In this revelatory book, discover the power of the nocebo effect—how negative expectations can create real symptoms. Uncover its role in medication side effects and the media’s impact on public health perceptions. Explore emerging insights and ethical strategies to mitigate this phenomenon’s influence.

This book is fascinating and a little frightening. It offers practical tips on how to interact with health professionals to help protect against the nocebo effect.

Thanks, NetGalley, for the ARC I received. This is my honest and voluntary review.

Thanks to Netgalley and the publisher for this eARC.

The Nocebo Effect: History & Contemporary Applications is a fascinating and timely exploration of the dark side of the mind-body connection. The authors, four experts in the field of placebo and nocebo research, provide a comprehensive and engaging account of how negative expectations can influence our health and well-being in various contexts, from clinical trials to public health crises.

The book begins with a historical overview of the concept of nocebo, tracing its origins from ancient times to the present day. The authors show how nocebo effects have been observed and documented in various cultures and medical traditions, as well as how they have been exploited for political and religious purposes. The book then delves into the contemporary experimental research on the mechanisms and moderators of nocebo effects, covering topics such as verbal suggestions, conditioning, social learning, personality, and genetics. The authors also discuss the ethical and practical implications of nocebo effects for clinical practice, informed consent, and communication.

The book is written in an accessible and engaging style, with clear explanations of complex concepts and ample examples and anecdotes. The book also features helpful illustrations, tables, and boxes that summarize key points and findings. The book is suitable for a wide audience, from students and researchers interested in the psychology and neuroscience of placebo and nocebo effects, to health professionals and policymakers who want to understand and minimize the negative impact of nocebo effects on patient outcomes and public health.

The Nocebo Effect - a must-read for anyone who wants to learn more about the power of the mind over the body, and the potential pitfalls and challenges of harnessing this power for good. The book offers a balanced and nuanced perspective on the nocebo effect, acknowledging both its scientific validity and its social and ethical implications. The book also provides useful suggestions and recommendations for future research and practice, as well as for raising awareness and educating the public about the nocebo effect. The book is a valuable contribution to the literature on placebo and nocebo effects, and a stimulating and thought-provoking read for anyone interested in the fascinating and mysterious workings of the human mind.

While there are zillions of books on the placebo effect, there seem to be not enough reads on its closest living relative, its cousin – the nocebo effect.
This was an entertaining and educating read for me.
Written by a group of PhDs, this is a trustworthy source of information.

Although my background is in psychology, I found the medical components of this book to be the most interesting. It's "mind over matter" in action… Or to put it in slightly more new age terms, it mirrors the principles laid out and Rhonda Byrne's "The Secret" or Deepak Chopra's explanation of quantum physics… Your expectations create the world in which you exist. I work in the medical industry and I've been sharing interesting tidbits from this book with our practitioners, so we can more closely pay attention to how we are explaining procedures to patients. There's a fine line to be walked between setting clear expectations for risks and outcomes versus creating the expectation for failure. I'm glad I had the opportunity to read this book ahead of publication.

For some reason, placebo is a well-known term, but its counterpart, nocebo, is not. Michael Bernstein and a host of other doctors and researchers set out to change that in The Nocebo Effect. I was surprised at how little work has been put into that effort over the millennia. Yes, millennia.

Simply put, nocebo is the opposite of placebo. Whereas a placebo is a fake medicine that patients believe will work (– and so it often does), nocebo is communicated negativity that results in real symptoms even though the patient is not sick. “Nocebo effects are adverse outcomes due to negative expectations,” the book says elegantly. Nocebos get applied all the time, even just in conversation when someone relates fake news. But the results are distressingly real. They can result in death.

The authors give a variety of examples of people who learned or had been told of bad reactions, the spread of disease, the long menu of side effects and flat out fake news that result in the spread of disease and the eruption of symptoms. People have beliefs, and believing can make it so.

This is why drugs must be tested against placebos. Because all too often, the actual drug doesn’t perform much better than the totally innocuous placebo. So those who took the real med might have simply believed in the drug, much like those who only received the placebo. But even with placebos, 19% of adults and 26% of seniors develop side effects of drugs, even though they were in the placebo group. The result is 25% of participants quitting the study by stopping their meds. Nobody wants to end up worse.

With nocebos, word of mouth is sufficient to cause negative outcomes. Early on, the authors cite a doctor whose patient was allergic to roses. He hid an artificial rose from the patient, and when he brought it out, she began suffering allergic reactions within minutes of seeing it.

Fear plays a big role. Fear of COVID-19 for example, has resulted in far too many people developing the symptoms of the disease without exposure. Told that after treatment there might be a rebound effect, even one of the authors here developed the symptoms of the rebound. The human mind is a powerful being, and it can bring on the symptoms and make them real, even without infection. The authors cite conspiracy theories that are firmly believed by huge portions of the population as examples of nocebos in action. People believe, and can’t talked out of it once they do.


When television news reports the side effects of a common drug, suddenly hundreds of reports come in of people newly suffering these effects, and worse, quitting their meds in order to stop them from continuing to worsen.

In one study, when patients were told their painkiller would be stopped, a huge percentage complained of increased pain. When the same meds were stopped but not pre-announced, almost no one complained of more pain.

And perhaps most shockingly, people in Flint, Michigan developed symptoms of the bad water they had been drinking, far in excess of people in other Michigan cities, even though the lead levels in Flint were lower. Yet researchers found that “teachers openly expressed their belief that Flint children had been brain damaged, were incapable of learning, and that there was little point in trying to teach them.”

Therapists in particular can have devastating effects on their patients by labeling them.

The authors sum it up elegantly as nocebos work by “exacerbating the side effects of medications, causing harm through overdiagnosis or overtreatment, ascribing negative health effects to wind turbines, and driving a surge in gluten intolerance,” (for example). Gluten has been the subject of so much news content, that a whole section of the grocery store is now dedicated to gluten-free products. This despite the fact gluten intolerance is all but confined to women who develop celiac disease in later life. This has not stopped children and young families from developing the same symptoms just recently.

Compounding the error is something called diagnostic overshadowing, in which such inexplicable symptoms are attributed to psychiatric conditions. Now the patient has mental health issues as well as physical ones. And to top it off, not everything psychosomatic can be attributed to the nocebo effect. So patients can sicken, and even die, while doctors try to trace what is what.

Nocebos have been recognized for thousands of years. The epigraphs at the beginning of every chapter go back farther and farther into history, from Mark Twain to William Shakespeare and into ancient Greece. Hippocrates himself weighed in on it: “Give necessary orders with cheerfulness and serenity…revealing nothing of the patient's future and present condition.” “Conceal most things from the patient.”

The book’s chapters are all written by different people, or teams of them. They refer to each other, so the reader does not suffer repetition. They are all delightfully fast reading, avoiding most jargon and unreadable terminology. It is a book that can be helpful to all.

Either because or in spite of it being so well recognized, the authors find there is insufficient research, and in particular in how doctors handle their own patients. There is one particular chapter on this, with examples of how doctors unintentionally foster the nocebo effect by simply employing the wrong words, as simple as saying “your tumor” instead of “the tumor” in a frank talk to a patient hanging on every word. The patient’s mind takes over, and negative results flow freely.

The authors attempt to provide workarounds that are obviously and maddeningly useless. As I read, I kept thinking No! That’s absurd. Just tell patients the truth. All the doctor has to say is, “I hesitate to tell you the potential side effects, because you might inadvertently develop them yourself. I want you to know that these side effects are extremely rare. Almost no one gets them. And you likely won’t either. But I am obliged by law to tell you. So get a load of this.” That will dilute the power of the nocebo in advance, much like the inoculation against fake news, where people who have learned about it in a formal course are all but totally immune to it. (See https://medium.com/the-straight-dope/vaccination-against-fake-news-no-really-7ce669e283d )

Finally, at the end of the chapter, the authors belatedly suggest this honesty approach themselves, but complain there is insufficient research. This disarming via honesty idea has not been sufficiently tested for them to say it would be effective in reducing the nocebo effect. Common sense and working models in other domains don’t merit validation.

Clearly, nocebo is a concept in need of the light of day. Sunshine is the best disinfectant, and a lot of disease and medication could be eliminated with anti-nocebo inoculations.

David Wineberg

The book is written in an easy to understand and comprehensive way. The discussions of the ideas are thoroughly laid out even though several writers are involved.

Moreover, the subject of the book is very timely given that more people I think are experiencing nocebo effect due to unprecedented access to all kinds of information from the internet especially social media.