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Bob's case is dramatic because he did not appear to respond well to standard medical treatment, yet four years later he continues not to show any signs of cancer. His turnaround could have been a delayed response to the chemotherapy, although most physicians would not predict or expect such an occurrence. We believe that his recovery had to do with Bob himself. It cannot be attributed to a normal response to medical treatment. This is an apparent case of spontaneous remission; it "just happened."

When a disease does not proceed in ways that can be explained by physical intervention, the result is called "spontaneous." The word covers today's ignorance in much the same way as the term "spontaneous generation" covered medical ignorance during the late Middle Ages. In those times, no explanation was available as to why living organisms such as maggots, could grow out of nonliving matter, such as spoiled foods, and so it was said they were "spontaneously" generated. (It was not until 1765 that Spallanzani showed that when food was placed in airtight jars the living organism that normally appeared in spoiled food did not appear. In other words, something in the air carried the larvae. When no air reached the food, there was no "spontaneous generation.") "Spontaneous remission," too, results from processes or mechanisms that are not yet understood.

The number of spontaneous remissions from cancer appears to be small, though all estimates are guesses because we have no idea how many such remissions take place before patients are diagnosed as having the disease. Yet however many cases there are, none of them is "spontaneous." In each case there is some kind of cause-and-effect process. The process by which spontaneous remission takes place is simply beyond our present understanding. It may be that we are unable to recognize the processes because we are not paying sufficient attention to the effect on the body of the mental and emotional aspects of human beings, including their beliefs about their illness, their treatment, and their chances for recovery.

This exclusion of beliefs and feelings from medical practice is unwarranted and, in a way, surprising, because it fails to take into account the significance of what many physicians regard as one of their most powerful drugs, the placebo. Every physician knows the effectiveness of treatments which Me only a sugar pill or other medicineless preparation. This is known as the "placebo effect." A patient is told that a prescription will produce a certain beneficial side effect—and è does—even though there is no medication in the pill that I could produce it.

A physician may give a placebo either because medicine is not required (for example, to a chronic complainer) or be-I an ê an appropriate treatment is not available and the doctor docs not want the patient to feel abandoned. (For obvious è lions, doctors do not frequently discuss placebos with their patients ) In many cases, the placebo proves to be exceedingly effective in reducing or eliminating physical symptoms, including ailments for which there are no known cures. The only active ingredient in the treatment appears to be the power of the belief - the positive expectations—patients have that they have received a helpful treatment. Since they believe the placebo is helpful, because the physician has created positive expectations about the results, the treatment does, in fact, help.

A striking illustration of the placebo effect occurred in a research study conducted with two groups of patients who had bleeding ulcers. One group was told by a physician that they were to receive a new drug that would undoubtedly produce relief. The second group was told by nurses that a new experimental drug would be administered, but that little was known about its effects. The same drug was then administered to both groups. Seventy percent of the patients in the first group showed significant improvement in their ulcers; in the second group 25 percent showed significant improvement. The only difference in treatment was the positive expectancy created in the first group by the physician.

Countless other studies have confirmed the results of positive expectancy on treatment.

  • Dr. Henry K. Beecher and Dr. Louis Lasagna of Harvard University conducted a study of postoperative pain. Some patients were given morphine, others placebos. Fifty-two percent of the people who took the morphine reported relief from pain; 40 percent who took the placebos reported relief. In other words, the placebo was more than three-quarters as effective as morphine. In fact, Drs. Beecher and Lasagna discovered that the more severe the pain, the more effective the placebo.
  • Eighty-three arthritic patients were given sugar pills instead of their usual medicine, aspirin or cortisone. A second group received their usual medication. The percentage of patients who reported relief was the same among those who received the sugar pills as among those who received conventional medication. In addition, when those patients who received sugar pills but reported no relief were given placebo injections of sterile water, 64 percent reported relief or improvement. (Apparently, injections inspired greater positive expectancy than did pills, regardless of the medical value of either.)
  • Medical officials at the National Institute of Geriatrics in Bucharest, Romania, conducted a study of a new drug designed to enhance health and longevity by activating the endocrine system. One hundred fifty patients were divided into three equal groups. The first group received no medication, the second received a placebo, and the third was given the new drug. The three groups were then observed for several years.

Members of the group that received nothing had similar mortality rates and incidence of illness as people in the same age groups in the patients' geographical areas. The second group, which had received the placebo, showed a substantial improvement in health and a lower death rate than the first group. The third group, which had received the drug, showed about the same improvement over the placebo group that the placebo group showed over the first group. Than, although the drug made an important difference in longevity and health, the placebo effect by itself was able to produce improvements in both the degree of illness and the length of life.

The placebo effect is not limited to the administration of sugar pills. Throughout medical history there have been countless practices, such as "bleeding" the patient (which was common during the Middle Ages), that have no physiological basis for curing but still frequently worked, apparently because everyone—including the physician—believed in their efficacy. Indeed, some surgical procedures that were in vogue during the last fifty years seemed to produce remarkable results even though we now know that, in many cases, there are serious questions about their value. Thus, patients not infrequently reported feeling much better after unnecessary hysterectomies or tonsillectomies were performed. Once again, the results can be attributed to the patient's belief that the treatments would work and because of his confidence in the doctor.

The placebo effect may also account for a portion of the benefit received from real medication. The effect is created both by the doctor's manner in administering the drug and also by the process by which drugs are approved by the medical profession. Everyone knows that new drugs must undergo extensive testing by pharmaceutical companies and receive approval by agencies of the federal government. These same federal agencies are also actively involved in attempting to remove harmful foods and drugs from the market, further inspiring public confidence. So when research, testing, and approval by respected federal agencies are combined with a few publicly acclaimed successes, such as the polio vaccine, the ritual for establishing social belief in medical treatment is complete, and the public comes to believe that a medicine prescribed by a doctor must be effective.

A most dramatic case of the placebo effect has been reported by Dr. Bruno Klopfer, a researcher involved in the testing of the drug Krebiozen. In 1950, Krebiozen had received sensational national publicity as a "cure" for cancer and was being tested by the American Medical Association and the U.S. Food and Drug Administration.

One of Dr. Klopfer's patients had lymphosarcoma, a generalized, far-advanced malignancy involving the lymph nodes. The patient had huge tumor masses throughout his body and was in such desperate physical condition that he frequently had to take oxygen by mask, and fluid had to be removed from his chest every two days. When the patient discovered that Dr. Klopfer was involved in research on Krebiozen, he begged to be given Krebiozen treatments. Klopfer did so, and the patient's recovery was startling. Within a short time the tumors had shrunk dramatically, and the patient was able to resume a normal life, including flying his private plane.

Then as AMA and FDA reports of the negative results of Krebiozen started being publicized, the patient took a dramatic turn for the worse. Thinking the circumstances extreme enough to justify unusual measures, Klopfer told his patient that he had obtained a new, superrefined, double-strength Krebiozen that would produce better results. Actually, the injections Klopfer gave were simply sterile water. Yet the patient's recovery was even more remarkable. Once again the tumor masses melted, chest fluid vanished, and he became ambulatory and even went back to flying. The patient remained symptom-free for over two months. The patient's belief alone, independent of the value of the medication, produced his recovery.

Then further stories of the AMA and FDA's tests appeared in the press: "Nationwide tests show Krebiozen to be a worthless drug in the treatment of cancer." Within a few days the patient was dead.



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