Why health warnings can be bad

Here seems to be a counter attack to poo-poo people with ES.
"Rubin has little doubt that the symptoms exhibited by  
electrosensitives are real. “Something cognitive is going on –  
something to do with the expectation is triggering the symptoms,” he  
says. And the idea of a psychological basis to electrosensitivity is  
supported by the fact that cognitive behavioural therapy can be an  
effective treatment."

Any body know of an effective "cog behav therapy?"
Andrew



Full Transcript:
Why health warnings can be bad
By Stuart Blackman

Published: April 25 2009 01:27 | Last updated: April 28 2009 12:33
http://www.ft.com/cms/s/2/0d9499ec-2d75-11de-9eba 
-00144feabdc0,dwp_uuid=a712eb94-dc2b-11da-890d-0000779e2340.html

It is perhaps surprising that scientists behind an experiment conducted  
at the University of California 25 years ago were able to recruit any  
volunteers. The researchers, purporting to study the effects of  
electric currents on brain function, warned potential participants that  
electrodes would be strapped to their temples, and could cause serious  
headaches. Despite this, 34 students came forward. At the end of the  
trial, two thirds of the volunteers did report headaches – despite the  
electric current never having been turned on. Such is the power of the  
“nocebo” effect, the real subject of the experiment. The current had  
not been switched on because the scientists were investigating whether  
expectation alone could make healthy people ill. Apparently it could.

In the 25 years since then, research has been accumulating that the  
nocebo effect – the evil twin of the better-known placebo effect – is a  
widespread phenomenon that affects many aspects of our lives and which  
might contribute to a host of 21st-century ailments, from food  
allergies to obesity, chronic fatigue, back pain and  
electrosensitivity. Some experts are concerned that the situation is  
being compounded by the efforts of health professionals to raise  
awareness of threats. “When someone receives a placebo and they get  
better, it’s because of a variety of self-healing processes in the body  
that are cognition-related,” says Brian Hughes, a psychologist at the  
National University of Ireland, Galway, who specialises in how mental  
stress affects physical health. “One expects to get healed and certain  
symptoms go away.” In the case of the nocebo, it is negative  
expectations that become self-fulfilling prophecies.

When we expect something to make us ill – electrodes wired to our  
temples, for example, or, more routinely, a medicine with known  
side-effects – we start looking for signs of illness. And we’ll  
probably find some, says Hughes, even if the pill is a dummy one or the  
electric field a sham. That is because unpleasant physical symptoms are  
a normal part of life for perfectly healthy people. Headaches come and  
go. Some nights it is hard to get much sleep, and some days it is  
difficult to keep our eyes open. We might feel light-headed one moment  
and in a bad mood another. These are all experiences that we would not  
think twice about were we not looking for signs that things are wrong.  
But when we are looking, it is easy to interpret a bad night’s sleep as  
insomnia, tiredness as fatigue, light-headedness as dizzy spells or a  
bad mood as depression – and then to reattribute those symptoms to  
whatever it was that we expected to harm us. And once we start  
believing that something is making us ill, we get anxious, which can  
itself exacerbate existing symptoms or induce others. “Anxiety  
generally leads to elevations in blood pressure and immune deficiency,”  
says Hughes. And more symptoms mean more anxiety.

Everyday expressions such as “worried sick” or “scared to death”  
suggest that the link between negative emotions and ill-health was made  
long before the phenomenon was given a medical label. But once in the  
realm of scientific investigation, the nocebo effect started turning up  
with surprising frequency. It is now recognised as a regular occurrence  
in double-blind clinical trials of new medicines, where people taking  
an inert, placebo control pill develop side-effects of the drug being  
tested – if they are warned about them beforehand. If the nocebo effect  
can make us ill in clinical trials, it can also do so in real life.

Placebo and Nocebo effectsJames Rubin, researcher at King’s College  
London, has been following up the early Californian experiments to  
investigate the role of the nocebo effect in a debilitating condition  
that afflicts increasing numbers of westerners, including, reportedly,  
one in every 20 Swedes. Electrosensitivity is supposedly caused by  
exposure to the electromagnetic fields given off by power lines, mobile  
phone handsets and masts, wi-fi and other electrical appliances.  
Sufferers report a range of symptoms, including headaches, tingling  
skin, dry throat, eye irritations, problems with memory and  
concentration, dizziness, inflammation and muscle and joint pains.

Crucially, Rubin’s research provides little reason to think that the  
reported symptoms are caused by the electromagnetic fields. “There is  
no robust evidence that there is a direct link, and there is reasonably  
robust evidence that there is no link,” he says. Experiments show that  
electrosensitive people are no better than anybody else at identifying  
when they are being exposed to an electric field. And when they are  
exposed, sufferers report more symptoms only if they have been told  
that they are being exposed. It is this sort of evidence that has led  
to the failure of court cases brought against mobile phone companies by  
people who believe their symptoms to be caused by their handsets. Rubin  
has little doubt that the symptoms exhibited by electrosensitives are  
real. “Something cognitive is going on – something to do with the  
expectation is triggering the symptoms,” he says. And the idea of a  
psychological basis to electrosensitivity is supported by the fact that  
cognitive behavioural therapy can be an effective treatment.

Even non-specific worries about the state of the world in general can  
be enough to make us ill, according to research from the University of  
Auckland. Prior to a huge pesticide-spraying programme in New Zealand,  
people were asked about their attitudes towards new technologies and  
environmental threats. After the spraying, those who were most  
concerned about the health risks reported the greatest number of  
symptoms.

If negative expectations generate symptoms, what generates the negative  
expectations? John Adams, professor emeritus at University College  
London and an expert on risk, says there is a current fashion among  
health professionals and other authorities for issuing precautionary  
advice concerning the health risks posed by new medicines and  
technologies. And that, he says, is a major contributing factor.

Despite finding a dearth of evidence for a risk to health from mobile  
phones, The Stewart Report, published in 2000 by the Independent Expert  
Group on Mobile Telephones and Health (and named after the group’s  
chairman, Sir William Stewart), recommended that people limit their use  
of the technology, just in case. Adams says that such an ambiguous  
message is an example of just the sort of thing that can encourage  
people to keep an eye out for signs of illness.

A similar message accompanied the UK Health Protection Agency’s 2004  
report on the dangers of exposure to electromagnetic fields. “The  
report found no evidence of an aetiological connection between the  
fields and the symptoms,” says Adams. “And yet at the press conference  
that launched it, they went beyond that and said that people who  
believe they are sensitive should stay away from electromagnetic  
radiation.” Hence the ensuing headline from the Daily Mail: “Household  
appliances such as kettles, computers and microwaves could be health  
hazards, a government expert suggested yesterday.” The Swedish  
government has issued similarly precautionary advice.

“This process is more general than just taking a pill,” says Arthur  
Barsky, professor of psychiatry at Harvard Medical School. “However you  
induce negative expectations – whether it’s through a pill, a health  
warning or advertising by a drug company – you set in motion the same  
process of symptom reattribution, which then amplifies the symptom,  
which further solidifies the reattribution.” David Wainwright, a  
sociologist at the University of Bath, agrees that health warnings  
issued for precautionary reasons can be bad for our health: “It’s a bit  
like flicking through a medical encyclopaedia and imagining you’ve got  
symptoms of disease X, Y and Z. But this effect has a lot more potency  
when it’s a health professional telling you this stuff.”

Not even health professionals are immune. Medical students, who flick  
through more than their fair share of medical encyclopaedias, are  
themselves susceptible to a phenomenon known as “medical students’  
disease”, whereby they develop symptoms of whatever condition they  
happen to be studying. Research has shown that medics display more  
signs of hypochondria than their peers studying law. Today, the  
“worried well” are more likely to go online than to a library to  
self-diagnose, in which case patient websites such as Medinfo or  
NetDoctor could be exacerbating symptoms at the same time as raising  
awareness of them. No research has yet been conducted that directly  
addresses internet health sites and the nocebo effect.

But research published last year by psychologists at Harvard and Yale  
universities raises the possibility that even our weight is susceptible  
to the power of suggestion. The study looked at the health of hotel  
chambermaids over a four-week period. Half of subjects were told at the  
start that their work counted as good exercise that satisfied the  
recommendations of the US surgeon-general. A month later, they had lost  
weight and gained other health benefits such as lower blood pressure.  
Their uninformed colleagues showed no change.

This puzzling finding does not seem to be explained by extra exercise  
prompted by the briefing: this was weight-loss by placebo effect. And  
where there is a placebo effect, nocebo is often lurking in the  
shadows. In an age when health professionals and governments are  
inclined to talk of obesity as an epidemic, of the entire population as  
unhealthy and to demand that we exercise more, such pronouncements  
might be doing more harm than good. “I very much believe that health  
warnings can be adversely effective via a nocebo effect,” says Alia  
Crum, one of the chambermaid study’s authors. “Whether or not this  
overrides the benefit of getting the message out there is another  
story.” Her current research attempts to tease apart these conflicting  
effects.

Not all health warnings are likely to cause what they are intended to  
prevent. Warnings on cigarette packets don’t give anyone cancer, for  
example; in fact, no rigorous research has turned up evidence that  
cancer, or any other serious, fatal disease, can be caused or cured by  
the power of negative or positive thinking – although both might well  
influence the strength of the symptoms. But it is not the cancer  
statistics that many of these scientists fret over. Their concern is  
the rise of conditions such as back pain, fibromyalgia (chronic fatigue  
syndrome) and food allergies, which are characterised by the symptoms  
expressed rather than by the underlying biology. These symptoms may  
have a biological basis in some individuals and a psychological one in  
others. So, while rare and tragic deaths resulting from extreme food  
allergies can be attributed to physiological anaphylactic shock, health  
warnings on food that “may contain nuts” might be contributing to the  
rise of food allergies in general, and to the statistics that less than  
20 per cent of teenagers who believe they have a food allergy actually  
test positive.

“It’s quite remarkable how the illnesses that are increasing at the  
moment are not the big, killer diseases, grounded in real, physical  
pathology,” says David Wainwright. “It’s the subjective problems of  
everyday life that are becoming medicalised, where there’s no actual  
evidence of any physical illness. “Even hassles at work are interpreted  
through the medicalised category of work stress rather than political  
or industrial relations issues” – a practice that Wainwright says is  
promoted by government agencies. “Health policy is promoting this  
belief that we’re all at risk from absolutely everything we come into  
contact with, and that just encourages us to feel more vulnerable and  
to interpret our normal experiences as health problems. It’s all just  
amplifying this epidemic of non-specific illness, which has incredibly  
disabling effects on people.”

Certain changes in doctors’ bedside manner might have been  
counter-productive. “Doctors feel more and more bound to warn patients  
about any possible consequences of taking a drug,” says Arthur Barsky  
of Harvard, which can mean reeling off a long list of possible, albeit  
unlikely side-effects. “There’s clearly a fundamental reason for  
putting out health information,” he says, “but I think it’s become a  
kind of hysteria.” If that hysteria means that more patients stop  
taking a medicine, having been put off by possible side-effects, then  
both the effectiveness of medical treatments and people’s confidence in  
conventional medicine is undermined. It is one reason, says Barsky,  
that people are putting increasing faith in alternative therapies. And  
a loss of confidence in conventional medicine and its practitioners  
might itself induce a nocebo effect that detracts further from its  
efficacy.

We are actually freer from serious illness than our grandparents were,  
and yet we worry about our health more than they did. Barsky calls this  
the “paradox of health”: dramatic improvements in our clinical  
well-being, accompanied by a rise in dissatisfaction with our health  
and a tendency to report more symptoms. He suspects that excessive  
awareness-raising is at least partly to blame.

John Adams at UCL has coined a phrase for the overemphasis on possible  
negative outcomes by health professionals and their political masters:  
compulsive risk assessment psychosis, or more succinctly, Crap. The  
phenomenon has emerged, he says, from a climate of low and declining  
trust, in which the health professions practise defensively. “The  
doctors aren’t trusting their patients not to sue them. There’s all  
this ass-covering going on all over the place.”

But if they don’t look out, health professionals and policymakers might  
find that this strategy has left them dangerously exposed to attack  
from other directions. Legal cases brought against mobile phone  
companies by people who believe that the electromagnetic radiation  
given off by their handsets is making them ill might have failed, but  
cases brought against those who issue health warnings, on the grounds  
that it exacerbates illness through the nocebo effect, might prove more  
successful. At least they would have some scientific evidence to  
support their claims.

Stuart Blackman is a freelance writer with a focus on science and the  
environment

Copyright The Financial Times Limited 2009

"FT" and "Financial Times" are trademarks of the Financial Times.  
Privacy policy | Terms
© Copyright The Financial Times Ltd 2009.


Andrew McAfee
Music Director/Conductor Triangle Youth Ballet
Adjunct Instructor of Horn, University of North Carolina at Chapel Hill
Former Principal Horn, North Carolina Symphony (1992-2007)

919.787.3022









[Non-text portions of this message have been removed]

Stuart Blackman is a big fan of the nocebo effect, and
also writes on a blog called Climate Resistance that promotes disbelief in
global warming. He's a "freelance" writer. Just a PR guy in sheep's
clothing is my bet.

Where are the references to the Berkeley study on imaginary headaches? The
right way to do it is double blind, otherwise the experimenter can easily
browbeat someone into saying "yeah I guess I feel a little like I have a
headache". The nocebo effect was basically invented by the tobacco
industry, as an excuse to not warn people of the dangers.

Bill

On Tue, Apr 28, 2009 at 10:34 AM, Andrew McAfee <[hidden email]> wrote:


[Non-text portions of this message have been removed]

Hi Andrew
 
from day one this has always bothered me - that somehow I could have wishedthis illness on myself. I think there are  a couple of things going on here - they are trying to do with electrosensitivity what they did very successfully [and its odd that it should be the same King's College Hospitallot involved!!] with ME/CFS/CIFIDS - they are trying to portray it as a somatoform disorder which they maintain can be easily treated with CBT. They did this to ME/CFS etc because it suited them to psychologise a physiological illness, the proper treatment of which would involve expensive medical testing and would have rebounded on the insurance companies. High quality peer reviewed biomedical research continues to demonstrate that there are complex multiorgan malfunctions in people with ME which cannot be explained away by a "nocebo" effect or treated with CBT which can only offer sufferers a coping strategy at best and offers nothing at all to those who are
severely affected. Iimagine that this type of research similarly suits thecell phone and electricity utility companies down to the ground because ifpeople are merely "imagining" that they are ill then they don't have to change any of their current practices and can still generate huge profits from them without having to spend multimillions in either making their technologies safer or in paying off damaging law suits. Just like big tobacco.
 
If I thought CBT would stop me getting the electric shocks and feeling electrical curren running over my body I'd sign up for it in a heartbeat. But then you read all the well documented research by people like Neil Cherry etc and you know that the whole premise on which the CBT argument is based isflawed.
 
Best wishes
 
Steph

--- On Tue, 28/4/09, Andrew McAfee <[hidden email]> wrote:


From: Andrew McAfee <[hidden email]>
Subject: [eSens] Why health warnings can be bad
To: [hidden email]
Date: Tuesday, 28 April, 2009, 4:34 PM


Here seems to be a counter attack to poo-poo people with ES.
"Rubin has little doubt that the symptoms exhibited by 
electrosensitives are real. “Something cognitive is going on – 
something to do with the expectation is triggering the symptoms,” he 
says. And the idea of a psychological basis to electrosensitivity is 
supported by the fact that cognitive behavioural therapy can be an 
effective treatment."

Any body know of an effective "cog behav therapy?"
Andrew



Full Transcript:
Why health warnings can be bad
By Stuart Blackman

Published: April 25 2009 01:27 | Last updated: April 28 2009 12:33
http://www.ft.com/cms/s/2/0d9499ec-2d75-11de-9eba 
-00144feabdc0,dwp_uuid=a712eb94-dc2b-11da-890d-0000779e2340.html

It is perhaps surprising that scientists behind an experiment conducted 
at the University of California 25 years ago were able to recruit any 
volunteers. The researchers, purporting to study the effects of 
electric currents on brain function, warned potential participants that 
electrodes would be strapped to their temples, and could cause serious 
headaches. Despite this, 34 students came forward. At the end of the 
trial, two thirds of the volunteers did report headaches – despite the 
electric current never having been turned on. Such is the power of the 
“nocebo” effect, the real subject of the experiment. The current had 
not been switched on because the scientists were investigating whether 
expectation alone could make healthy people ill. Apparently it could.

In the 25 years since then, research has been accumulating that the 
nocebo effect – the evil twin of the better-known placebo effect – is a 
widespread phenomenon that affects many aspects of our lives and which 
might contribute to a host of 21st-century ailments, from food 
allergies to obesity, chronic fatigue, back pain and 
electrosensitivity. Some experts are concerned that the situation is 
being compounded by the efforts of health professionals to raise 
awareness of threats. “When someone receives a placebo and they get 
better, it’s because of a variety of self-healing processes in the body 
that are cognition-related,” says Brian Hughes, a psychologist at the 
National University of Ireland, Galway, who specialises in how mental 
stress affects physical health. “One expects to get healed and certain 
symptoms go away.” In the case of the nocebo, it is negative 
expectations that become self-fulfilling prophecies.

When we expect something to make us ill – electrodes wired to our 
temples, for example, or, more routinely, a medicine with known 
side-effects – we start looking for signs of illness. And we’ll 
probably find some, says Hughes, even if the pill is a dummy one or the 
electric field a sham. That is because unpleasant physical symptoms are 
a normal part of life for perfectly healthy people. Headaches come and 
go. Some nights it is hard to get much sleep, and some days it is 
difficult to keep our eyes open. We might feel light-headed one moment 
and in a bad mood another. These are all experiences that we would not 
think twice about were we not looking for signs that things are wrong. 
But when we are looking, it is easy to interpret a bad night’s sleep as 
insomnia, tiredness as fatigue, light-headedness as dizzy spells or a 
bad mood as depression – and then to reattribute those symptoms to 
whatever it was that we expected to harm us. And once we start 
believing that something is making us ill, we get anxious, which can 
itself exacerbate existing symptoms or induce others. “Anxiety 
generally leads to elevations in blood pressure and immune deficiency,” 
says Hughes. And more symptoms mean more anxiety.

Everyday expressions such as “worried sick” or “scared to death” 
suggest that the link between negative emotions and ill-health was made 
long before the phenomenon was given a medical label. But once in the 
realm of scientific investigation, the nocebo effect started turning up 
with surprising frequency. It is now recognised as a regular occurrence 
in double-blind clinical trials of new medicines, where people taking 
an inert, placebo control pill develop side-effects of the drug being 
tested – if they are warned about them beforehand. If the nocebo effect 
can make us ill in clinical trials, it can also do so in real life.

Placebo and Nocebo effectsJames Rubin, researcher at King’s College 
London, has been following up the early Californian experiments to 
investigate the role of the nocebo effect in a debilitating condition 
that afflicts increasing numbers of westerners, including, reportedly, 
one in every 20 Swedes. Electrosensitivity is supposedly caused by 
exposure to the electromagnetic fields given off by power lines, mobile 
phone handsets and masts, wi-fi and other electrical appliances. 
Sufferers report a range of symptoms, including headaches, tingling 
skin, dry throat, eye irritations, problems with memory and 
concentration, dizziness, inflammation and muscle and joint pains.

Crucially, Rubin’s research provides little reason to think that the 
reported symptoms are caused by the electromagnetic fields. “There is 
no robust evidence that there is a direct link, and there is reasonably 
robust evidence that there is no link,” he says. Experiments show that 
electrosensitive people are no better than anybody else at identifying 
when they are being exposed to an electric field. And when they are 
exposed, sufferers report more symptoms only if they have been told 
that they are being exposed. It is this sort of evidence that has led 
to the failure of court cases brought against mobile phone companies by 
people who believe their symptoms to be caused by their handsets. Rubin 
has little doubt that the symptoms exhibited by electrosensitives are 
real. “Something cognitive is going on – something to do with the 
expectation is triggering the symptoms,” he says. And the idea of a 
psychological basis to electrosensitivity is supported by the fact that 
cognitive behavioural therapy can be an effective treatment.

Even non-specific worries about the state of the world in general can 
be enough to make us ill, according to research from the University of 
Auckland. Prior to a huge pesticide-spraying programme in New Zealand, 
people were asked about their attitudes towards new technologies and 
environmental threats. After the spraying, those who were most 
concerned about the health risks reported the greatest number of 
symptoms.

If negative expectations generate symptoms, what generates the negative 
expectations? John Adams, professor emeritus at University College 
London and an expert on risk, says there is a current fashion among 
health professionals and other authorities for issuing precautionary 
advice concerning the health risks posed by new medicines and 
technologies. And that, he says, is a major contributing factor.

Despite finding a dearth of evidence for a risk to health from mobile 
phones, The Stewart Report, published in 2000 by the Independent Expert 
Group on Mobile Telephones and Health (and named after the group’s 
chairman, Sir William Stewart), recommended that people limit their use 
of the technology, just in case. Adams says that such an ambiguous 
message is an example of just the sort of thing that can encourage 
people to keep an eye out for signs of illness.

A similar message accompanied the UK Health Protection Agency’s 2004 
report on the dangers of exposure to electromagnetic fields. “The 
report found no evidence of an aetiological connection between the 
fields and the symptoms,” says Adams. “And yet at the pressconference 
that launched it, they went beyond that and said that people who 
believe they are sensitive should stay away from electromagnetic 
radiation.” Hence the ensuing headline from the Daily Mail: “Household 
appliances such as kettles, computers and microwaves could be health 
hazards, a government expert suggested yesterday.” The Swedish 
government has issued similarly precautionary advice.

“This process is more general than just taking a pill,” says Arthur 
Barsky, professor of psychiatry at Harvard Medical School. “Howeveryou 
induce negative expectations – whether it’s through a pill,a health 
warning or advertising by a drug company – you set in motion the same 
process of symptom reattribution, which then amplifies the symptom, 
which further solidifies the reattribution.” David Wainwright, a 
sociologist at the University of Bath, agrees that health warnings 
issued for precautionary reasons can be bad for our health: “It’s a bit 
like flicking through a medical encyclopaedia and imagining you’ve got 
symptoms of disease X, Y and Z. But this effect has a lot more potency 
when it’s a health professional telling you this stuff.”

Not even health professionals are immune. Medical students, who flick 
through more than their fair share of medical encyclopaedias, are 
themselves susceptible to a phenomenon known as “medical students’ 
disease”, whereby they develop symptoms of whatever condition they 
happen to be studying. Research has shown that medics display more 
signs of hypochondria than their peers studying law. Today, the 
“worried well” are more likely to go online than to a library to 
self-diagnose, in which case patient websites such as Medinfo or 
NetDoctor could be exacerbating symptoms at the same time as raising 
awareness of them. No research has yet been conducted that directly 
addresses internet health sites and the nocebo effect.

But research published last year by psychologists at Harvard and Yale 
universities raises the possibility that even our weight is susceptible 
to the power of suggestion. The study looked at the health of hotel 
chambermaids over a four-week period. Half of subjects were told at the 
start that their work counted as good exercise that satisfied the 
recommendations of the US surgeon-general. A month later, they had lost 
weight and gained other health benefits such as lower blood pressure. 
Their uninformed colleagues showed no change.

This puzzling finding does not seem to be explained by extra exercise 
prompted by the briefing: this was weight-loss by placebo effect. And 
where there is a placebo effect, nocebo is often lurking in the 
shadows. In an age when health professionals and governments are 
inclined to talk of obesity as an epidemic, of the entire population as 
unhealthy and to demand that we exercise more, such pronouncements 
might be doing more harm than good. “I very much believe that health 
warnings can be adversely effective via a nocebo effect,” says Alia 
Crum, one of the chambermaid study’s authors. “Whether or not this 
overrides the benefit of getting the message out there is another 
story.” Her current research attempts to tease apart these conflicting 
effects.

Not all health warnings are likely to cause what they are intended to 
prevent. Warnings on cigarette packets don’t give anyone cancer, for 
example; in fact, no rigorous research has turned up evidence that 
cancer, or any other serious, fatal disease, can be caused or cured by 
the power of negative or positive thinking – although both might well 
influence the strength of the symptoms. But it is not the cancer 
statistics that many of these scientists fret over. Their concern is 
the rise of conditions such as back pain, fibromyalgia (chronic fatigue 
syndrome) and food allergies, which are characterised by the symptoms 
expressed rather than by the underlying biology. These symptoms may 
have a biological basis in some individuals and a psychological one in 
others. So, while rare and tragic deaths resulting from extreme food 
allergies can be attributed to physiological anaphylactic shock, health 
warnings on food that “may contain nuts” might be contributing to the 
rise of food allergies in general, and to the statistics that less than 
20 per cent of teenagers who believe they have a food allergy actually 
test positive.

“It’s quite remarkable how the illnesses that are increasing at the 
moment are not the big, killer diseases, grounded in real, physical 
pathology,” says David Wainwright. “It’s the subjective problems of 
everyday life that are becoming medicalised, where there’s no actual 
evidence of any physical illness. “Even hassles at work are interpreted 
through the medicalised category of work stress rather than political 
or industrial relations issues” – a practice that Wainwright says is 
promoted by government agencies. “Health policy is promoting this 
belief that we’re all at risk from absolutely everything we come into 
contact with, and that just encourages us to feel more vulnerable and 
to interpret our normal experiences as health problems. It’s all just 
amplifying this epidemic of non-specific illness, which has incredibly 
disabling effects on people.”

Certain changes in doctors’ bedside manner might have been 
counter-productive. “Doctors feel more and more bound to warn patients 
about any possible consequences of taking a drug,” says Arthur Barsky 
of Harvard, which can mean reeling off a long list of possible, albeit 
unlikely side-effects. “There’s clearly a fundamental reason for 
putting out health information,” he says, “but I think it’s become a 
kind of hysteria.” If that hysteria means that more patients stop 
taking a medicine, having been put off by possible side-effects, then 
both the effectiveness of medical treatments and people’s confidence in 
conventional medicine is undermined. It is one reason, says Barsky, 
that people are putting increasing faith in alternative therapies. And 
a loss of confidence in conventional medicine and its practitioners 
might itself induce a nocebo effect that detracts further from its 
efficacy.

We are actually freer from serious illness than our grandparents were, 
and yet we worry about our health more than they did. Barsky calls this 
the “paradox of health”: dramatic improvements in our clinical 
well-being, accompanied by a rise in dissatisfaction with our health 
and a tendency to report more symptoms. He suspects that excessive 
awareness-raising is at least partly to blame.

John Adams at UCL has coined a phrase for the overemphasis on possible 
negative outcomes by health professionals and their political masters: 
compulsive risk assessment psychosis, or more succinctly, Crap. The 
phenomenon has emerged, he says, from a climate of low and declining 
trust, in which the health professions practise defensively. “The 
doctors aren’t trusting their patients not to sue them. There’s all 
this ass-covering going on all over the place.”

But if they don’t look out, health professionals and policymakers might 
find that this strategy has left them dangerously exposed to attack 
from other directions. Legal cases brought against mobile phone 
companies by people who believe that the electromagnetic radiation 
given off by their handsets is making them ill might have failed, but 
cases brought against those who issue health warnings, on the grounds 
that it exacerbates illness through the nocebo effect, might prove more 
successful. At least they would have some scientific evidence to 
support their claims.

Stuart Blackman is a freelance writer with a focus on science and the 
environment

Copyright The Financial Times Limited 2009

"FT" and "Financial Times" are trademarks of the Financial Times. 
Privacy policy | Terms
© Copyright The Financial Times Ltd 2009.


Andrew McAfee
Music Director/Conductor Triangle Youth Ballet
Adjunct Instructor of Horn, University of North Carolina at Chapel Hill
Former Principal Horn, North Carolina Symphony (1992-2007)

919.787.3022









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In a message dated 4/28/2009 7:27:49 P.M. GMT Daylight Time,
[hidden email] writes:

Any body know of an effective "cog behav therapy?"
> Andrew


Paul replies -




Personal Cognitive volution -
Co behav therapy in many cases is a waste of time, another jobs for the
boys ie phychologists, they are constantly looking for new market shares like
everyone else so ESsers are open season. If you are a reasonably rational
person it should not take long to work out whats good and whats bad in
terms of everyday ES intiators, balanced and reasoned behavoural adaption then
should regulate your cognitive response and prevent you from pre-empting
the worst case scenario, suck it and see as opposed to complete avoidance can
reap rewards and keep you in the real world, therefore in the face of some
very real symptoms your own cognitive bahavioural therapy exists minute by
minute..the trap for us all is not to fall into this state of withdrawal
and pessimism, so by constantly re-evaluating and re-moddelling our
perception of the threat to keep it real.
Things could be worse to boot.


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Hey, Steph!
 
Great to see you, dear!  I guess you are doing "fairly" well, since you are back with us so soon after your surgery! 
 
I used to think the same thing.  But then I nearly died a half dozen times.  I finally got a doctor who told me you cannot imagine liver disease and pernicious anemia.  (Besides I don't have a good enough imagination to come up with some of my symptoms on my own!  lol)
 
Take care, Steph.  Glad you feel well enough to venture online,
Diane

--- On Tue, 4/28/09, Stephanie Smith <[hidden email]> wrote:

From: Stephanie Smith <[hidden email]>
Subject: Re: [eSens] Why health warnings can be bad
To: [hidden email]
Date: Tuesday, April 28, 2009, 5:07 PM








Hi Andrew
 
from day one this has always bothered me - that somehow I could have wishedthis illness on myself. I think there are  a couple of things going on here - they are trying to do with electrosensitivity what they did very successfully [and its odd that it should be the same King's College Hospitallot involved!!] with ME/CFS/CIFIDS - they are trying to portray it as a somatoform disorder which they maintain can be easily treated with CBT. They did this to ME/CFS etc because it suited them to psychologise a physiological illness, the proper treatment of which would involve expensive medical testing and would have rebounded on the insurance companies. High quality peer reviewed biomedical research continues to demonstrate that there are complex multiorgan malfunctions in people with ME which cannot be explained away by a "nocebo" effect or treated with CBT which can only offer sufferers a coping strategy at best and offers nothing at all to those who are
severely affected. Iimagine that this type of research similarly suits the cell phone and electricity utility companies down to the ground because if people are merely "imagining" that they are ill then they don't have to change any of their current practices and can still generate huge profits fromthem without having to spend multimillions in either making their technologies safer or in paying off damaging law suits. Just like big tobacco.
 
If I thought CBT would stop me getting the electric shocks and feeling electrical curren running over my body I'd sign up for it in a heartbeat. But then you read all the well documented research by people like Neil Cherry etc and you know that the whole premise on which the CBT argument is based isflawed.
 
Best wishes
 
Steph

--- On Tue, 28/4/09, Andrew McAfee <amcafeerr@nc. rr.com> wrote:

From: Andrew McAfee <amcafeerr@nc. rr.com>
Subject: [eSens] Why health warnings can be bad
To: eSens@yahoogroups. com
Date: Tuesday, 28 April, 2009, 4:34 PM

Here seems to be a counter attack to poo-poo people with ES.
"Rubin has little doubt that the symptoms exhibited by 
electrosensitives are real. “Something cognitive is going on – 
something to do with the expectation is triggering the symptoms,” he 
says. And the idea of a psychological basis to electrosensitivity is 
supported by the fact that cognitive behavioural therapy can be an 
effective treatment."

Any body know of an effective "cog behav therapy?"
Andrew

Full Transcript:
Why health warnings can be bad
By Stuart Blackman

Published: April 25 2009 01:27 | Last updated: April 28 2009 12:33
http://www.ft. com/cms/s/ 2/0d9499ec- 2d75-11de- 9eba
-00144feabdc0, dwp_uuid= a712eb94- dc2b-11da- 890d-0000779e234 0.html

It is perhaps surprising that scientists behind an experiment conducted 
at the University of California 25 years ago were able to recruit any 
volunteers. The researchers, purporting to study the effects of 
electric currents on brain function, warned potential participants that 
electrodes would be strapped to their temples, and could cause serious 
headaches. Despite this, 34 students came forward. At the end of the 
trial, two thirds of the volunteers did report headaches – despite the 
electric current never having been turned on. Such is the power of the 
“nocebo” effect, the real subject of the experiment. The current had 
not been switched on because the scientists were investigating whether 
expectation alone could make healthy people ill. Apparently it could.

In the 25 years since then, research has been accumulating that the 
nocebo effect – the evil twin of the better-known placebo effect – is a 
widespread phenomenon that affects many aspects of our lives and which 
might contribute to a host of 21st-century ailments, from food 
allergies to obesity, chronic fatigue, back pain and 
electrosensitivity. Some experts are concerned that the situation is 
being compounded by the efforts of health professionals to raise 
awareness of threats. “When someone receives a placebo and they get 
better, it’s because of a variety of self-healing processes in the body 
that are cognition-related,” says Brian Hughes, a psychologist at the 
National University of Ireland, Galway, who specialises in how mental 
stress affects physical health. “One expects to get healed and certain 
symptoms go away.” In the case of the nocebo, it is negative 
expectations that become self-fulfilling prophecies.

When we expect something to make us ill – electrodes wired to our 
temples, for example, or, more routinely, a medicine with known 
side-effects – we start looking for signs of illness. And we’ll 
probably find some, says Hughes, even if the pill is a dummy one or the 
electric field a sham. That is because unpleasant physical symptoms are 
a normal part of life for perfectly healthy people. Headaches come and 
go. Some nights it is hard to get much sleep, and some days it is 
difficult to keep our eyes open. We might feel light-headed one moment 
and in a bad mood another. These are all experiences that we would not 
think twice about were we not looking for signs that things are wrong. 
But when we are looking, it is easy to interpret a bad night’s sleep as 
insomnia, tiredness as fatigue, light-headedness as dizzy spells or a 
bad mood as depression – and then to reattribute those symptoms to 
whatever it was that we expected to harm us. And once we start 
believing that something is making us ill, we get anxious, which can 
itself exacerbate existing symptoms or induce others. “Anxiety 
generally leads to elevations in blood pressure and immune deficiency,” 
says Hughes. And more symptoms mean more anxiety.

Everyday expressions such as “worried sick” or “scared to death” 
suggest that the link between negative emotions and ill-health was made 
long before the phenomenon was given a medical label. But once in the 
realm of scientific investigation, the nocebo effect started turning up 
with surprising frequency. It is now recognised as a regular occurrence 
in double-blind clinical trials of new medicines, where people taking 
an inert, placebo control pill develop side-effects of the drug being 
tested – if they are warned about them beforehand. If the nocebo effect 
can make us ill in clinical trials, it can also do so in real life.

Placebo and Nocebo effectsJames Rubin, researcher at King’s College 
London, has been following up the early Californian experiments to 
investigate the role of the nocebo effect in a debilitating condition 
that afflicts increasing numbers of westerners, including, reportedly, 
one in every 20 Swedes. Electrosensitivity is supposedly caused by 
exposure to the electromagnetic fields given off by power lines, mobile 
phone handsets and masts, wi-fi and other electrical appliances. 
Sufferers report a range of symptoms, including headaches, tingling 
skin, dry throat, eye irritations, problems with memory and 
concentration, dizziness, inflammation and muscle and joint pains.

Crucially, Rubin’s research provides little reason to think that the 
reported symptoms are caused by the electromagnetic fields. “There is 
no robust evidence that there is a direct link, and there is reasonably 
robust evidence that there is no link,” he says. Experiments show that 
electrosensitive people are no better than anybody else at identifying 
when they are being exposed to an electric field. And when they are 
exposed, sufferers report more symptoms only if they have been told 
that they are being exposed. It is this sort of evidence that has led 
to the failure of court cases brought against mobile phone companies by 
people who believe their symptoms to be caused by their handsets. Rubin 
has little doubt that the symptoms exhibited by electrosensitives are 
real. “Something cognitive is going on – something to do with the 
expectation is triggering the symptoms,” he says. And the idea of a 
psychological basis to electrosensitivity is supported by the fact that 
cognitive behavioural therapy can be an effective treatment.

Even non-specific worries about the state of the world in general can 
be enough to make us ill, according to research from the University of 
Auckland. Prior to a huge pesticide-spraying programme in New Zealand, 
people were asked about their attitudes towards new technologies and 
environmental threats. After the spraying, those who were most 
concerned about the health risks reported the greatest number of 
symptoms.

If negative expectations generate symptoms, what generates the negative 
expectations? John Adams, professor emeritus at University College 
London and an expert on risk, says there is a current fashion among 
health professionals and other authorities for issuing precautionary 
advice concerning the health risks posed by new medicines and 
technologies. And that, he says, is a major contributing factor.

Despite finding a dearth of evidence for a risk to health from mobile 
phones, The Stewart Report, published in 2000 by the Independent Expert 
Group on Mobile Telephones and Health (and named after the group’s 
chairman, Sir William Stewart), recommended that people limit their use 
of the technology, just in case. Adams says that such an ambiguous 
message is an example of just the sort of thing that can encourage 
people to keep an eye out for signs of illness.

A similar message accompanied the UK Health Protection Agency’s 2004 
report on the dangers of exposure to electromagnetic fields. “The 
report found no evidence of an aetiological connection between the 
fields and the symptoms,” says Adams. “And yet at the pressconference 
that launched it, they went beyond that and said that people who 
believe they are sensitive should stay away from electromagnetic 
radiation.” Hence the ensuing headline from the Daily Mail: “Household 
appliances such as kettles, computers and microwaves could be health 
hazards, a government expert suggested yesterday.” The Swedish 
government has issued similarly precautionary advice.

“This process is more general than just taking a pill,” says Arthur 
Barsky, professor of psychiatry at Harvard Medical School. “Howeveryou 
induce negative expectations – whether it’s through a pill,a health 
warning or advertising by a drug company – you set in motion the same 
process of symptom reattribution, which then amplifies the symptom, 
which further solidifies the reattribution.” David Wainwright, a 
sociologist at the University of Bath, agrees that health warnings 
issued for precautionary reasons can be bad for our health: “It’s a bit 
like flicking through a medical encyclopaedia and imagining you’ve got 
symptoms of disease X, Y and Z. But this effect has a lot more potency 
when it’s a health professional telling you this stuff.”

Not even health professionals are immune. Medical students, who flick 
through more than their fair share of medical encyclopaedias, are 
themselves susceptible to a phenomenon known as “medical students’ 
disease”, whereby they develop symptoms of whatever condition they 
happen to be studying. Research has shown that medics display more 
signs of hypochondria than their peers studying law. Today, the 
“worried well” are more likely to go online than to a library to 
self-diagnose, in which case patient websites such as Medinfo or 
NetDoctor could be exacerbating symptoms at the same time as raising 
awareness of them. No research has yet been conducted that directly 
addresses internet health sites and the nocebo effect.

But research published last year by psychologists at Harvard and Yale 
universities raises the possibility that even our weight is susceptible 
to the power of suggestion. The study looked at the health of hotel 
chambermaids over a four-week period. Half of subjects were told at the 
start that their work counted as good exercise that satisfied the 
recommendations of the US surgeon-general. A month later, they had lost 
weight and gained other health benefits such as lower blood pressure. 
Their uninformed colleagues showed no change.

This puzzling finding does not seem to be explained by extra exercise 
prompted by the briefing: this was weight-loss by placebo effect. And 
where there is a placebo effect, nocebo is often lurking in the 
shadows. In an age when health professionals and governments are 
inclined to talk of obesity as an epidemic, of the entire population as 
unhealthy and to demand that we exercise more, such pronouncements 
might be doing more harm than good. “I very much believe that health 
warnings can be adversely effective via a nocebo effect,” says Alia 
Crum, one of the chambermaid study’s authors. “Whether or not this 
overrides the benefit of getting the message out there is another 
story.” Her current research attempts to tease apart these conflicting 
effects.

Not all health warnings are likely to cause what they are intended to 
prevent. Warnings on cigarette packets don’t give anyone cancer, for 
example; in fact, no rigorous research has turned up evidence that 
cancer, or any other serious, fatal disease, can be caused or cured by 
the power of negative or positive thinking – although both might well 
influence the strength of the symptoms. But it is not the cancer 
statistics that many of these scientists fret over. Their concern is 
the rise of conditions such as back pain, fibromyalgia (chronic fatigue 
syndrome) and food allergies, which are characterised by the symptoms 
expressed rather than by the underlying biology. These symptoms may 
have a biological basis in some individuals and a psychological one in 
others. So, while rare and tragic deaths resulting from extreme food 
allergies can be attributed to physiological anaphylactic shock, health 
warnings on food that “may contain nuts” might be contributing to the 
rise of food allergies in general, and to the statistics that less than 
20 per cent of teenagers who believe they have a food allergy actually 
test positive.

“It’s quite remarkable how the illnesses that are increasing at the 
moment are not the big, killer diseases, grounded in real, physical 
pathology,” says David Wainwright. “It’s the subjective problems of 
everyday life that are becoming medicalised, where there’s no actual 
evidence of any physical illness. “Even hassles at work are interpreted 
through the medicalised category of work stress rather than political 
or industrial relations issues” – a practice that Wainwright says is 
promoted by government agencies. “Health policy is promoting this 
belief that we’re all at risk from absolutely everything we come into 
contact with, and that just encourages us to feel more vulnerable and 
to interpret our normal experiences as health problems. It’s all just 
amplifying this epidemic of non-specific illness, which has incredibly 
disabling effects on people.”

Certain changes in doctors’ bedside manner might have been 
counter-productive. “Doctors feel more and more bound to warn patients 
about any possible consequences of taking a drug,” says Arthur Barsky 
of Harvard, which can mean reeling off a long list of possible, albeit 
unlikely side-effects. “There’s clearly a fundamental reason for 
putting out health information,” he says, “but I think it’s become a 
kind of hysteria.” If that hysteria means that more patients stop 
taking a medicine, having been put off by possible side-effects, then 
both the effectiveness of medical treatments and people’s confidence in 
conventional medicine is undermined. It is one reason, says Barsky, 
that people are putting increasing faith in alternative therapies. And 
a loss of confidence in conventional medicine and its practitioners 
might itself induce a nocebo effect that detracts further from its 
efficacy.

We are actually freer from serious illness than our grandparents were, 
and yet we worry about our health more than they did. Barsky calls this 
the “paradox of health”: dramatic improvements in our clinical 
well-being, accompanied by a rise in dissatisfaction with our health 
and a tendency to report more symptoms. He suspects that excessive 
awareness-raising is at least partly to blame.

John Adams at UCL has coined a phrase for the overemphasis on possible 
negative outcomes by health professionals and their political masters: 
compulsive risk assessment psychosis, or more succinctly, Crap. The 
phenomenon has emerged, he says, from a climate of low and declining 
trust, in which the health professions practise defensively. “The 
doctors aren’t trusting their patients not to sue them. There’s all 
this ass-covering going on all over the place.”

But if they don’t look out, health professionals and policymakers might 
find that this strategy has left them dangerously exposed to attack 
from other directions. Legal cases brought against mobile phone 
companies by people who believe that the electromagnetic radiation 
given off by their handsets is making them ill might have failed, but 
cases brought against those who issue health warnings, on the grounds 
that it exacerbates illness through the nocebo effect, might prove more 
successful. At least they would have some scientific evidence to 
support their claims.

Stuart Blackman is a freelance writer with a focus on science and the 
environment

Copyright The Financial Times Limited 2009

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Andrew McAfee
Music Director/Conductor Triangle Youth Ballet
Adjunct Instructor of Horn, University of North Carolina at Chapel Hill
Former Principal Horn, North Carolina Symphony (1992-2007)

919.787.3022

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