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Dr. Sloan Misses The Point: A Fighting Spirit Is Vital In Overcoming Illness

Jim Prevor’s Perishable Pundit, February 2, 2011

Readers of the Pundit know that recently we had many occasions to focus on what makes for effective medical care. Our friend Jan Fleming, from The Strube Celery & Vegetable Co., has had significant health issues and we’ve chronicled that story here, here, and here.

Our own father, Michael Prevor, was recently diagnosed with pancreatic cancer and we explained that process in a piece we titled Never Tell Me The Odds: One Man, One Disease, One Battle.

So we turned with special interest to an op-ed piece in The New York Times by Richard P. Sloan, a professor of behavioral medicine at Columbia University Medical Center, that carried the provocative title, A Fighting Spirit Won’t Save Your Life.

Dr. Sloan points to a long history of people believing that positive attitude can impact illness:

The idea that an individual has power over his health has a long history in American popular culture. The “mind cure” movements of the 1800s were based on the premise that we can control our well-being. In the middle of that century, Phineas Quimby, a philosopher and healer, popularized the view that illness was the product of mistaken beliefs, that it was possible to cure yourself by correcting your thoughts. Fifty years later, the New Thought movement, which the psychologist and philosopher William James called “the religion of the healthy minded,” expressed a very similar view: by focusing on positive thoughts and avoiding negative ones, people could banish illness.

The idea that people can control their own health has persisted through Norman Vincent Peale’s “Power of Positive Thinking,” in 1952, to a popular book today, “The Secret,” by Rhonda Byrne, which teaches that to achieve good health all we have to do is to direct our requests to the universe.

But Dr. Sloan points out that the science isn’t there to support this idea:

But there’s no evidence to back up the idea that an upbeat attitude can prevent any illness or help someone recover from one more readily. On the contrary, a recently completed study of nearly 60,000 people in Finland and Sweden who were followed for almost 30 years found no significant association between personality traits and the likelihood of developing or surviving cancer. Cancer doesn’t care if we’re good or bad, virtuous or vicious, compassionate or inconsiderate. Neither does heart disease or AIDS or any other illness or injury.

And that imposing this expectation on people is bad medicine:

But such beliefs have implications for how we regard people who are ill. If people are insufficiently upbeat after a cancer diagnosis or inadequately “spiritual” after a diagnosis of AIDS, are we to assume they have willfully placed their health at risk? And if they fail to recover, is it really their fault? The incessant pressure to be positive imposes an enormous burden on patients whose course of treatment doesn’t go as planned.

Very early in my career, I participated in a study of young women who were hospitalized and awaiting the results of biopsies to determine if they had cervical cancer. While I was interviewing one of my patients, the biopsy results of the woman in the next bed came back to her — negative. The fortunate woman’s father, who was there with her, said in relief: “We’re good people. We deserve this.” It was a perfectly understandable response, but what should my patient have said to herself when her biopsy came back positive? That she got cancer because she wasn’t a good person?

It is difficult enough to be injured or gravely ill. To add to this the burden of guilt over a supposed failure to have the right attitude toward one’s illness is unconscionable. Linking health to personal virtue and vice not only is bad science, it’s bad medicine.

It is an interesting piece but we thought it something of an attack on a straw man. Yes, of course, being nice doesn’t mean you won’t get ill and being reverential provides no assurance of recovery.

But our experience is that “a fighting spirit” is EVERYTHING in a serious illness. To start with if one doesn’t have a fighting spirit, one may not get treated at all. After all, undergoing surgeries, chemotherapy and radiation is all a form of completely optional fighting for one’s health and survival. And Dr. Sloan would surely acknowledge that getting treated helps one’s prognosis enormously.

Then it is “a fighting spirit” that leads one to seek out optimal care. Jan Fleming lives in Chicago but flew to Pittsburgh to get the best surgeon. Mike Prevor went to M.D. Anderson in Houston, TX, though he lives in Florida. Dr. Sloan works for one of the most prominent medical institutions in the world. People make great sacrifices to go there for treatment rather than with a local oncologist or community hospital. Surely Dr. Sloan would see in the “fighting spirit” that leads one to sacrifice and travel to get optimum care an increased likelihood of positive outcome.

Once one is in care, recovery often depends crucially on patient motivation. It is often the case that physicians will emphasize the importance of getting up and walking after an operation or blowing into a Spirometer. Presumably Dr. Sloan agrees that these often very difficult and painful steps are not being prescribed to torture patients, so a “fighting spirit” that compels one to do these things will actually help in recovery and thus in securing a more successful outcome.

Finally, when the operations and procedures are over the patient has to continue to take medication, come in for follow-up visits, do appropriate blood work, scans, etc. Many patients don’t. At M.D. Anderson they won’t even do a stem cell transplant on you unless you have another person who signs a “contract” to make sure that you will show up for all your follow-up care.

The study Dr. Sloan relies on in proving his thesis that personality traits don’t matter in things medical is actually a study of extraversion and neuroticism in reference to getting cancer or surviving cancer.

But a “fighting spirit” is different than being an extrovert. One can be highly introverted and want to fight very hard for one’s life.

When the Pundit Poppa went in for his stem cell transplant five years years ago, we had gathered all his children, grandchildren, siblings, nephews and nieces at the hospital in Houston. The Pundit sister and brother-in-law had a new born baby and, not being allowed to fly yet, they heroically drove that baby from Los Angeles to Houston so that the newest grandchild could be part of the party.

This gathering was highly recommended by his physician, Dr. Richard Champlin, because for a then 69 year old man, the stem cell transplant was not likely to be an easy process. Put another way, he would need all the “fighting spirit” he could muster and the family gathering, just before he went into the hospital, was a powerful way of reminding him that he had something to fight for.

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