Doctors Recognize the Power of Negative Thinking, and They Want to Change

Long ago, before tort lawyers ruled the land, the family doctor knew how important it was to reassure and support patients.  Physicians wouldn't dream of giving a treatment in a negative context because the power of suggestion (what we now call the placebo response) was respected as a healing factor. Fast forward to the modern era when doctors afraid of malpractice suits routinely give patients long lists of what might go wrong and often tend to err on the side of worst case scenarios.

Nurse Ratched: the poster child for caregiver negativity.Now along comes a wake-up call from the Department of Bioethics at the NIH basically telling doctors to stop being so negative. Deeply researched and thoughtful, the communication published in the vaunted Journal of the American Medical Association describes the potent effects of nocebos (negative suggestions) and calls for a new direction in the medical community that ethically takes into consideration the power of negativity. The communication sites some pretty astonishing research to back-up the authors' eye-popping assertion that "just one occasion of negative information can induce long-lasting negative effects."

Informing men about the potential sexual dysfunction induced by a drug--by saying, “It may cause erectile dysfunction, decreased libido, problems of ejaculation but these are uncommon”--was associated with 43.6% of men actually experiencing sexual adverse effects. In comparison, 15.3% of the men who were not told of the potential side effect experienced similar adversity.

Negative commentary from a health care provider--including doctors, nurses and front office staff (anyone who comes in contact with patients in the healthcare environment)--can effect a wide-range of physical responses from pain to impotence.  In a paper published in the journal Pain, researchers found that clinical-trial participants have reported a wide variety of nocebo-fueled medical complaints, including burning sensations outside the stomach, sleepiness, fatigue, vomiting, weakness and even taste disturbances, tinnitus and upper-respiratory-tract infection.

Enough to scare any medical professional into communicating better is a study conducted on sexual dysfunction. In a study of men recieving the drug finasteride for benign prostatic hyperplasia, informing the men about the potential sexual dysfunction induced by finasteride--by saying, “It may cause erectile dysfunction, decreased libido, problems of ejaculation but these are uncommon”--produced 43.6% of sexual adverse effects vs 15.3% when the same adverse effects were concealed. It turns out the simple word "may," which no doubt sounded harmless enough to the providor, sounded quite threatening to the patient--enough to make some of them lose their mojo. 

No one is suggesting people not be informed of potential side-effects, but there are ways to do it that will cause less harm. Rather than merely delivering general lists of specific adverse effects the JAMA authors suggest, "clinicians should incorporate in their communication positive framing and percentage formats as opposed to negative framing and frequency format." In other words, the exact stastic--ie saying this happens to 2% of people --is more reassuring than hearing it's "a possiblity." Think specific information as opposed to doomsday scenarios.

The biological mechanisms to explain the nocebo--or even for that matter the placebo--are not well understood.  Since the late 1970s advances in neuroscience research have been able to show that the brain produces its own pharmacy, it's able to secrete substances similar to morphine and heroin to a name a couple. And research has established that some individuals' "brain pharmacies" are more susceptible to suggestion than others.

But this doesn't explain clearly why ailing patients who are mistakenly informed that they have only a few months to live have died within their given time frame, even though postmortem investigations show that there was no physiological explanation for early death. Possibly nocebos pull the rug out from under the body's attempts to self-heal. 

In any case, framing a concept more positively is an easy way to help a person heal. Wouldn't it be wonderful if everyone in your doctors' office--from the person who makes your appointment to the person who takes your payment (and yes the doctor him or herself)--actually believed in you and your ability to heal. What a pleasure it would be to visit that office.

Jeremy Lin's Infectious Joy

MSG stock's rally coincides with Jeremy Lin's play time.The improbable success of basketball phenom Jeremy Lin (professional basketball being one of the only careers where his Harvard degree makes him an underdog) has not only improved his status in life, but its lifted the ratings at the MSG network (viewership is up 70%), sent MSG stock soaring and made a boatload of cash for vendors selling his jersey, which is sold out at the NBA store in New York. Even the couch that Lin slept on at his brothers' apartment in the city is having its 15 minutes of fame, being featured in newspapers around the country.  

Amar'e Stoudemire, the Knick's center who's out on family leave last week after the untimely death of his older brother, explains the Lin effect "We were watching Linsanity, and my family was getting a kick out of it. That's the only smiles they had all week." It's amazing how one person's joy can multiply.

A Bumper Crop of Introverts

So far 2012 is shaping up to be a great year for introverts.  First, author and former corporate lawyer Susan Cain all but hijacked the communal conversation with her book "Quiet: The Power of Introverts in a World that Can't Stop Talking." Cain's message is perhaps quite timely: the ego-maniacal show-off personality so successful in the 24/7 news cycle is not the type of person who is likely to contribute all that much to the advancement of human-kind. Cain urges us all to spend more time alone - not social networking (which is computer simulated extroversion for introverts)- but actually thinking, creating, contemplating. She's got a veritable introvert hall-of-fame to prove her point:  Abraham Lincoln, Eleanor Roosevelt, Rosa Parks, Frederic Chopin, Charles Darwin, Marcel Proust--all people who'd rather stay home than walk the red carpet.  And now along come two more quiet heroes to add to her list.

Introverts make good leaders because they are more likely to let talented employees run with their ideas.

Complacent or introverted?

This weekend athletic introvert Eli Manning takes center stage again, quiet and unassuming. His father, Archie Manning, says, "I have always heard them saying "Eli doesn't care. Eli cares, he just doesn't worry." Manning has been critiized for being complacent and compliant, when really he's just rather polite and not into the spotlight. "He's calm and not outward, he doesn't holler and scream," says Archie.

When Eli was asked this week if he thought getting to the Superbowl for a second time would cement his legacy, he insisted he wasn't thinking about that. He told The Washington Post, “I’m thinking about this team and this opportunity and how proud I am of the guys and what we both have overcome this year and what we have been through. I just never had any doubts and just kept believing.” Classic introvert leadership; according to Cain, introverts make good leaders because they are more likely to let talented employees run with their ideas. Introverts make good leaders precisely because they believe the world does not revolve around them.

And finally, there's the Facebook IPO, from which untold riches will go to Mark Zuckerberg about whom not much is known beyond the fictional character in The Social Network. What is a matter of record is that he lives in an unassuming house with a girlfriend he met in college, and besides being renowned for his success as a computer programmer he was notably in the news for giving a couple of hundred million dollars to the Newark, New Jersey public school system.  Introverts can recognize a kindred spirit in Zuckerberg, and perhaps rejoice at his quiet, spectacular triumph.

Two Shrinks Plumb the Depths of Longevity

By Laura Landro for The Wall Street Journal

What can 1,500 Americans born a century ago, most of them long dead, tell us about the secret to a long life? Plenty, according to Howard S. Friedman and Leslie R. Martin, two psychologists who, in "The Longevity Project," mine an eight-decade research effort for answers to the kinds of questions that sent Ponce de León searching for the Fountain of Youth.

There are no magic potions on offer here, but many of the findings are provocative. The best childhood predictor of longevity, it turns out, is a quality best defined as conscientiousness: "the often complex pattern of persistence, prudence, hard work, close involvement with friends and communities" that produces a well-organized person who is "somewhat obsessive and not at all carefree."

The study was initiated in 1921 by Stanford University psychologist Lewis Terman, who asked San Francisco teachers to pick out their brightest students—most were about 10 years old—to help him try to identify early glimmers of high potential. Terman was most interested in intellectual achievement (his revision of Alfred Binet's intelligence scale produced the Stanford-Binet IQ test), but his interviews were so detailed that the results could be used as a basis for studying the respondents' lives in follow-up interviews across the years. Terman himself died in 1956, just shy of 80; after his death his work was picked up by others, with Mr. Friedman and Ms. Martin launching their portion of the project in 1990.

The study's participants, dubbed Terman's Termites, were bright students, but having a high IQ didn't seem to play a direct role in longevity. Neither did going on to an advanced degree. The authors suggest that persistence and the ability to navigate life's challenges were better predictors of longevity.

Some of the findings in "The Longevity Project" are surprising, others are troubling. Cheerful children, alas, turned out to be shorter-lived than their more sober classmates. The early death of a parent had no measurable effect on children's life spans or mortality risk, but the long-term health effects of broken families were often devastating. Parental divorce during childhood emerged as the single strongest predictor of early death in adulthood. The grown children of divorced parents died almost five years earlier, on average, than children from intact families. The causes of death ranged from accidents and violence to cancer, heart attack and stroke. Parental break-ups remain, the authors say, among the most traumatic and harmful events for children.

Read more.

New Study Sheds Light on Why People Don't Pick Up Prescriptions

Every pharmacy has prescriptions ordered but left uncollected. It's a small but growing problem, and now a new study in the Annals of Internal Medicine sheds some light on why this is happening. It turns out cost is the biggest reason. Prescriptions with copayments of $40 to $50 and prescriptions costing more than $50 were 3.40 times and 4.68 times more likely, respectively, to be abandoned than prescriptions with no copayment. The second biggest group of prescription deadbeats was new users of medications, who had a 2.74 times greater probability of abandonment than prevalent users. New users were, perhaps, in denial about needing  the drug. The third category of abandonment was prescriptions sent in electronically, which were, no doubt, forgotten.

Money, denial and abandonment--sounds like the chorus of a country song titled, "The Healthcare Debate, 2010."