I recently came across a fantastic resource for current developments in medicine. It is a weekly subscription to The Scope, check out one of their short and sweet articles below on the Placebo Effect.
Just like you feel worse when your friends remind you that you’re working Friday night, patients feel worse when they’re reminded that they’re taking meds. New research explores the nocebo effect in statins.
The placebo effect, where patients feel better after treatment with an inactive substance, is old news. But the nocebo effect, where patients pin unrelated symptoms on a prescribed therapy, is less well-studied. Statins have been a poster child: despite proven efficacy, over 200,000 patients in the United Kingdom stopped taking their meds after media reports surfaced of increased rates of myalgias in statin users. Multiple blinded RCTs have found no difference in myalgias between those taking statins and placebo.
ASCOT, a double-blinded RCT that evaluated the use of atorvastatin in over 10,000 hypertensive patients, was stopped early after demonstrating that statins decreased heart attacks compared to placebo. Investigators then followed patients for a 3-year non-randomized, unblinded trial extension. Though there was no difference in adverse events while the study was blinded, once patients knew they were on statin therapy they suffered increased rates of myalgias, connective tissue-related issues, and hematologic complaints compared to placebo, even after adjusting for baseline differences between groups. Lancet
We’ve all seen our patients decline therapies with real but rare side effects (the flu shot in particular comes to mind). This study is among the first to formally demonstrate a nocebo effect, something that may increase with the rapid spread of sensational news.
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