While I have not had a complete personality change — I can see that there is an industry out there feeding on the fears of the seriously ill — I have come to realise that the alliance between doctor and patient can be a powerful therapeutic force for good. I now know at first hand that those doctors who take an upbeat attitude to my illness leave me with less pain and more “fight”, whereas those dwelling on the gloomier aspects of my condition increase my need for analgesia, leading me to suspect that what I always prized above all else — the pure, unvarnished truth — may depress the immune system along with the spirits.
The truth is that the medical profession does not do hope very well, especially once you have “advanced” to “late stage” (the modern euphemisms for “terminal”) cancer. If many oncologists treat “hope” like a four-letter word, I can understand why. Sensitive to charges of paternalism or malpractice, they are more likely to hit the pessimistic note rather than an optimistic one; to draw a worst-case scenario that might leave you pleasantly surprised months, or years, down the line rather than furious (and perhaps litigiously inclined) that things did not work out as rosily as you thought you had been promised.
The H-word is, I am convinced, the principal reason why, according to the first Europe-wide survey on the subject, published in Annals of Oncology earlier this year, a third of cancer patients in Europe use alternative and complementary therapies. The study found that those users tended to be female, younger, better educated and, surprise, surprise, to have cancers with a poorer prognosis (moi, moi et moi!).
So are the purveyors of conventional medicine missing a trick? Dr Jerome Groopman, a US haematologist specialising in cancer, certainly thinks so. In his thought-provoking new book The Anatomy of Hope (Simon & Schuster, £10), he distinguishes the hope that heals (and he is convinced it does) from both the trap of wishful thinking and the clichéd “positive attitude” that we cancer patients are so often instructed to have. “Hope does not arise from being told to ‘think positively’,” he writes. “Or from hearing an overly rosy forecast. Hope is rooted in unalloyed reality. Hope is the elevating feeling we experience when we see — in the mind’s eye — a path to a better future. For all my patients, hope, true hope, has proved as important as any medication I might prescribe or any procedure I might perform.”
His words are borne out by a recent study at the Royal Marsden, which tracked 500 women with breast cancer for ten years and found that those who had a “hopeless” response to their diagnosis were at greater risk of relapse and early death. The authors of the study, published in the European Journal of Cancer this April, do not explain why a hopeful outlook should exert such “a significant effect” on disease-free survival, though various possible mechanisms are suggested, including an effect on the body’s immune status.
The truth is that, much as I trust and respect my medical experts, I glean little hope from the Middlesex Hospital’s oncology department, tucked away like an apology in its farthest corner, a no-go zone where nobody wanders by accident. Only an alternative practictioner would have the effrontery to suggest that a Stage Four patient like me might not have just months, but many years of active life ahead of her, but I now realise that I need to hear it every bit as much as I need the chemotherapy that has knocked back the malignant cells in my lungs.
Call me credulous, but the acupuncturist I see three times a fortnight and the herbalist who prescribes possibly the worst-tasting concoctions in the world give me hope each time I see them. When the healer I went to see last week held his hands lightly over my chest and told me that he couldn’t promise anything, but that he has cancer patients who were told to put their affairs in order still coming to see him nine and ten years down the line, I felt a surge of optimism that felt as powerfully therapeutic as any drug.
I haven’t been completely suckered by alternative practitioners, and some of their more outrageous claims make my blood boil even more furiously than it did in the old days. But now that I am a member of their target audience I am finding out for myself how hard it is to turn my back on something — anything — that offers a reasonable chance of keeping my cancer on hold. The key word here is “reasonable”. I am still a practising sceptic, reserving the right to reject anything that doesn’t feel “right”.
Nevertheless, my bathroom shelves bear witness to my new mindset. I now swallow 40 different pills and potions every day, from high-potency vitamins and immune boosters to a controversial ayurvedic remedy called carctol and a mysterious agaricus mushroom extract from Brazil.
These days, rather than dismiss improbable survival stories out of hand, I find myself compelled to suspend my disbelief — like Professor Madeleine Ennis, a pharmacologist at Queen’s University in Belfast and sworn opponent of pseudo-medical mumbo-jumbo, who was dumbfounded when the irrational claims of homoeopathy not only held up in a series of double-blind experiments that she had designed herself but were replicated in four independent research laboratories.
How can a remedy that has been diluted so many times it is unlikely to contain a single molecule of the original induce a potentially therapeutic response in white blood cells? Ennis, whose trial was published in the medical journal Inflammation Research, is still “searching for a rational explanation” for her findings.
I find myself increasingly persuaded that the mind can influence the body’s biochemistry in ways as yet beyond scientific explanation. The placebo effect should not happen. It does not make sense. But researchers investigating new drugs now expect that over a third of their subjects will benefit from taking a pharmacologically inert dummy pill if they believe they are receiving active treatment.
While it’s perhaps not so surprising that the effectiveness of placebos given in anti-depressant drug trials often matches that of the active drug — it is, after all, the effect of the mind on the mind — it is difficult to dismiss as “purely psychological” trials on asthmatics in which researchers can produce dilation of the airways simply by telling people they are inhaling a bronchodilator even when they aren’t, or the study in which over half of the patients with colitis, a painful inflammatory gut condition, not only reported feeling better after taking the placebo drug, but showed clear evidence of improvement when their intestines were examined with a sigmoidoscope.
What has this to do with cancer? Well, people do recover when they “shouldn’t”, go into unexpected remissions, outlive the survival times they have been “given” by years, not months. In the four months since my diagnosis, I have been in touch with at least five people whose cases were pronounced hopeless but whose cancer has “disappeared” — ie, can no longer be found on state-of-the-art CT and MRI scans — to the mystification of the experts treating them, who, rather than admit that miracles can happen, doubt their original diagnoses. Is it possible that there are more things in heaven and earth than are dreamt of in their oncology? I choose to hope so.
Deborah Hutton, Vogue © The Condé Nast Publications Ltd. Taken from a feature in the July issue of Vogue, on sale now. Deborah Hutton’s book What Can I Do To Help? Practical Ideas for Family and Friends from Cancer’s Frontline is published on July 14 by Short Books, priced £7.99. Royalties go to Macmillan Cancer Relief
