Notable Articles

The following are remarkable clinical research articles on subjects of interest:
Attitudes
Longevity
Perception
Patient and Physician Relationship
Placebo Effects

Attitudes
  1. Optimists vs. Pessimists: Survival Rate Among Medical Patients.
    840 general medical patients, mean age 35, completed the MMPI as part of their workup in 1962-65 at the Mayo clinic. Cohorts were divided on the basis of their answers into optimists, mixed, or pessimists. 200 had died 30 years later; 116 could not be located for a follow up rate of 86%. After controlling for confounders, optimists lived or were living a mean of 19% longer than pessimists (p=.01) which translates to roughly 15 additional years of life. This increased longevity is greater than the estimated extension of life that would be attributable to conquering cancer, or eliminating trauma or heart disease.
    ~ Marute T et al.; Mayo Clin Proc. 2000. Feb;75(2):140-143.
Longevity
  1. Longevity increased by positive self-perceptions of aging.
    660 subjects >50 years of age were followed up to 23 years after determination of self-perceptions of aging determined at baseline. After adjustments for age, gender, socioeconomic status, loneliness, and functional health it was determined that a more positive self-perception about aging was linked to an increased longevity of 7.5 years (p<0.0004). The key question was “As I get older, things are (better, worse, the same) as I thought they would be.” The RR for mortality became .89 in those who chose “better/the same”.
    ~ Levy BR, Slade MD, Kunkel SR, Kasl SV. J Pers Soc Psychol 2002 Aug: 83(2):261-70.
  2. The Development of Secondary Pathology with Free Radical Reactions as a Threshold Mechanism.
    Stress increases circulating catecholamines. The metabolism of catecholamines produces free radicals that may potentially damage neuronal receptors, as well as promote artherosclerosis, oncogenic deterioration, and a variety of other tissue damage that contributes to aging & disease.
    ~ Demopoulos HB, Pietronigro KK, Deligman ML.; J Amer Coll Toxicol. 1983; 3(2):173-84.
Perception
  1. Narrative Descriptions of Parental Love and Caring Predict Health Status in Midlife: a 35-Year Follow-Up of the Harvard Mastery of Stress Study.
    The Harvard Parental Caring Scale (HPCS), the SCL90R, and the Marlowe-Crowne (MC) scale (a measure of defensiveness), were administered to 400 students between 1952 and 1954. In a 35-year follow-up assessment evaluating present health, the number of positive descriptors for mothers and fathers was very significantly higher in healthy subjects compared to sick subjects in both men and women (p<.002). The most reflective positive parental descriptors were “loving”, “just”, “fair”, and “hard working” (p<.01). 95% of those who both used few positive descriptors of their parents and rated them low in parental caring had diseases diagnosed in mid-life, versus only 29% of those who both used positive descriptors and rated their parents high in caring. This study concluded that a child’s positive perceptions of love and caring from parents are associated with reduced psychiatric and somatic symptoms in adult life.
    ~ Russek LG, Schwartz GE. ;Altern Ther Health Med. 1996. Nov;2(6):55-62.
  2. Significant correlation between negative emotions & proinflammatory cytokines.
    The authors review multiple human psychoneuroimmunology studies focusing on the impact of psychological factors on immune function. Negative emotions stimulate the production of proinflammatory cytokines that contribute to immune dysregulation which predisposes to a spectrum of conditions including aging, cardiovascular disease, osteoporosis, arthritis, type II diabetes, and cancer. Higher social support is robustly associated with higher NK cell activity and mitogenic leukocyte in responsiveness in those under stress. Conversely, chronically abrasive close relationships are seen to provoke persistent immune down regulation. Differences in perceptions to the same event provoke different endocrine and immune responses.
    ~ Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R.; Psychoneuro-immunology: Psychological influences on immune function & health. J Consult Clin Psychol. 2002 Jun; 70(3):537-47.
  3. Our perceptions of life determine whether stressors are able to affect us.
    The psychological processes that accompany our attitudes, perceptions, & personality traits all mediate whether a stressor is able to affect the body.
    ~ Pelletier, KR. Herzing, DL. Psychoneuroimmunology: Toward a Mindbody Model. Advances. 1988; 5(1):27-56.
  4. Psychophysiologic phenomena in multiple personality and hypnosis.
    Three case histories of patients with multiple personality disorder. One client was found to be allergic to citrus fruit in all personality state save one; the allergic response was abruptly terminated by switching to a different personality. The second client was severely allergic to cats except in one personality state in which she could play with cats indefinitely with no rash, lacrimation, or wheezing. The third client responded to cigarette smoke with marked dypsnea and asthmatic bronchospastic wheezing in one personality and was totally free of symptoms in smoky environment in a second personality. Shifts in personality were also shown to cause significant changes in healing rate and response to medications.
    ~ Braun BG.; Am J Clin Hyp. 1983;26(2):124-37.
  5. Neuroendocrine and Stress Hormone Changes During Mirthful Laughter.
    In 10 male volunteers, ACTH, cortisol, beta-endorphin, 3,4,-dihydrophenylacetic acid (dopac, the major metabolite of dopamine, epinepharine, and norepinepharine), growth hormone and prolactin levels were determined. With mirthful laughter induced by watching a 60-minute humorous videotape (Gallagher Over Your Head), cortisol and dopac levels decreased quickly and more rapidly than other measures (p=.011 and .025 respectively), and growth hormone also decreased with laughter.
    ~ Berk LS et al. ; Am J Med Sci. 1989;Dec;298(6):390-96.
Patient and Physician Relationship
  1. Linking Primary Care Performance to Outcome of Care.
    7,200 patients completed a Primary Care Assessment Survey. The leading causes of self-reported health improvements were integration of care, thoroughness of physical examinations, communication, and comprehensive knowledge of patients and trust (p<.001).
    ~ Safran DG et al. ; J Fam Pract. 1998. Sep;47(3):213-20.
  2. Calibrating the Physician.
    Physician beliefs and attitudes, emotional responses to challenging clinical situations, as well as physician self care can all enhance a physician’s effectiveness in clinical care, personal work relationships, & level of personal satisfaction.
    ~ Novack DH et al.; JAMA.1997. Aug 13;278(6):502-09.
Placebo Effects
  1. Angina pectoris and the placebo effect.
    A meta-analysis of 13 studies and 1,187 patients with angina found subjective improvement in 82% of the patients over 4 decades which were shown subsequently to be treated with placebos that possessed no specific therapeutic effect. Significant objective measures of improvement were also frequently seen, including improved exercise tolerance, improvements in the ECK, and decreased medication use.
    ~ Benson H et al. ; N Engl J Med. 1979. Jun 23;232(12): 1225-27.
  2. The Powerful Placebo.
    In the early 1950’s, 100 patients were subjected to a sham cardiovascular operation in which the chest was opened, the ribs interrupted, and the wound closed without any intervention applied to the heart. The patients falsely operated on experienced the same 70% rate of relief as those who had actual cardiovascular surgery. Many of these placebo patients also experienced improvements in their ECG, exercise tolerance, and a significant reduction in the use of pain medications.
    ~ Beecher HK. ; JAMA. 1955; Dec 29; 159(17):1602-06.
  3. Surgery as Placebo.
    Up to 50% of subjects in placebo studies experienced side effects after administration of a placebo treatment.
    ~ Beecher HK. ; JAMA. 1961. July 1;176(13):1102-07.