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Breaking news: Can the media make you sick?
Journal of Psychosomatic Research 79 (2015) 173–174
Contents lists available at ScienceDirect
Journal of Psychosomatic Research
Editorial
Breaking news: Can the media make you sick? Crichton and Petrie [1] provide compelling evidence that symptom reporting following exposure to infrasound that has been driven by media-induced negative expectations can be reversed. Their study tests two hypotheses. First, that providing a positive health message about infrasound would counteract the previous effects of a negative health message on mood and symptom reporting following exposure to infrasound. Second, that receiving a positive health message would buffer against the effects of a negative health message before exposure to infrasound in the future. Their results support both these hypotheses. Providing a positive health message before exposure to infrasound cancelled out the deleterious effects of a previous negative health message, leading to a drop from baseline in symptoms and negative mood and a return to baseline in symptom intensity and positive mood. Those who had previously received a positive health message reported fewer symptoms, lower symptom intensity and less negative mood upon subsequently receiving a negative health message and infrasound exposure than those who had not received a positive message. Wind farm syndrome has no identified organic basis. There is no evidence that infrasound, the supposed culprit, has a deleterious effect on the human body [2]. Levels of infrasound near wind farms are no higher than in typical urban environments [3] and are outside the range of human perception [4]. However the effects of inert, ‘nocebic’ stimuli are well established, varied and widespread. For example, a quarter of patients who take dummy pills in randomised-controlled trials report side effects, and an even higher percentage will admit to them if asked directly. If the disorder or disease relevant to the trial is asymptomatic, rates of side effects in the control arm are routinely equal to those in the active arm [5]. Around 20% of people in the UK report symptoms of intolerance to certain types of food, but less than a tenth of these can reliably identify foods containing the supposedly intolerable ingredients under controlled conditions [6]. Many others report symptoms from exposure to weak electromagnetic fields, like those from Wi-Fi devices, but symptoms are reported just as often following sham exposure [7]. The most likely cause of nocebic symptoms is the misattribution of normal and common physical sensations to infrasound. This further heightens monitoring for such sensations, creating a vicious cycle of somatisation. Illuminatingly, people report less symptoms if they cannot see a wind turbine from their property compared to people who can, even if they live geographically closer to one [8], presumably because they lack the constant visual reminder to screen themselves for symptoms and attribute them accordingly. There are several mediators to this process. Physical symptoms are common, normal occurrences in the general population, and a higher level of pre-existing symptoms prior to the introduction of a novel event; in one case, a local insecticide spraying programme was found DOI of original article: http://dx.doi.org/10.1016/j.jpsychores.2015.04.014.
http://dx.doi.org/10.1016/j.jpsychores.2015.06.007 0022-3999/© 2015 Published by Elsevier Inc.
to predict later attribution of symptoms to the event [9]. Anxious people are particularly liable to attribute symptoms to an environmental risk, for many reasons. Anxiety not only creates symptoms of its own (palpitations, tingling fingers) but also increases awareness and monitoring of these symptoms, increases the likelihood of recalling them and of interpreting them catastrophically [10]. Of particular interest, however, is the role of negative expectations in the production of nocebo-driven symptoms. Such expectations are in reality often fuelled by the media. In Australia, 73% of complainants lived near one of six wind farms targeted by very public protests. Conversely, 65% of all Australian wind farms, sited near an approximate total of 21,000 people, received no complaints at all. And 90% of complaints occurred after 2009 when wind farm activists became more prominent, long after the introduction of wind farms themselves [11]. Other conditions have also been shown to be modulated by expectation: rates of neck pain following car accidents in Lithuania, where the population are not aware of whiplash as an entity, are lower than in the UK [12]. Media-induced negative expectations can be experimentally recreated. People shown negative information about wind farms on the internet report more symptoms following sham infrasound exposure [13]. Similarly, people shown leaflets by groups raising awareness about ‘multiple chemical sensitivity’ were more likely to report symptoms following exposure to a harmless odour [14]. And watching a television programme detailing the dangers of Wi-Fi signals increased the reporting of symptoms following sham Wi-Fi exposure [15]. Crichton and Petrie’s findings, which suggest that providing positive health information about a neutral stimulus can counteract the negative expectations resulting from misinformation, leading to less reporting of functional symptoms, are encouraging and reassuring. However, adverse health outcomes caused by irresponsible media reporting may prove rather more difficult to reverse in reality. As they note, their participants received only one negative and one positive health message, immediately before exposure to infrasound. This is in contrast to real life, in which individuals are bombarded with multiple, often ambiguous pieces of information, which may be poorly attended to and temporally disconnected from stimulus exposure. It is unclear how long the beneficial effect of the positive health message might last and whether it might result in measurable behavioural change. Furthermore, in contrast to the students used in the study, people who report symptoms of wind farm syndrome might reasonably be expected to have strong prior health beliefs, to have contact with others that do, or to have personality traits associated with resistance to relinquishing negative expectations. Whether they would be so easily affected by simple positive health messages is of crucial importance. Unfortunately, irresponsible media reporting can lead to undesirable health outcomes without inducing symptoms at all. In 1998, the Lancet
174
Editorial
published a case series of 12 children diagnosed with autism after receiving the MMR vaccine, authored by Andrew Wakefield. The British media seized upon, sometimes with some glee, the now-discredited work. In 2002, there were 1,257 articles on MMR, typically written by journalists with no science background, of which less than a third mentioned that MMR had been found to be overwhelmingly safe and only 11% mentioned that no other countries had any concerns [16]. Uptake of MMR fell below 80% in England in 2003–2004 [17], and cases of mumps in England and Wales increased from 121 in 1998 to 43,378 in 2005 [18]. The negative effects of the propagation of irresponsible health advice are rarely as easy to quantify. The British magazine What Doctors Don’t Tell You faced heavy criticism after its launch in 2012 for making several poorly evidenced claims, including that vitamin C can cure HIV, that homeopathy can cure cancer and that the HPV vaccine has killed hundreds of young women. Several supermarkets removed it from their shelves but the magazine did not go quietly, threatening science writer Simon Singh with legal action for portraying it negatively on Twitter [19]. The adverse health outcomes resulting from these types of publication are almost impossible to gauge and regulation has been lax. Likewise, one can only guess at the potentially nocebic consequences of modern celebrity health and lifestyle advice, which is routinely non–evidencebased [20]. There are some means to limit the harms to health caused by irresponsible reporting, previously summarised by Lewandowsky [21]. Making sure that retractions of incorrect or damaging information are repeated and an alternative, more helpful narrative is presented appear to lead to changing views. Giving a prior warning that scientific information contained in an article may be inaccurate or provisional also appears to reduce commitment to incorrect. However, uptake of either idea by today’s press seems hard to imagine, as column inches are limited and hyperbole sells. Moreover, the possibility of the ‘backfire’ effect, wherein giving an opposing view simply makes a reader’s pre-existing view more entrenched, should not be underestimated. Asking that all journalists reporting on science stories have a basic grasp of science seems prudent, if impossible to enforce. It would prevent embarrassment to the likes of the Telegraph’s arts correspondent Florence Waters, who tweeted that her article on the dangerous effects of electromagnetic radiation from Wi-Fi on children was ‘the most important article I’ve written’, only to be met with light-hearted ridicule from social media users who understood the evidence base and politely and sometimes impolitely suggested otherwise [22]. The Science Media Centre, which offers speedily sourced critiques of breaking science stories by experts in the UK, is a reliable counterweight to media hype and it is encouraging to see other countries develop similar organisations. The media are here to stay. Asking them to only report according to the strict standards of scientific accuracy and peer review would be naïve and arrogant. Their aims and incentives are simply different from ours. Claims that any new addition to modern life, be it chemical, medical, electromagnetic or subsonic, is causing ill health, especially when such claims are accompanied by the testimony of sufferers, will always get coverage. The best we can do is to discern and highlight the mechanisms by which this can do harm, and promote research into how best the nocebo effect can be modified by its much better behaved and more welcome cousin, the placebo effect. Conflict of interest SW is a Trustee of the UK Science and Media Centre.
References [1] F Crichton, K Petrie, Accentuate the positive: Counteracting psychogenic responses to media health messages in the age of the internet, J. Psychiatr. Res. (2015). [2] G Leventhall, Concerns about infrasound from wind turbines, Acoust. Today 9 (2013) 30–38. [3] Health Protection Agency, Health Effects of Exposure to Ultrasound and Infrasound. Report of the Independent Advisory Group on Non-ionising RadiationAvailable from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/ 335014/RCE-14_for_web_with_security.pdf2010. [4] G Leventhall, Infrasound from wind turbines – fact, fiction or deception, Can. Acoust. 34 (2006) 29–36. [5] AJ Barsky, R Saintfort, MP Rogers, JF Borus, Nonspecific medication side effects and the nocebo phenomenon, JAMA 287 (2002) 622–627. [6] E Young, MD Stoneham, A Petruckevitch, J Barton, R Rona, A population study of food intolerance, Lancet 343 (1994) 1127–1130. [7] GJ Rubin, R Nieto-Hernandez, S Wessely, Idiopathic environmental intolerance attributed to electromagnetic fields (formerly ‘electromagnetic hypersensitivity’): An updated systematic review of provocation studies, Bioelectromagnetics 31 (2010) 1–11. [8] E Pedersen, F van den Berg, R Bakker, J Bouma, Response to noise from modern wind farms in The Netherlands, J. Acoust. Soc. Am. 126 (2009) 634–643. [9] KJ Petrie, EA Broadbent, N Kley, R Moss-Morris, R Horne, W Rief, Worries about modernity predict symptom complaints after environmental pesticide spraying, Psychosom. Med. 67 (2005) 778–782. [10] GJ Rubin, M Burns, S Wessely, Possible psychological mechanisms for ‘wind turbine syndrome’. On the windmills of your mind, Noise Health 16 (2014) 116–122. [11] S Chapman, A St George, K Waller, V Cakic, The pattern of complaints about Australian wind farms does not match the establishment and distribution of turbines: Support for the psychogenic ‘communicated disease’ hypothesis, PLoS One 8 (2013) e76584. [12] H Schrader, et al., Natural evolution of late whiplash syndrome outside the medicolegal context, Lancet 347 (1996) 1207–1211. [13] F Crichton, G Dodd, G Schmid, G Gamble, KJ Petrie, Can expectations produce symptoms from infrasound associated with wind turbines? Health Psychol. 33 (2014) 360–364. [14] W D S Winters, I VanDiest, B Nemery, H Veulemans, P Eelen, K VandeWoestijne, O VandenBergh, S Devriese, W Winters, H Veulemans, B Nemery, P Eelen, KP VandeWoestijne, Media warnings about environmental pollution facilitate the acquisition of symptoms in response to chemical substances, Psychosom. Med. 65 (2003) 332–338. [15] M Witthoft, GJ Rubin, Are media warnings about the adverse effects of modern life self-fulfilling? An experimental study on idiopathic environmental intolerance attributed to electromagnetic fields, J. Psychosom. Res. 74 (2013) 206–212. [16] T Boyce, Health, Risk and News: The MMR Vaccine and the Media, Peter Lang Publishing, 2007. [17] NHS Immunisation Statistics, England 2012–13, Health and Social Care Information Centre, 2013. (Available at http://www.hscic.gov.uk/catalogue/PUB11665/nhsimmu-stat-eng-2012-13-rep.pdf). [18] Confirmed Cases of Measles, Mumps and Rubella 1996-2013. Public Health EnglandAvailable at http://webarchive.nationalarchives.gov.uk/20140505192923/ http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/ 1195733833790. [19] Simon Singh threatened with legal action for criticising health magazine. GuardianAvailable at http://www.theguardian.com/science/2012/oct/03/healthmagazine-sue-simon-singh-twitter3 October 2012. [20] T Caulfield, Is Gwyneth Paltrow Wrong About Everything? Viking (2015). [21] S Lewandowsky, et al., Misinformation and Its correction: Continued influence and successful debiasing, Psychol. Sci. Publ. Interes. 13 (2012) 106–131. [22] F Waters, Is Wi-Fi making your child ill? Telegraph, http://www.telegraph.co.uk/ lifestyle/wellbeing/11589857/Is-Wi-Fi-making-your-child-ill.html9 May 2015.
Alex Langford South London and Maudsley NHS Foundation Trust, London, UK Corresponding author at: Bethlem Royal Hospital, London, BR3 3BX. E-mail address: [email protected]. Simon Wessely Kings College London, UK
Contents lists available at ScienceDirect
Journal of Psychosomatic Research
Editorial
Breaking news: Can the media make you sick? Crichton and Petrie [1] provide compelling evidence that symptom reporting following exposure to infrasound that has been driven by media-induced negative expectations can be reversed. Their study tests two hypotheses. First, that providing a positive health message about infrasound would counteract the previous effects of a negative health message on mood and symptom reporting following exposure to infrasound. Second, that receiving a positive health message would buffer against the effects of a negative health message before exposure to infrasound in the future. Their results support both these hypotheses. Providing a positive health message before exposure to infrasound cancelled out the deleterious effects of a previous negative health message, leading to a drop from baseline in symptoms and negative mood and a return to baseline in symptom intensity and positive mood. Those who had previously received a positive health message reported fewer symptoms, lower symptom intensity and less negative mood upon subsequently receiving a negative health message and infrasound exposure than those who had not received a positive message. Wind farm syndrome has no identified organic basis. There is no evidence that infrasound, the supposed culprit, has a deleterious effect on the human body [2]. Levels of infrasound near wind farms are no higher than in typical urban environments [3] and are outside the range of human perception [4]. However the effects of inert, ‘nocebic’ stimuli are well established, varied and widespread. For example, a quarter of patients who take dummy pills in randomised-controlled trials report side effects, and an even higher percentage will admit to them if asked directly. If the disorder or disease relevant to the trial is asymptomatic, rates of side effects in the control arm are routinely equal to those in the active arm [5]. Around 20% of people in the UK report symptoms of intolerance to certain types of food, but less than a tenth of these can reliably identify foods containing the supposedly intolerable ingredients under controlled conditions [6]. Many others report symptoms from exposure to weak electromagnetic fields, like those from Wi-Fi devices, but symptoms are reported just as often following sham exposure [7]. The most likely cause of nocebic symptoms is the misattribution of normal and common physical sensations to infrasound. This further heightens monitoring for such sensations, creating a vicious cycle of somatisation. Illuminatingly, people report less symptoms if they cannot see a wind turbine from their property compared to people who can, even if they live geographically closer to one [8], presumably because they lack the constant visual reminder to screen themselves for symptoms and attribute them accordingly. There are several mediators to this process. Physical symptoms are common, normal occurrences in the general population, and a higher level of pre-existing symptoms prior to the introduction of a novel event; in one case, a local insecticide spraying programme was found DOI of original article: http://dx.doi.org/10.1016/j.jpsychores.2015.04.014.
http://dx.doi.org/10.1016/j.jpsychores.2015.06.007 0022-3999/© 2015 Published by Elsevier Inc.
to predict later attribution of symptoms to the event [9]. Anxious people are particularly liable to attribute symptoms to an environmental risk, for many reasons. Anxiety not only creates symptoms of its own (palpitations, tingling fingers) but also increases awareness and monitoring of these symptoms, increases the likelihood of recalling them and of interpreting them catastrophically [10]. Of particular interest, however, is the role of negative expectations in the production of nocebo-driven symptoms. Such expectations are in reality often fuelled by the media. In Australia, 73% of complainants lived near one of six wind farms targeted by very public protests. Conversely, 65% of all Australian wind farms, sited near an approximate total of 21,000 people, received no complaints at all. And 90% of complaints occurred after 2009 when wind farm activists became more prominent, long after the introduction of wind farms themselves [11]. Other conditions have also been shown to be modulated by expectation: rates of neck pain following car accidents in Lithuania, where the population are not aware of whiplash as an entity, are lower than in the UK [12]. Media-induced negative expectations can be experimentally recreated. People shown negative information about wind farms on the internet report more symptoms following sham infrasound exposure [13]. Similarly, people shown leaflets by groups raising awareness about ‘multiple chemical sensitivity’ were more likely to report symptoms following exposure to a harmless odour [14]. And watching a television programme detailing the dangers of Wi-Fi signals increased the reporting of symptoms following sham Wi-Fi exposure [15]. Crichton and Petrie’s findings, which suggest that providing positive health information about a neutral stimulus can counteract the negative expectations resulting from misinformation, leading to less reporting of functional symptoms, are encouraging and reassuring. However, adverse health outcomes caused by irresponsible media reporting may prove rather more difficult to reverse in reality. As they note, their participants received only one negative and one positive health message, immediately before exposure to infrasound. This is in contrast to real life, in which individuals are bombarded with multiple, often ambiguous pieces of information, which may be poorly attended to and temporally disconnected from stimulus exposure. It is unclear how long the beneficial effect of the positive health message might last and whether it might result in measurable behavioural change. Furthermore, in contrast to the students used in the study, people who report symptoms of wind farm syndrome might reasonably be expected to have strong prior health beliefs, to have contact with others that do, or to have personality traits associated with resistance to relinquishing negative expectations. Whether they would be so easily affected by simple positive health messages is of crucial importance. Unfortunately, irresponsible media reporting can lead to undesirable health outcomes without inducing symptoms at all. In 1998, the Lancet
174
Editorial
published a case series of 12 children diagnosed with autism after receiving the MMR vaccine, authored by Andrew Wakefield. The British media seized upon, sometimes with some glee, the now-discredited work. In 2002, there were 1,257 articles on MMR, typically written by journalists with no science background, of which less than a third mentioned that MMR had been found to be overwhelmingly safe and only 11% mentioned that no other countries had any concerns [16]. Uptake of MMR fell below 80% in England in 2003–2004 [17], and cases of mumps in England and Wales increased from 121 in 1998 to 43,378 in 2005 [18]. The negative effects of the propagation of irresponsible health advice are rarely as easy to quantify. The British magazine What Doctors Don’t Tell You faced heavy criticism after its launch in 2012 for making several poorly evidenced claims, including that vitamin C can cure HIV, that homeopathy can cure cancer and that the HPV vaccine has killed hundreds of young women. Several supermarkets removed it from their shelves but the magazine did not go quietly, threatening science writer Simon Singh with legal action for portraying it negatively on Twitter [19]. The adverse health outcomes resulting from these types of publication are almost impossible to gauge and regulation has been lax. Likewise, one can only guess at the potentially nocebic consequences of modern celebrity health and lifestyle advice, which is routinely non–evidencebased [20]. There are some means to limit the harms to health caused by irresponsible reporting, previously summarised by Lewandowsky [21]. Making sure that retractions of incorrect or damaging information are repeated and an alternative, more helpful narrative is presented appear to lead to changing views. Giving a prior warning that scientific information contained in an article may be inaccurate or provisional also appears to reduce commitment to incorrect. However, uptake of either idea by today’s press seems hard to imagine, as column inches are limited and hyperbole sells. Moreover, the possibility of the ‘backfire’ effect, wherein giving an opposing view simply makes a reader’s pre-existing view more entrenched, should not be underestimated. Asking that all journalists reporting on science stories have a basic grasp of science seems prudent, if impossible to enforce. It would prevent embarrassment to the likes of the Telegraph’s arts correspondent Florence Waters, who tweeted that her article on the dangerous effects of electromagnetic radiation from Wi-Fi on children was ‘the most important article I’ve written’, only to be met with light-hearted ridicule from social media users who understood the evidence base and politely and sometimes impolitely suggested otherwise [22]. The Science Media Centre, which offers speedily sourced critiques of breaking science stories by experts in the UK, is a reliable counterweight to media hype and it is encouraging to see other countries develop similar organisations. The media are here to stay. Asking them to only report according to the strict standards of scientific accuracy and peer review would be naïve and arrogant. Their aims and incentives are simply different from ours. Claims that any new addition to modern life, be it chemical, medical, electromagnetic or subsonic, is causing ill health, especially when such claims are accompanied by the testimony of sufferers, will always get coverage. The best we can do is to discern and highlight the mechanisms by which this can do harm, and promote research into how best the nocebo effect can be modified by its much better behaved and more welcome cousin, the placebo effect. Conflict of interest SW is a Trustee of the UK Science and Media Centre.
References [1] F Crichton, K Petrie, Accentuate the positive: Counteracting psychogenic responses to media health messages in the age of the internet, J. Psychiatr. Res. (2015). [2] G Leventhall, Concerns about infrasound from wind turbines, Acoust. Today 9 (2013) 30–38. [3] Health Protection Agency, Health Effects of Exposure to Ultrasound and Infrasound. Report of the Independent Advisory Group on Non-ionising RadiationAvailable from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/ 335014/RCE-14_for_web_with_security.pdf2010. [4] G Leventhall, Infrasound from wind turbines – fact, fiction or deception, Can. Acoust. 34 (2006) 29–36. [5] AJ Barsky, R Saintfort, MP Rogers, JF Borus, Nonspecific medication side effects and the nocebo phenomenon, JAMA 287 (2002) 622–627. [6] E Young, MD Stoneham, A Petruckevitch, J Barton, R Rona, A population study of food intolerance, Lancet 343 (1994) 1127–1130. [7] GJ Rubin, R Nieto-Hernandez, S Wessely, Idiopathic environmental intolerance attributed to electromagnetic fields (formerly ‘electromagnetic hypersensitivity’): An updated systematic review of provocation studies, Bioelectromagnetics 31 (2010) 1–11. [8] E Pedersen, F van den Berg, R Bakker, J Bouma, Response to noise from modern wind farms in The Netherlands, J. Acoust. Soc. Am. 126 (2009) 634–643. [9] KJ Petrie, EA Broadbent, N Kley, R Moss-Morris, R Horne, W Rief, Worries about modernity predict symptom complaints after environmental pesticide spraying, Psychosom. Med. 67 (2005) 778–782. [10] GJ Rubin, M Burns, S Wessely, Possible psychological mechanisms for ‘wind turbine syndrome’. On the windmills of your mind, Noise Health 16 (2014) 116–122. [11] S Chapman, A St George, K Waller, V Cakic, The pattern of complaints about Australian wind farms does not match the establishment and distribution of turbines: Support for the psychogenic ‘communicated disease’ hypothesis, PLoS One 8 (2013) e76584. [12] H Schrader, et al., Natural evolution of late whiplash syndrome outside the medicolegal context, Lancet 347 (1996) 1207–1211. [13] F Crichton, G Dodd, G Schmid, G Gamble, KJ Petrie, Can expectations produce symptoms from infrasound associated with wind turbines? Health Psychol. 33 (2014) 360–364. [14] W D S Winters, I VanDiest, B Nemery, H Veulemans, P Eelen, K VandeWoestijne, O VandenBergh, S Devriese, W Winters, H Veulemans, B Nemery, P Eelen, KP VandeWoestijne, Media warnings about environmental pollution facilitate the acquisition of symptoms in response to chemical substances, Psychosom. Med. 65 (2003) 332–338. [15] M Witthoft, GJ Rubin, Are media warnings about the adverse effects of modern life self-fulfilling? An experimental study on idiopathic environmental intolerance attributed to electromagnetic fields, J. Psychosom. Res. 74 (2013) 206–212. [16] T Boyce, Health, Risk and News: The MMR Vaccine and the Media, Peter Lang Publishing, 2007. [17] NHS Immunisation Statistics, England 2012–13, Health and Social Care Information Centre, 2013. (Available at http://www.hscic.gov.uk/catalogue/PUB11665/nhsimmu-stat-eng-2012-13-rep.pdf). [18] Confirmed Cases of Measles, Mumps and Rubella 1996-2013. Public Health EnglandAvailable at http://webarchive.nationalarchives.gov.uk/20140505192923/ http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/ 1195733833790. [19] Simon Singh threatened with legal action for criticising health magazine. GuardianAvailable at http://www.theguardian.com/science/2012/oct/03/healthmagazine-sue-simon-singh-twitter3 October 2012. [20] T Caulfield, Is Gwyneth Paltrow Wrong About Everything? Viking (2015). [21] S Lewandowsky, et al., Misinformation and Its correction: Continued influence and successful debiasing, Psychol. Sci. Publ. Interes. 13 (2012) 106–131. [22] F Waters, Is Wi-Fi making your child ill? Telegraph, http://www.telegraph.co.uk/ lifestyle/wellbeing/11589857/Is-Wi-Fi-making-your-child-ill.html9 May 2015.
Alex Langford South London and Maudsley NHS Foundation Trust, London, UK Corresponding author at: Bethlem Royal Hospital, London, BR3 3BX. E-mail address: [email protected]. Simon Wessely Kings College London, UK