The nocebo effect in current practice

I thank Dr. Agnihotri for his commendable article on the immense power we as care providers and prescribers can wield when it comes to how our patients respond to medication. The placebo and nocebo effects are inextricably linked to how we frame our discussions about therapeutic options, and the conscious or unconscious expectations that are thereby created. One particular approach that I have found tremendously helpful to navigate these tricky waters in my own practice is the Medication Interest Model, described in detail in Dr. Shawn Christopher Shea's 2018 book of the same name (1). Dr. Shea, a psychiatrist with decades of expertise in the careful art of interviewing, illuminates with many practical examples how we can tailor our discussions to respond to patients' concerns and overcome the barrier of medication disinterest that often seems endemic. I suspect that such an approach may yield promising results with respect to decreasing the nocebo effect as well, and I would recommend this publication to all my colleagues who have an interest in more effective therapeutic counselling.

(1) Shea SC. The Medication Interest Model: How to Talk With Patients About Their Medications, 2nd Edition. Wolters Kluwer, 2018.