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Changing mindsets about side effects
  1. Kari A Leibowitz1,
  2. Lauren C Howe2,
  3. Alia J Crum1
  1. 1Department of Psychology, Stanford University, Stanford, California, USA
  2. 2Department of Business Administration, University of Zurich, Zurich, Switzerland
  1. Correspondence to Dr Kari A Leibowitz; kleibow{at}; Dr Lauren C Howe; lauren.howe{at}; Dr Alia J Crum; crum{at}


Given research showing that the very act of communicating side effects can increase their likelihood, how can providers inform patients about side effects while upholding their oath to do no unnecessary harm? An emerging approach provides a potential solution: truthfully describe certain minor side effects as a sign the treatment is active and working in the body. This approach focuses on instilling adaptive mindsets about the meaning of side effects while still keeping patients informed. This article describes existing research suggesting that this approach can be helpful in improving experience and outcomes in treatments for pain, hypertension and allergy. Compared with control groups given a standard, empathetic message about side effects, patients who were informed that side effects are a sign treatment is working were less anxious about side effects and rated them as less threatening and intense. A longitudinal, randomised controlled trial of this approach in patients receiving oral immunotherapy for food allergies found that describing side effects as a sign treatment was working reduced the rate at which patients contacted providers with concerns about side effects and led to greater increases in a biomarker of allergic tolerance from pretreatment to post-treatment (peanut-specific blood IgG4). In unveiling this approach, this article also raises important issues regarding which treatments and symptoms this approach should be applied to. Finally, we outline questions future research should address to further understand and leverage this approach.

  • adverse events
  • general medicine (see internal medicine)
  • epidemiology
  • quality in health care
  • primary care

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  • Twitter @karismatically, @howelaurenc, @AliaCrum

  • Correction notice This article has been corrected since it was published. Ted Kaptchuk has been acknowledged in the Acknowledgements section.

  • Contributors KAL, LCH and AJC are experts in health psychology and have conducted research testing the approach of describing side effects as positive signals in clinical practice. All authors contributed to the concepts and structure of this manuscript. AJC is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.