Test results, Prognosis, Worldviews & Nocibo effects

     A good friend and colleague, George Kaugars, was given 3 months to live. He had metastatic colon cancer. An attempt to de-bulk the primary was abandoned when they saw directly the extent of the tumor. Chemo was discontinued because it was ineffective and made him feel continuously sick. George had a wife and two very young children whom he loved dearly. George lived for 6 more years - working full time until a month before he passed away.
     How we present "hard data" to patients says a lot about our worldview AND usually has a powerful impact on their prognosis. I'm quite convinced that showing the image of a large malignant tumor to a patient is the present-day equivalent of a witch doctor sticking pins into a voodoo doll. Both are clear messages that the patient is expected to die quickly. Fortunately, George had a much broader, deeper worldview.
     Most people, including health-care professionals, give test results an unreasonable importance. An image is but one piece of data. If indeed the patient has a malignant neoplasm, it took the confluence of a myriad of causes and conditions to cause it. Prognosticating from any one piece of data should - without the nocibo effect - be extremely inaccurate.
     In the future, we'll know how to effectively address many of the inputs, and thus have much more effective treatments. In the meantime, we should be much more scientific and open-minded. Even if we're not particularly good at communicating "bad news" to patients, we should consciously guard against inadvertently dispensing nocibo effects - "at least do no harm"!

Halloween - nervous laughter