Health: beware negative self-fulfilling prophecy

Everyone has heard the expression "scared to death." But can the mind actually influence life and death — or at least our well-being? Medical science is asking the same question.

Consider the case of Sam Londe. In 1974, Dr. Clifton Meador, a Nashville physician, treated him for cancer of the esophagus, considered fatal back then. Londe died a few weeks later, but an autopsy revealed that his esophagus was fine. He had a few cancerous spots on his liver and one on his lung, but not enough to kill him.

Three decades later Meador told the Discovery Health Channel: "He died with cancer, but not from cancer. ... I thought he had cancer. He thought he had cancer. Everybody around him thought he had cancer. Did I remove hope in some way?"

Though we'll never know for sure, Londe could have fallen victim to the nocebo phenomenon. Coined in 1961, "it's sort of a nasty counterpart of the placebo phenomenon," says Robert Hahn, a senior scientist at the Centers for Disease Control and Prevention.

With a placebo, a harmless substance is given to patients in medical studies to test the efficacy of a drug. Patients normally expect a positive outcome. With the nocebo effect, people expect something bad to occur, developing symptoms after learning about painful side effects of medication.

"People get worse because they believe they'll get worse," says Dr. Julio Licinio, chairman of the Department of Psychiatry and Behavioral Sciences at the University of Miami. "It's almost like a negative self-fulfilling prophecy."

There are few documented studies on the nocebo effect because "it's usually hard to get any study approved that could make people sicker than they are," Licinio says. Nocebo, after all, is Latin for "I will harm," whereas placebo is Latin for "I shall please."

One example of the nocebo effect was extracted from the ongoing Framingham Heart Study, which began in 1948 to identify common factors that contribute to cardiovascular disease. It began with 2,873 women and 2,336 men. Women who believed they were prone to heart disease were nearly four times as likely to die as women with similar risk factors — high blood pressure, excessive weight, high cholesterol — who didn't believe.

In a classic nocebo experiment conducted in the early 1980s volunteers were told that a mild electrical current would pass through their head, and although no electrical current was used, two-thirds of the volunteers complained of a headache after the experiment.

Daniel Moerman, professor emeritus of anthropology at the University of Michigan-Dearborn, who was not involved in that study, would call the headaches a "meaning response."

"One thing we can be certain of is if a person changes it's not because of the placebo. What is it? It's because of what the placebo means."

Take the number four. David Phillips, professor of sociology at the University of California at San Diego, looked at mortality rates of 200,000 Chinese- and Japanese-Americans and 47 million white Americans from 1973-1998. He found deaths from heart disease were 27 percent higher on the fourth day of months for people of Asian descent. There was no such pattern among white Americans.

Could this have anything to do with the words "four" and "death" having similar pronunciations in Cantonese, Mandarin and Japanese?

"The effect was quite striking," Moerman says. "Four is just a number ... but if a four is meaningful in some particular way, it's not the four, it's the meaning of the four."

Phillips notes that "most occasions that stimulate fear also disrupt medical services." For example, hurricanes cause heart rates to increase, and they disrupt ambulance travel, which leads to fatalities.

"I wanted to find an occasion that stimulates fear but had no effect on ambulance travel." He got the idea for the study after he realized the number nine in Chinese sounds similar to something meaning "fortunate." He checked to see if any numbers had negative connotations. Number four popped up and thus began his study.

When you expect bad things to happen, Licinio says, stress hormones rise, your heart beats faster and your immune system becomes suppressed. "It's similar to the feeling you'd get if you saw a car rushing toward you. It's good in an acute situation when you need to run away. It's not good when you're having surgery."

Neither is it good, apparently, when a priest administers last rites. In the 1997 report, "Nocebo: The Power of Suggestibility," Dr. Herbert Spiegel of Columbia University writes about a case in which a priest was summoned to administer last rites at a large American Roman Catholic hospital. "With an impressive air of authority and a brusque voice," Spiegel said, the priest gave last rites to the wrong patient. Within 15 minutes, that patient died, but the other one lived a few more days.

So, is it possible to be scared to death? "I think so," Licinio says. "Specifically if you have other diseases. For a healthy young man it would be rare."

Phillips agrees to a point. "Our data are consistent with this, but you wouldn't want to bet your life on it."