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Hi Reader,

Can your beliefs change the outcomes you experience? Make you sick, or protect you from harm?

Modern medicine increasingly says yes.

The way patients anticipate side effects or benefits can shape what they actually experience. This is now called the science of placebo and nocebo effects.

The placebo effect shows us how positive expectations can trigger measurable health improvements even without an active treatment. Its lesser-known counterpart, the nocebo effect, reveals the darker side of this mind–body connection: negative expectations can cause real harm. This effect isn’t fringe; it’s a well-documented, potent psychological phenomenon. It was exemplified very well during the COVID-19 pandemic, and I was surprised, reading about this, by the amount of research that has been conducted in this field so far.

The COVID-19 Vaccine as a Case Study

​A 2022 meta-analysis in JAMA Network Open found that 76% of systemic side effects occurred after the first dose and 52% after the second dose in placebo arms (nocebo responses). At the very least, these are observations noted so far, and they are not limited to the COVID vaccine; similar patterns have been reported across a wide range of drugs and medical interventions.

Can science fully explain this? I don't know. One day, we may find out!

But for now, perhaps this tells us something about the power of mindset and makes us wonder whether the fear and anxiety circulated on social media during the pandemic shaped people’s experiences. I found this especially thought-provoking when viewed alongside conspiracy theory narratives. I’m not here to endorse or dismiss them, but rather to encourage people to think about this as part of the bigger picture of mind-body connections. This idea matters more than ever for those of us who communicate health information.

What Does it Mean for Us? Medical Writers and Health Communicators

From an ethical point of view, clinicians must walk a delicate line in how to honestly inform patients about potential side effects without unintentionally inducing them. Studies suggest that framing matters. Phrases like “most patients tolerate this well” rather than "you may feel X or Y side effect" can reduce nocebo reactions and encourage medication adherence.

As medical writers, particularly those of us focused on patient education, I believe our work does more than just inform; it has the power to influence. The takeaway lesson of the nocebo effect should reinforce the ethical responsibility that comes with the words we choose.

In practice, these are some key points I think worth remembering when creating patient-facing content:

Frame with balance

Saying “most patients tolerate this treatment well” is more effective (and less harmful) than simply listing every possible side effect.

Be precise

Avoid vague or alarmist language that inflates risk perception.

For example, avoid saying "because you have a family history of diabetes, you are more likely to develop it in the future." From the epigenetics side of view, this is now arguable. Therefore, use the concept of genetic predisposition as a call to action for modifiable lifestyle factors, which is supported by our understanding of epigenetics.

I'd frame it this way:

"Your family history means you may be more susceptible to diabetes. This isn't a prediction, but powerful information. It means the lifestyle choices you make, like nutrition and physical activity, are even more impactful for you, and this knowledge gives you a clear path to focus on for powerful prevention."

Educate about expectations

Explaining that some side effects may stem from anticipation itself can empower patients without invalidating their experiences. The time has come to open the "nocebo" conversation in clinics and our work. And as we do, we must remain aware of the ripple effect. In our context, this is how words in social media, consent documents, or patient education resources may "ripple out" to influence far more people than we intend.

To your success,

Guanine Medical Academy

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