December 11, 2024

"If we expect to feel better, then we probably will"

Have you ever taken phenylephrine for a stuffed-up nose and then felt better? If so, you might have been perplexed when last year, Food and Drug Administration experts said that that the drug — which is in some versions of DayQuil, Sudafed, and other medicines — is no more effective than a placebo.

But to Michael H. Bernstein, an assistant professor of diagnostic imaging at the Warren Alpert Medical School of Brown University, it all makes sense. Bernstein says that "no better than a placebo" still means that it works, sort of. "If we expect to feel better, then we probably will," he told Torie. And that complicates the idea of what medical treatment "works."

On this episode from the archives of the "First Opinion Podcast," Torie and Michael discuss the placebo effect and its counterpart, the "nocebo effect" — if you tell patients something will make them feel worse, it generally comes true. "You're better off hearing from a doctor something to the effect of 3 out of 4 patients who take this drug have no side effects at all versus 25% of people who take this drug do get side effects," he said.

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