From the article: https://thesecondbestworld.substack.com/p/your-doctors-words-can-make-you-sick
In 2007, a group of Italian urologists ran an experiment that would make any bioethicist sweat. They gave 120 men with enlarged prostates the same drug, finasteride, at the same dose, for the same duration. The only difference was what they told the two groups. Group A got the drug without any mention of sexual side effects. Group B heard the disclosure: the drug “may cause erectile dysfunction, decreased libido, problems of ejaculation but these are uncommon.”
Of the 107 men who completed the study, 15.3% of the uninformed group reported sexual problems after a year. In the informed group? 43.6%. The rate of erectile dysfunction specifically was 9.6% versus 30.9%
Same drug. Same dose. Same prostates. The words changed the outcomes.
(...)
Informed consent is a cornerstone of modern medical ethics. You tell patients what you’re giving them and what it might do. That principle exists for excellent reasons, most of which boil down to: patients are adults, they have the right to make decisions about their own bodies, and concealment is paternalistic even when well-intentioned.
But the nocebo evidence creates an awkward wrinkle. If telling patients about side effects causes some of those side effects, then the act of obtaining informed consent is itself a source of harm. Shlomo Cohen called this the “nocebo effect of informed consent” in an influential 2014 bioethics paper. The tension is between autonomy (the patient’s right to know) and nonmaleficence (the clinician’s duty not to harm).