Recognizing and publicizing the potential contribution of nocebo responses can be helpful in generic substitutions.
Implications for COVID vaccinations
Vaccinators should avoid inadvertently contributing to nocebo responses when counseling their patients. They could use positive framing on the very low risk of serious adverse events. They could also briefly explain that nocebo responses are common and self-limiting.
However, my own experience as a patient receiving three COVID vaccines was disconcerting. No one in the various vaccination teams said anything positive about the vaccine or its effectiveness in preventing me or my family from catching the virus, or in reducing the severity of the disease if we did. .
And right after I got the third injection, I was even more worried about warnings about chest pain and reminders that I needed to see a doctor right away if I had any. This additional information about heart problems as a potential adverse event followed recent concerns about rare cases of myocarditis after vaccination.
All of the vaccination staff were conscientious and kind, but it seemed odd that they weren’t tasked with discussing the benefits of vaccination. This could have been a useful approach to tackling vaccine hesitancy nationwide.
Although well-intentioned, it is possible that a focus on serious vaccine side effects could increase the incidence of nocebo responses in a population already primed for them. This could mean that more patients will present to their doctors or emergency departments with symptoms unrelated to the vaccine itself.
How to improve awareness
For the record, the advice of vaccinators seems quite variable. It may be helpful for them to incorporate an understanding of potential placebo and nocebo responses into their vaccination advice to each patient.
Health authorities and healthcare professionals need to understand the meaning of the responses and their role in clinical practice. Incorporating this knowledge into health care communication can prevent unnecessary patient anxietyworrying symptoms and considerable health costs.
Respecting autonomy means patients should be asked if they wish to receive information about side effects or adverse events. It’s about how to inform patients of the very low risk of serious harm while not increasing their apprehension.
Pandemic research is now also exploring potential parallels between long COVID and other chronic diseases such as myalgic encephalitis/chronic fatigue syndrome as well as tentative associations between negative childhood experiences and vaccine hesitancy.
Without wishing to minimize the devastating impact of the pandemic, it provides us with useful information on broader current medical and sociological issues.
Hamish John Wilson is Associate Professor of General Medicine at the University of Otago.