BY RALPH BLUM
This report is about a disgrace in the practice of American medicine. It is not an objective report. Because I have been subjected to it, I cannot hope to be dispassionate in my approach to the subject of medical hexing.
The stress of a diagnosis of cancer can throw patients into an “altered state” in which they are particularly vulnerable to suggestion—good or bad. And because most of us, as children, are taught to believe in the infallibility of doctors, the manner in which a doctor delivers a life-threatening diagnosis has a profound effect, and actually has the power to influence the course of the disease.
If the doctor’s words are positive, they can plant within you, at a very deep level, positive expectations that you will beat the cancer, that you can be cured. Unfortunately, the reverse is equally true. The doctor can literally sentence you to death by using the dreaded word “terminal,” and telling you to go home and “set your affairs in order.”
This reprehensible behavior is a form of “hexing,” the medical equivalent of a voodoo curse. If a witch doctor leaped out of the jungle, pointed a bone at you and told you that you were going to die within six months, you’d probably laugh, albeit a trifle nervously. But when a modern-day witch doctor, wearing a white coat, carrying a stethoscope, licensed by the all-powerful American Medical Association, and supported by state-of-the-art scans and test results, tells you that you have only six months to live, his “curse” can significantly raise the chances that you actually will die. And often, right on schedule.
Everyone has heard of the placebo effect, the beneficial results that a sugar pill or some sham medical procedure can produce if the patient is told by his doctor that it will bring relief or healing. However, the placebo (Latin for “I will please”) has a less known evil twin, the nocebo (Latin for “I will harm”), which can produce equally powerful adverse effects. Medical hexing is a prime example of a nocebo at work.
In his breakthrough book, The Biology of Belief, cell biologist Bruce Lipton examines the mechanisms by which both our positive and negative beliefs control our biology. According to Lipton, our biology adapts to our beliefs—something all of us should keep in mind every time we step into a doctor’s office.
A significant part of any doctor’s job is to create a relationship with his patients based on trust, confidence and hope. Fact: regardless of his or her experience, no physician can predict the future for a specific individual, or the outcome of their disease. So if you are unfortunate enough to receive a “death threat” from your doctor, just remember: That’s his belief, not mine. And head for the door.
Andrew Weil, M.D, was among the first doctors to bring medical hexing to our attention, pointing out that it was a daily occurrence practiced by the entire medical profession—in hospitals, clinics and doctors’ offices. Weil called this behavior “unconscionable,” a term defined in The Concise Oxford Dictionary as “Not guided or restrained by conscience.”
At its most reprehensible, medical hexing becomes a form of “iatrogenics,” from the Greek iatros meaning “physician” and genic, meaning “caused by,” the term used to identify physician- or drug-induced illness; illness attributable, at least in part, to negative suggestions by doctors, drug companies or other health care professionals.
To some extent, physicians and pharmaceutical companies are in a bind. Out-of-control malpractice suits have obliged them to protect themselves legally. Before surgery, for instance, patients are required by law to sign a consent form that describes everything that could conceivably go wrong as a result of the procedure. And the form you receive from your pharmacist, along with your drug prescription usually contains a depressing list of warnings about the drug’s possible appalling side effects (“Tell your doctor immediately if any of these rare but very serious side effects occur” . . . “increases the risk of death” and on and on). The problem is that once these warnings have taken root in a patient’s mind, they can bear toxic fruit and become the stuff of self-fulfilling prophecy, the modern equivalent of a voodoo curse.
There is, in surgeon Atul Gawande’s words, “an art to being a patient,” and practicing that art must include protecting ourselves against medical hexing. But what about the art of being a doctor, which begins with the oath every doctor takes to “First do no harm?” What puzzles and disturbs me is why more doctors haven’t spoken out against the insidious practice of medical hexing.