A brand new study of studies in the European Heart Journal has found that the majority of people who take statins and report side effects are actually experiencing the “nocebo” effect.
The study suggests that the prevalence of true statin-intolerance is between 6-10%, and yet nearly 50% of patients on statins either reduce their dose or stop taking the drug altogether over side effects.
In other words, for the majority of folks, anxiety about the statin is causing the side effect, not the drug’s properties itself.
Which is called the “nocebo” effect, “a situation where a negative outcome occurs due to the belief that the intervention will cause harm.”
Professor Maciej Banach, who led the study noted:
“These results were not a surprise to me but they were for many other experts. They show that in most cases statin intolerance is over-estimated and over-diagnosed, and they mean that around 93% of patients on statin therapy can be treated effectively, with very good tolerability and without any safety issues.
“Our findings mean that we should evaluate patients’ symptoms very carefully, firstly to see whether symptoms are indeed caused by statins, and secondly, to evaluate whether it might be patients’ perceptions that statins are harmful – so called nocebo or drucebo effect – which could be responsible for more than 50% of all symptoms, rather than the drug itself.”
While the study was specific to statins, the nocebo effect is a common phenomenon in the context of other medications.
This is why so many people in the placebo group of a drug trial (in other words, they don’t take the medication) of a clinical trial still experience adverse reactions.
The mind expects it, worries about it, and then feels something that’s actually real, but not a side effect of the drug.
As Harvard’s Dr. Ted Kaptchuk tells The Financial Times, “A nocebo response feels exactly the same as the side-effect from a drug.”
That’s because anxiety is such a powerful force when it comes to affecting our physical health, and a 2016 study in Pharmacology Research & Perspectives found that patients with anxiety, depression, and a pessimistic outlook are more likely to experience the “nocebo” effect.
I’ve chronicled quite a bit of the ways anxiety can produce genuine symptoms (for example, who could ever imagine that anxiety could cause…a fever!), and taking a new medication is particularly fraught for many of us.
This can have a huge impact on our lives.
For example, many discontinue or lower their dose of statins because of the “nocebo” effect.
That puts them at major risk of a cardiovascular event.
That’s why it so important to always talk to a doctor frankly and deeply about these things.
There’s no doubt statins can have real (and sometimes dangerous) side effects, but the study suggests that most side effects of statins come from our minds, not the medication.
This has implications for our relationship with life-saving medications, vaccines, and the entire medical industry (which, unlike many evangelical Christians these days, I believe are all gifts from God).
(I give a big thanks to God for big pharma. Sure, they’re making profits. But they’re also saving lives, helping people manage pain, just generally doing a lot more good than 99% of companies).
Now, I’ll speak about my own experience. Just personally with this issue.
I have generalized anxiety disorder.
And I get really anxious every time I start a new medication, and those leaflets can be terrifying.
“If 30 potential serious side effects can occur (however rare), isn’t there some chance that I’ll experience at least one?”
Yes, my brain says, even though statistically, I know that chances remain remote.
And guess what?
I do experience lots of “side effects” to medicine, but I know a great many are thanks to the nocebo effect.
Why’s that?
Well, first off, before I developed an anxiety disorder, I didn’t experience a single adverse reaction to any medicine.
That’s not to say that medicines don’t cause adverse reactions. They can!
It’s just to say that my own body never experienced adverse reactions to medicine.
And then I developed generalized anxiety disorder, and started reacting to almost everything. Interesting, I thought.
And I’ve now learned that if I take my anti-anxiety medicine, concurrently with a new medication, the vast majority of the time — I don’t experience side effects from the new medication.
If I don’t take my anti-anxiety medicine with the new medication, then I’ll probably experience at least ten of the side effects listed on the leaflet.
So I know that I’m particularly prone to the nocebo effect.
Of course, that’s not to invalidate anyone else’s experience, because there have been plenty of true adverse reactions, directly related to the body’s experience of any medication, but the nocebo effect is real.
John Gapper points to a study published this year in JAMA, that showed 35% of participants in Covid vaccine placebo groups experienced adverse effects after their first “dose.”
That’s jaw-dropping.
In other words, 35% got injected with nothing and experienced adverse effects.
That 35% might be particularly prone to anxiety, and anxious folks are the type to fill up the discussion boards and the Facebook groups with alarming misinformation about what the vaccine does.
In turn, that disinformation can lead to the loss of countless lives.
So the “nocebo” effect is very real and, as seen in the case of statins and the Covid vaccines, can have life-or-death consequences.
And if you have anxiety, depression, or a pessimistic outlook on life, you’re statistically more likely to experience the nocebo effect.
Of course, that’s not to invalidate anyone’s experience with side effects. I want to emphasize that. You know you, and your doctor knows you.
And we know that drugs have side effects, and can have profound ones, and we always talk to our doctor.
But it’s also a reminder of self-awareness, and that treating our anxiety is absolutely crucial to our overall health.
And to help manage that anxiety…
Find a psychiatrist here.
Find a therapist here.
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