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"MIRACULOUS" CURES: WHAT DO THEY TELL US?

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A problem for rationalists?

From time to time we read reports of people who have recovered from serious or normally fatal illnesses thanks to what appears to be miraculous intervention. Sometimes this is ascribed to healing, sometimes to prayer, but there is always the implication that something paranormal has occurred, which is often attributed to divine origin. A recent example reported in the British Medical Journal will serve as an example of the kind of thing I have in mind (Westcott R, 2002).

Dr Westcott is a GP who describes himself as an atheist doctor and wants to know how he should respond to what happened to one of his patients. This was Jim, a non-religious man suffering from asbestosis which he had acquired as a result of his work as a submarine engineer. Then he was diagnosed with a mesothelioma of the chest wall.

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 is now no longer apparent and Jim appears to be in remission, though Dr Westcott is still concerned that he may relapse later.

Skeptics 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.

I find it interesting that the majority of claims for miraculous cures concern recovery from cancer. These are certainly 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:
  1. adult T-cell leukaemia/lymphoma (Takezako et al., 2000)
  2. adult T-cell leukaemia (Murakawa M et al., 1990)
  3. oesophageal leiomyosarcoma (Takemura et al., 1999)
  4. lung cancer following myxoedematous coma (Hercbergs, 1999)
  5. hepatocellular carcinoma (2 cases; Magalotti et al., 1998)
  6. non-small-cell lung cancer (Kappauf et al., 1997)
  7. lung metastases from primary uterine cancer (Mastall H, 1997)
  8. liver cancer (Van Halteren HK et al., 1997)
  9. pleural and intrapulmonary metastases from renal carcinoma (Lokich J, 1997)
  10. squamous cell lung cancer (Schmidt W., 1995)
  11. bladder cancer (Hellstrom PA et al., 1992)
  12. intrahepatic, peritoneal and splenic metastases after hepatectomy for hepatocellular carcinoma (Terasaki et al., 2000)
  13. disappearance of lung metastases from hepatocellular carcinoma (Toyoda et al., 1999)
  14. large-cell and polymorphic lung cancer with extensive metastatic disease (Kappauf H. et al., 1997)
  15. 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?

Mechanisms of cure

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.

In summary, then, while the mechanisms of spontaneous remission are by no means fully understood, there are plausible suggestions to explain the phenomenon.

Conclusion: 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 do not, 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 certainly 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 certainly count as a miracle in my opinion. To my knowledge, however, 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.

I therefore think that, although there are well-attested instances of spontaneous recovery from cancer within a religious or paranormal context, this is not convincing evidence for divine intervention. The fact that a patient recovers after having been prayed for does not prove that the prayer was responsible for the recovery.

Alternative explanations

  1. It could be coincidence. We do not know how many patients suffering from cancer are prayed for but the proportion is probably considerable. We do not normally hear about those for whom the prayers are not answered. If very many patients are prayed for, it is possible that among these there will by chance be some who recover spontaneously but who would have done so even if they had not been prayed for.

  2. If as seems likely the immune system is involved in spontaneous remissions of cancer, the known influence of the nervous system on the immune system could explain why the patient's beliefs and emotional state might on occasion bring about a remission. The fact that a patient had no conscious expectation of cure (as in the case reported by Dr Westcott) does not negate a possible influence of this kind.

  3. A believer in miracles could argue that even apparently spontaneous remissions are really miraculous. Perhaps God works his miracles through "normal" physiological pathways rather than by suspending the ordinary laws of physiology, and perhaps he refrains from curing glaucoma and regenerating amputated limbs in order to keep us guessing, or because he does not want to force our belief. This is logically possible but unverifiable and so can be neglected in a scientific context.

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.
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