
I am going out on a limb here and assuming he is trying to prevent the nocebo effect. The nocebo effect is just as real and strong as the placebo effect. You tell someone certain things can happen and then they report that that they do even with inert "sugar'" pills. The negative are the 'nocebo' and the positive are the 'placebo'.
Well I wrecked that by rattling off the all side effects  I knew. Of course she could have read the package insert too. IMHO, she should know all the facts ahead of time before making a decision.

Before I had babies, I was listening to a friend practice for being a  LaMaze instructor. She accidentally used the word 'pain' a few times and quickly corrected herself and told me she was told never to use that word because anticipation of pain increases the perception of pain. She already had two babies with difficult, painful births. I asked her if she didn't feel a tad dishonest implying this all will be a piece of cake if you just would breathe correctly. She thought her births were exceptions (she is tiny; husband big: babies got their size from Dad).

The placebo effect is especially powerful for antidepressants. Allegedly effective ones are barely statistically superior to the placebo. I can understand why the placebo effect is so strong for treating pain but I was puzzled with its effect in depressed people. Don't they feel hopeless and nothing will ever become better? But I was told that even depressed people really want to get better.

What is shocking to me is that physicians actually prescribe known placebos to their patients. Of course they have to tell them or it would not be ethical. I imagine the speech goes something like this:

I am going to prescribe you a placebo today. In some studies, it is just as effective as X and with fewer side effects.

Sounds good to me, doc.

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