Dr Westcott is a GP, describing himself as an atheist, who wrote to
the BMJ wanting to know how he should respond to what
happened to one of his patients. Jim, a non-religious man, was
suffering from asbestosis, acquired as a result of his work as a
submarine engineer. Then he was diagnosed with a mesothelioma of the
chest wall (Westcott R, 2002).
This is a well-known complication of asbestosis, and is a malignant
tumour which is regarded as invariably fatal. Radiotherapy had little
effect and Jim was becoming weaker. His wife decided that they should go
for a Mediterranean holiday, and they picked the Greek island of
Kefallinia. While there they visited a monastery. An old nun singled Jim
out and and asked him what his illness was. She took him to a priest,
who performed some kind of prayer or ritual involving some holy relics.
Immediately after this Jim felt stronger, and his recovery continued.
The tumour was now no longer apparent and Jim seemed to be in remission,
though Dr Westcott was still concerned that he might relapse later. (Dr
Westcott has told me that this did happen.)
Alternative explanations
Sceptics who are confronted with cases of this kind generally take
refuge in two kinds of objection: either the original diagnosis was
wrong or the cure was due to the conventional treatment the patient had
received previously. Neither of these seems likely to apply in the
present case, nor in a number of others. So does this mean that we must
accept that divine intervention, or at least paranormal healing, is a
reality? Do miracles really occur? Cases like that reported by Dr
Westcott certainly provide food for thought, but before accepting them
as proof positive of the miraculous, I think we need to look a little
more closely at what they actually tell us.
Why do apparent miracles so often relate to cancer?
I find it interesting that so many claims for miraculous cures
concern recovery from cancer. These are highly impressive and
dramatic and to many people seem to provide incontrovertible evidence
for a miracle. But how often does cancer remit spontaneously outwith a
religious context?
Do spontaneous cancer cures occur?
I carried out a search via Medline for reports of spontaneous remissions
of cancer (that is, remissions occurring without treatment or with
inadequate treatment). This produced some twenty-odd papers on the
subject; there are doubtless many more to be found. Among the cancers
reported to have remitted spontaneously are:
adult T-cell leukaemia/lymphoma
(Takezako et al., 2000)
adult T-cell leukaemia (Murakawa M et al., 1990)
oesophageal leiomyosarcoma (Takemura et al.,
1999)
lung cancer following myxoedematous coma (Hercbergs, 1999)
hepatocellular carcinoma (2 cases; Magalotti et al., 1998)
non-small-cell lung cancer (Kappauf et al., 1997)
lung metastases from primary uterine cancer (Mastall H, 1997)
liver cancer (Van Halteren HK et al., 1997)
pleural and intrapulmonary metastases from renal carcinoma (Lokich J, 1997)
squamous cell lung cancer (Schmidt W., 1995)
bladder cancer (Hellstrom PA et al., 1992)
intrahepatic, peritoneal and splenic metastases after hepatectomy for
hepatocellular carcinoma (Terasaki et al., 2000)
disappearance of lung metastases from hepatocellular carcinoma
(Toyoda et al., 1999)
large-cell and polymorphic lung cancer with extensive metastatic
disease (Kappauf H. et al., 1997)
metastatic malignant melanoma (Hurwitz PJ. 1991); several similar
cases cited in the literature
As this undoubtedly incomplete list indicates, spontaneous remission of
cancer, though very rare, does occur and is well authenticated outside a
religious context. This will probably come as a surprise to many
people, including some doctors. How do such events come about?
Possible mechanisms of cure in cancer
A number of papers discuss possible mechanisms by which spontaneous
remission of cancer might occur. The most popular suggestion is some
form of immunological reaction, though this is still unproven (Lokich J,
1997; Heim ME, Kobele C, 1995). There seems to be a connection between
fever and remission of cancer (Murakawa M et al., 1990); fever in
childhood or adulthood may protect against the later onset of cancer and
spontaneous remissions are often preceded by feverish infections (Kleef
R et al., 2001). The case of remission following myxoedema coma
(Hercbergs A, 1999) suggests that hypothyroidism may trigger apoptosis
(cell death) in tumours. Yet another idea is that DNA methylation, which
is involved in cell differentiation, may play a part (Sugimura T,
Ushijama T, 2000). And there is a long-standing impression that
psychological states influence the functioning of the immune system.
Note added 24 January 2014: A cell biologist, Uwe Hobohm, believes
it is time to revive an old idea: the treatment of cancer by means of
fever. This was done, apparently successfully, in the nineteenth
century. Hobohm discusses the immunological basis for the treatment in
New Scientist ('Hot, toxic and healing': 4 January 2014).
Hobohm and his colleagues are currently testing the idea in mice.
In summary, then, while the mechanisms of spontaneous remission are by
no means fully understood, there are plausible suggestions to
explain it.
Limits to the miraculous?
What emerges from the cases I have cited is that if we divide diseases
into those that may, no matter how rarely, recover spontaneously and
those that don't, we must place cancer in the "may recover" category.
This means that cancer cures, no matter how gratifying to patients who
experience them and to their relatives, are not necessarily miraculous.
They lie within the boundaries of the natural world.
What, then, would count as a genuine miracle, an event that could not
be accommodated within the realm of the natural? It is of course
difficult to set limits on what can occur naturally, but I think an
example of something which, if it happened, would have to be
taken as miraculous would be regrowth of an amputated finger or limb.
If this seems a lot to ask, how about something seemingly simpler? An
optic nerve damaged by glaucoma never recovers its function in the
ordinary course of events; sight lost through glaucoma is lost for good.
If sight were restored in a reliably diagnosed glaucomatous eye, that
would count as a miracle in my opinion (I'd certainly like it
to happen to me). But to my knowledge no such case has been reported.
These are just two examples out of many; what we need for a "genuine"
miracle is recovery from some accident or illness in which no
spontaneous cure has ever been shown to occur. But cancer doesn't fit
the bill.
References
Ada GL. Host factors important in immune surveillance against tumours.
IARC Scientific Publications. (39):223-39, 1982.
Booth G. A "spontaneous" recovery from cancer. Journal d'Urologie et de
Nephrologie. 78(7):723-6, 1972 Jul-Aug.
Heim ME. Kobele C. Spontaneous remission in cancer. Onkologie. Vol
18(5) (pp 388-392), 1995.
Heim M, Schwarz R. Spontaneous remission of cancer: Epidemiological and
psychosozial aspects. Zeitschrift Fuer Psychosomatische Medizin und
Psychotherapie. Vol 46(1) (pp 57-70), 2000.
Hellstrom PA. Malinen L. Malinen H. Spontaneous remission of bladder
neoplasm. European Journal of Surgical Oncology. Vol 18(5) (pp 521-523),
1992.
Herbert V. Unproven (questionable) dietary and nutritional methods in
cancer prevention and treatment. Cancer. Vol 58(8 SUPPL.) (pp
1930-1941), 1986.
Hercbergs A. Spontaneous remission of cancer—A thyroid hormone
dependent phenomenon?. Anticancer Research. Vol 19(6 A) (pp 4839-4844),
1999.
Hercbergs A. Leith JT. Spontaneous remission of metastatic lung cancer
following myxedema coma. Journal of the National Cancer Institute. Vol
85(16) (pp 1342-1343), 1993.
Hurwitz PJ. Spontaneous regression of metastatic melanoma. Annals of
Plastic Surgery. Vol 26(4) (pp 403-406), 1991.
Kappauf HW. Unexpected benign course and spontaneous recovery in
malignant disease. Onkologie. Vol 14(SUPPL. 1) (pp 32-35), 1991.
Kappauf H et al. Complete spontaneous remission in a patient with
metastatic non-small- cell lung cancer. Case report, review of
literature, and discussion of possible biological pathways involved.
Annals of Oncology. Vol 8(10) (pp 1031-1039), 1997.
Kleef R et al 1. Fever, cancer incidence and spontaneous
remission. Neuroimmunomodulation. Vol 9(2) (pp 55-64), 2001.
Lokich J. Spontaneous regression of metastatic renal cancer: Case report
and literature review. American Journal of Clinical Oncology-Cancer
Clinical Trials. Vol 20(4) (pp 416-418), 1997.
Magalotti D. Gueli C. Zoli M. Transient spontaneous regression of
hepatocellular carcinoma. Hepato-Gastroenterology. Vol 45(24) (pp
2369-2371), 1998.
Mastall H. Spontaneous remission of lung metastases of a primary uterus
carcinoma during immune therapy. Zeitschrift fur Onkologie. Vol 29(3)
(pp 87-88), 1997.
Merkin L. The aetiology of cancer: clues from spontaneous recovery.
Medical Hypotheses. 4(2):136-40, 1978 Mar-Apr.
Murakawa M et al. Spontaneous remission from acute exacerbation of
chronic adult T-cell leukemia. Blut. Vol 61(6) (pp 346-349), 1990.
Niakan B. A hypothesis on the biochemistry of spontaneous remissions of
cancer: Coupling of oxidative phosphorylation and the remission of
cancer. Cancer Biotherapy & Radiopharmaceuticals. Vol 14(4) (pp
297-298), 1999.
Schartz R, Heim M. Psychosocial considerations about spontaneous
remission of cancer. Onkologie. Vol 23(5) (pp 432-435), 2000.
Schmidt W. Spontaneous remission of a cancer of the right lung,
following left side pneumonectomy because of squamous cell lung cancer,
four years ago. Atemwegs- und Lungenkrankheiten. Vol 21(10) (pp
536-538), 1995.
Sugimura T. Ushijima T. Genetic and epigenetic alterations in
carcinogenesis. Mutation Research-Reviews in Mutation Research. Vol
462(2-3) (pp 235-246), 2000.
Takemura et al. Case of spontaneous regression of metastatic lesions of
leiomyosarcoma of the esophagus. Diseases of the Esophagus. Vol 12(4)
(pp 317-320), 1999.
Takezako Y et al. Spontaneous remission in acute type adult T-cell
leukemia/lymphoma. Leukemia & Lymphoma. Vol 39(1-2) (pp 217-222), 2000.
Abstract
Toyoda H. et al. Hepatocellular carcinoma with spontaneous regression
of multiple lung metastases. Pathology International. Vol 49(10) (pp
893-897), 1999.
Van Halteren HK et al. Spontaneous regression of hepatocellular
carcinoma. Journal of Hepatology. Vol 27(1) (pp 211-215), 1997.
Westcott R. Can miracles happen? BMJ 2002;325:553.