Monday, February 18, 2013

Optimism Worthless For Cancer Patients?

 Optimism Worthless For Cancer Patients?

A good friend and fellow "miracle" cancer survivor called to my attention a fairly recent article from a group of Australian researchers who were reporting on a clinical study of optimism. These fellows were purporting to study the role, if any, that optimism might play in the recovery of cancer patients. I found it prominently displayed on the webpage of a national cancer patient support organization. It was almost as if this particular association was rejoicing in good news.
Since the Associated Press has seen fit to share this gem of pseudo (junk) science with the world, I decided I should do no less. Mark this one well, dear reader, as you are not likely to see its like elsewhere for some time to come. It is presented here exactly as it appeared in the news release.
According to a recent Associated Press story, a positive attitude does not improve chances of surviving cancer, and doctors who encourage patients to keep up hope maybe burdening them.
Patients are burdened by trying to maintain a positive outlook during their difficult situations, said researchers from the Peter Mac Callum Cancer Center in Melbourne, Australia and five other health centers in an article published in the journal, Cancer.
Optimism made no difference in the fate of most of the nearly two hundred lung cancer patients that Australian followed over 5 years. Only eight people were still living by the time the study ended in 2001. According to health experts, this is the first scientifically valid look at optimism and cancer.
The results surprised some researchers who expected optimistic patients to live longer."
Now this is certainly worth some commentary, particularly from one such as I who has personally beaten metastatic renal cell cancer with plural metastices to the lungs. Not only did my doctors not "burden" me with optimism, they seemed to actually worry that I might somehow develop "false hope". This term is, itself, an outrage, even though it is used universally throughout the halls of medicine. Hope is neither true nor false, it is just hope and a beautiful word it is
This story doesn't say very much for the Australian cancer system now does it? They had 192 out of 200 patients die and they blame it on optimism! As a child I can recall hearing the old saying to the effect that a poor excuse is better than none. It might be just as well to note that were a group of the most optimistic persons in the world to be stood up against a wall before a firing squad, the optimism would be seen to be of little value when the bullets started flying. A better question might be to ask how a patient in a medical system no better than that could possibly find anything to be optimistic about. Had I been a peer reviewer of this bit of pseudo-scientific pot boiling I think I would have asked the following questions.
1) How does one quantify optimism? Can it be distinguished from wishful thinking? Has a numerical scale been derived that allows the "researcher" to, for example, distinguish between a high value #10 optimizer compared and a lowly #3 optimizer? Further, since optimism has been presented as an independent variable in the study, did it remain constant all the way to the ventilator? If not, then how was the time variant figured into the evaluation of data? Perhaps eight of the patients exhibited "durable optimism" while the others "failed optimism" to use the parlance of our clinical trials.
2) What, if any, qualifications did the researchers have that enabled them to either induce or evaluate optimism. If they were not doctors, were they there looking over the shoulders of doctors? Were they present during consultations, infusions or through the long hours in the waiting rooms? Were they there when the mountains of paperwork were being filled out? If they were not involved in the above then they missed a wonderful opportunity to see what a failed medical system can do to any semblance of optimism. "Durable optimism" can be as difficult to muster up as a cancer remission.
3) Were these "researchers" present with the patients through the long nights, black as death, when life seems elusive and hopes fail? If they weren't then it is the height of arrogance to claim to know the condition of a patients optimism. It would be interesting to know if any of these experts on optimism for cancer patients ever had the disease themselves.
4) Perhaps the best question is just how these 200 patients contracted their optimism in the first place? For the study to have any value, all 200 would had to have been optimistic throughout. Since optimism typically is not present at the diagnosis of cancer, then where did this optimism come from at the beginning and how was it maintained? It seems to me that there would have to have been at least one creative genius involved whose accomplishments are not revealed in any detail. By this I refer to the person in the study who managed to induce simultaneous optimism in 200 cancer patients and maintain it all the way to death. Now here is indeed a wonderful discovery that should be shared with the world!! It seems to me that the clinicians are giving themselves a generous dose of undeserved credit in this matter. I seem to see an image of a white jacketed clinician slamming his clipboard down and arrogantly declaring, "They were optimistic, by God, because I told them to be optimistic!". Perhaps there were doctors stretching the truth a bit along the way to impart this optimism, unwarranted as it were in these circumstances. If this is the case, then I suspect it was the doctors doing this false cheer leading who were fooled. Cancer patients who have been around a while usually get pretty good at reading the tea leaves whether anyone recognizes it or not.
It is a fact that, unburdened by any of the above nagging questions, this little parcel of bovine scatology burst across the cancer scene like a meteor. Critics of mind/body medicine were able to say, "See, I told you so!". It turned out that the cancer organization that featured the article the first time I saw it was at that very time engaged in an all out drive to recruit human subjects into clinical trials. It has been observed that the elimination of hope can make even a good prospect look weak. I hate to say it but I seem to keep getting back to the notion that hope and money sit on opposite sides of the cancer table. We know that it is scientific because the Associated Press says that it is scientific. We know that optimism is now worthless for cancer outcomes because the Associated Press says it is. And, if you believe this, I have some Florida swamp land that I can sell to you at a great price!
Back in 1993 Gerald White survived a 20 pound kidney tumor that subsequently went metastatic to distant organs. After all medical treatments had failed and the dreadful "only three more months" death sentence had been delivered. He worked out a self- directed program of guided imagery that induced a remission in three months. He has served a three year term as a Director of the National Kidney Cancer Association. Through his webpage he maintains an active world wide mentoring program that has yielded many similar remissions of cases thought to be hopeless. His book has been translated into Chinese and Hungarian. A credible Scientist, in his career before cancer, he achieved some 20 technology patents in 9 countries.

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