Sunday, September 1, 2013

HOPE OR EVIDENCE?


   Lately I scanned an article about the benefits of an altruistic life style. The article claimed that altruistic people survived cancer at a greater rate than, I assume, a bunch of selfish patients. At the time I did not give it much attention because it seemed to be the usual Judeo/Christian propaganda – “Morally upright people are rewarded by God with good health...blah, bah.”
  Common sense and personal experience indicate this as a vicious fallacy.
  Not only have I been diagnosed with cancer, but now I also have to deal with a bunch of self-righteous smarty pants who suspect that there is something wrong with my psyche, my spirit, my mind, my karma! I obviously did something wrong, something really bad. I deserve the cancer!
   And to explain the cancer of young children, too young to accumulate bad karma – well, they were probably Nazis in their former incarnation!
   We do know that getting cancer is about as random as being hit by lightning, winning in the lotto or being run over by a car.
   There is nothing you can do to prevent cancer! Supposedly one in three people will get cancer during their lifetime, statistically.
   And we only have statistics, but they don't apply to specifically you, they apply to all people. If the estimated survival chance is 20% or 80%, it doesn't matter – as long as you manage to belong to the surviving group!
   I could not find the exact article mentioned. All I found was a study that was trying to determine if patients who participated in random controlled studies had altruistic motives. The study was inconclusive.
   Then I remembered, when in the seventies and eighties several cancer prone personality types were suggested. Particularly sad and hopeless are the personalities by Eysenck:
   Type A:
  Briefly, the cancer-prone personality type deals with stress through loss of the loved' object, or frustrative non-reward by the loved object, with feelings of hopelessness, helplessness and depression, retains emotional closeness with withdrawing objects, shows a tendency to idealise the withdrawing objects, and represses overt emotional reactions.”
   In its vagueness this reminds me a bit too much of astrological charts – I instantly recognized myself as cancer-prone:
   ...loss of the loved object... hopelessness...depression...
   Of course, after you have been diagnosed with cancer these feelings might be justified.
   So the question remains: How much influence has the psyche on the evolution of cancer?
   Psychologists would like to believe -- a lot!
   But that is not so. A meta-study from 2004 “Psychotherapy and Survival in Cancer: The Conflict Between Hope and Evidence” by Coyne, Stefanek, and Palmer.
    The study starts:
  The belief that psychological factors affect the progression of
cancer has become prevalent among the lay public and some
oncology professionals (Doan, Gray, & Davis, 1993; Lemon &
Edelman, 2003). An extension of this belief is that improvement in
psychological functioning can prolong the survival after a diagnosis
of cancer. Were this true, psychotherapy could not only benefit
mood and quality of life but increase life expectancy as well.”
   And it ends:
   “There is no good a priori reason to reject the assumption that
with appropriate tailoring to the demands of cancer and its treatment,
interventions that reduce prolonged or functionally impairing
distress in other contexts will benefit persons with cancer.
However, we are concerned that the necessary retreat from the
claim that all persons with cancer need or will benefit from formal
psychosocial interventions becomes more awkward and embarrassing
when it is accompanied by a delayed concession that such
interventions do not extend survival.”
http://dcscience.net/coyne-psych-bul-07.pdf
   So here we are again at the beginning. Isn't it reassuring – you can be a bastard, kill a million people and never get cancer, or a saint who is forsaken by his God.
   One in three people will get cancer, regardless who they are, what they think, where they come from and psychotherapy will not keep anyone alive – but maybe it helps dealing with life and death issues.
   And this is not to be underestimated.