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Nocebo Effect

February 2, 2003

1 Corinthians 8:1-13

by Tony Grant


I now invite you to turn in your Bibles to 1 Corinthians chapter 8 and follow along as I read verses 1-13. Hear what the Spirit says to us.

1 Now concerning food sacrificed to idols: we know that "all of us possess knowledge." Knowledge puffs up, but love builds up.

2 Anyone who claims to know something does not yet have the necessary knowledge;

3 but anyone who loves God is known by him.

4 Hence, as to the eating of food offered to idols, we know that "no idol in the world really exists," and that "there is no God but one."

5 Indeed, even though there may be so-called gods in heaven or on earth--as in fact there are many gods and many lords--

6 yet for us there is one God, the Father, from whom are all things and for whom we exist, and one Lord, Jesus Christ, through whom are all things and through whom we exist.

7 It is not everyone, however, who has this knowledge. Since some have become so accustomed to idols until now, they still think of the food they eat as food offered to an idol; and their conscience, being weak, is defiled.

8 "Food will not bring us close to God." We are no worse off if we do not eat, and no better off if we do.

9 But take care that this liberty of yours does not somehow become a stumbling block to the weak.

10 For if others see you, who possess knowledge, eating in the temple of an idol, might they not, since their conscience is weak, be encouraged to the point of eating food sacrificed to idols?

11 So by your knowledge those weak believers for whom Christ died are destroyed.

12 But when you thus sin against members of your family, and wound their conscience when it is weak, you sin against Christ.

13 Therefore, if food is a cause of their falling, I will never eat meat, so that I may not cause one of them to fall.

Amen. The word of God. Thanks be to God.


Nocebo Effect.

About a decade ago, researchers made a surprising discovery: Women who believed that they were prone to heart disease were nearly four times as likely to die as women who did not hold such fatalistic views. Their risk factors were the same: age, blood pressure, cholesterol, weight. So their higher risk of death had nothing to do with the usual physical causes of heart disease. Instead, the only difference was their beliefs. The only difference was whether or not they believed they were at risk for heart disease. They thought they were going to get sick and die, and so they did.

This study is a classic in research on the "nocebo" phenomenon. Nocebo is the evil twin of placebo. While the placebo effect refers to health benefits produced by a treatment that should have no effect, the nocebo effect is the opposite. Patients presume the worst, and that is what they get. The word placebo is Latin for "I will please," and that is exactly what those little sugar pills do. They please us and make us feel better. But nocebo is Latin for "I will harm," and that is precisely what negative beliefs tend to do. Think sick, be sick. [Reid, Brian. "The Nocebo Effect: Placebo's evil twin," The Washington Post, April 30, 2002, HE01]

Though ethical considerations have prevented a rigorous investigation of the nocebo effect, a number of studies hint at its potency. In one experiment, asthmatic patients breathed in a vapor that researchers told them was a chemical irritant or allergen. Nearly half of the patients experienced breathing problems, with a dozen developing full-blown attacks. They were "treated" with a substance they believed to be a bronchodilating medicine and recovered immediately. In actuality, both the "irritant" and the "medicine" were a nebulized saltwater solution. The bronchial constriction was caused - or cured - by the patients' expectations alone.

In another experiment, Japanese researchers tested 57 high-school boys for their sensitivity to allergens. The boys filled out questionnaires about past experiences with plants, including lacquer trees, which can cause itchy rashes much as poison oak and poison ivy do. Boys who reported having severe reactions to the poisonous trees were blindfolded. Researchers brushed one arm with leaves from a lacquer tree but told the boys they were chestnut tree leaves. The scientists stroked the other arm with chestnut tree leaves but said the foliage came from a lacquer tree. Within minutes the arm the boys believed to have been exposed to the poisonous tree began to react, turning red and developing a bumpy, itchy rash. In most cases the arm that had contact with the actual poison did not react. [Gardiner Morse, "The nocebo effect," Hippocrates, November 1999, ]

Most doctors know about nocebo, because almost all doctors have experienced it themselves in the form of MSD--medical student's disease. The medical student reads the symptoms of a disease and becomes convinced that she has the disease. "Headaches:, I have headaches. Dizziness: I am feeling a little dizzy. Insomnia: I hardly got any sleep last night. Nervousness: Thinking about this stuff makes me nervous. Oh, No, I have a brain tumor. Probably inoperable. But let me read on. What are the symptoms of tetanus? Headaches, dizziness, agitation ..." I have it. I have tetanus and a brain tumor. It is not unusual for medical students to read about rabies, look in the mirror and see themselves beginning to foam at the mouth. Most doctors remember this period in their career with some embarrassment, but perhaps it gives them sympathy for victims of the nocebo effect.

Nocebo in Corinth

A nocebo effect was running wild in Corinth back in the first century, and it was tied to concerns about eating meat that had been sacrificed to idols. Transport yourself, just for a second, back to this bustling Greek city, a hub of commercial activity and religious diversity. Look around, check out the temples to the Greek gods. Worshipers in Corinth routinely sacrifice animals to their gods, and then the remainders of the sacrificial animals are sold to the meat markets for resale to the public.

If you go to a Corinthian McDonalds, your Big Mac might include leftovers from a sacrifice to Zeus, Diana, or Hermes. This is common practice, and no one has a problem with it—no one except some of the early converts to Christianity. These followers of Jesus have turned their backs on the Greek gods, and they feel guilty about eating meat that has been sacrificed to those gods. They want to be faithful followers of Jesus Christ, and they sense that eating this tainted meat will make them spiritually unclean. These fears about impurity are enough to make them miserable. It is an ancient example of "think sick, be sick." The Apostle Paul, however, has the cure.

Corinthian Food Fight

In I Cor. 8, the ethical issue is whether to voluntarily stop doing certain things which we believe to be OK, when those actions might lead other, weaker members of the Christian community to sin. Two principles form the crux of Paul's reply:

The subjective nature of sin--by which he means that sin depends upon the sinner.

Concern for other believers, or to put it another way, the supreme importance of the community of faith.

Paul has an extensive discussion beginning in chapter 8 and extending until 11:1. The reason Paul devotes such attention to the subject is because of the underlying theological doctrine, which is the nature and appropriate exercise of Christian freedom. The Christian is free both from Jewish law and pagan superstition, but the Christian is not free to do harm to other people.

Because they were in a pagan society, Corinthian Christians had no choice about being present at pagan worship. In ancient paganism, every aspect of public life was religious. There was no separation of church and state. Every social, domestic, and economic function was sanctified by pagan ritual. So there is not question of not being exposed to pagan sacrifices. The only question is what do we do about the meat of the sacrifice.


In v1 of chapter 8, Paul writes "all of us possess knowledge." Knowledge played an important role in ancient religion, and in particular in the Corinthian community. Among Paul's numerous opponents and competitors were the Gnostic Christians, whose claims to esoteric knowledge (Greek gnosis), provided one of the earliest challenges to the church. Such claims to privileged knowledge was extremely divisive in early Christian communities (and still is). It is always tempting for some Christians to say that I know more than other believers, so I am better than they are, I am nearer to God than they are. Paul is absolutely opposed to that way of thinking. Paul warned earlier in this letter about the dangers of being "puffed up" with pride (4:6).

In contrast to knowledge, which puffs up, love "builds up" (v. 1b). Knowledge puffs up individuals, whereas love builds up the Christian community, the body of Christ. Love is the solution to the Corinthian food fight.

Eating or abstaining from sacrificial food is not a sin, and is of no consequence to the believer's standing before God; its significance lies only in its effect on other members of the Christian community (vv. 10-11). Here Paul enters into the most difficult aspect of his argument. He advises some Christians to refrain from exercising their freedom in Christ in order to prevent other, weaker Christians from sinning. Two problems Paul is addressing: On the one hand, the Christian who refrains from eating meat sacrificed to idols may reinforce the idea that idols are real. The Christian might say, "I do not eat sacrificial meat because those idols are real gods--which Paul denies categorically. On the other hand, by eating such meat, other Christians, for whom such an act would be (or would feel) sinful, would be spiritually destroyed.

The issue, on both sides of the problem, is that members of the community may misunderstand the actions of one another. The seriousness of such misunderstanding is underscored by Paul when he declares that such harmful misunderstanding is not simply injurious to other "members of your family" (v. 12) that is other believers, but sinful "against Christ," whose body is the church.

As I said, Paul is addressing the subjectivity of sin. What is sin for one person is not sin for another, which means that as we mature in the faith, one of our concerns has to be the impact of our actions on others--which is the other issue Paul addresses, the communion of believers, the love that binds together the Christian community.

So is there any problem with eating meat offered to idols? No, not really. Idols do not exist, so sacrifices to Greek gods are sacrifices to nothing. Meat cannot be tainted by something that is nothing.

But the nocebo effect reminds us that people can get sick based on beliefs, not just facts. In the study mentioned a minute ago, the women who believed they were prone to heart disease died at a higher rate based on their beliefs, not based on their physical health. It is not enough for a doctor to say, "You're perfectly healthy." And it is not enough for Paul to say, "Idol meat is perfectly fine." People have to believe it for it to have an effect.

Paul knows that not everyone is going to believe what he says about idol meat. And so he recommends that the Christians in Corinth put more emphasis on love than on knowledge. Love is the key, according to Paul - regardless of where you stand on idol meat, or anything else. Love describes how believers relate to one another. Love transforms circumstances and people. Love restores, love enlarges, love makes whole.


There are numerous nocebo effects crippling our Christian health today. We make ourselves sick when we disagree over issues that may someday seem as antiquated as the Corinthian disagreement over meat sacrificed to idols.

Evangelical Christian scholars battle over whether or not God's knowledge of the future is limited. Roman Catholics, in the wake of numerous scandals, debate whether their priests are trustworthy, and whether priests should be allowed to marry, and whether women should be ordained. Gender-inclusive language in Today's New International Version Bible creates a tug of war between camps in the evangelical world, just as similar changes in the New Revised Standard Version created conflicts a decade ago. Believers of all denominations wrestle every day with the issue of gays and lesbians in the life of the church. Religious school vouchers, doorbell evangelism, and capital punishment reform have all made their way to the Supreme Court this past year, and all have been topics of religious controversy in recent years.

It is enough to make you ill. Not that these issues are unimportant, each in its own way, but the cumulative effect of all this dueling and debating is downright sickening. What we have now is a church that has been fighting for so long that it is "worried sick" and "scared to death." And these are not simply figures of speech. They are becoming observable scientific phenomena--the nocebo effect.

So, what is the cure? Paul's advice is to avoid rating knowledge or certainty or "being right" too highly. The operative principle for the church is love, shown through an attitude of respect for Christians of diverse beliefs. Not everyone has the same knowledge, Paul says, and this is as true for the issue of idol meat as it is for the issues that vex us today. Christians do not all have the same position on issues. Get used to it. Get over it.

The important thing is to behave in such a way that you do not become a stumbling block to your fellow Christians. For Paul, this meant that he abstained from eating meat, even though he believed that nothing was really wrong with it. He took seriously the fact that some of his fellow Christians believed that idol meat was unclean, and that their faith would be harmed by eating such meat. So Paul put their needs ahead of his own, and promised "I will never eat meat, so that I may not cause one of them to fall" (v. 13).

What a concept: to put the needs of our Christian opponents ahead of our own; to invest our energy in building up their faith, instead of knocking down their points of view. To love our neighbors as we love ourselves, and to follow the words of Jesus when he said "In everything do to others as you would have them do to you" (Matthew 7:12).

In the church today, we are so concerned about being right that we have forgotten about being loving. This is particularly a failing among those who regard themselves as conservative, evangelical christians.

Theologian Roger Olson of Baylor University's Truett Seminary became convinced last fall that his fellow evangelical scholars were rejecting controversial views too quickly, and using a "rhetoric of exclusion."

Olson believes that an attitude of suspicion greets evangelical scholars who do not embrace a particular brand of conservative theology. "I'm an Arminian. Yet, more and more frequently, [I] encounter fellow evangelicals who seem to think that Reformed theology is normative evangelical theology - so that if you're not in the center of Reformed thought, you're not fully evangelical." [Timothy C. Morgan, "Theologians decry 'narrow' boundaries," Christianity Today, June 10, 2002, 18.]

I should expand that a little. Baptists and Presbyterians are usually described theologically as Calvinist or Reformed. Churches that come out of the Methodist traditon are described as Arminian. Most conservatives today are Reformed. Arminians tend to emphasize the importance of human action, and most conservatives tend to view them as halfway down the road to atheism. The problem is that in conservative circles, if you are even willing to talk about unusual ideas, then you are immediately branded as outside the fold. Olson is right when he talks about a "rhetoric of exclusion" We need to temper our certainty that we have right knowledge with a unifying love.

As Paul points out, our primary Christian responsibility is not to be correct, but to be compassionate. Our job is to care for, nurture, and build up one another in love, and to recognize that everyone is a precious child of God, a brother or sister "for whom Christ died" (v. 11). If we fail to see each other in this way--see even those with whom we have profound disagreements in this way--then we sin against members of our family, and, according to Paul, we "sin against Christ" (v. 12).

A slight variation of the nocebo effect seems applicable to the church today: "Act sick, be sick." When we fail to behave as Christians, showing love and mercy and grace and understanding, we fail to function as a healthy church. Our sick actions invariably result in our becoming a weak and sickly community of faith. But when we act in ways that are loving, we discover a health and vitality that we have never known before. A church that loves God and neighbor is a community of faith that is reaching out and transforming human lives. When we behave this way, we become a truly strong and healthy part of the body of Christ in the world today. Amen.



If you have questions or comments, email Tony Grant

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