Review of *This Book May Cause Side Effects: Why Our Minds Are Making Us Sick* by Helen Pilcher
Back in the early days of Viagra—the famous “little blue pill”—I came across a story about a woman who decided to try it for herself. After all, if it’s beneficial for men, why not for women too? She took the pill and described an incredible night of intimacy. Best experience ever! But come morning, she realized the blue pill was actually Aleve. At least, no headache there.
Most of us are familiar with the placebo effect, right? That inert “sugar pill” given to a control group during trials while the experimental group receives the actual drug. It helps researchers measure the drug’s real benefits, free from the influence of expectations. Interestingly, studies on Viagra for women showed that they often did better on the placebo, leading Pfizer to reconsider their strategy. Expectations can play such a huge role: the more substantial the placebo—be it a larger pill or even a sham surgery—the greater its impact. On the battlefield, when soldiers are out of morphine, a saline solution given under the pretext of being a strong painkiller can relieve their suffering.
Then there’s the notion of the nocebo, which Pilcher explores in her book. She dives into how our negative expectations can affect us, much like the placebo operates on positive expectations. If you felt chills or headaches post-COVID shot, chances are, it’s because you were told those are common side effects. Reading a list of potential symptoms for a new medication? You might find yourself experiencing some of them, or even opting out of the medication altogether. “Just thinking about certain foods can make you feel unwell,” she argues. Many who believe they’re intolerant to ingredients, like gluten or lactose, may owe their distress to psychological triggers rather than physical reactions. People with gluten intolerance given gluten-free bread but told it contained gluten often suffer gastrointestinal issues, while those unknowingly eating regular bread labeled gluten-free feel perfectly fine.
Pilcher makes her case about the nocebo in twelve chapters, discussing everything from hexes to “psychogenic” deaths without a clear physiological cause, and the potential downsides of labeling illnesses. Her argument suggests that nocebo effects can create real symptoms, including allergies, with no underlying cause. While there isn’t a strong scientific distinction between placebos and nocebos—they both reflect how beliefs can influence physical health—the nocebo is a hot topic right now. Pilcher emphasizes that nocebo effects are broader and more powerful than most might think: “Every illness can be worsened by our thoughts.” But does she truly mean every single illness, or just that many might be influenced?
That ambiguity somewhat detracts from her argument. While detailing every study she mentions could be overwhelming, a lack of specific numbers or percentages leaves us uncertain about the validity of her claims. One passage discusses a study where people falsely diagnosed with a negative gene variant performed worse in endurance tasks, but how many people were involved? Are we talking about a handful or a significant number? Such vagueness, paired with dramatic anecdotes about stress-related deaths, might weaken her claim that nocebo effects apply to everyone. Did Johnny Cash really die from heartbreak or complications from diabetes? It’s a fine line.
More troubling is her uncritical acceptance of outdated or discredited studies, like the “Pygmalion” experiment showing teachers boosting students’ IQs through expectations. Pilcher seems too enamored with Ellen Langer’s long-criticized studies, failing to verify their validity. Langer’s claims regarding hotel maids losing weight simply through reframing their tasks as “exercise” are called into question, as reliance on self-reported data blurs the line on actual activity changes. And the “counterclockwise” experiment where elderly men supposedly reversed aging effects by living in a retro setting has never been peer-reviewed or replicated.
Yet, some studies Pilcher includes are striking. In one, 60 patients who had previously stopped taking statins due to side effects were asked to try them again, receiving a mix of statins, placebos, and empty bottles over a year. They reported their symptoms daily, and it turned out that 90% of reported symptoms when on statins were also experienced with the placebo. This suggests that many side effects might stem from patients’ expectations rather than the medication itself.
In her concluding chapter, Pilcher proposes strategies to combat the nocebo effect. For instance, reframing pain post-injection as evidence of medication effectiveness rather than potential side effects can be helpful. When cautioning about medication’s possible headaches, focusing on the majority who don’t experience them may shift perspectives. For those suspecting gluten allergies—unlike individuals with celiac disease—why not try a double-blind study with a friend? What’s the worst that could happen? You might just rediscover a whole world of delicious bread.
