Correspondence (letter to the editor): Dilemma in Jurisdiction

The article only touches on the fact that the so called nocebo effect is known but that barely any research has been conducted to find out more about this effect. In my opinion this constitutes a wide gap in research, because the nocebo effect can occur even if the instructions for use of medications are known and information has been provided—for example, about the risks of surgery. This means that possible side effects of a medication or operation may be caused primarily by the nocebo effect. This presents jurisdiction with difficult situation: on the one hand, it is a legal requirement that patients who have reached the age of consent are fully informed about their treatment. If, however, such nocebo effects develop around the treatment then a legal dilemma arises. It needs to be clarified whether not passing on information about a defined medication weighs more heavily in the balance than a possible nocebo effect. In order to gain an understanding of the frequency of nocebo effects, one might compare, say, the frequency of adverse effects before and after the now legally compulsory information about defined adverse effects was introduced. On the other hand, one might compare the rate of adverse effects associated with a particular treatment in Germany—where a high degree of information about certain adverse effects is a legal requirement—with the rate of adverse effects in countries where German physicians work but where the legal requirement for information about medical therapies is less stringent. The United Arab Emirates is one such example.