Positivity and the Placebo Effect


How we think about things can have a powerful impact on our experiences. Here's why that matters for people with cancer.

Most of my friends know better - a lot better - than to tell me to "think positive." In the midst of coming to terms with my diagnosis and the three years since then, I've probably heard it all, many times over, but the power of positivity is a constant refrain. I admit to wondering why so many people think that is a suitable response to someone who's received a cancer diagnosis of any type. Do they know something I don't? Have my negative thoughts, even though I'm naturally an optimist, brought about this illness? No. Negative thoughts did not cause my cancer and positive thoughts will not cure it.

Still, there is something to positive thinking. I remember the first time I was told how to think about my cancer treatment. I was in the car with my husband and he said, "If you think the treatment won't work, it won't." I remember that conversation clearly because it was so out of character. My husband is a cancer researcher and professor whose extended family is littered with health professionals of all types. He doesn't just believe in science, it is his life. I mention that statement to him from time to time, and we talk about the power of the placebo effect. I reluctantly remind him that what we're actually living with is not something that can be cured by thinking positively. The placebo effect, which at one time was credited with a significant impact on the effectiveness of medications, is one reason that researchers prefer double-blind studies (where neither the patients nor the clinicians know who's receiving what) and has been used by doctors in patient care.

In short, a placebo effect can't cure me, but my belief in what I'm doing can improve my quality of life. For example, as much I hate being told to "be positive," optimism can improve my mood, make me more willing to ignore or downplay neuropathic pain and, I think, make it easier for the nurse to get an IV in my arm. I put positive thinking in the same category as therapies like acupuncture and mindfulness. With a belief that they will make difference, they invariably do. I don't believe that everything about these therapies is due to some sort of placebo effect, but I do know that how we think about things can have a powerful impact on our experiences.

For me, positivity (when not pushed on me by well-meaning strangers), acupuncture and mindfulness are invaluable additions to the medical treatment I receive, which is doing the hard work of keeping me alive. I recently came across an online conversation between clinicians arguing that the effectiveness of acupuncture in relieving pain is a placebo effect. That really made me wonder: If acupuncture impacts quality of life issues, such as perceived pain, even as a placebo effect, then why would a doctor dismiss it out of hand? When I perceive the neuropathic pain in my feet as tolerable, I'm more likely to go outside and to be in a better mood. Is the pain actually less? Maybe not. Does that matter? Not to me.

I understand why the clinicians arguing that something like acupuncture is "just" a placebo effect take that stand; when we believe that alternative treatments are as effective as evidence-based medical treatment then there's a real risk to our long-term health. But it is shortsighted to think that only a cure has meaning in the life of someone trying to live well with this disease. To me, as the patient, the temporary nature of the placebo effect, wherever it comes from, is not a problem. Instead, it's a reprieve from pain or anxiety or stress and that is nothing to dismiss.

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