In this New York Times article, A-list actress Angelina Jolie bravely announced that she made the tough decision to undergo elective bilateral mastectomy after her doctors warned her that she has an 87% risk of developing breast cancer and a 50% risk of getting ovarian cancer because her mother died of breast cancer and she carries the BRCA1 gene. While I fully support Angelina’s right to write The Prescription for herself, and while I admire her courage to go public with what some might hide, as an OB/GYN physician with a passion for mind-body medicine, this breaking news concerns me for a variety of reasons.
The Nocebo Effect
In Chapter 2 of Mind Over Medicine, I share the scientific data about “the nocebo effect,” the opposite of the placebo effect, when we think something will harm our health – and it does. In one case study, a man was misdiagnosed with cancer and told he would only live 3 months. He died exactly 3 months later and was found to have no cancer on autopsy.
In another case study that is the stuff of fairy tales, a woman born on Friday the 13th in the Okefenokee Swamp near the Georgia-Florida border was one of three girls delivered that day by a midwife, who proclaimed that all three girls, born on such a fateful day, were hexed. The first, she announced, would die before her 16th birthday. The second would not survive her 21st. And the patient in question was told she would die before her 23rd birthday.
As it turns out, the first two girls died within one day of their 16th and 21st birthdays. The third woman, terrified that she would die on her 23rd birthday, showed up at the hospital the day before her birthday, hyperventilating. Soon afterwards, just before she turned 23, she died, proving the midwife’s predictions correct. This is an extreme example of the nocebo effect, when fear-based thoughts about your health can actually kill you.
In his book Spontaneous Healing, Dr. Andrew Weil argues that physicians may unwittingly engage in what he calls “medical hexing.” When we pronounce patients with “chronic,” “incurable,” or “terminal” illnesses, we may be programming their subconscious minds with negative beliefs and activating stress responses that do more harm than good. What proof do we have that they will not be one of the case studies who winds up in the Spontaneous Remission Project, having been cured of a so-called “incurable” illness?
By labeling a patient with a negative prognosis and robbing a patient of the hope that cure might be possible, we may ultimately prove the poor prognosis we have bestowed upon our patient correct. Wouldn’t we be better off offering hope and triggering the mind to release health-inducing chemicals intended to aid the body’s self-repair mechanisms?
Is it really healthy for any of us to know that we might have an 87% risk of any illness? Do we really want to poison our minds with such fear-based thoughts that then force us to make decisions about whether or not we will electively cut off perfectly healthy body parts?