Did Sam Londe really die from a cancer misdiagnosis in 1974?

[Ocelot]

If you discuss the power of the placebo effect and its evil twin the nocebo for any length of time then you will soon hear the story of Sam Londe who was apparently diagnosed with cancer of the esophagus, which was invariably fatal back in 1974 where our story is set.

Dutifully a few weeks later he died and yet the autopsy revealed no cancer in his esophagus and whilst he did have cancer elsewhere, that's not what killed him.

The story is all over the web, google reveals the same story 1,000s of times with mostly the same language. The earliest instance I found was from 2007 http://patientadvocare.blogspot.co.u...ty-nocebo.html

This attributes the tale to the Discovery Channel but this article appears to be a trimmed down version of earlier text. Later repeats include information missing from this early retelling. The Doctor's name is included in most copies as Dr. Clifton Meador, a Nashville physician, a few give us the name of the show as Discovery Health Channel 2003 program “Placebo: Mind Over Medicine”

Despite all this wealth of checkable information, a search on Google Scholar or PubMed fails to turn up any more authoritative citation for such a fascinating case.

That's a little curious and given that the story can be ultimately traced to the people who brought us such gems as "160 Tumor!" and the "Oprah Winfrey Network" I'd like to ask if anybody else has tried to verify Dr Meador's tale? It's just that I'm 42% certain, the folks at discovery channel wouldn't risk investigating further in case they found out that the truth didn't quite match up to the story they wanted to run.

[jasonpatterson]

Googling a bit indicates that there is indeed a Dr. Clifton Meador in Nashville, TN. Even though he is a real doctor (and a prominent one, at that) I'm going to be wary of anyone's testimonial about an event that occurred 30 years before a show was produced. If there are actual records of the events to go by, perhaps, but more than enough time for an interesting case to have been embellished to the point of a big fish tale.

ETA: This reminded me of an Onion story.

Loved Ones Recall Local Man's Cowardly Battle with Cancer

[Ocelot]

Yeah I didn't really doubt the existence of the Doctor. I mean doscovery has dumbed down but it's not the national enquirer. But my thoughts exactly on the 30 year old tale.

I'd like to see the show, or second best talk to someone who has seen it to see what sort of corroboration might have been given. I couldn't find any clips on You Tube so I've popped a message onto the Discovery UK Facebook Wall http://www.facebook.com/DiscoveryUK/...50819129786711

[Dancing David]

Cancer diagnosis and death are real, but 1974 is a long time ago.

[Ocelot]

Originally Posted by Dancing David

Cancer diagnosis and death are real, but 1974 is a long time ago.

An alternative and better documented example would be great too. Can you provide one (where the cause of death was the nocebo effect from the diagnosis rather than the cancer or aggressive treatment)

[Dancing David]

Originally Posted by Ocelot

An alternative and better documented example would be great too. Can you provide one (where the cause of death was the nocebo effect from the diagnosis rather than the cancer or aggressive treatment)

I am not sure that the cause of death was nocebo at all.

Someone died: did they do an autopsy, what was the cause of death? Just because they had a diagnosis of cancer does not mean that diagnosis caused them to die.

ETA: most sites just cut and paste the same article. As you stated.

[jasonpatterson]

Originally Posted by Dancing David

Someone died: did they do an autopsy, what was the cause of death? Just because they had a diagnosis of cancer does not mean that diagnosis caused them to die.

At this point, are we even sure that someone died for real after being misdiagnosed with cancer? I'm sure that somewhere there is an obituary for the guy if he was real, but again, 30 years is a long time, and if there hasn't been a similar case since, it really casts a shadow over the reliability of the original story.

[Dr. Imago]

http://seattletimes.nwsource.com/htm...ofdying02.html

I was not familiar with this story until this thread. I am using the above referenced article from 2008 as a starting point.

From the above article...

Quote:

He had a few cancerous spots on his liver and one on his lung, but not enough to kill him.

First off, I'm not sure at this point that we can reconstruct posthumously a complete cause-effect case for any reason this man died. But, the current undisputed fact is that he did die with cancer.

Secondly, just because Meador says "he died with cancer but that's not what killed him" doesn't mean he's correct. For example, there is a now well-known phenomenon in patients with widely metastatic cancer - especially from gastrointestinal origin (stomach, bowel, pancreas, etc.) - where they become hypercoaguable and prone to clots in the deep venous system. Many patients die "suddenly" from pulmonary embolism.

This condition, called Trousseau's syndrome, is real and was probably under-appreciated in 1974. I have already personally seen multiple examples of this over the past 7 years as a practicing physician. Furthermore, unless someone was specifically looking for this at the time (i.e. a clot in the lung) it may have been missed during autopsy.

Who knows? And, that's the point. But, I have provided at least one plausible and very real alternative explanation for this man's death that is a known and frequently occurring phenomenon in the human body consistent with this man's clinical presentation. Regardless, I'm sure we can all agree that an anecdote, especially a relatively ancient one rife with recall bias, does not a study make.

Lastly, it seems to me that such a "nocebo effect" is more akin to conversion disorder. And, I'm not sure that "nocebo effect" is otherwise considered a widely recognized and accepted separate diagnosis, if you will, in the medical community. Can conversion disorder kill you? I'm not a betting man, but excluding suicide I'd put my money on "no". Still such stories clearly makes for titillating fodder for the lay media.

~Dr. Imago

[Dancing David]

The E in JREF.

Thanks

[Ocelot]

Originally Posted by Dancing David

I am not sure that the cause of death was nocebo at all.

Someone died: did they do an autopsy, what was the cause of death? Just because they had a diagnosis of cancer does not mean that diagnosis caused them to die.

ETA: most sites just cut and paste the same article. As you stated.

Sorry I misunderstood what you were saying.

[Ocelot]

Originally Posted by Dr. Imago

http://seattletimes.nwsource.com/htm...ofdying02.html

I was not familiar with this story until this thread. I am using the above referenced article from 2008 as a starting point.

Yep that's a pretty typical retelling. At least they're somewhat cautious about ascribing the cause as being the power of suggestion.

Originally Posted by Dr. Imago

From the above article...

First off, I'm not sure at this point that we can reconstruct posthumously a complete cause-effect case for any reason this man died. But, the current undisputed fact is that he did die with cancer.

Secondly, just because Meador says "he died with cancer but that's not what killed him" doesn't mean he's correct. For example, there is a now well-known phenomenon in patients with widely metastatic cancer - especially from gastrointestinal origin (stomach, bowel, pancreas, etc.) - where they become hypercoaguable and prone to clots in the deep venous system. Many patients die "suddenly" from pulmonary embolism.

This condition, called Trousseau's syndrome, is real and was probably under-appreciated in 1974. I have already personally seen multiple examples of this over the past 7 years as a practicing physician. Furthermore, unless someone was specifically looking for this at the time (i.e. a clot in the lung) it may have been missed during autopsy.

Who knows? And, that's the point. But, I have provided at least one plausible and very real alternative explanation for this man's death that is a known and frequently occurring phenomenon in the human body consistent with this man's clinical presentation. Regardless, I'm sure we can all agree that an anecdote, especially a relatively ancient one rife with recall bias, does not a study make.

Lastly, it seems to me that such a "nocebo effect" is more akin to conversion disorder. And, I'm not sure that "nocebo effect" is otherwise considered a widely recognized and accepted separate diagnosis, if you will, in the medical community. Can conversion disorder kill you? I'm not a betting man, but excluding suicide I'd put my money on "no". Still such stories clearly makes for titillating fodder for the lay media.

~Dr. Imago

Thanks Doc, that's a pretty authoritative and substantial debunking and of course a crying shame.

When discussing alternative health claim we often come up against people with personal experiences. Dare to mention the placebo effect to them and you'll hear that their symptoms cannot be "all in the mind" as if that's all the placebo effect can be: imagined symptoms. It's would be handy to have some rhetoric that demonstrates as well as this would that placebos may have causes that are "all in the mind" but the effects can be very real and very profound.

I've seen this example given a number of times in these scenarios yet when I wanted to do so myself, my habit of trying to find a decent citation left me with too many doubts. The idea of death by suggestion does not appear to be well supported beyond a single example reported via Chinese whispers tracked back to pop science show.

[Dancing David]

Originally Posted by Ocelot

Sorry I misunderstood what you were saying.

No sorry,

[Dr. Imago]

Herein is a nice summary of "wishful thinking" (good or bad) by the American Cancer Society:

http://www.cancer.org/Treatment/Trea...des-and-cancer

Also, a nice review of the so-called "placebo effect" can be found on the Skeptic's Dictionary:

http://www.skepdic.com/placebo.html

I can currently see no reason why the same principles wouldn't apply to the "nocebo" effect.

The bottom line, in my educated opinion, is that when you have a concrete diagnosis, and not just a subjective one that relies heavily on self-reported symptoms (e.g., pain syndromes, depression, etc.), the evidence for an effect of non-active treatment dwindles.

It would be nice if we could simply through prayer, positive-thinking, and/or "attitude adjustment" affect non-sympathetically mediated (and by that I mean literally the sympathetic nervous system) diseases to go away or be ameliorated. Sadly, the culmination of studies reported to date would indicate that this is just not the case.

~Dr. Imago

[fuelair]

www.dogpile.com

Dr. Clifton Meador Nashville (fetch)

more than one listing re: misidentification of illness from symptoms (as in a problem, not re: doing it specifically)

example: http://www.medpagetoday.com/Columns/At-Large/27606