PREVENTIVE medicine may soon mean more than just monitoring your vegetable intake and exercise levels, and include how many negative thoughts go through your head in a day.

There is a growing body of evidence to suggest that a patient’s beliefs and hopes affect their prognosis. “One of the major contributors to maintaining health and removing disease is the attitude of the patient,” says Professor Oakley Ray, a psychologist from Vanderbilt University in Tennessee. He reviewed 100 years of research on psychology and disease for a paper published in American Psychologist, and concluded that “words can have the same effect as drugs: thinking optimistically can change your whole biology”.

Ray quotes a wide range of evidence, including various studies linking mindset to heart disease: one such study, by Professor Laura Kubzansky, from the Harvard School of Public Health, established that optimism lowers the risk of heart disease in older men, while pessimism and hopelessness increase it. “There is strong evidence that patients with heart disease who feel hopeless about their condition do worse,” says Professor Alan Steptoe, a psychologist at University College London, “but whether this attitude can be changed is still an open question.” Indeed, large randomised trials have shown that the use of drug therapy and cognitive behavioural therapy to treat depression in heart-disease patients has failed to improve survival in the depressed group.

Ray — who has survived lymphoma against the odds — would have optimism inculcated in schools, so that no one faces illness with a “woe is me” attitude or has to shift years of ingrained negative thinking in response to an illness. He would also have teaching hospitals spend as much time on human relations as on neuroanatomy. Graham Archard, of the Royal College of General Practitioners, says that while this would make no difference to the way GPs treat patients, “a positive attitude of ‘I’m going to get better’ can affect prognosis”. People who give up don’t do so well or live so long, while some people who do everything can defy serious illness.

“This is why counselling and complementary therapies can be so good, and why GPs will suggest books and courses on relaxation and stress management. However, ten minutes per patient doesn’t give GPs much time to harness this response. In an ideal world we would double appointment times so GPs could address the biopsychosocial aspects of disease and how people could help themselves.”

Not all the evidence that Ray cites is of equal quality. “There are some good studies alongside bad studies in his paper,” says Professor Amanda Ramirez, who runs the Cancer Research UK psychosocial research programme at King’s College London. “The idea that ‘fighting spirit’ is important in cancer prognosis has, for instance, been discredited.”

“Furthermore, current best studies don’t support any link between stress and cancer. We can say with increasing confidence that there is no evidence that cancer is a response to your psyche.”

She adds that it’s important to remember that if you are ill, it’s only natural not to feel positive about it straight away. “There is a process you have to go through, and you may need to talk and cry and get depressed first. This is entirely normal and appropriate. What we’re worried about is people who go down and stay down, or people who don’t go down at all — that sort of positivity is so brittle that it’s likely to come unstuck.”