In this New York Times article, A-list actress Angelina Jolie bravely announced that she made the tough decision to undergo elective bilateral mastectomy after her doctors warned her that she has an 87% risk of developing breast cancer and a 50% risk of getting ovarian cancer because her mother died of breast cancer and she carries the BRCA1 gene. While I fully support Angelina’s right to write The Prescription for herself, and while I admire her courage to go public with what some might hide, as an OB/GYN physician with a passion for mind-body medicine, this breaking news concerns me for a variety of reasons.
The Nocebo Effect
In Chapter 2 of Mind Over Medicine, I share the scientific data about “the nocebo effect,” the opposite of the placebo effect, when we think something will harm our health – and it does. In one case study, a man was misdiagnosed with cancer and told he would only live 3 months. He died exactly 3 months later and was found to have no cancer on autopsy.
In another case study that is the stuff of fairy tales, a woman born on Friday the 13th in the Okefenokee Swamp near the Georgia-Florida border was one of three girls delivered that day by a midwife, who proclaimed that all three girls, born on such a fateful day, were hexed. The first, she announced, would die before her 16th birthday. The second would not survive her 21st. And the patient in question was told she would die before her 23rd birthday.
As it turns out, the first two girls died within one day of their 16th and 21st birthdays. The third woman, terrified that she would die on her 23rd birthday, showed up at the hospital the day before her birthday, hyperventilating. Soon afterwards, just before she turned 23, she died, proving the midwife’s predictions correct. This is an extreme example of the nocebo effect, when fear-based thoughts about your health can actually kill you.
In his book Spontaneous Healing, Dr. Andrew Weil argues that physicians may unwittingly engage in what he calls “medical hexing.” When we pronounce patients with “chronic,” “incurable,” or “terminal” illnesses, we may be programming their subconscious minds with negative beliefs and activating stress responses that do more harm than good. What proof do we have that they will not be one of the case studies who winds up in the Spontaneous Remission Project, having been cured of a so-called “incurable” illness?
By labeling a patient with a negative prognosis and robbing a patient of the hope that cure might be possible, we may ultimately prove the poor prognosis we have bestowed upon our patient correct. Wouldn’t we be better off offering hope and triggering the mind to release health-inducing chemicals intended to aid the body’s self-repair mechanisms?
Is it really healthy for any of us to know that we might have an 87% risk of any illness? Do we really want to poison our minds with such fear-based thoughts that then force us to make decisions about whether or not we will electively cut off perfectly healthy body parts?
The Slippery Slope of Elective Surgery
Once we start surgically removing healthy body parts, it’s a slippery slope. Should we cut out appendixes and gallbladders in babies, since appendicitis and gallbladder disease can kill you? Should we cut out uteri and ovaries after childbearing, since all they’re doing is waiting to get cancer? Should we cut off all moles because some could become melanomas?
How is it that we live in a culture where barbaric surgeries – like elective bilateral mastectomy as prevention for breast cancer – have become not only normalized, but even recommended?
When We Live In Fear, We Predispose Ourselves To Illness
To live in fear of what might happen only triggers stress responses in the body. And as I teach in Mind Over Medicine, the body has natural self-repair mechanisms that can kill cancer cells, fight infection, repair broken proteins, and retard aging. But they ONLY work if the nervous system is relaxed. When the amygdala in your primal lizard brain is threatened – as it would be if anyone told you that you have an 87% risk of getting cancer – your body’s natural self-repair mechanisms are going to deactivate. And when this happens, you’re at risk not only of breast cancer, but of other illnesses.
The Risks of Genetic Testing
Should Angelina Jolie have undergone BRCA testing? There’s no simple answer to this. Angelina Jolie might carry the breast cancer gene, but that in no way guarantees that she will get breast cancer. While the presence of the BRCA gene – and her family history of breast cancer – may statistically put her at an 87% risk of breast cancer, there is no way to know whether she will be one of the 87% who get sick or one of the 13% who remain healthy. But what we do know from the scientific literature is this – what you believe about your health is likely to come true.
Your body is your business, and you are the guardian of your mind, so it’s your responsibility to be careful what kinds of thoughts you put into your brain.
We Are Not Victims Of Our Genes
Epigenetic research proves to us that environmental influences, including hormonal factors that are affected by your thoughts, beliefs, and feeling, affect how your genes express themselves.
Your genetic code is like a blueprint that can be interpreted in millions of different ways. Before the Human Genome Project, biologists assumed that we would have at least 120,000 genes, one gene for every protein made in the body. We now know that each of those 25,000 genes can express itself in at least 30,000 ways via regulatory proteins that are influenced by environmental signals. Studies have even shown that environmental factors can override certain genetic mutations, effectively changing how the DNA is expressed. These altered genes can even be passed down to offspring, allowing the offspring to express healthier characteristics, even though they still carry the genetic mutation.
Few diseases result from a single gene mutation. Less than 2% of diseases, such as cystic fibrosis, Huntington’s chorea, and beta thalassemia, result from a single faulty gene, and only about 5% of cancer patients can attribute their diseases to heredity. Scientists are now learning that the genome is far more responsive to the environment of the cell – especially the hormonal environment created by our thoughts, beliefs, and feelings – than we once thought. (Yes, how you think can change how your DNA expresses itself!)
The study of epigenetic control is revolutionizing how the medical community thinks about genes. We used to think that some people were blessed with “good genes,” while others were cursed with what some in the medical community insensitively refer to as “piss poor protoplasm.” But we need not be victims of our DNA.
Angelina Jolie might be a BRCA1 carrier, but that doesn’t mean she need be a victim of her genes either. She may feel she has made an empowering choice to be proactive about breast cancer prevention – and more power to her. I respect and honor her body wisdom and intuition and greatly admire her willingness to speak her truth.
But I worry that other women with family histories of breast cancer will now rush out to get BRCA testing, and if they test positive, they will follow her lead and undergo potentially unnecessary and possibly dangerous elective surgery. I sincerely hope others think twice before undergoing genetic testing that will put them in the difficult position of having to choose between their breasts and their peace of mind.
But as always, I know that you know your body better than any doctor does – and only you can know what’s right for you.
What Do You Think?
Share your thoughts in the comments.