Magic is for fairy tales: A useful placebo

Michael Spencer's story:
Three years ago, a week before Thanksgiving, while I was sitting in my office, my chest began to throb. It was a diffuse pain, but pain nonetheless. I am a middle-aged man with the usual amount of stress (too much) and I handle it in the usual way (denial). My cholesterol and blood pressure are normal, and I exercise regularly and try to eat sensibly. Still, I have read many obituaries of "healthy" men my age who ignored chest pain. So, somewhat sheepishly, I called my doctor and explained the situation, and he told me to come right over.

He conducted a thorough examination, and then we talked. He told me I was fine, that Thanksgiving is often a tense time, and that I should relax. My pain suddenly disappeared. I have written frequently of my belief that magic is for fairy tales and science is for humans. But something about that process soothed me. Of course, it was a relief to know that I wasn't sick. But could words really banish a pain I had struggled with for hours?

After I got home, I realized that I had been given a placebo. Not purposefully, perhaps, but it had the same effect. My doctor told me that I was fine, and that made my pain go away. It also eased my anxiety at least as effectively as if I had swallowed a pill. My doctor takes an extremely science-based approach to his work. That's what makes him so good at his job. But that afternoon we engaged in exactly the type of ritual that, according to Harvard Medical School Professor Ted Kaptchuk, will have to play a critical role in the future of American health care. And, at least in this instance, it would have been hard to argue that it didn't work.

Thanks to Michael Spencer, from whose article in Dec. 12 issue of the The New Yorker this was reprinted.

To spare him pain: Healing by doctors through symbolic action

My son will turn 21 in a few days, and he's a fine, healthy young man, now bigger than me. He was born prematurely, and spent the first few weeks of his life in a NICU (neonatal intensive care unit). For such baby boys, Jewish law required that we delay his circumcision, normally performed on the eighth day of life, until after he arrived home. The circumcision was performed routinely, and was only notable for the number of my doctor friends in attendance who discussed their preferred techniques of circumcision. Other than that creepy conversation, it was a joyful event. Such a bris symbolizes the continuation of God's covenant with mankind, just as the Jewish patriarch Abraham first performed on his own son under God's direction.

In today's New York Times, Dr. Mark Litwin movingly describes how he performed a circumcision for a newborn boy, far less healthy than my son, who had just passed away. The parents had requested that it be performed after he passed away, to spare him any unnecessary pain. Dr. Litwin performed the bris so the parents could mark the baby's brief life "before being wrapped in the ancient tradition of his ancestors." Two years later, the couple bore, and circumcised, another son, a healthy one.

Sometimes doctors' symbolic actions like that circumcision can help people heal. Two very different examples come to mind. First, sometimes emergency personnel might persist with resuscitation efforts they know are hopeless, so the family will know that everything possible has been done to try to save the patient. That could clear the minds of the grieving family from dwelling on a painful question. Another type of symbolic action is a doctor's use of a placebo, given to stimulate healing without a pharmacologically effective drug. Dr. Litwin's essay shows that doctors have powerful, subtle, non-medical ways to symbolically help in healing.

With an impressive air of authority: The nocebo effect

Everyone has heard the expression "scared to death." But can the mind actually influence life and death — or at least our well-being? Medical science is asking the same question.

In 1974, a Nashville physician treated Sam Londe for cancer of the esophagus, which was then considered fatal. Sam died a few weeks later, though an autopsy revealed that his esophagus was fine. He had a few cancerous spots on his liver and one on his lung, but not enough to kill him.

Three decades later his doctor told the Discovery Health Channel: "He died with cancer, but not from cancer. ... I thought he had cancer. He thought he had cancer. Everybody around him thought he had cancer. Did I remove hope in some way?"

Sam could have fallen victim to the "nocebo" phenomenon. With a placebo, a harmless substance is given to patients in medical studies to test the efficacy of a drug. Patients normally expect a positive outcome. But with the nocebo effect, people expect something bad to occur, developing symptoms after learning about painful side effects of medication.

"People get worse because they believe they'll get worse," says Dr. Julio Licinio, chairman of the Department of Psychiatry and Behavioral Sciences at the University of Miami. "It's almost like a negative self-fulfilling prophecy." (Nocebo is Latin for "I will harm.")

An example: Women who were studied in the landmark Framingham Heart Study who believed they were prone to heart disease were nearly four times as likely to die as women with similar risk factors — high blood pressure, excessive weight, high cholesterol — who didn't believe.

When you expect bad things to happen, Dr. Licinio says, stress hormones rise, your heart beats faster and your immune system becomes suppressed. "It's similar to the feeling you'd get if you saw a car rushing toward you. It's good in an acute situation when you need to run away. It's not good when you're having surgery."

Neither is it good, apparently, when a priest administers last rites. In the 1997 report, "Nocebo: The Power of Suggestibility," Dr. Herbert Spiegel of Columbia University writes about a case in which a priest was summoned to administer last rites at a large American Roman Catholic hospital. "With an impressive air of authority and a brusque voice," Spiegel said, the priest gave last rites to the wrong patient. Within 15 minutes, that patient died, but the other one lived a few more days.

Advice to patients: Share this story with any downbeat family members.

Read a story about the power of hope, or read Desonta Holder's source story in the McClatchy Newspapers.