This account of recent research in the field of psychoneuroimmunology is a welcome antidote to unfounded beliefs and speculations about the relationships between the brain, behaviour, immunity and disease. For instance, Martin casts doubt on the clinical importance of "life events" in the aetiology of illness, contrary to widespread belief that such experiences as divorce, house-moving are reliable predictors of illness:
"the statistical correlation between life events and illness is highly consistent but it is also fairly weak. Life events do have a bearing on health, but not a very major bearing. Typically, life events account for only 10-15 percent of the total variation in the incidence of illness." (p.37)
These matters are not easy to assess, and this is not always helped when, after reviewing some of the research problems, Martin seems to overlook what he himself has written, summarizing thus:
"Despite these caveats there is consistent evidence...for a connection between life events and subsequent illness." (p.40)
There are several mentions of miracle cures and New Wage remedies, including a reference to Lourdes, where Martin notes that only 64 out of about 6000 well-documented cases were candidates for miracle status, according to the Vatican. He would have done well to read Sagan on this question.
Towards the end of the book, Martin doubts, reasonably enough, that "prolonged psychological stress is a uniquely modern phenomenon." He then seems strangely timid, going on to say that,
"We shall probably never know for certain and any evidence is bound to be tenuous... If, as I suspect, our hunter-gatherer ancestors also suffered from chronic social stress and stress-induced immune suppression, the evolutionary mystery of why it happens remains unsolved." (p.308)
Yet an expert he mentions a few pages later is quoted by Budiansky in The Covenant of the Wild in a passage that makes this scenario entirely plausible:
"As Sapolsky points out, the stess response in all animals is a survival mechanism, preparing the animal for fight or flight. Hormones released in response to stress cause glucose to be mobilized from storage and blood diverted from those parts of the body needed for a quick physical response - the heart, the brain, and the muscles - and away from such 'nonessential' functions as growth, digestion, disease resistance, and reproduction. But continual activation of these hormones can lead to chronic physical disabilities, including hypertension, ulcers, impaired growth, and decreased fertility." (op. cit., p.134)
What's more, a clue to the aforementioned "mystery" is provided by Martin himself in a useful reminder as to what evolution by natural selection is about:
"It has nothing to do with contentment or physical well-being, except in so far as they may affect an organism's ability to survive and reproduce. Natural selection has no remit to make us happy or healthy all our lives. We have seen that genes can thrive in the gene pool... even if they cause diseases, provided they have countervailing benefits or do not impair the carrier's ability to produce children and grandchildren. The same is true for genes that predispose us to unhappiness, depression and anxiety." (p.302)
Anyone looking for evidence to support the value of "alternative" treatments for serious diseases will find there is little here to encourage further belief. Anyone caring for someone who is ill, or concerned about their own health, may, on the other hand, save themselves much time, money and disappointment by heeding Martin's warning:
"Contrary to the claims of certain self-help manifestos, there are no quick fixes or easy solutions to problems like cancer or heart disease. It is probably safe to conclude that having the right attitudes to life, a satisfying job and a network of supportive personal relationships is of greater benefit than any of the esoteric therapies or self-help remedies on offer." (p.260)
One last remark for those who may read this useful book: beware of Martin's crass habit of giving away the entire plot of classic novels that you may not have yet read (e.g Jude the Obscure, p.64). If you would find that as irritating as I did, you can perhaps get a friend to help you skip those passages, which in any case only have the dubious purpose of providing case histories of diseases affecting fictional characters.
|"And indeed the practice of physic is properly enough compared by Hippocrates to a fight, and also to a farce acted between three persons, the patient, the physician, and the disease."
Rabelais, Gargantua and Pantagruel, Epistle Dedicatory for the Fourth Book
© Paul Taylor 2002