When patients do better, there is a temptation for doctors—whether they practice alternative or conventional medicine—to take credit for such outcomes. Kramer of the NIH says, “There is a tendency to believe that whatever you did caused the response, whereas we underestimate the natural course of the disease.” The fact that some patients do better or experience a regression following a seemingly useless treatment has raised questions about a possible placebo effect. Exploiting the placebo effect is explained by Campbell Murdoch, who writes in the British medical journal BMJ, “Another reason for using so-called ineffective treatments is to allow time to pass while the patients get better. Cold bottles were not treatments, they were like egg timers. You gave the patient or the parent an ineffective colored liquid in a bottle and asked them to take 5 ml four times a day out of it. By the time the bottle was empty, the patient was better, not because the contents worked, but because time had passed. It was effective, but for the wrong reason.”
But if a (useless) treatment is not the cause of an improved outcome, could the placebo effect explain some cases of spontaneous regression? It appears unlikely, since that effect would be expected to work through the same pathways already being tested with various mind-body techniques. If the placebo effect were at work, it should be observed in positive outcomes among people who join self-healing groups, pray, or visit Lourdes. Yet despite intense interest in such cures over the millennia, whether religious or secular, scientific or mystical, none of the approaches based on mind or spirit has proven to be particularly effective. Even the famed Lourdes, with over 1 million visitors annually, boasts only a few dozen “miracle cures” ever, according to the Vatican—leaving vast numbers of pilgrims to cope otherwise with cancer and other serious illnesses.
Our minds clearly have some effect on our physiology. Stress can reduce the number of natural killer cells that are known to battle cancer.
Underestimating Spontaneous Regression
While late-stage spontaneous regressions are as rare as hens’ teeth, early spontaneous remissions of microscopic cancers may be quite common—and their frequency may have been underestimated. And that might be causing an unexpected problem. With the advent of new technologies, like CT scans, MRIs, and more sophisticated blood and urine tests, doctors are discovering many cancers at very early stages. At first, doctors and patients welcomed early diagnosis, assuming that early detection would lead to improved survival. But that assumption can cause “medical mischief,” according to the NIH’s Kramer, who says that detecting such early-stage cancers can cause more harm than good if the cancer cells were unlikely to have caused a problem over the person’s lifetime. This, says Kramer, is especially true with prostate cancer and some melanomas and breast cancers that may never go on to cause harm. In those cases treatment offers none of the benefits while exposing the patient to the measurable harms of surgery, chemotherapy, and radiation therapy.
As the “medical mischief” caused in part by an underestimation of the frequency of early spontaneous remissions has become apparent, doctors have had to abandon several cancer screening programs. For example, when researchers developed a simple urine screening test for neuroblastoma—a childhood cancer that arises in immature nerve cells—officials in Japan launched a public health campaign to screen infants. By 2001, over 90 percent of infants were being screened. When the cancer was detected, the children were treated with surgery, radiation, and chemotherapy. But as it was later learned, many of the babies had a slow-growing form of neuroblastoma that would either cause no problems or disappear spontaneously. Worse, the interventions did not reduce the number of deaths from neuroblastoma—but the unnecessary surgeries and treatments did cause some deaths, leading authorities to halt the program. Similar concerns are now being raised about prostate and breast cancer screening programs that detect many slow-growing, less aggressive cancers that are generally more common in older patients than the more aggressive forms of breast and prostate cancer that tend to occur in younger patients.
Like many areas of medicine, progress comes in fits and starts. At the same time that mistakes are made, small triumphs are achieved. Coley’s legacy lives on in the bacillus Calmette-Guérin (BCG) vaccine now in use to treat some forms of bladder cancer. Doctors instill the bacillus into the bladders of patients who have been treated for superficial bladder cancer. The bacillus provokes the immune system to produce an inflammatory response that in turn prevents cancer recurrence. Derived from a bovine form of tuberculosis, BCG is used as a vaccine against TB in many parts of the world.
Although medical advances have dramatically improved outcomes in certain cancers—treatment of testicular cancer and childhood leukemia now routinely lead to cures—when it comes to many other cancers, modern medicine has yet to come close to nature’s handiwork in inexplicably producing spontaneous remission without apparent side effects for people like John Matzke and Alice Epstein, who have experienced the rarest hints of nature’s healing mysteries.
