Science writer Jo Marchant has written a fascinating book examining the role of the mind in healing. In her book “Cure: A Journey Into the Science of Mind Over Body“, Marchant separates the fact from fiction when it comes to mental strategies —and accidental benefits— when it comes to healing. This includes everything from meditation to prayer to the placebo effect.
The bottom line? Mental strategies usually help heal the body, and sometimes in profound ways rivaling medical interventions. Of course the underlying disease dictates the degree to which mental strategies show efficacy. Clearly, a placebo pill alone is not going to fix a compound fracture. But the effects of mental strategies are still surprising and intriguing, especially considering that most mental strategies have no adverse side-effects and no cost.
Studies have shown that pill size, color, and perceived cost all play significant roles in a treatment’s perceived effectiveness. A study of placebos in JAMA in 2008 showed that 85% of healthy volunteers found the “more expensive” pain reliever more effective, compared to 61% who used the “cheaper” pain reliever. All of the pills in this study were placebos, and contained no pain relief medicine. The fact that people found any pain relief at all is surprising. Researchers at the University of Cincinnati in 2015 found the same results in a much more serious setting: Parkinson’s disease. Other studies have shown that placebos sometimes even work when patients know they are taking placebos.
One of the most consistent benefits mentioned in Marchant’s book comes from compassion. Patients with friendly, supportive teams of family, friends and medical practitioners, do better as a group than those who do put together an effective team. Not surprisingly, patients seeing doctors with a good “bedside manner” generally do better than those who see cold, impersonal, doctors.
There is a growing body of science helping to explain why perception and other mental strategies have physiological effects. Many mental strategies such as visualization, meditation and prayer, have obvious benefits such as lower heart rate, blood pressure and stress levels. Many strategies have been examined in multiple, large clinical studies. Several peer reviewed studies have even tried to explore the science of prayer. Prayer has been shown to have “relaxation response” benefits similar to meditation. It should be noted, however, that intercessory prayer (praying for someone other than yourself) shows no statistical benefit if the patient is unaware of the prayer. Patients aware that someone is praying for them feel compassion, and thus receive a benefit.
The ramifications to cancer patients are also profound. If you view cancer prevention and therapy as probabilistic, where every potential benefit makes it more likely that you will succeed, a 5% gain is important. And there are many indications that mental strategies can result in benefits greater than 5%.
In 2009, Johns Hopkins published a large study of 1052 patients with high grade astrocytoma patients, which includes grade III and IV brain cancers. Their results showed that depression could affect overall survival by 20% or more, independent of treatment modality or degree of disability. This is an astounding figure, considering that many chemo drugs have lower efficacy rates, and hints at the importance of treating mental health during cancer treatment.
The ramifications of mental health strategies in cancer may be even more profound than currently realized, especially if some intriguing studies can be translated into therapies.
Scientists at MIT have discovered that rats who are raised in a low-stress environment produce more HDAC (histone deacetylase) inhibitors in their brains (or something which causes the equivalent result), while rats raised in stressful environments (with all other controls being equal) produce less. The difference may involve the same relaxation response as we see in meditation. Scientists were able to reverse an Alzheimer’s-like condition in the rats, simply by lowering their stress levels. The ramifications are potentially very important for cancer patients, because of the benefits of HDAC inhibitors both as radiosensitizing and therapeutic agents. Several HDAC inhibitors are already approved in cancer patients, including vorinostat (SAHA).