Wednesday, February 10, 2016

What I Read: Cure

A perpetual item on my 101 in 1001 list (guess I should update about that one at some point! today is not that day, though) is to read one nonfiction book a month. I love novels and literature, but I also am endlessly curious about the world around me. So you can imagine how my eyes lit up when I saw that Cure was one of the books available for me on Blogging For Books. I requested it the same day I signed up and, after a little futzing around with NetGalley and Amazon, I dove right in.

Image courtesy Crown Publishers

The full title is Cure: A Journey Into the Science of Mind Over Body, and it's right what it says on the tin. The one thing I'd like to add is that when Marchant uses the word "science" in the subtitle there, she means good, solid science—not some fuzzier woo usage of "science." The entire book is built on extensive interviews with professional scientists: experts in medicine, human physiology, biology, genetics, and so forth. It's also built on the premise that Western, evidence-based medicine mostly works and has been a net boon to society. There is no "you can cure your cancer with positive thinking!" or "vaccines cause autism!" quackery going on here.

The reasonable hypothesis that Marchant explores in the book is that the placebo effect, as well as feeling cared for, is an underrated and potentially immensely useful tool in our healthcare arsenal. For many people with a more materialist view of things, this can seem like nonsense, or uncomfortably close to lying. Materialism—that all we are is the body and its physical components and interactions—has driven Western medicine for years. Marchant challenges that view and offers a more pragmatic one: however you feel about the inherent honesty of offering a placebo, we can't deny that the placebo effect works.

There is case study after case study in her book about chronically ill patients who, say, underwent a sham surgery and still reported a drastic decrease in pain and quality of life; or who have been able to reduce the dosage of powerful immuno-suppressive or stimulant drugs by taking a placebo alongside their regular medication, or by forging strong mental associations between their medicine and a particular concept. They're all fascinating to read, and Marchant approaches all of them with respect and good-natured interest without veering into condescension. It's pretty much impossible for me to pick a favorite; instead, I want to focus on the  limits of the placebo effect.

Marchant gets to the limits of what the placebo effect can do right in the first chapter (though not before a juicy hook, natch). It has to do with altitude sickness.

Fabrizio Benedetti has a high-altitude lab in the Alps. I don't know how he finds study subjects, but he does—and he encourages them to travel to his lab as quickly as possible, rather than the suggested staggered journey, so as to maximize their altitude sickness. Then he runs all kinds of tests with diodes and treadmills and real oxygen and fake oxygen.

The results are multifaceted, but they're consistent: in a nutshell, a placebo can't fix the physical thing wrong with you (in the case of altitude sickness: a lack of oxygen in your blood), but it can do a lot to mitigate your brain's reaction to what's wrong with you—which is often what causes the worst symptoms of a sickness. In Marchant's words: "Breathing fake oxygen can cause the brain to respond as if there is more oxygen in the air, but it cannot increase the underlying level of oxygen in the blood."

Everything else that Marchant discusses later, which sometimes borders on what some would call "the miraculous," remains well within that boundary. She also points out the pitfalls of going too far woo: namely, that if you subscribe to a philosophy that illness is entirely in your mind, then when you become gravely ill, you will blame yourself for it, which is about the worst guilt trip of all time. (This victim-blaming mentality is why I side-eye The Secret so very hard.) The book is overall hopeful and fuzzy feel-goody, but this particular encounter stands out as a stark warning:
"One problem, of course, is that patients who adopt alternative medicines do not always have a positive outcome. While researching this book, for example, I met 37-year-old Tunde Balogh. Originally from Hungary, she lives in Ireland with her husband and young son...A year earlier, she had been diagnosed with cancer in her right breast. 'I was so against doctors, hospitals, nurses,' she told me, '...I knew inside—if I caused this I can fix this.' Then she found German New Medicine, which teaches that cancer is caused by emotional conflict...Tunde says this resonated with her, because insecurities about her body had been causing her to distance herself from her husband. 'Why did you do that, now you have cancer!' she says. 'It took me around six months to forgive myself.' 
But her cancer wasn't cured. In January 2014, she started suffering from searing joint pains; the disease had spread to her bones. 'Cancer in the bones is when you don't feel valuable,' she says. She stood in front of the bedroom mirror each day, repeating: 'I'm valuable. I love myself.' 
By June, Tunde struggled to walk and was in severe pain. She was as convinced as ever that the answer was inside her, though, and still searching for a cure."
There is definitely a place for evidence-based medicine in Marchant's schema. Not only that; it's absolutely essential. Nearly all of the best possible effects and outcomes in Marchant's case studies are due to the combination of evidence-based medicine and the placebo effect, rather than just one or the other.

Still, even within those limits, the placebo effect can accomplish some incredible things. The only question Marchant doesn't really touch on (and this may be because we don't know the answer yet) is why the placebo effect works for some people, but not others. Is it just random? Does it have to do with personality, habits, psychology?

There's more to this book than the placebo effect. Marchant also investigates, to a more limited extent, the social determinants of health, defined by the WHO as "the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life." It's not just genetics and lifestyle choices that affect your health: where you're born, what kind of lives your parents and even grandparents had (separate from the genetic predispositions they passed on to you), and even the kind of stresses and relationships you had as child and teenager all seem to have long-lasting physiological effects.

All in all, Cure is a quick but by no means shallow read. Some might accuse Marchant of trying to pander, or to play to both sides (instead of coming down hard on woo), but I think those critics are coming down way too harsh. The truth is, our brain is a fantastically complex organ and not only do we not know how it all works, we don't even know how much we don't know. Even if just a handful of the therapies Marchant investigates were to bear out in real life use, it would mean an incredible improvement in the quality of life for millions of people worldwide. Hopefully Cure will nudge the popular and medical consciousness towards implementing these therapies.

I received a free copy of this book from NetGalley and Blogging For Books in exchange for an honest review. And trust me: I don't hold back when I think something is bullshit.

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