It is daily practice for doctors to explain the possible side effects and complications of medications and treatments to patients before prescribing or administering them.
This is a part of informed consent and a routine part of medical care.
However, is this practice always beneficial or helpful for patients?
An interesting study published in the Journal of Sexual Medicine in 2007 (current impact factor: 3.802) explored this issue.
The study involved 120 patients with benign prostatic hyperplasia treated with 5mg finasteride, who were divided into two groups.
Group 1 was not informed of the possible side effects, while Group 2 was told that the medication ". . . it may cause erectile dysfunction, decreased libido, problems of ejaculation but these are uncommon".
After one year of treatment, 43.6% of Group 2 patients who were informed of the side effects reported sexual dysfunction-related problems, which was nearly 30% more than the 15.3% in Group 1!
When comparing specific sexual problems, Group 2 had a higher incidence of erectile dysfunction (30.9% vs. 9.6%), decreased libido (23.6% vs. 7.7%), and ejaculation disorders (16.3% vs. 5.7%).
However, previous studies have shown that the highest percentage of sexual dysfunction related to finasteride treatment is only about 15% after one year.
The reason for such a difference is the so-called nocebo effect, which is the opposite of the placebo effect.
The nocebo effect refers to the negative physical response that occurs when patients expect a particular treatment or medication to have negative effects, even if these effects are not related to the pharmacological action of the treatment or medication.
It is true that explaining side effects or complications is often based on a defensive medical mentality or legal requirements in the context of the doctor-patient relationship.
However, doctors also encounter patients who are more anxious and generate nocebo effects, as in the study discussed here.
Some patients even refuse treatment because of fear of side effects or risks, which can delay the treatment or control of their illness.
In such situations, doctors should carefully consider whether to explain the side effects or complications of treatment or to use their clinical judgment to adapt to each patient's unique situation.
The power of the mind is truly strong, and this study demonstrates the potential negative impact of the nocebo effect on patient outcomes
Reference: https://pubmed.ncbi.nlm.nih.gov/17655657/
