In her New York Times piece published today, Angelina Jolie bravely announced that she just underwent elective bilateral mastectomy as a breast cancer prevention measure after losing her mother to breast cancer, and testing positive for the BRCA gene.
Told by her doctors that she had an 87% chance of developing breast cancer and a 50% chance of getting ovarian cancer, Jolie chose to undergo radical elective surgery to remove her breasts. According to her doctors, this would reduce her risk of breast cancer to 5%.
Jolie explains that after losing her mother to breast cancer, her children have been fearful that they would lose their own mother, too. She feels relieved to reassure them that this is less likely now.
The Nocebo Effect
As I discuss in my new book Mind Over Medicine, the medical establishment has been proving that the mind can heal—or harm—the body for over 50 years. When hopeful, optimistic beliefs heal the body, we call it “the placebo effect.” When fearful, pessimistic beliefs harm the body, we call it “the nocebo effect,” placebo’s evil twin.
The placebo effect occurs when patients in clinical trials get better—as they do 18 to 80% of the time—even though they know they have a 50% chance of not getting the real treatment, but instead are likely to get a sugar pill, a saline injection, or fake surgery. On the other hand, the nocebo effect happens when patients believe something may harm them—and it does.
In clinical trials, patients getting sugar pills often experience the very side effects they're warned they might experience if they get the real drug. For example, patients getting saline injections who think they’re getting chemotherapy may throw up and even lose their hair.
A Nocebo Effect Case Study
One case study reported in the medical literature is the stuff of fairy tales. A woman born on Friday the 13th in the Okefenokee Swamp near the Georgia-Florida border was one of three girls delivered that day by a midwife, who proclaimed that all three girls, born on such a fateful day, were hexed. The first, she announced, would die before her 16th birthday. The second would not survive her 21st. And the patient in question was told she would die before her 23rd birthday.
As it turns out, the first two girls died within one day of their 16th and 21st birthdays. The third woman, terrified that she would die on her 23rd birthday, showed up at the hospital the day before her birthday, hyperventilating. Soon afterwards, just before she turned 23, she died, proving the midwife’s predictions correct. This is an extreme example of the nocebo effect, when fear-based thoughts about your health can actually kill you.
How The Nocebo Effect Works
The body is equipped with natural self-healing mechanisms that kill cancer cells, fight infectious agents, fix broken proteins and influence how genes express themselves. These natural self-repair mechanisms are under the influence of hormones that respond to positive or negative thoughts, beliefs, and feelings. In this way, the mind can harm every cell in the body by poisoning the cells with toxic stress hormones like cortisol and epinephrine.
When the body experiences what Walter Cannon at Harvard coined “stress responses” (also known as “fight-or-flight”), the body’s natural self-repair mechanisms are disabled, so the body can’t maintain healthy homeostasis.
If someone is “hexed” with a negative diagnosis, whether it’s a midwife saying you’ll die before your 23rd birthday or your doctor telling you that you have an 87% risk of developing breast cancer, or your oncologist telling you that you have a 5% five-year survival, or your internist telling you you’ll have to take drugs for the rest of your life, fearful thoughts are likely to activate stress responses.
When this happens, your body’s natural self repair mechanisms are deactivated and the likelihood of a negative health outcome becomes a self-fulfilling prophecy. In this way, doctors can unwittingly make us victims not so much of our genes, but of what Dr. Andrew Weil terms “medical hexing.”
When Doctors Hex Patients
When doctors pronounce our patients “incurable” or even label them with a “chronic” disease, insisting that they will be afflicted their whole lives, are we not, in essence, activating the nocebo effect? What proof do we have that they will not be one of the case studies who winds up in the Spontaneous Remission Project, having been cured of a so-called “incurable” illness?
When we pronounce patients with "chronic" or "incurable" or "terminal" illnesses, or when we tell them they have an 87% risk of breast cancer or a 50% risk of ovarian cancer, we may be programming their subconscious minds with negative beliefs and activating stress responses that do more harm than good.
By labeling a patient with a negative prognosis and robbing a patient of the hope that cure might be possible, we may ultimately make our negative diagnosis a self-fulfilling prophecy. Wouldn’t we be better off offering hope and triggering the mind to release health-inducing chemicals intended to aid the body’s self-repair mechanisms?
Do I Support Angelina Jolie’s Decision?
In Mind Over Medicine, I teach patients how to make their own Diagnosis and write The Prescription for themselves. So I certainly support Angelina Jolie’s decision to listen to her intuition and write her own Prescription. It’s her body. Her choice. Her family to consider. Her breasts.
I also admire her courage to go public about such a sensitive issue.
Though I’m grateful to her for bringing this issue to the light so we can discuss the pros and cons of such decisions, I’m concerned that her decision will trigger an onslaught of women with family histories of breast cancer who choose to undergo BRCA testing—and if positive, will choose elective bilateral mastectomy, modeling themselves after Angelina Jolie’s choice.
Then it’s a slippery slope. Once we start cutting off perfectly healthy body parts, what’s to keep us from cutting out appendixes and gallbladders in all babies, since appendicitis and gallbladder disease could kill you? Should we cut out uteri and ovaries after childbearing, since all they’re doing is waiting to get cancer? Should we cut off all moles because some could become melanomas?
How is it that as a culture, it has become not only acceptable but even medically advisable, that we should even consider undergoing such barbaric surgery—surgery not without risk, mind you—ostensibly so we can live longer, healthier lives?
The Good News For Angelina
Because she has made what she considers the right choice for herself, and embraced the courage to go public with this information, Angelina Jolie is surely reducing stress responses, activating relaxation responses, and further reducing her risk not only of breast cancer, but of other diseases. This is why we must each write The Prescription for ourselves in order to optimize our health.
But at least in Angelina Jolie’s case, this peace of mind came at a huge cost.
Is genetic testing really worth the price? I’d love to hear what you think.