The 'Nocebo Gap' in Healthcare: How Discrimination Influences Medication Side Effects

A recent study has uncovered a significant connection between patients' experiences of discrimination within healthcare settings and their susceptibility to adverse side effects from medications. The research highlights that individuals from Black, Asian, and other Minority Ethnic (BAME) groups who perceive discrimination during consultations with their general practitioners (GPs) are more likely to report experiencing medication side effects. Additionally, these patients tend to have lower medication adherence.

Published in the Journal of Racial and Ethnic Health Disparities, the study surveyed over 800 participants representing the four largest ethnic groups in the UK. It explored whether negative expectations, possibly driven by discriminatory experiences, can trigger a nocebo effect—a phenomenon where negative beliefs about a treatment lead to real side effects, even if the medication itself does not cause them.

The findings revealed that perceived discrimination correlates with increased reports of side effects and decreased adherence to prescribed medications. Crucially, the analysis suggests that negative expectations regarding side effects significantly mediate this relationship. Interestingly, within the BAME groups, participants identifying as mixed race reported fewer side effects than white participants who experienced similar levels of discrimination. This points to a complex interplay of factors influencing the nocebo effect.

Lead researcher Dr. Rebecca Webster explained that recognizing discrimination as a modifiable factor offers a vital opportunity for intervention. Addressing perceived discrimination could reduce negative medication experiences and promote better adherence, ultimately improving health equity.

The study also emphasizes the need for longitudinal research to track patients from their initial prescriptions and better understand the types of discrimination faced in healthcare. Such insights could help develop targeted strategies to mitigate the nocebo effect among diverse populations.

This research marks a significant step in understanding the psychological components of medication response, revealing that the emotional and social context in healthcare can substantially impact treatment outcomes. Addressing these factors holds promise for enhancing medication adherence and reducing health disparities across different ethnic groups.

Source: https://medicalxpress.com/news/2025-04-nocebo-gap-health-exploring-discrimination.html