Empowerment is the best medicine

Does a positive mental attitude help patients beat cancer?

November 20, 2002

A study published earlier this month in BMJ, the journal of the British Medical Association, thinks not. The study – an analysis of 37 earlier studies that have examined the role of mental attitudes on cancer – reported that having a “fighting spirit,” as doctors refer to spunkiness in patients, doesn’t help them survive cancer or prevent its recurrence.

“We’re not saying it’s a bad thing,” lead researcher Dr. Mark Petticrew of the University of Glasgow told The New York Times last week, “only that if you don’t, it’s probably not going to affect survival.”

Similarly, the study – co-authored by Ruth Bell at the University of Newcastle in the U.K. and Duncan Hunter at Queens University in Canada – dismissed the consequences of having feelings of “helplessness/hopelessness,” which cancer studies had associated with higher rates of recurrence and death.

The motivation behind the study is noble – to spare cancer patients from overzealous psychologists and others intent on coercing patients into feeling good about their lot. Such coercion is often counterproductive, making patients feel guilty, and adding to their already immense burden, if they don’t put on a brave face. The study rightly deplores such medical intervention: “It has been suggested that clinicians need to detect coping styles such as helplessness and hopelessness and treat them vigorously. Our findings show that such interventions may be inappropriate.”

But in the authors’ zeal to protect patients from “feel-good-or-else” medical advice – medical attempts to “empower” patients – they have produced a dubious study. The authors didn’t base their conclusions on the findings of the 37 studies; they more dismissed the majority of the studies for failing to live up to ideal standards – either the studies were small, or they were potentially biased, or they had methodological flaws, or the relationships that some studies found between attitude and cancer weren’t found by others. In the real world, few studies are conducted under unimpeachable conditions, including the authors’ own study. In fact, even the basis on which they selected and dismissed studies was largely subjective, making their study a medical muddle that more resembled opinion than analysis.

The issue of whether a positive attitude helps beat cancer is part of a larger discussion, over empowerment. On the health benefits of empowerment there is no dispute. The medical world accepts that the more empowered people are – the more affluent they are, the better they are educated and the more they are in control of their lives – the longer and healthier their lives.

But what empowers? Can a doctor cajole or coerce a patient to feel free and in charge? On the face of it, such attempts are doomed to fail, even if the patients succeed in tricking others into believing they’re in control and coping well. Similarly, coercing patients into pretending that they are happy could also increase their sense of helplessness and hopelessness. This coercion may explain the poor results the authors noted in some of the 37 studies – although we won’t know until someone asks meaningful, instead of muddled, questions.

An immense amount is at stake in discovering the secret to empowerment: If the middle class became as healthy as the wealthy, for example, its gain in life expectancy would exceed that obtained by eradicating cancer. But although the medical world knows empowerment somehow relates to socio-economic factors such as affluence and education, it can only guess at the actual mechanisms or underlying factors at work.

And yet, despite the stakes, few of those who would reform health care – certainly not Roy Romanow, whose report is due next week – have promoted the empowerment of patients. The health establishment’s well-meaning emphasis, like that of the overzealous psychologists intent on exercising control over their patients, has been in controlling patients by controlling an ever-larger segment of the health industry. The establishment determines which medical procedures will be covered and when, which drugs will be available and when. It will spend money on patients’ behalf, but it will not give the patients the money to spend on their own behalf, despite the success that this approach has had elsewhere.

Lawrence Solomon is executive director of Urban Renaissance Institute and policy director at Consumer Policy Institute, divisions of Toronto-based Energy Probe Research Foundation.

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About Lawrence Solomon

Lawrence Solomon is one of Canada's leading environmentalists. His book, The Conserver Solution (Doubleday) popularized the Conserver Society concept in the late 1970s and became the manual for those interested in incorporating environmental factors into economic life. An advisor to President Jimmy Carter's Task Force on the Global Environment (the Global 2000 Report) in the late 1970's, he has since been at the forefront of movements to reform foreign aid, stop nuclear power expansion and adopt toll roads. Mr. Solomon is a founder and managing director of Energy Probe Research Foundation and the executive director of its Energy Probe and Urban Renaissance Institute divisions. He has been a columnist for The Globe and Mail, a contributor to the Wall Street Journal, the editor and publisher of the award-winning The Next City magazine, and the author or co-author of seven books, most recently The Deniers, a #1 environmental best-seller in both Canada and the U.S. .

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