The Biology Of Hope

For years, the idea of a mind-body connection was scientifically disreputable. Now new research suggests positive emotions may play a part in healing.

JEROME GROOPMAN, M.D.

Not long ago, a woman whom I will call Julie Greene came to me for a second opinion. Julie was 56 years old and a school teacher. Four years earlier she had found a lump in her breast. A needle biopsy showed an invasive cancer; blood tests and X rays revealed that it had already spread to several ribs. Analysis of the cancer cells indicated that they lacked hormone receptors, and so would not be sensitive to treatment with estrogen blockers like tamoxifen; moreover, the tumor was negative for the amplification of the oncogene HER2, so therapy with trastuzumab, a recently developed antibody that targets this protein, was not appropriate. Julie received several courses of chemotherapy, and her cancer regressed. Then, three weeks before she consulted me, she felt a pain in her hip. Tests showed the cancer was growing again, this time in the bones of her pelvis.

It was a crisp New England morning, the leaves turning their glorious colors, when Julie and I sat in the clinic to discuss her next steps. She had already seen two other cancer specialists besides her treating doctor. The therapeutic options I outlined for her were similar to those proposed by the other oncologists. “There are still a number of good drugs that may control the cancer—that is, cause the tumors in the pelvis to shrink and prevent any new ones from developing,” I told her. Julie asked how long she could expect these backup drugs to work. I answered that the statistics I had were derived from groups, and that she should remember that people tend to seize on the average length of remission when reviewing data. But, I said, there is a bell curve, and some people are at the far end. Although her cancer was advanced, she might live for several more years. “I heard that already from my treating oncologist,” she said. Then her voice grew heavy and tears began to well in her eyes. “One of the other oncologists told me that I had to have a positive attitude, and that the amount of anxiety I�m feeling is bad for my immune system. I know what that means.” I paused for a moment and then asked her to elaborate. And what Julie said was what I had heard from many other patients. “How can I not worry and, at times, despair? Does that mean I�m helping to dig my own grave?”

The biology of hype
Patients with maladies that have no ready cure are often burdened with information and misinformation about how feelings influence the outcome of their disorders. The past three decades have been marked by the ascent of alternative medicine, in which models of disease causation and treatment differ sharply from those of modern Western medicine. For much of those decades, each camp—the scientific establishment and the non-Western “healers”—has brusquely dismissed the other. One major point of contention has been the existence of a mind-body connection, the notion that emotions can be primary determinants of the genesis and eradication of disease. Recently, some Western physicians have adopted some of the tenets of alternative medicine: in a kind of hedge, they have proposed using the term complementary medicine to describe this integration. It was complementary medicine that Julie encountered when one of her consulting oncologists said her attitude could be deleterious to her immune system, that “negative” emotions like anxiety and despair would impair her body�s defenses and give the malignancy free rein to grow and spread.