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September 16, 1988, Vol 260, No. 11 >
ARTICLE | September 16, 1988

Intangibles in Medicine: An Attempt at a Balancing Perspective FREE

Norman Cousins
[+] Author Affiliations

Reprint requests to Norman Cousins, Dean's Office, School of Medicine, 12-138 CHS, University of California at Los Angeles, Los Angeles, CA 90024.


JAMA. 1988;260(11):1610-1612. doi:10.1001/jama.1988.03410110118040
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References

UNDERSTANDABLY, reaction has set in against efforts to emphasize the importance of psychological factors in the treatment of patients. Medical periodicals have carried articles and letters from physicians who feel they are being pushed by imponderables in the wrong direction. The following letter is a composite of reactions:

I am not interested in charming or entertaining my patients or winning popularity contests. I want to give them the benefit of my special knowledge and ability. If I myself were seriously ill, I would have no difficulty in expressing my preference for a physician who is capable of making an absolutely correct diagnosis and who would know exactly what has to be done—rather than choose a physician who is adept at sweet talk, or in making friends and influencing people, or in gaining recognition as one hell of a fine fellow.

This letter and dozens like it are the understandable response

REFERENCES

1 +
Cannon W: Bodily Changes in Pain, Hunger, Fear and Rage . New York, Harper & Row Publishers Inc, 1963;.
2 +
Ader R, Grota LJ, Cohen N:  Conditioning phenomena and immune function . Ann NY Acad Sci 1987;;496:532-544.
3 +
Besedovsky HO, del Rey A, Sorkin E, et al:  Immunoregulatory feedback between interleukin-1 and glucocorticoid hormones . Science 1986;;233:652-654.
4 +
Blalock JE:  A molecular basis for bidirectional communication between the immune and neuroendocrine systems . Physiol Rev , in press.
5 +
Bulloch K, Cullen MR, Schwartz RH, et al:  Development of innervation within syngeneic thymus tissue transplanted under the kidney capsule of the nude mouse: A light and ultrastructural microscope study . J Neurosci Res 1987;;18:16-27.
6 +
Felten DL, Felten SY, Bellinger DL, et al:  Noradrenergic sympathetic neural interactions with the immune system: Structure and function . Immunol Rev 1987;;100:225-260.
7 +
Kiecolt-Glaser JK, Glaser R:  Psychosocial moderators of immune function . J Behav Med 1987;;9:16-20.
8 +
Pert CB, Ruff MR, Weber RJ, et al:  Neuropeptides and their receptors: A psychosomatic network . J Immunol 1985;;135:820-826.
9 +
Stein M, Keller SE, Schleifer SJ:  Stress and immunomodulation: The role of depression and neuroendocrine function . J Immunol 1985;;135:827-833.
10 +
Wolf S, McCabe WR, Yamamoto J, et al:  Changes in serum lipids in relation to emotional stress during rigid control of diet and exercise . Circulation 1962;;26:379-387.
11 +
Thomas CB, Murphy EA:  Further studies on cholesterol levels in the Johns Hopkins medical students: Effect of stress at examinations . J Chronic Dis 1958;;8:661.
12 +
Grundy SM, Griffin AC:  Effects of periodic mental stress on serum cholesterol levels . Circulation 1958;;17:852.
13 +
Friedman M, Rosenman RH, Carroll V:  Changes in the serum cholesterol and blood clotting time in men subjected to cyclic variation of occupational stress . Circulation 1958;;17:852.
14 +
McClelland D:  Inhibited power motivation and blood pressure in man . J Abnorm Psychol 1979;;88:182-190.
15 +
Dillon K, Baker K, Minchoff B:  Positive emotional states and enhancement of the immune system . Int J Psychiatry Med 1985 -1986;;15:13-18.
16 +
Levy S:  Host differences in neoplastic risk: Behavioral and social contributors to disease . Health Psychol 1983;;2:21-44.
17 +
Riley V, Fitzmaurice MA, Spackman DH:  Psychoneuroimmunologic factors in neoplasia: Studies in animals , in Ader R (ed): Psychoneuroimmunology . Orlando, Fla, Academic Press Inc, 1981;, pp 31-102.
18 +
Sklar LS, Anisman H:  Stress and coping factors influence tumor growth . Science 1979;;205:513-515.
19 +
Visintainer MA, Volpicelli JR, Seligman MEP:  Tumor rejection in rats after inescapable or escapable shock . Science 1982;;216:437-439.
20 +
Laudenslager ML, Ryan SM, Drugan RC, et al:  Coping and immunosuppression: Inescapable but not escapable shock suppresses lymphocyte proliferation . Science 1983;;221:568-570.
21 +
Shavit Y, Ryan SM, Lewis JW, et al:  Inescapable but not escapable stress alters immune function . Physiologist 1983;;26:64.
22 +
Felten DL, Felten SY, Carlson S, et al:  Noradrenergic and peptidergic innervation of lymphoid tissue . J Immunol 1985;;135:755-765.
23 +
Bulloch K, Moore RY:  Innervation of the thymus gland by brainstem and spinal cord in mouse and rat . Am J Anat 1981;;162:157-166.
24 +
Morley JE, Kay NE, Solomon GF, et al:  Neuropeptides: Conductors of the immune orchestra . Life Sci 1987;;41:527-544.
25 +
Korneva EA, Khai LM:  Effect of stimulating different mesencephalic structures on protective immune response patterns . Fiziol Zh SSSR 1967;;53:42-47.
26 +
Janković BD, Isaković K:  Neuroendocrine correlates of immune response: I. Effects of brain lesions on antibody production, arthus reactivity and delayed hypersensitivity in the rat . Int Arch Allergy Appl Immunol 1973;;45:360-372.
27 +
Keller SE, Stein M, Camerino MS, et al:  Suppression of lymphocyte stimulation by anterior hypothalamic lesions in the guinea pig . Cell Immunol 1980;;52:334-340.
28 +
Pert CB, Hill JM, Ruff MR, et al:  Octapeptides deduced from the neuropeptide receptor-like pattern of antigen T-4 in brain potently inhibit human immunodeficiency virus receptor binding and T-cell infectivity . Proc Natl Acad Sci USA 1986;;83:9254-9258.
29 +
Ader R, Cohen N:  Conditioned immunopharmacologic responses , in Ader R (ed): Psychoneuroimmunology . Orlando, Fla, Academic Press Inc, 1981;, pp 281-319.
30 +
Hazum E, Chang KJ, Cuatrecasas P:  Specific nonopiate receptors for betaendorphin . Science 1979;;205:1033-1035.
31 +
Smith EM, Brosnan P, Meyer MJ, et al:  An ACTH receptor on human mononuclear leukocytes . N Engl J Med 1987;;317:1266-1269.
32 +
Besedovsky HD, del Rey A:  Neuroendocrine and metabolic responses induced by interleukin-1 . J Neurosci Res 1987;;18:172-178.
33 +
Smith EM, Meyer WJ, Blalock JE:  Virus-induced corticosterone in hypophysectomized mice: A possible lymphoid adrenal axis . Science 1982;;218:1311-1312.
34 +
Blalock JE:  The immune system as a sensory organ . J Immunol 1983;;132:1067-1070.
35 +
MacLean D, Reichlin S:  Neuroendocrinology and the immune process , in Ader R (ed): Psychoneuroimmunology . Orlando, Fla, Academic Press Inc, 1981;, pp 475-520.
36 +
Kiecolt-Glaser JK, Garner W, Speicher C, et al:  Psychosocial modifiers of immunocompetence in medical students . Psychosom Med 1984;;46:7-14.
37 +
Glaser R, Kiecolt-Glaser JK, Stout JC, et al:  Stress-related impairments in cellular immunity . Psychiatry Res 1985;;16:233-239.
38 +
Glaser R, Kiecolt-Glaser JK, Speicher CE, et al:  Stress, loneliness, and changes in herpes virus latency . J Behav Med 1985;;8:249-260.
39 +
Glaser R, Rice J, Sheridan J, et al:  Stress-related immune suppression: Health implications . Brain Behav Immunity 1987;;1:7-20.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Cannon W: Bodily Changes in Pain, Hunger, Fear and Rage . New York, Harper & Row Publishers Inc, 1963;.
2 +
Ader R, Grota LJ, Cohen N:  Conditioning phenomena and immune function . Ann NY Acad Sci 1987;;496:532-544.
3 +
Besedovsky HO, del Rey A, Sorkin E, et al:  Immunoregulatory feedback between interleukin-1 and glucocorticoid hormones . Science 1986;;233:652-654.
4 +
Blalock JE:  A molecular basis for bidirectional communication between the immune and neuroendocrine systems . Physiol Rev , in press.
5 +
Bulloch K, Cullen MR, Schwartz RH, et al:  Development of innervation within syngeneic thymus tissue transplanted under the kidney capsule of the nude mouse: A light and ultrastructural microscope study . J Neurosci Res 1987;;18:16-27.
6 +
Felten DL, Felten SY, Bellinger DL, et al:  Noradrenergic sympathetic neural interactions with the immune system: Structure and function . Immunol Rev 1987;;100:225-260.
7 +
Kiecolt-Glaser JK, Glaser R:  Psychosocial moderators of immune function . J Behav Med 1987;;9:16-20.
8 +
Pert CB, Ruff MR, Weber RJ, et al:  Neuropeptides and their receptors: A psychosomatic network . J Immunol 1985;;135:820-826.
9 +
Stein M, Keller SE, Schleifer SJ:  Stress and immunomodulation: The role of depression and neuroendocrine function . J Immunol 1985;;135:827-833.
10 +
Wolf S, McCabe WR, Yamamoto J, et al:  Changes in serum lipids in relation to emotional stress during rigid control of diet and exercise . Circulation 1962;;26:379-387.
11 +
Thomas CB, Murphy EA:  Further studies on cholesterol levels in the Johns Hopkins medical students: Effect of stress at examinations . J Chronic Dis 1958;;8:661.
12 +
Grundy SM, Griffin AC:  Effects of periodic mental stress on serum cholesterol levels . Circulation 1958;;17:852.
13 +
Friedman M, Rosenman RH, Carroll V:  Changes in the serum cholesterol and blood clotting time in men subjected to cyclic variation of occupational stress . Circulation 1958;;17:852.
14 +
McClelland D:  Inhibited power motivation and blood pressure in man . J Abnorm Psychol 1979;;88:182-190.
15 +
Dillon K, Baker K, Minchoff B:  Positive emotional states and enhancement of the immune system . Int J Psychiatry Med 1985 -1986;;15:13-18.
16 +
Levy S:  Host differences in neoplastic risk: Behavioral and social contributors to disease . Health Psychol 1983;;2:21-44.
17 +
Riley V, Fitzmaurice MA, Spackman DH:  Psychoneuroimmunologic factors in neoplasia: Studies in animals , in Ader R (ed): Psychoneuroimmunology . Orlando, Fla, Academic Press Inc, 1981;, pp 31-102.
18 +
Sklar LS, Anisman H:  Stress and coping factors influence tumor growth . Science 1979;;205:513-515.
19 +
Visintainer MA, Volpicelli JR, Seligman MEP:  Tumor rejection in rats after inescapable or escapable shock . Science 1982;;216:437-439.
20 +
Laudenslager ML, Ryan SM, Drugan RC, et al:  Coping and immunosuppression: Inescapable but not escapable shock suppresses lymphocyte proliferation . Science 1983;;221:568-570.
21 +
Shavit Y, Ryan SM, Lewis JW, et al:  Inescapable but not escapable stress alters immune function . Physiologist 1983;;26:64.
22 +
Felten DL, Felten SY, Carlson S, et al:  Noradrenergic and peptidergic innervation of lymphoid tissue . J Immunol 1985;;135:755-765.
23 +
Bulloch K, Moore RY:  Innervation of the thymus gland by brainstem and spinal cord in mouse and rat . Am J Anat 1981;;162:157-166.
24 +
Morley JE, Kay NE, Solomon GF, et al:  Neuropeptides: Conductors of the immune orchestra . Life Sci 1987;;41:527-544.
25 +
Korneva EA, Khai LM:  Effect of stimulating different mesencephalic structures on protective immune response patterns . Fiziol Zh SSSR 1967;;53:42-47.
26 +
Janković BD, Isaković K:  Neuroendocrine correlates of immune response: I. Effects of brain lesions on antibody production, arthus reactivity and delayed hypersensitivity in the rat . Int Arch Allergy Appl Immunol 1973;;45:360-372.
27 +
Keller SE, Stein M, Camerino MS, et al:  Suppression of lymphocyte stimulation by anterior hypothalamic lesions in the guinea pig . Cell Immunol 1980;;52:334-340.
28 +
Pert CB, Hill JM, Ruff MR, et al:  Octapeptides deduced from the neuropeptide receptor-like pattern of antigen T-4 in brain potently inhibit human immunodeficiency virus receptor binding and T-cell infectivity . Proc Natl Acad Sci USA 1986;;83:9254-9258.
29 +
Ader R, Cohen N:  Conditioned immunopharmacologic responses , in Ader R (ed): Psychoneuroimmunology . Orlando, Fla, Academic Press Inc, 1981;, pp 281-319.
30 +
Hazum E, Chang KJ, Cuatrecasas P:  Specific nonopiate receptors for betaendorphin . Science 1979;;205:1033-1035.
31 +
Smith EM, Brosnan P, Meyer MJ, et al:  An ACTH receptor on human mononuclear leukocytes . N Engl J Med 1987;;317:1266-1269.
32 +
Besedovsky HD, del Rey A:  Neuroendocrine and metabolic responses induced by interleukin-1 . J Neurosci Res 1987;;18:172-178.
33 +
Smith EM, Meyer WJ, Blalock JE:  Virus-induced corticosterone in hypophysectomized mice: A possible lymphoid adrenal axis . Science 1982;;218:1311-1312.
34 +
Blalock JE:  The immune system as a sensory organ . J Immunol 1983;;132:1067-1070.
35 +
MacLean D, Reichlin S:  Neuroendocrinology and the immune process , in Ader R (ed): Psychoneuroimmunology . Orlando, Fla, Academic Press Inc, 1981;, pp 475-520.
36 +
Kiecolt-Glaser JK, Garner W, Speicher C, et al:  Psychosocial modifiers of immunocompetence in medical students . Psychosom Med 1984;;46:7-14.
37 +
Glaser R, Kiecolt-Glaser JK, Stout JC, et al:  Stress-related impairments in cellular immunity . Psychiatry Res 1985;;16:233-239.
38 +
Glaser R, Kiecolt-Glaser JK, Speicher CE, et al:  Stress, loneliness, and changes in herpes virus latency . J Behav Med 1985;;8:249-260.
39 +
Glaser R, Rice J, Sheridan J, et al:  Stress-related immune suppression: Health implications . Brain Behav Immunity 1987;;1:7-20.

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