The Power of Positive Intent: A Medical Reason to Hope

I have been impressed by how much negative sentiment there is out there about the current global economic crisis. The front page of the New York Times over the weekend had a huge picture of a couple grieving the change in income of a man who was earning $60,000/year who is now earning $12/hour as a janitor. It was impossible to not feel sorrow for this family, and also, some fear that this man could be anybody including you or me. The glaring horror of the impact of the financial crisis can be seen everywhere: the US government lends AIG $30 billion; Ukraine, the former bastion of Eastern Europe is falling to pieces; the European Union is threatened due to conflicting priorities among its constituents. Regardless of where you look, there is bad news about the recession everywhere. In the context of this harsh reality, how can you be hopeful? And even if you could be, why might this make sense? Before we examine this question, let’s take a look at what hope is. Hope is an investment in the future without any evidence that it will occur. It is a wish or expectation, or in effect, a positive intent. Does it really matter that we have positive intents and if so, why? In medicine, positive intents have had powerful effects in a number of situations tested in various experiments. For example, multiple sclerosis (MS) is a disease that may be treatable although it has a chronic course of destruction of white matter in the brain. While there are recognized drugs and chemotherapy that can treat MS, one of the questions researchers have asked is: does hope play a role? It turns out that it does. In 1996, a researcher administered cyclophosphamide, a drug used to treat MS, and paired this with an anise-flavored syrup. Anise has a strong liquorice flavor. They then administered only the anise-flavored syrup and found that in 8 of 10 patients, the white cell count that is normally reduced by cyclophosphamide, was reduced by anise alone. Many disregard this as a placebo effect, yet this “placebo” effect – a positive association- was strong enough to affect the blood count. There are a growing number of instances in medicine where we can see a beneficial and detectable effect of placebo. One particularly remarkable study looked at people with Parkinson’s disease and administered real surgery to one group and sham surgery to the other. This study showed that when patients believed that they had received the surgery, they did much better, even when they received the sham surgery. Another dramatic study examined two groups of patients who received thoracotomies: a surgery that involves cutting into the chest wall. One group was given saline and told that it was pain medication while the other group was given saline but not told anything. The group that expected pain relief had a much lower need for analgesia than the group that was not expecting pain relief. Subsequent studies on pain relief have proven over and over again that the expectation of pain relief results in significant pain relief even when no active analgesia is given. In fact, the effects of positive expectation have been documented on liver enzymes, lung function, blood glucose and numerous other physiologic parameters, indicating that positive intent affects the body at a physiologic level. So is this positive expectation or placebo response a trick? Does it have any real basis? Well, apart from affecting these various elements of our physiology, recent research has shown that this positive intent creates changes in the human brain. The exact brain system involved probably depends on what the intent relates to, but with the expectation of pain relief, for example, the opioid receptors usually activated by analgesia medications, are activated. Similarly, the dopamine and serotonin systems in the brain have also been shown to be a part of this response. Thus, the basis for the placebo effect lies in the human brain, and by changing our brains, we can change the way we feel, act and execute our physiologic functions. More recent research has clarified the effects of placebo even further by showing that an active treatment may be superior to placebo even when placebo has a beneficial effect. Thus, apart from positive intent having positive consequences on the brain and body, it also sets up the brain and body to respond to future interventions. In fact, one study that looked at people who had had a heart attack showed that sticking with the prescribed treatment predicted whether or not a person was more likely to die, even when the prescribed treatment was placebo. Imagine that. Just staying with the course of positive intent can prevent death. I fully recognize that not all people can and will believe in positive intent, especially if the situation looks like a disaster, the current economic crisis being a good example. But I would ask those of you hesitant to “believe” to consider the following. There is no need to deny the crisis. It is indeed happening. But you can still have a positive intent for yourself in this environment, without succumbing to what is happening. Intent is an expectation. It is a belief. In effect, it is not dissimilar to the placebo response. And we can see that the placebo response actually sets up your brain and body for greater success by activating relevant brain pathways. This sets up your life for a greater chance of success. And if we can all do this, we will perpetuate each other’s success by making it easier to have a positive intent. At difficult times like these, it is very important to ask your brain to expect the best. As Somerset Maugham, the English playwright and novelist said: “It is funny about life: if you refuse to accept anything but the very best you will very often get it.”