“Finish last in your league and they call you idiot. Finish last in medical school and they call you doctor.” — Abe Lemons
The placebo effect has been known to at least some lay people, but few, if any, know of the powerful ‘nocebo’ effect on human health and illness. Nocebo is a detrimental effect on health produced by psychological or psychosomatic factors, such as negative expectations of treatment or prognosis. While the placebo effect can have a powerful healing capacity, as shown in elegant studies in medical and surgical situations where placebo has proven better than drugs or surgery, there has been no study done on the dangerous effects of the nocebo on patients’ life and illness.
When I wrote in the British Medical Journal (BMJ) that “In the company of specialists life becomes miserable on earth,” there was a spate of rapid responses. In my response, I had said: “In view of the new scientific wisdom on the placebo effect in human illnesses, are we right in giving cancer patients a deterministic predictability prognosis about their future? Does that not further deplete their immune guard? Doctors have been predicting the unpredictable future (BMJ, 1991; 303: 1565) of cancer sufferers. Why are we nocebo cancer doctors?”
One doctor Herbert Nehrlich from Australia wrote a response which reads, “I remember the time, back in the Fatherland, when doctors were fibbers. Not only did they talk in Latin with an occasional Greek twist thrown in for difficult patients, they actually painted rosy pictures of the future for doomed patients. There were far too many experts in medicine in post-WW II Germany and most were taken seriously, which was probably due to the need for paternal guidance that was felt by nearly all survivors of a lost war.
“So, some preached that lying to a patient was a strict no, no. Others maintained that a patient’s immunity would surely collapse if the truth were told. From the chaos sprang a new order: Always tell the truth, consequences be damned. Hope cannot be taken away, my father used to say, and many were doing just that in a slipshod, hurried manner. When I saw my first wart fade within days after the application of one drop of dandelion milk during a full moon I became a believer in the power of the placebo… Faith in the doctor, like faith in general, is all about things hoped for. Take this hope away and you may be politically correct. But so are those physicians who believe in euthanasia.” (BMJ, 2011; 342: d20530) Thinkers like Herbert are rare these days.
The stimulus for this piece was a visit to my neighbour, who had just died from fibro sarcoma of the vertebral canal area. The death warrant given by his cancer specialist almost killed him a couple of years ago. He was told that he would not last more than three months, at the most. After many hours of psychotherapy and symptomatic Ayurvedic treatment at a good centre, the man lived with his family for a good two years.
In cardiology, thanks to monetary fascism, we are in a terrible position. The way our young catheter-pushers predict the hapless victims’ future is something that has to be seen to be believed. They show the patient their gadget, the angiogram of the epicardial coronary vessels and tell the patient and his relatives that “this vessel is 100% blocked. If you do not have it angioplastied right away I cannot even guarantee that you will reach home alive!” I would be happy to angiogram the doctor himself and give him that kind of prognosis. What would happen to him? The fear thus generated (nocebo effect) could really kill him!
Cancer is equally bad, if not worse. Specialists are sure about the life span of a patient just looking at the biopsy report, as if it gives them a holistic picture of the disease. These nocebo specialists, who abound in many other fields, deliberately generate fear to capture their prey in their web of disease-mongering.
“Some doctor told me I had six months to live and I went to his funeral.” — Keith Richards