Twenty-three months ago, I underwent surgery to remove a huge mass from my heart. While the surgeon was able to excise most of it, a portion about the size of an apricot had become interwoven with my heart wall and could not be removed.
After the pathology report on the excised tissue came back, showing a form of malignant cancer called synovial sarcoma, I received radiation and chemotherapy. I was told by my oncologist that even with those treatments, I could expect to live an additional six to 18 months.
Those of you doing a bit of math in your head will realize that I’ve already sent this cancer game into extra innings. I’m very fortunate: My last CT scan showed that the remnant tumor has not grown, and no metastases have developed. And so, at the age of 61, I find myself in the weird and liminal state of having a terminal illness but feeling fine and having no immediate threat to my health.
Since my diagnosis, I have received a lot of unsolicited medical advice. Much of this fell into the category of “mind/body medicine.” In order to fight cancer, I was urged to meditate, breathe, pray or exercise in a certain way. While I appreciate these well-meaning suggestions, whenever I hear them my skepticism kicks in, as befits my job as a biomedical researcher. In fact, when the explanations offered for the efficacy of mind/body medicine employ vague terms like “energy flow” and “resonance,” my baloney detector rings out strong and clear.
How can one take mind/body medicine seriously when the proposed mechanisms have scientific-sounding names but are ultimately metaphoric and unmeasurable? Energy and resonance are real concepts in physics, but their use in explanations of the mechanisms by which, say, meditation could relieve illness has nothing to do with physics. Ultimately, such explanations are not falsifiable through observation or experiment and so must be taken on faith. While many people are perfectly comfortable with the exercise of faith and with supernatural explanations, for those of us who aren’t, it becomes all too easy to discount mind/body medicine.
This takes me back to conversations I had with my father when I was a teenager, in the 1970s. My dad was a psychoanalyst of the old school who engaged in the talking cure, the traditional psychotherapy method of treatment that encourages patients to talk through their experiences and feelings. Every Wednesday night, from my kindergarten days to the week I left for college, he and I had dinner together, where we’d talk about everything, including the progress of his psychiatric clients (with names and identifying details obscured, of course).
I was curious about how mere conversation could relieve the depression, anxiety or compulsions that afflicted his clients. His response was that when the talking cure works, it doesn’t work on some amorphous airy-fairy level: Rather, it works by changing the function of the brain in subtle ways. Similarly, he explained, when diverse behavioral practices like meditation, prayer or exercise are psychiatrically effective, they, too, are ultimately acting through biology, not some form of supernatural ether. At 15, that conversation blew my adolescent mind and helped to set me on the path to become a neuroscientist.
In fact, part of my motivation to study neuroscience has been to understand the biological underpinnings of behavioral interventions in medicine. Some of the claims of mind/body medicine are almost certainly true, even if the pseudoscientific explanations offered for them are not.
Consider the idea that regulated breathing might help to control chronic pain. It seems reasonable, and there are some well-designed studies supporting such effects. And crucially, one can hypothesize about the mechanisms underlying the relief of chronic pain by breath work without having to resort to the supernatural.
For example, we know that there are circuits in the brain that control and monitor breathing, and we know that these circuits connect to other regions of the brain that imbue pain with its negative emotional tone. So, even if we don’t understand all the details, we can devise experiments to test the hypothesis that breath work can attenuate pain perception by conveying electrical signals from breathing centers to emotional pain centers of the brain in order to reduce activity in the latter.
But is pain perception a good general case for the utility of mind/body medicine? After all, pain perception happens in the brain, so it’s not much of a leap to imagine that it might be affected by how we behave or think.
What about a potentially fatal illness that often manifests outside of the brain? Could the course of cancer progression be affected by behavioral practices like meditation or breath work? The short answer is that we don’t know, but the longer and more interesting answer is that, in at least some cases, there are reasonable and testable hypotheses for how this might occur.
One potential biological explanation is that some type of signal must be sent from the brain to the cancer cells in the body. The main way that the brain communicates with the body is through nerve fibers that form paths from the brain to the body to conduct electrical signals, which in turn release neurotransmitter molecules at their endings. (The brain can also communicate with the body through molecules that are secreted into the bloodstream.)
In recent years we have learned that certain types of cancer in the body receive nerve fibers, which originate in the brain and are passed to the body via electrochemical signals that travel in a chain from neuron to neuron. These include tumors of the lung, prostate, skin, breast and pancreas and the gastrointestinal system. This innervation of tumors often contributes to the growth and spread of cancer. In most cases, if you are a cancer patient and your tumor is innervated, then your prognosis is worse. However, nerves fibers come in several types and there are others that may slow cancer progression and yet others that have no effect.
Understanding the cellular and molecular mechanisms by which innervation contributes to tumor growth and spread is an active and promising area of investigation. One recent report led by the lab of Sebastien Talbot at Queen’s University in Kingston, Ontario, showed that melanoma is often innervated by nerve fibers that secrete a chemical messenger. This compound, CGRP, acts on a particular type of immune cell, inhibiting its ability to fight tumors.
When these nerve fibers were silenced in melanoma-bearing mice, which stopped the secretion of CGRP, the spread and growth of melanoma was greatly reduced, leading up to a tripling of the mice’s survival rate. This means that blocking the electrical activity of these nerve fibers allowed the immune cells to help subdue the cancer.
This finding and others like it hold promise for the development of improved cancer therapies that, while not an actual cure, could improve the life span and health of people suffering from cancer. But it will take careful investigation of different innervated tumors to understand the molecular mechanisms at work in each of them. Any new nerve-based therapy would most likely be used in combination with the best treatments we currently have, including surgery, radiation, chemotherapy and immunotherapy.
To me, the innervation of tumors and its role in cancer progression suggest an interesting hypothesis in mind/body medicine. If behavioral practices like meditation, exercise, breath work or even prayer can attenuate or reverse the progression of certain cancers (and, granted, that’s a huge if), then perhaps they do so, ultimately, by changing the electrical activity of the nerve cells that innervate tumors. It’s a provocative idea but one that it is testable in both humans and laboratory mice.
I’m left wondering if this hypothesis relates to my own situation. It’s not known whether the remnant tumor in my heart is innervated or not and, if so, by what type of nerve fibers. But if there is such a connection, it opens up the possibility that my own cognitive approach to terminal illness — in my case, hopefulness coupled with curiosity — could contribute to keeping my cancer at bay and do so, not through supernatural means, but by altering the electrical activity of tumor-innervating nerve fibers. I hope so, as however they are granted, these extra innings are a pure delight.
David J. Linden is a professor of neuroscience at the Johns Hopkins University School of Medicine and the author of “Unique: The New Science of Human Individuality.”
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