Sunday, February 21, 2010

Mr Wright's Cancer - Placebo/Nocebo Effect



The good and the bad effects of a man's beliefs.
The case study that follows is worth reporting since much of the focus in self-healing discussions has been in the context of life-threatening illnesses such as cancer. Obviously evidence of spontaneous healing is more impressive in such cases. The case of Mr Wright is one such case, but from the point of view of the clinical psychologist it also presents an example of the perfect one trial field experiment. In effect "treatment" was presented, then withdrawn, then presented again, and finally withdrawn. The “treatment” in question is Mr. Wright’s belief in the healing effects of a new drug. His belief, followed twice by a failure of belief, had dramatic and opposing effects on his health.
Klopfer (1957) describes this situation in a seriously ill cancer patient with an optimistically assessed life expectancy of about two weeks. The systematic variations in the patient's condition in response to changes in his belief in the power of the treatment condition offer persuasive support for importance of patient expectations, or belief in health outcomes. The patient, Mr Wright "had a generalized far advanced malignancy involving the lymph nodes, lymphosarcoma. . . Huge tumor masses, the size of oranges, were in the neck, axillas, groin, chest and abdomen. The spleen and liver were enormous. The thoracic duct was obstructed, and between 1 and 2 liters of milky fluid had to be drawn from his chest every other day " (p. 337). His treating physician became involved in trials of a new cancer drug called "Krebiozen", and though Mr Wright had too short a life expectancy to be admitted under the protocols of the study, he had read about the drug and he begged to be included. Thus the first treatment period began.
Three days after his first injection, though his physician had expected that he might be dead by this time, his condition was spectacularly improved. "The tumour masses had melted like snowballs in a hot stove, and in only these few days were half their original size". No other patients showed any such effects and indeed it was later to be shown that the drug was inert for the treatment of cancer. Within ten days Mr Wright was discharged from hospital, "practically all signs of his disease having vanished". Within about two months reports began to appear in the press indicating that "Krebiozen" was ineffective, and Mr Wright began to lose faith in his treatment. As he became more depressed and his faith waned and finally disappeared he relapsed into his former state of ill health. Thus the treatment was effectively withdrawn.
His physician saw the opportunity to test Mr. Wright for his responsiveness to placebo, and deceived him with a story about receiving a new "super-refined, double strength" batch of the drug capable of duplicating the initial healing effects. Thus, albeit somewhat sceptically, he reinstituted the treatment procedure. Convinced by this new story, which was presented with much conviction and some theatrics, Mr. Wright expressed renewed optimism and eagerness to begin a second treatment program.
His physician tantalised him with delays in the "shipment", to allow for some increase in anticipation, and presented the injections only after Mr. Wright was almost ecstatic with expectation and faith. This time the injection was fresh water, yet the effects were as astounding as with the first injections. Again "tumour masses melted, chest fluid vanished, he became ambulatory, and even went back to flying again. At this time he was the picture of health".
Mr Wright was symptom free for over two months before new reports began to appear stating that the AMA had declared "Krebiozen" to be a useless drug. Again Mr. Wright became aware of these statements and again he began to doubt. We might say that once again the treatment effect was withdrawn because of his waning conviction. Within a few days of the press report Mr. Wright was readmitted to hospital in a very distressed condition. Without remaining faith in his treatment (to use his doctor's terminology) he died within two days.
Many members of the medical profession prefer to use the label "spontaneous remission" to describe the remission of disease in instances of self-healing. This label is given to indicate that no known mechanistic explanation is available to account for the changes that occur. Yet the term seems to mean something more than that. It is used almost as a blanket to put over phenomena that do not fit available frames of reference. The same people who use the expression are perfectly willing to deny the observed facts and speak as though the organism is not capable of intentional (by which I mean self-originating) healing. Clearly something extraordinary happened with Mr. Wright as a result of his belief in his treatment. Unless one prefers to believe in the intervention of a fairy Godmother, the conclusion is inescapable that his own system was responsible for bringing about the changes. As Dr. Ainslie Meares has put it, you need see an effect like this only once to know that it is possible.
In my opinion, instead of speaking of events labeled "spontaneous remissions" as though they are mystical phenomena beyond the realm of human understanding, it is more appropriate for the scientist to describe the reality, even to speak of self-healing, and to search for the key to unlocking the organism's own healing processes. That is how science progresses.
Reference. Klopfer, B. (1957) Psychological variables in human cancer. Journal of Projective Techniques, 21, 331-340 (The original report by one of his personal physicians, Dr. Philip West)

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