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We’ve all heard of the placebo effect in which around 30% of patients will respond to any treatment. My wife coined a new term this morning: the cynical effect. This is the opposite of the placebo effect in which nothing you do heals a patient. Let me explain.
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The Cynical Effect is where
nothing you do helps a patient.
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My wife has hypothyroidism and has been dealing with thin, friable fingernails (a common symptom of the disorder). She’s been taking an over-the-counter supplement for the past couple of months without any effect. This morning, she was looking at the ingredients of her supplement, and it turns out the first two are corn syrup and glycerin. There’s basically nothing in the pill of chemical therapeutic significance!
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This started us off on a discussion about the relative merits of a pill with no active substance, at which point my wife said, “It’s too bad I’m a cynic. The placebo effect won’t work on me.” And it really doesn’t! As if she is a robot, medications and other treatments will work on her when they’re legitimate and will not when they’re bunk. She’s a veritable laboratory of what works and what doesn’t.
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This has me thinking…
Could there be an opposite to the placebo effect, a cynical effect?
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One of the well-cited mechanisms for the placebo effect is the idea of “expectancy”.1,2 If the substance or treatment is viewed by the patient as helpful, then it will, in fact, be helpful and vice versa.
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Unfortunately for my new cynical effect term the “vice versa” I mentioned above (in which a patient who believes a treatment will not help leads to the treatment being ineffective) is actually called the nocebo effect. In addition to the psychological explanation, dopamine release has also been demonstrated in association with the placebo effect.1 I’ll keep using these two terms interchangeably just because it’s fun!
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In my almost 10 years of active practice since training, I’ve learned that there are some patients who will recover seemingly no matter what I do, while there are a – thankfully small – number of patients who don’t resolve their medical complaint no matter what treatment I throw at them. Could these patients suffer from the cynical or nocebo effect?
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Here are some signs and symptoms of patients potentially suffering from the cynical effect:
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A lack of facial emotion (flat affect) and generally poor social interaction.
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Saying they suffer from 10/10 pain despite sitting comfortably and not in visible pain.
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A prior diagnosis of fibromyalgia, anxiety, or depression.
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Anyone who has been to several other physicians for the same problem without success and says, “You, doctor, are going to be the one to save me.”
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A diffuse, nonfocal pain that seems to be “everywhere.”
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Let’s call someone with these characteristics as suffering from You-Can’t-Help-Me Syndrome. Sounds really scientific right? I know! I love it. We should call the American Psychiatric Association and have them add it to the next Diagnostic and Statistical Manual of Mental Disorders. Good idea? Ok, maybe not….
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Perhaps those experiencing the nocebo effect just need a little more dopamine when they come in to the doctor. Until someone invents a pill just for this, we’ll have to remain vigilant for those patients who suffer from You-Can’t-Help-Me Syndrome.
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