A Breakthrough Workshop on
Nocebo (Negative Placebo) Effects and
Expectation Mediated Symptoms
18 February 1997
Georgetown University
Conference Center
Washington, DC
Sponsored by
American Health Foundation and
The Institute for Science and Public Policy

Objectives: Review the state of the science regarding nocebo effects and EMS; Define research objectives for future work and strategies for implementation.



Workshop Announcement

Over the past twelve months, interest in nocebo (or negative placebo) effects and Expectation Mediated Symptoms (EMS) has reached a level necessitating rigorous scientific inquiry. Two exploratory conferences have been held: the first was sponsored by the American Health Foundation (November 1995); the second was co-sponsored by the National Institutes of Health, The Institute for Science and Public Policy, and the American Health Foundation (December 1996). These conferences served to focus a definition of nocebo and EMS as that aspect of an intervention that induces an expectation mediated adverse outcome or disease. However, these learned scientific exchanges among experts from around the world underscored the dearth of scientific knowledge regarding these potentially far-reaching phenomena.

Are nocebo effects impacting symptoms among Gulf War veterans, women with breast implants, users of cellular telephones, and people consuming fat substitutes? What are the societal costs of nocebo effects and EMS in terms of public health, suffering among the population, misappropriation of limited health care resources, and unnecessary litigation? Answers to these questions can only be gleaned through thoughtful scientific research.

The Institute for Science and Public Policy and American Health Foundation invite you to attend A Breakthrough Workshop on Nocebo (Negative Placebo) Effects and Expectation Mediated Symptoms, 18 February 1997, at Georgetown University, where critical decisions about research into nocebo effects and EMS will be made. We have invited experts to present the state of the art regarding the biological underpinnings of nocebo effects, the medical and health care delivery impacts, and general legal, regulatory, communication, and public policy implications. Discussion sessions will be included to encourage participant input as we define a research agenda to move this critically important area of inquiry forward.

The cost to participants for the intensive one-day workshop is $295. Space is limited, so please register early.

We look forward to having you with us for this important breakthrough activity.


Your Hosts

Ernst L. Wynder, M.D.

Dr. Wynder is the Founder and President of the American Health Foundation (AHF). Established in 1969, AHF is a private research organization uniquely devoted to the prevention of major chronic diseases such as various cancers and heart disease. Dr. Wynder is a widely recognized medical authority and has served on many task forces, workshops, and advisory committees for the National Cancer Institute and the American Cancer Society. He is an author on over 700 scientific articles.

George L. Carlo, Ph.D., J.D.

Dr. Carlo is Chairman of The Institute for Science and Public Policy (ISPP). ISPP is a private organization dedicated to providing constructive scientific input to decision-makers on significant science and public policy issues. Dr. Carlo is a certified epidemiologist and serves on the faculty of The George Washington University. He has served in many domestic and international scientific advisory capacities and has published numerous research articles, commentaries, chapters in books, and policy papers addressing issues in the health sciences.


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A Breakthrough Workshop on
Nocebo (Negative Placebo) Effects and
Expectation Mediated Symptoms
18 February 1997

Presenters on

Panel I: Biological Mechanisms in Nocebo Effects (Scientific Underpinnings) will provide participants with an overview of the theoretical mechanisms, both psychologic and biologic, that regulate the expectation mediated symptoms resultant from the nocebo phenomenon.

  • Dr. Robert Hahn from the Centers for Disease Control and Prevention, will present a review on the state of the science.
  • Dr. Robert Ader, University of Rochester, a leader in the field of psychoneuroimmunology, will discuss the role of conditioning and pharmacotherapy and the nocebo phenomenon.
  • Joseph Sundram will present the biological mechanisms of perception and how it may be possible to quantify autonomic function which plays an integral role in psychosomatic disease.

    Panel II: Medical and Health Care Implications of Nocebo Effects and Expectation Mediated Symptoms, chaired by Dr. Ernst L. Wynder of the American Health Foundation, will present the implications of the nocebo phenomenon from the vantage point of the practicing physician with Dr. Fred Epstein, Beth Israel Medical Center, Dr. William Flynn, Georgetown University, and Dr. Herbert Spiegel speaking to their experiences as health care providers. Dr. Peter Ross, of the American Health Foundation, will review multiple chemical sensitivities and how the nocebo phenomenon may play a role in this syndrome.

    Panel III: Legal, Regulatory, Public Policy, and Risk Communication Implications of Nocebo Effects and Expectation Symptoms, will challenge the audience to consider the wide array of disciplines that may be impacted by the nocebo phenomenon. I [DR GEORGE CARLO] will examine how many of the non-specific symptoms experienced by Gulf War veterans, women with breast implants, users of cellular telephones, and consumers of fat substitutes could be due, in part, to the nocebo phenomenon. Could the communication of adverse health experiences, real or speculative, jeopardize consumer confidence in a product and question years of sound scientific research?

  • Dr. Richard Adamson, Vice President of Scientific and Technical Affairs of the National Soft Drink Association, will discuss the possible role of the nocebo phenomenon in non-specific symptom reporting by consumers of artificial sweeteners.
  • Michael Fumento, well known for his reports on "junk science" in the print media, will share findings from his recent investigative look into Gulf War syndrome.
  • James Archibald, Partner at Venable, Baetjer, Howard, and Civiletti, will examine the legal implications of the nocebo phenomenon and the judicial requirements that must be met in order for this phenomenon to be entered into evidence. A more comprehensive discussion of the nocebo phenomenon and its legal, regulatory, public policy, and pubic health implications is enclosed for your review.
    ispp@hesgroup.com

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