Nausea and headaches are typically reported side-effects of the jab. Yet some people get them when given a dummy drug. What’s going on?
The Times
Helen Rumbelow
Gerry Gajadharsingh writes:
“This is a really interesting article published in The Times and based on a forthcoming book about patient expectations, and the effect they can have, both positive and negative on clinical outcomes.
I’ve written before on the effect of placebo and what is sometimes called placebo plus and how we can use this to enhance clinical outcomes. Placebo used to be a dirty word in medicine, certainly when I started my undergraduate training almost 40 years ago. Luckily, we are much more enlightened now and we can see the positive aspects of using as many things as we can to improve patient outcomes. So, adding placebo to whatever therapeutic intervention clinicians and their patient feel is going to improve their clinical problem (placebo plus) is generally helpful.
Obviously, the question arises, what if the psychology of the patient believes that the intervention may well cause side-effects, or in the case of catching coronavirus, is going to give you really nasty symptoms, hospitalise or kill you or even if you survive you may go on to develop long Covid symptoms.
So, when the Lancet publishes that 25% of 45,000 people involved in testing Covid vaccines developed serious fatigue and headache after receiving a dummy jab (i.e. there was nothing in the injection), which was a very similar rate to the side-effects of those people actually receiving a proper Covid vaccine, hopefully that makes you think.
There are many people, particularly as they get older seem to take multiple medications with the risks of adverse reactions. But there are now increasing numbers of people who seem to be afraid of taking any medication. I know some medical colleagues sometimes wish that the extensive information leaflets enclosed with most prescription drugs sometimes weren’t there (for some people!).
Patient expectations, also play a very big part in whether patients are satisfied with the diagnosis and treatment provided by their clinicians. Inevitably what most patients want is a complete cessation of all of their symptoms, sadly, for multiple reasons this is sometimes not possible. Society has now become so risk averse that the choices that we make as individuals, and which businesses and governments make on our behalf will often have unintended consequences, such as the devastating economic consequences which have already occurred for many people and which will continue to occur in increasing numbers over the next few years, never mind the impact on both NHS and private healthcare treatment for non-Covid conditions.
After watching the excellent film The Irishman there is a wonderful phrase when Robert De Niro is talking to Al Pacino and he says “it is what it is”.
Sometimes we all wish that what we have was different or that there was a simple cure sometimes there is and sometimes there isn’t. Accepting that “it is what it is” then allows us to deal with in the best way we can with treatment and advice from clinicians who care for you. Sometimes we also have a part to play in better understanding how our minds, the way we think, what we believe and our lifestyles can contribute towards disturbed physiology and eventual disease and therefore improving these things can improve our physiology and improve our health And I’m not talking about just the usual culprits of smoking alcohol and recreational drugs.
Covid vaccination is a particularly relevant topic at the moment. People are finally understanding that just because you’ve had your Covid vaccines even boosters does not prevent you catching Covid. Science and medicine can do what it can to help us we all have a responsibility to understand and see if we can actually improve our own immune systems.
If you want more of my thoughts on this, wait till my next blog which will discuss a good article in the Telegraph regarding my some people seem to keep on catching the coronavirus”
You’ve probably had a Covid vaccine or three in the past year, and may have joined the vast numbers of people sharing — let’s not say moaning about — how the jab left them poleaxed with fevers, headaches and biblical agues. Just hearing your brother-in-law wang on about his side-effects can act like a medication on your brain and this, rather than the vaccine itself, can give a large proportion of us real and horrible symptoms. “Nocebo” — when negative expectations of a treatment create their own side-effects — is placebo’s bad twin, and just as potent.
To illustrate: a study in The Lancet of 45,000 people involved in Covid-vaccine testing showed that in those being injected with nothing, a dummy jab, about a quarter reported serious fatigue and about a quarter headaches — not far off the figures reported by those getting the vaccine. Previous studies show that the more you hear about side-effects, the more likely you are to experience them. Yet I bet, if you’re anything like me, you’ll tell yourself you were not one of the ones “imagining fake illness”, because that somehow reeks of hysteria and is quite frankly embarrassing.
David Robson, in his new book, The Expectation Effect, is here to tell us that this is far from embarrassing — it is one of the most exciting new areas in medical research. The power of expectations on your body is extraordinary, both to harm and heal: it could reduce obesity, increase fitness, save the NHS millions by speeding up healing, even “have real consequences for your longevity”. For example, in one Harvard study, hotel cleaners, who had little time to exercise, were carefully instructed as to how their daily cleaning activities actually were as good as an exercise regimen for their fitness and health. Within a month their fitness had measurably improved, and their average blood pressure went from elevated to normal: “Real physiological benefits, without any change in lifestyle,” Robson says.
For those of us deciding on a new year overhaul to better ourselves, put down that dumbbell for a moment. This book goes against all this season’s self-lacerating advice: to feel better you need to think better. Can you improve your health by mind power alone?
“It’s nothing to be ashamed of: it’s actually powerful,” Robson tells me.
I’m aware this is sounding like a book written by someone in wafty guru trousers promising gullible readers they can think themselves rich — as rich as the writers of books about thinking yourself rich. But Robson is not that person. As I sit in his London flat with a mug of tea, he is neat and precise, which makes the mind-over-matter studies he reports on in his book — one found people’s digestive systems absorbed more iron the more they enjoyed their meal — all the more intriguing. Are we Jedis now?
After graduating with a maths degree from Cambridge, Robson has had a career in science reporting, working for the BBC and New Scientist. He stumbled upon the “expectation” field while researching an article on “nocebo”. This research was hampered by the mother of all migraines, “like an ice pick had penetrated” his skull. He knew the cause. He had begun taking antidepressants for the first time and his GP had warned him of headaches. Robson then learnt how side-effect warnings alone induce side-effects: for example in Britain, where the muscle pain side-effect of statins is regularly discussed, far more muscle pain is experienced than in Europe.
“I saw the research on nocebo, I opened my mind to that possibility and then the headaches vanished,” Robson says.
How quickly? “It was almost instantaneous.”
That’s just one anecdote, but Robson has spent three years collating research into this effect, which has yet to be exploited fully because it meets with such resistance. First, rational people don’t like to be told they have “psychogenic” symptoms, there’s a stigma to it. This is a timely problem because in our Facebook age, and never more than in this pandemic era, we have created an anxious modern culture that could not be more prone to encouraging catastrophic thoughts about our health, and so induce worse symptoms.
Second, scientists have long been hampered by this field’s false association with books such as Rhonda Byrne’s The Secret, a 35-million-copy bestseller about “manifesting” good fortune, lately much popularised on TikTok. We don’t like hucksters, or conversely to feel like suggestible hypnotist’s marks. Another bad precedent is the “positivity” cult of the 1990s that bullied cancer patients with the idea that if they only cheered up they’d be cured. Robson cites studies that show denying the difficulty of a situation can lead to worse outcomes. It’s not quite true what Hamlet, the well-known health influencer, said about there being nothing good or bad “but thinking makes it so”.
“If you want to lose weight, Rhonda Byrne might ask you to imagine yourself being thin. That’s not going to do any good,” Robson says. “I am concerned that people would mistake it for those types of pure pseudoscience. The difference with this book is that it is based on clear evidence. I’ve referenced 450 scientific studies, so this isn’t wishful thinking.”
That said, it’s hard not to feel there is something a bit “witchy” about the power of mind over body, because it is something that science is only just beginning to explore and Robson acknowledges many of these studies are small. However, we all have examples from our own lives that we repeat with awe: the deathbed father who “hung on” until his son reached him to say goodbye; the widow who died of a broken heart; the mother who lifted a car with superhero strength to save her baby.
“I think we have an intuition that our thoughts can affect important outcomes,” Robson says. “It’s probably something we have experienced ourselves. But we don’t really know how to use that effectively. This research puts clear boundaries on what can and can’t work, and how you should reframe your expectations.”
One hypothetical biological pathway for this effect is that our bodies create inflammation when trying to rid ourselves of a pathogen, but that inflammation delays long-term healing. The faster you can convince your body, via your mind, to rein in inflammation, the better. It has long been known that placebo medicines do this by giving the expectation of relief: “dummy” skin cream reduces the size of weals in an allergic skin reaction.
But it’s also true of shifts of pure mental outlook if, Robson argues, you can convince your mind in specific ways. In one study participants were given an itchy rash. Those that were told the rash was fleeting recovered quicker than the control group. The same effect was shown in patients visiting their GP about the common cold. Those patients whose GP stressed the cold was fleeting recovered on average a day earlier. One German study of patients getting a heart bypass gave two groups sessions with a psychologist in advance. One group got general emotional support, the second group explored in detail the benefits of the operation. This second group was released from hospital several days earlier, and had lower levels of inflammatory markers at the six months follow-up.
“A doctor’s visit without a prescription is not wasted. Doctors’ words are biologically active and are having an effect just as if you put a cream on the patients with the rash,” Robson says.
“For the heart operation patients, they not only got out of hospital quicker but they got back to work quicker, all those things that are costing individuals and the country quite a lot.”
As professional athletes often attest, the extremes of human performance are dependent on mental “toughness” and there is an interesting discussion in this book on placebo doping, which is effective as long as the athlete believes they are taking an illegal drug. But for the park jogger, the same applies. First, don’t age yourself out of the fitness game: many studies show how predictive your feelings about your age are of your physical frailty, not the other way around. In one example a lab experiment on older people who were primed with negative age stereotypes had higher blood pressure when subsequently given stressful challenges.
“These beliefs are the hardest to change because ageism is so pervasive.”
We are prejudicing people to death? “And it’s socially acceptable at the moment.”
Second, keep your mind open to the possibility of untapped potential that can be accessed almost effortlessly: for example a study of cyclists asked to ride to exhaustion for a few minutes managed to increase their stamina by 18 per cent when the clock was rigged to run “slow” and they didn’t notice. In one weird study, people who thought they were fit did better on physical metrics independent of how fit they objectively were. Diets don’t work because your brain feels denied; healthy eating needs to ooze luxury and indulgence.
Apart from being a glimpse at medicine of the future, this book guards against predictable new year gloom: don’t think you’re unfit; don’t think you’re getting too old; don’t think about restricting food and, this year especially, don’t dwell too long on Covid horror. We can expect better.