What we are today comes from our thoughts of yesterday, and our present thoughts build our life of tomorrow: our life is the creation of our mind.
— THE DHAMMAPADA
A 1957 case study by Dr. Bruno Klopfer (who famously pioneered the Rorschach inkblot test) reports the story of Dr. Philip West and his patient Mr. Wright. Dr. West was treating Mr. Wright, who had an advanced cancer called lymphosarcoma. All treatments had failed, and time was running out. Mr. Wright’s neck, chest, abdomen, armpits, and groin were filled with tumors the size of oranges, his spleen and liver were enlarged, and his cancer was causing his chest to fill up with two quarts of milky fluid every day, which had to be drained in order for him to breathe. Dr. West didn’t expect him to last a week.
But Mr. Wright desperately wanted to live, and he hung his hope on a promising new drug called Krebiozen. He begged his doctor to treat him with the new drug, but the drug was only being offered in clinical trials to people who were believed to have at least three months left to live. Mr. Wright was too sick to qualify.
But Mr. Wright didn’t give up. Knowing the drug existed and believing the drug would be his miracle cure, he pestered his doc until Dr. West reluctantly gave in and injected him with Krebiozen. Dr. West performed the procedure on a Friday, but deep down, he didn’t believe Mr. Wright would last the weekend.
To his utter shock, the following Monday, Dr. West found his patient walking around out of bed. According to Dr. Klopfer, Mr. Wright’s “tumor masses had melted like snowballs on a hot stove” and were half their original size. Ten days after the first dose of Krebiozen, Mr. Wright left the hospital, apparently cancer free.
Mr. Wright was rockin’ and rollin’, praising Krebiozen as a miracle drug, for two months—until the scientific literature began reporting that Krebiozen didn’t seem to be effective. Mr. Wright, who trusted what he read in the literature, fell into a deep depression, and his cancer came back.
This time, Dr. West, who genuinely wanted to help save his patient, decided to get sneaky. He told Mr. Wright that some of the initial supplies of the drug had deteriorated during shipping, making them less effective, but that he had scored a new batch of highly concentrated, ultra-pure Krebiozen, which he could give him. (Of course, this was a bald-faced lie.)
Dr. West then injected Mr. Wright with distilled water.
And a seemingly miraculous thing happened—again. The tumors melted away, the fluid in his chest disappeared, and Mr. Wright was feeling great again for another two months.
Then the American Medical Association blew it by announcing that a nationwide study of Krebiozen proved that the drug was utterly worthless. This time, Mr. Wright lost all faith in his treatment. His cancer came right back, and he died two days later.1
When I read this, I thought, Yeah, right. Surely, this case study couldn’t be true. How could cancerous tumors just “melt like snowballs” in response to an injection of water? If the case report was true and something so simple could make a cancer go away, why weren’t oncologists wandering through the wards, injecting stage 4 cancer patients with water? If they had nothing to lose, what was the harm?
The whole thing seemed improbable, so I kept looking. Surely, if there was any truth to such a story, there would be similar case studies reported in the literature.
Another patient reported in The Journal of Clinical Investigation suffered from severe nausea and vomiting. Instruments measured the contractions in her stomach, indicating a chaotic pattern that matched her diagnosis. Then she was offered a new, magical, extremely potent drug, which her doctors promised would undoubtedly cure her nausea.
Within a few minutes, her nausea vanished, and the instruments measured a normal pattern. But the doctors had lied. Instead of receiving a potent new drug, she had been dosed with ipecac, a substance known not to prevent nausea but to induce it.
When this nauseated patient believed her symptoms would resolve, her nausea and abnormal stomach contractions disappeared, even when the ipecac should have made them worse.2
I sat there scratching my head. Curious, but it didn’t prove anything.
Soon after, I stumbled across an article in the New England Journal of Medicine that featured Dr. Bruce Moseley, an orthopedic surgeon renowned for the surgeries he performed on people with debilitating knee pain. To prove how effective his knee surgery was, he designed a brilliantly controlled study.
The patients in one group of the study got Dr. Moseley’s famous surgery. The other group of patients underwent an elaborately crafted sham surgery, during which the patient was sedated, three incisions were made in the same location as in the real surgery, and the patient was shown a prerecorded tape of someone else’s surgery on the video monitor. Dr. Moseley even splashed water around to mimic the sound of the lavage procedure. Then he sewed the knee back up.
As expected, one-third of the patients getting the real surgery experienced resolution of their knee pain. But what really shocked the researchers was that those getting the sham surgery had the same result! In fact, at one point in the study, those who had received the sham surgery were actually having less knee pain than those who’d gotten the real surgery, probably because they hadn’t undergone the trauma of the surgery.3
What did Dr. Moseley’s patients think about the study results? As one World War II veteran who benefited from Dr. Moseley’s placebo knee surgery said, “The surgery was two years ago and the knee has never bothered me since. It’s just like my other knee now.”4
This study hit me in the gut.
Mr. Wright and the lady getting ipecac were just case studies, and case studies, well known to have biases, aren’t considered the gold standard when it comes to interpreting the medical literature. The gold standard by which I was taught to investigate scientific data is the randomized, double-blind, placebo-controlled clinical trial published in a peer-reviewed journal. Dr. Moseley’s study, a randomized, double-blinded, placebo-controlled clinical trial—published in one of the most highly respected medical journals in the whole world—showed that a significant percentage of patients experienced resolution of their knee pain solely because they believed they had gotten surgery.
That was the first real evidence I collected that suggested to me that a belief—something that happens solely in the mind—could alleviate a real, concrete symptom in the body. Dr. Moseley’s study is what led me to research the placebo effect, the mysterious, powerful, reliably reproducible treatment effect some patients experience when given fake treatment as part of a clinical trial.
Like every scientist, I had long known about the placebo effect. Fake treatments, such as sugar pills, saline injections, and sham surgeries, are routinely used in modern clinical trials to determine whether a particular drug, surgery, or treatment is truly effective. The term placebo, from the Latin for “I shall please,” showed up in medical lingo ages ago to indicate inert treatments traditionally given to neurotic patients to placate them.
For centuries, doctors prescribed treatments without any clinical data to prove that the treatments themselves actually worked. Nobody questioned the treatments the doctor prescribed, and nobody did studies to prove whether something was effective. The doctors simply mixed up tonics, dosed up their patients, and the patients got better, at least a percentage of the time. Or the doctor cut someone open, performed a surgery, and the symptoms improved, or they didn’t.
It wasn’t until late in the 19th century that the idea of using placebos in clinical research began to emerge. Then, in 1955, the Journal of the American Medical Association published a seminal article by Dr. Henry Beecher called “The Powerful Placebo,” which made the case that if you dosed people up with drugs, many got better. But if you gave them plain salt water or some other inert ingredient, about a third of them were also cured, not only in their minds, but in real, physiological ways that could be demonstrated in the body.5
Suddenly, the concept of “the placebo effect” became a mainstay of contemporary medicine, and modern clinical trials were born. Now good scientific studies bear the burden of proving that the healing effect of the drug or surgery being tested transcends the potent healing power of the placebo. If a drug or surgery demonstrates that it’s more effective than a placebo, then it is deemed “effective.” If not, the FDA probably won’t approve the drug, the surgery will fall out of favor, and the treatment will be dismissed as ineffective, as Dr. Moseley’s surgery was. Prescribing treatments that prove to be no better than a placebo is believed to violate the principles of evidence-based medicine. It’s what separates the real doctors from the quacks.
Or so I was taught.
It got me thinking. What exactly is the placebo effect? Until I began my research, I had never really stopped to think about it. We all know people in clinical trials get better when you treat them with nothing but a sugar pill. But why?
That’s when I realized I had hit the mother lode in my quest for proof that the mind can affect the body. If a percentage of people in clinical trials get better simply because they believe they’re getting a real drug or surgery, the response they are getting is triggered solely by the mind. This realization threw me into a bit of a tailspin.
Back to the medical journals I went, in search of more evidence that the mind’s belief that the body is getting a drug or surgery is enough to result in real live symptom relief. I found that nearly half of asthma patients get symptom relief from a fake inhaler or sham acupuncture.6 Approximately 40 percent of people with headaches get relief when given a placebo.7 Half of people with colitis feel better after placebo treatment.8 More than half of patients studied for ulcer pain have resolution of their pain when given a placebo.9 Sham acupuncture cuts hot flashes almost in half (real acupuncture helps only a quarter of patients). As many as 40 percent of infertility patients get pregnant while taking placebo “fertility drugs.”10
In fact, when compared to morphine, placebos are almost equally effective at treating pain.11 And multiple studies demonstrate that almost all of the happy-making responses patients experience as a result of antidepressants can be attributed to the placebo effect.12
It’s not just pills and injections that work wonders when it comes to symptom relief. As proven by Dr. Moseley’s knee surgery study, sham surgeries can be even more effective. In the past, ligation of the internal mammary artery in the chest was considered standard treatment for angina. The thought was that, if you blocked blood flow through that artery, you’d shunt more blood to the heart and relieve the symptoms people experience when they’re not getting enough coronary blood flow. Surgeons performed this procedure for decades, and almost all the patients experienced improvement in their symptoms.
But were they really responding to the ligation of the internal mammary artery? Or were their bodies responding to the belief that the surgery would be helpful?
On a quest to find out the answer, one study compared angina patients who got their internal mammary arteries ligated with patients who underwent a surgical procedure during which an incision was made on the chest wall, but the artery itself was not ligated.
What happened? Seventy-one percent of those subjected to the sham surgery got better, whereas only 67 percent of those who got the real surgery improved.13 Internal mammary artery ligation now exists only in medical history.
The data I was collecting was impressive, and I had to wonder if it might be even more impressive if every effort weren’t made to minimize the placebo effect in clinical trials. If researchers perceived the placebo effect as a positive phenomenon, something to embrace, perhaps we’d see even higher percentages. But that’s not the focus most researchers have. On the contrary, clinical-trial coordinators and medical researchers (who are mostly employed by pharmaceutical companies) go out of their way to diminish the placebo effect. After all, patients who get better from placebos interfere with a drug’s ability to get approved for market. To screen out those considered to have “excessive placebo responses,” many randomized, double-blinded, placebo-controlled trials of drugs are actually preceded by a “washout phase,” in which all participants take an inert pill and anyone who reacts favorably to it is eliminated from the study.
So, if the majority of researchers for new pharmaceuticals weren’t getting paid handsomely by Big Pharma, we might see placebo response rates shoot even higher in clinical trials. I know this from personal experience, since I was once one of those clinical researchers, enrolling patients in pharmaceutical trials as a way to try to cover the skyrocketing cost of malpractice insurance and the overhead of running a practice in California, where reimbursement rates were plummeting. We were instructed by the pharmaceutical company to screen out the people who seemed to have an unusually exaggerated placebo response. In fact, after observing me with study patients, one pharmaceutical researcher suggested to me that I stop being so nice to my patients, since their symptoms seemed to be resolving before they even got randomized into the study. The goal of this research is to prove that the drug works better than placebo. If placebo rates are too high, it’s hard to prove that a new drug is efficacious, since efficacy is defined as “better than placebo.”
As I pondered the placebo effect, I found myself doubting whether I would ever respond to a placebo if I were a patient in a clinical trial. After all, I’m a doctor. I’ve been an investigator in clinical trials myself. I’m a smart cookie, and I think I’d just know whether I was getting a real treatment or not. If I suspected I was getting a placebo, clearly it wouldn’t help me, right?
It got me thinking. Are certain types of patients more susceptible to placebo responses than others? Is there any data to suggest whether there’s a classic profile for placebo responders? Are there personality traits or intelligence measures that predict who gets better when given a sugar pill? Do people with high IQs demonstrate less responsiveness to placebos? Are some people just more gullible?
Turns out scientists have studied this. Researchers originally postulated that those who responded to placebos would have lower IQs or be more “neurotic.” But what they discovered is that nearly everybody can be induced to respond to a placebo under the right conditions. We are all susceptible, even doctors and scientists. In fact, some studies suggest that those with higher IQs are even more placebo responsive. Studies also found that optimists are more likely to respond to placebos than pessimists,14 and that people who score higher for emotional resilience and friendliness respond more readily to placebos.15 I took this as good news that it’s not just gullible people who are vulnerable to placebo effects; it’s also smarty-pants people like you.
As my research continued, I couldn’t quite wrap my brain around what I was learning. Clearly, the evidence I was collecting looked promising. When patients—not just the gullible ones but all patients—believe they might get well, a hearty percentage of them experience clinical improvement.
But this failed to fully satisfy my curiosity. I could make the argument that symptom relief really is all in your head. What is pain, after all, if not a perception in the mind? What is depression, if not a mental state? Even with more tangible diseases like asthma or colitis, maybe you just perceive that you can breathe better or think you have fewer gastrointestinal symptoms. Maybe the mental perception is changing, but the body isn’t actually responding in any measurable physiological way. Maybe you just think it is, and that’s enough to make you feel better.
If it’s true that the mind can heal the body, there must be some way to demonstrate that the body is responding, not just with symptom relief, but in physiological ways that can be studied. The next phase of my research led me in search of proof that it’s not all in your head, that the mind’s belief can actually alter the body’s physiology.
With hundreds of thousands of placebo-controlled trials published out there, finding an answer was no small feat, mostly because many of the studies I encountered evaluated symptoms such as headaches, back pain, depression, and decreased libido—which are difficult to quantify. When patients experience relief from such symptoms, it’s largely subjective. There’s no objective measurement that can prove that what they report is true.
But I did finally find proof that, at least a percentage of the time, real physiological changes happen in the body in response to placebos. When given placebos, bald men grow hair, blood pressure drops, warts disappear, ulcers heal, stomach acid levels decrease, colon inflammation decreases, cholesterol levels drop, jaw muscles relax and swelling goes down after dental procedures, brain dopamine levels increase in patients with Parkinson’s disease, white blood cell activity increases, and the brains of people who experience pain relief light up on imaging studies.16
When clinical researchers talk about the placebo effect, they’re actually referring to a whole host of events that happen when you bring people into a clinical setting, offer them a treatment that they know may be either the treatment under investigation or a placebo, and pay attention to them over a designated period of time. Let’s clarify what those five explanations are so we’re all using the right lingo.
The most obvious explanation is that patients experience symptom relief because they expect they will. Because of the ethics of informed consent, patients know they may be receiving a placebo, but many patients in a placebo group believe they are getting the real treatment when they’re not, which creates expectancy. In other words, the expectation that you will feel differently leads you to feel differently.17
But expectation may not be the only factor contributing to the body’s response. The second explanation for why people may get better is classical conditioning. We all know Pavlov’s classic dog experiment. Not only did Pavlov’s dog salivate in response to his Scooby Snack, he also started salivating when he heard the bell that accompanied it. The placebo effect may work in much the same way. If you’re used to getting a real drug from a person in a white coat and subsequently getting better, then you may be conditioned to feel better by simply receiving a sugar pill from someone in a white coat.18 This combination of expectation and conditioning creates measurable changes in brain activity and neurochemistry. Scientists have shown that placebo effects rely on complex neurobiological mechanisms involving neurotransmitters (endorphins, cannabinoids, and dopamine), as well as the activation of relevant areas of the brain (prefrontal cortex, anterior insula, rostral anterior cingulate cortex, and amygdala).19 This suggests that anything we can do to mimic these neurobiological changes might alter perception of symptomatology.
The third explanation is that patients participating in clinical trials go through the ritual of treatment, and this ritual may have therapeutic benefits. Ted Kaptchuk, director of Harvard’s Program in Placebo Studies and the Therapeutic Encounter (PiPS), says, “When you look at these studies that compare drugs with placebos, there is the entire environmental and ritual factor at work. You have to go to a clinic at certain times and be examined by medical professionals in white coats. You receive all kinds of exotic pills and undergo strange procedures. All this can have a profound impact on how the body perceives symptoms because you feel you are getting attention and care.” Kaptchuk often makes the argument that the nurturing care of a respected authority figure may account as much for the placebo effect as positive belief, or even more. A patient in a clinical trial receives attention, support, and sometimes even healing touch, often delivered by an authority figure in a white coat, which has historically come to represent health and healing. We all want to feel seen, heard, even loved, and this alone may relieve symptoms and stimulate positive physiological change, again because of a mind-body-spirit link.
The fourth explanation for why people respond to placebos is that, while most studies try to screen out patients who are self-prescribing other treatments, a percentage of patients in clinical trials may still be surreptitiously seeking other treatments that may confound the data. If someone gets better while in a clinical trial, it’s possible that the other treatments he or she has been sneaking under the table may be responsible for the improvement. This is true whether the patient is receiving the real treatment or the placebo. In either case, other treatments may be responsible for symptom relief that is then falsely attributed to either the drug or the placebo. After all, sick people are often experimenting with diet changes, supplements, and alternative medicine treatments, which are hard to screen out in clinical studies. How are we sure they’re not getting better because of these other interventions?
The fifth explanation is that some patients may get better because the disease resolves itself on its own. After all, the body is a self-healing organism, constantly striving to return to homeostasis. So even if you stuck patients in a dark room, with no treatment or personal attention, a certain percentage of them might improve. Though there is controversy around this subject, a few scientists believe that the phenomenon of spontaneous remission is the only explanation for the placebo effect. Dr. Asbjørn Hróbjartsson and Dr. Peter Gøtzsche’s New England Journal of Medicine article “Is the Placebo Powerless?” claims that we can’t demonstrate a clear placebo effect unless studies also include a no-treatment group that gets neither the drug nor the sugar pill (which most don’t).20 In their study, they found little evidence of any meaningful placebo effect when no-treatment groups were studied, suggesting that it’s not positive belief or nurturing care responsible for disease remission, but rather the natural history of the disease.21 Others criticize this study, however, for its design flaws, claiming that comparing placebo groups from vastly different types of studies, evaluating completely different illnesses, is comparing apples and oranges, making interpretation of the combined data potentially misleading.22
While controversy exists among researchers, the general consensus is that the placebo effect is very real. It has even been reported in very young children and animals, suggesting that belief may be less important than we once thought. In the New England Journal of Medicine, Kaptchuk sums it up: “Placebo effects are improvements in patients’ symptoms that are attributable to their participation in the therapeutic encounter, with its rituals, symbols, and interactions. These effects are distinct from those of discrete therapies and are precipitated by the contextual or environmental cues that surround medical interventions, both those that are fake and lacking in inherent therapeutic power and those with demonstrated efficacy. This diverse collection of signs and behaviors includes identifiable health-care paraphernalia and settings, emotional and cognitive engagement with clinicians, empathic and intimate witnessing, and the laying on of hands.”23
What can we make of all this? Must we swallow fake pills or inject fake solutions in order to take advantage of the effects of expectation, conditioning, and ritual on symptom relief? Kaptchuk says that practicing self-help methods is one way. “Engaging in the ritual of healthy living—eating right, exercising, yoga, quality social time, meditating—probably provides some of the key ingredients of a placebo effect.”24
We know that the placebo effect is a real phenomenon. But what are the physiological mechanisms that explain how thoughts, feelings, and beliefs may translate into symptom relief? Researchers argue over the answer to this question, but several theories have been postulated. Thinking positively about getting well may stimulate natural endorphins, which help ameliorate symptoms, relieve pain, and lift your mood. The reverse is also true: when patients who responded positively to placebo were given the opioid blocker naloxone, which blocks natural endorphins, the placebo suddenly stopped being effective.25
Expecting you’ll get better, being nurtured by caring clinical researchers, and engaging in the ritual of a therapeutic encounter may also relieve physiological stress, known to predispose the body to illness, and initiate physiological relaxation, which is necessary for the body’s self-repair mechanisms to operate properly. As first described by Harvard professor Dr. Walter Cannon, the body is equipped with what Cannon named the stress response, also known as the fight-or-flight response, a survival mechanism that gets flipped on when your brain perceives a threat. When this hormonal cascade is triggered by a thought or emotion in the mind, such as fear, the hypothalamic-pituitary-adrenal (HPA) axis activates, thereby stimulating the sympathetic nervous system to race into overdrive, pumping up the body’s cortisol and adrenaline levels. Over time, filling the body with these stress hormones can manifest as physical symptoms, predisposing the body to disease over time.
But as we’ll discuss in more detail in Chapter 8, just as the stress response exists as a survival mechanism designed to help us stay alive in emergency situations, the body also has a counterbalancing relaxation response. When the relaxation response is elicited, stress hormones drop, health-inducing relaxation hormones that counter the stress hormones are released, the parasympathetic nervous system takes over, and the body returns to homeostasis. Even the most conventional medical doctors acknowledge that the body is fully equipped with an innate wisdom tuned in to an organizing intelligence that knows how to repair what breaks down in the body on a daily basis. Every day, we make and kill off cancer cells in our bodies. We fight off infectious agents and repair damaged cells and replace old tissues with fresh ones. But this inborn body wisdom only seems to operate at full capacity when the nervous system is in the parasympathetic “rest and repair” state. Anything that reduces stress and elicits a relaxation response not only alleviates the symptoms the stress response can cause but also frees the body to do what it does naturally—heal itself.
Positive belief, nurturing care, and the ritual of the therapeutic encounter may also alter the immune system. People treated with placebos may experience boosts in immune function resulting from flipping off the stress response and initiating the relaxation response. Placebos may also suppress the immune system when appropriate. In one study, rats were given the immunosuppressive drug cyclophosphamide (mixed with saccharin water). Then the drug itself was removed, and the rats were fed only the saccharin water (a placebo). Lo and behold: their immune systems stayed objectively suppressed, even when they were no longer getting the drug, suggesting that even rats may respond to the placebo effect with measurable physiological immune responses.26 This paradoxical reaction of the immune system to placebo influences suggests that the innate body wisdom may even know best when to mount an immune response, as when an infection is brewing, and when to suppress an immune response, as in the case of autoimmune diseases.
The placebo effect may also decrease the body’s acute phase response, a type of inflammatory response that leads to pain, swelling, fever, lethargy, apathy, and loss of appetite.27
The mind-body-spirit link may also be mediated by executive functions of the prefrontal cortex of the brain. The fact that placebo responses are disrupted in people with Alzheimer’s disease supports this theory.28 Many with Alzheimer’s disease fail to respond to placebos, supporting the idea that an area of the brain related to expectancy, which may be damaged in a neurological disease state, affects whether a patient responds to placebos. Evolutionary biologist Robert Trivers says that what the brain expects to happen in the near future affects its physiological state. Trivers suggests that those with Alzheimer’s don’t experience a placebo effect because they are unable to anticipate the future, so their minds cannot physiologically prepare for it.
Placebo responsiveness also correlates to activation of dopamine in the nucleus accumbens, a region of the brain involved in reward mechanisms. Scientists studied the brains of people after they were given money to see how much dopamine they released in the nucleus accumbens. The more the nucleus accumbens responded to a monetary reward, the more likely those patients were to get well with a placebo.29
Whatever the mechanism, it’s clear that the mind and body communicate through hormones and neurotransmitters that originate in the brain and then leave the brain to signal other parts of the body. So it should come as no surprise to us that what we think and how we feel can translate into physiological changes in the rest of the body.
But it kinda does, doesn’t it? At least in my medical school, there wasn’t much talk about how our thoughts, feelings, and expectations affect the health of the body. Yet, if they do, why are we not more careful about what we put into our minds? But I’m getting ahead of myself. We’ll talk more about how to keep your mind, body, and spirit healthy in Part Two of this book.
The next question that arose in my quest to understand the placebo effect was whether placebos work for every disease. Do all symptoms and diseases respond to placebos, or are there only certain types of diseases that respond?
What I found is that nearly every clinical trial demonstrates a placebo effect, but some health conditions appear to be more placebo responsive than others. Placebos seem to be most effective when given to patients with immune system conditions such as allergies, endocrine disorders such as diabetes, inflammatory conditions such as colitis, mental health conditions such as anxiety and depression, nervous system disorders such as Parkinson’s and insomnia, cardiac symptoms such as angina, respiratory conditions such as asthma and cough, and, especially, pain disorders.
But do placebos work to treat cancer? Heart attacks? Strokes? Liver failure? Kidney disease?
In my research, I couldn’t find much data to answer this question, perhaps because treating conditions like these in a clinical trial with a placebo would be considered unethical. With these kinds of life-threatening conditions, new treatments are usually studied against gold-standard treatments that already exist and have been proven to have at least some efficacy. So it’s hard to know the limits of what will and won’t respond to a placebo.
The American Cancer Society takes a clear stand: “In studies where doctors are looking at whether a tumor shrinks, placebos have very little, if any, effect. . . . The bottom line is that placebos don’t cure.”30 In a review article published in the New England Journal of Medicine, placebo researcher Kaptchuk concluded, “Though placebos may provide relief, they rarely cure.”31 While physiological changes have been observed in response to placebo treatment, placebos seem to resolve symptoms more than they resolve the disease itself. This is not to suggest that spontaneous remissions do not happen. We know they do. We just don’t fully understand the mechanism by which such seeming miracles happen.
While the placebo effect remains mysterious, what we do know is that placebos seem to work best by altering the patient’s perception of physical symptoms, which paves the way for changing our relationship to what we perceive as suffering. Since so many chronically ill people are plagued with symptoms that interfere with quality of life, I became curious about what sick people could do to alter their perception of the symptoms that cause suffering. Are there ways we can be proactive about helping the nervous system relax so the hormonal milieu of natural healing can be optimized? If we shift both our perception of suffering and the physiology of how our cells and organs are bathed with the hormones of stress or healing, what might be possible then?
While I doubted that I would every fully unravel the medical mystery of what seem like miraculous cures, I was dogged in my search for clues. I found my next lead at a holiday cocktail party at the Institute of Noetic Sciences (IONS) in Petaluma, California, where I was sipping a glass of wine and chatting about my research with Marilyn Schlitz, Ph.D., who was the president of IONS at the time. When I told her my conundrum, Marilyn smiled at me with a look that said, “No problem!” and referred me to an online database that Caryle Hirshberg and Brendan O’Regan had compiled called the Spontaneous Remission Project. This database includes an impressive annotated bibliography of 3,500 references from more than 800 journals in 20 different languages, documenting cases of unexplainable spontaneous disease remission. They defined spontaneous remission as “the disappearance, complete or incomplete, of a disease or cancer without medical treatment or treatment that is considered inadequate to produce the resulting disappearance of disease symptoms or tumor.”32
The bibliography includes some astonishing cases. An HIV-positive patient became HIV-negative. One woman with untreated metastatic breast cancer had breast, lung, and femur tumors that resolved spontaneously. The plaques blocking a man’s coronary arteries disappeared without treatment. A man’s brain aneurysm disappeared. A man with a gunshot wound in the brain recovered with no treatment. A woman with cardiomyopathy in heart failure got better. A woman with thyroid disease experienced a spontaneous cure.33
I also became aware of two similarly titled books written in the 1960s, Boyd’s The Spontaneous Regression of Cancer and Everson and Cole’s Spontaneous Regression of Cancer, which spawned an increase in the number of such case studies reported in the medical literature.
As I read through case study after case study of spontaneous disease remission, I felt my heart race with excitement. For the most part, the case studies didn’t address how the spontaneous remissions happened. The patients weren’t interviewed about whether they believed they would get well, whether they were taking placebos, or whether they had done anything else remarkable to heal themselves.
But they did give me proof that almost no disease can be called “incurable.” Many of the health conditions from which patients spontaneously got well were the kinds of illnesses I was taught were terminal and untreatable. Clearly, I had been taught wrong.
I wasn’t the only one whose curiosity was sparked by case studies like this, wondering why conventional medicine wasn’t asking more questions about those outliers who experienced cures from seemingly “incurable” diseases. At the same time as I was hounding the halls of IONS, Kelly Turner was getting her Ph.D. at the University of California, Berkeley, after traveling the world to interview people who experienced “radical remissions” from stage 4 cancers that had been either untreated by conventional medicine or given treatment deemed to be inadequate for cure. Her book Radical Remission, compiling her stories and conclusions about the nine factors these patients had in common, was released shortly after the first edition of Mind Over Medicine was published. (Review Dr. Turner’s nine factors, including one new one, in Appendix B.)
Years later, I would also meet physician, ordained minister, and Harvard instructor Jeffrey Rediger, M.D., M.Div., who, in addition to practicing medicine, received a master’s in divinity from the Princeton Theological Seminary, giving him the perfect credentials to research the intersection of science and spirituality. He published a book, Cured: The Life-Changing Science of Spontaneous Healing, detailing the findings of his research into the health outliers who have experienced unusual health outcomes. I was relieved and grateful to meet another legitimate academician with a tendency to nerd out like I did about the mind-body-spirit connection. I discovered that, since 2003, he has been collecting stories of radical remission, as Kelly Turner and I had. With degrees in both medicine and theology, he stood with one foot in two worlds, bridging the scientific explanation of such phenomena as “spontaneous remissions” or “placebo effects” on the one side of the bridge and holding the tension with the religious world on the other side that would classify such things as “miracles” or “spiritual healing.” As he writes, “These terms are all black boxes that have not been unpacked by the tools of modern science.”34 He has been tracking these cases for so long that he’s had the opportunity to see how some of these health outliers fare over the long haul–stories of better-than-expected outcomes in patients with pancreatic cancer, the worst forms of brain cancer, idiopathic pulmonary fibrosis, and other potentially fatal diseases.
Our shared interest would lead to hours of brain dumping and a new friendship. Dr. Rediger expressed frustration about why we obsess over outliers in other disciplines. We rigorously study the Steve Jobs of the business world or the Serena Williams of the tennis world, trying to understand what makes them such high achievers. But why don’t we study the high achievers in the arena of health with equal rigor and curiosity? What is it about radical remissions that makes most doctors and scientists so uncomfortable that we lose our scientific objectivity? Is it just that we’re so uncomfortable admitting that we simply don’t understand the mechanisms by which radical remissions happen?
Kelly Turner, Jeffrey Rediger, and I all marveled at how the conventional medical community responded to health outliers. One patient said to me, “He wasn’t even curious about what I’d done. In fact, he seemed mad at me for proving him wrong when he told me I had six months to live.” Another wrote me a letter about her doctor’s response. She said, “She insisted it must have been a misdiagnosis, since this disease cannot be cured. I was standing there in front of her with the medical evidence that my disease was gone, and she literally could not even look me in the eye. I think it was just too confronting to her. If I was cured, her whole worldview might have to change. I think she just couldn’t handle being wrong. If she was wrong about this, what else was she wrong about? I wonder if someone shamed her when she got something wrong when she was a little girl. That’s what it felt like, like she was a scared little girl who got a bad grade on a test and got punished for getting the answers wrong. I almost felt sorry for her, but mostly, I felt angry that she couldn’t even give me a high five or validate that my efforts had been rewarded with a miracle.”
I felt a lot of intense emotions in myself when patients told me their stories. I found myself apologizing on behalf of doctors I didn’t even know, feeling everything from rage to grief to guilt to relief to compassion to gratitude. By this point in my journey, I was getting used to feeling a lot of mixed feelings. Parts of me were excited and passionately devoted to this mission, feeling a strong sense of fulfillment and a devotion to my calling. Other parts were resisting the journey. I started experiencing somatic symptoms, as if I had a perpetual case of belly butterflies. I felt inexplicably frightened, as if I might get burned at the stake or at least rejected by my peers in the medical community that had once embraced and celebrated my achievements and contributions. I felt a lot of sadness and shame when I thought about all the patients I might have harmed with my own ignorance.
At one point I had to go out under the vast, starry sky of a moonless night and just gaze at the enormity of an unknowable universe while hugging myself and rocking. Somehow, this calmed my nervous system and helped me carry on. In spite of my resistance, I knew I was not going to stop diving down the rabbit hole. I had passed the point of no return. I started seeing a therapist to help me heal the parts of me that were resisting, and I found that when I loved and accepted my resistant parts, they relaxed and let me continue on my journey so I could help guide you on yours.
I had proven to myself, without a shadow of a doubt, that the mind-body-spirit connection can heal the body, at least some of the time. I even had some semblance of a logical physiological explanation for how it happens. But I knew I was only just beginning to understand the complexities of these mysteries, and I still didn’t understand how to harness this power in order to help people prevent illness and treat disease. So I dug deeper.