The Nocebo Effect ― Overdiagnosis and Its Costs

The Nocebo Effect documents the transformation of normal conditions into medical problems and brings out the risks that flow from this inflationary practice. One notable risk is that people labeled as sick may find themselves living up to their label through the alchemy of the nocebo effect. The lingering effect of revoked diagnoses, the over-detection of lumps through breast self-examination, the occurrence in placebo groups of adverse events listed in consent forms, and the persistence of labeled as opposed to unlabeled symptoms—all illustrate the kind of signal distortion likely in a climate of overdiagnosis. As normal conditions are branded as medical issues, they acquire powerful, suggestive labels that readily come to life in our minds and bodies. This unique study considers the effects of diagnostic inflation on the diagnosed.

Stewart Justman is Professor at the University of Montana, USA and has written many books and articles on both medicine and literary history. For Seeds of Mortality, a study of cancer, he received the 2004 PEN Award for the Art of the Essay.