Pharmacists often leaflet customers with long lists of their drugs side-effects, which, like Voodoo death, may become self-fulfilling prophesies. When one of the authors (JML) gives diamorphine IV to patients having a myocardial infarction, he says
in a loud voice Your pain will end now (maximizes placebo effect) and, in a very quiet voice to the spouse, Get a bowl: he may be sick. to avoid the reverse nocebo effect. We tend not to tell patients about side-effects such as impotence, justifying this dishonesty on the grounds that in such a sensitive area, the mere mention of impotence will bring it about. Central to this debate is the question of how paternalistic we should be. We do not know the answer, but simply recommend getting to know individual patients well, and having a flexible approach: in doing so we may occasionally strike the right balance.Advertisements
