There’s been plenty of information about the placebo effect the past few days. Some researchers are investigating the genetics of the placebo effect. Even the idea of drug-placebo interactions are on the table for discussion. I’ve seen the suggestion that it makes sense to have an additional treatment track in a drug trial: the drug, the placebo and a new “no treatment at all” track.

xkcd today has this amusing take on evaluating the placebo effect.

I had some recent experiences that might hint that there is an anti-placebo effect. With the placebo effect, the mind’s expectations modulate the properties of a pill. So, it seems to follow that normally effective drugs might have negative properties that are modulated by the mind.

This is different from the placebo/anti-placebo are imaginary or “all in your head.” A placebo is effective because there are biological consequences of the act of taking a medicine beyond the chemical properties of the drug.

I was talking to a nurse from my cardiologist’s office about headaches. I mentioned the headaches earlier to her earlier and she wondered why I hadn’t yet talked to my primary doctor about them. Almost immediately, my headache became worse until the phone call receded from my attention. A few days later, my doctor prescribed a medicine. Its effect of increased pain is similar to what happened after the conversation with the nurse. My symptoms get worse when I take the prescription medicine. An anti-placebo effect could even increase the likelihood of the side effects of a medicine developing.

So, with my headaches, I’m finding taking a small dose of Tylenol is more effective than the prescription medicine. I don’t think the dose I’m taking is enough to really have any direct effect and part of its effectiveness is a placebo effect.

How I discuss that with the doctor escapes me. “Hi doctor, I’m taking this tiny dose of acetaminophen and it working a lot better than the prescription medicine you ordered. I think part of its effectiveness is that it is having a placebo effect on my headaches.” I can only imagine that conversation going badly. “Err, we should try a different medicine that doesn’t have the same effects as the medicine I’m avoiding. Don’t take the Tylenol.” How do you talk to a doctor about placebos being effective in my case?

I’ve read that doctors think of the placebo effect as “cheating” or somehow improper. An anti-placebo for a specific individual might explain the appearance of side effects of a medicine.

Would an anti-side effect placebo be able to prevent the anti-placebo side effects of a regular drug? Perhaps an anti-side-effect placebo can be a good idea in patients that respond well to placebos.

It seems plausible.