Updated: Mar 12
My Dad wasn’t a particularly small man, nor was he a large one. Despite that, when he hugged you it felt like you were being enveloped by an NFL lineman who had one too many ecstasy pills. It was incredible. It started with a beaming smile and a “Hey Yimmer!”* Then, an outsized, surprisingly strong grip. Hard slap on the shoulder blade. A convulsive shake or a forced torso sway like an upside-down pendulum. He often held on a little too long, as if he was never going to hug you again. I’m glad he did. Because ultimately, the last hug came. Even from his hospice bed, in excruciating pain, rendered immobile by his cancer, the hug was a soft echo of the original. Delicate warm smile. Slow upward movement of the arms. Calm rub on the shoulder blade. Long embrace. A raspy “Hey Yimmer.”
A few weeks prior to that last one, I had sent him an awe-inspiring cancer episode of The TED Radio Hour Podcast. It chronicled some of the extraordinary progress that was being made in the research world.
I didn’t know how he would react to the technological advances since it would arrive too late for his benefit. But I knew that my Dad’s inner world was reflected in his hug. He was damn happy, damn resilient and damn optimistic. He had already made peace with his impending early death. So I figured the far-off remedies portrayed in the podcast certainly weren’t going to hurt him. I asked a few days later what he thought about the episode. “It’s amazing! The biomarkers* that the Mexican scientist was talking about were fascinating! It’s exciting to see how much progress is being made. Someday people won’t have to deal with this shit!”
How does a man four weeks away from his last breath exhibit such optimism? How did it affect his path? Did it help him live longer? Did it help him love harder? Did it push him, despite the pain, to raise his arms one last time for the epic embrace?
I've been dealt some challenging medical news, including a potential cancer diagnosis, more than once in my life. And during those times, optimism was hard to come by. Hope was elusive. But I really wondered, for my Dad, if it actually helped. I finally dug into the topic's scientific literature. The Positive Psychology movement, as it turns out, began to spur a ton of new investigations after the turn of the millennium.
Sure, you can find a few studies that show no effect whatsoever. Optimism or pessimism does nothing they say. Those papers, however, are a miniscule minority.
A systematic review article* titled “Optimism and Hope in Chronic Disease” looked at the hundreds of studies out there and took a microscope to 29 of those studies that met stringent selection criteria for quality. 27 of the 29 showed positive associations between good feelings and good results. “Optimism and Physical Health,” an impressively large meta-analysis*, showed that there is a mild to moderate correlation going on here. Both of these "studies of studies" show that more optimism equals more health. Importantly, they also show that all of the studies they reviewed are virtual no-doubters. (Some studies are so small that you can't really draw any legitimate conclusions from them. That was absolutely not the case with these.)
Now, you probably want to know just how much more life people get when they’re smiling, setting goals and pushing forward despite the tough diagnoses. But, alas, it’s really tough to scientifically say that “People who are Richard Simmons-level-happy live 9.7 years longer than the average person.” That study would take decades to complete and would be uber pricey, even if you paid the participants with ornately sequined Richard Simmons outfits and a lifetime supply of his white high-tops.
But the scientific community has found a ton of cool findings. Here are a few:
· Optimistic heart patients are less likely to be re-hospitalized even after a heart attack or bypass surgery,
· Optimistic patients have less chance of developing cardiovascular disease in the first place,
· Optimistic multiple sclerosis patients seek more opportunities to change their disease experience and worry less,
· Optimistic patients, in general, are far more likely to adopt healthy behaviors including weight loss regimens to prolong their lives, and
· Optimistic patients report lower amounts of pain.
And that’s just a little sample of what researchers have discovered.
Additionally, there was one Duke University study that was particularly earth shattering. More than 2,800 patients who were hospitalized for coronary artery disease were followed over the course of several years. At any point in time, the optimistic ones had a 24% less chance* of dying from a heart-related event than the others. In a separate analysis, they also had a 24% less chance of dying than the others for any reason. (The 24% result for both analyses is coincidental). Not surprisingly, their scores on questionnaires regarding physical function a year after hospitalization differed dramatically too. (This questionnaire even asked the elderly patients about their ability to move furniture around the house. It turns out grandma’s smiles help to keep her chiseled physique!)
Drs. Robert Grambling and Robert Epstein, who weren’t involved in this study, wrote an editorial regarding it. “The degrees of benefit observed in these studies suggest that optimism is a powerful drug that compares favorably with highly effective medical therapies,’’ they wrote. You might want to read that again. This is utterly astonishing. Let me say it another way: optimism, it turns out, is as good as a really good drug.
So, back to my Dad. When his oncologist declared him terminal, naturally, my father asked how long it would be. The doc said that with a liposarcoma as rare as his, it was really tough to know, but that he guessed between four months and eighteen months. So how long do you think Yimmer’s old man lasted?
Again, the range was four months to eighteen months. My Dad planned for eighteen months, swiftly drafted a bucket list and got into chemo as fast as he could. One round down. The tumors grew. So they changed the chemo cocktail. Round two down. The tumors still grew. He eventually would have 47 golf-ball-or-bigger tumors in his torso.
He passed four months and one day after being declared terminal.
Why? How? That doesn’t align with all the research above.
I mean, he was manically optimistic. Off the charts. His legal name was Rickie! Not Rick. Not Richard. Rickie! The name alone just screams "I AM A PARTY!" He got married twice and divorced twice and fell in love again and got married again! That’s optimism, people. (By the way, third time is a charm as it turns out. His third marriage lasted 19 years. He died at 60, about 18 years earlier than those in his demographic. So maybe you could call it 37 years of marriage. Not bad, Dad.)
Yeah, he admitted he was angry at Jesus C and had one and a half “Why me?” moments, but he smiled big and hugged hard throughout. He stayed as positive as anyone could. So how does it all reconcile? What the hell happened to the optimism effect?*
Well, here’s the thing. This was the second time he had cancer. He had thirteen healthy months of remission between the two. Thirteen more lively months with his seven grandkids. Thirteen more happy months with his four kids. Thirteen more loving months with his wife. Had Rickie Patrick Best not been so optimistic, I bet that godforsaken cancer would have taken him the first time around.
1. YIMMER. James = Jimmy = Yimmer? I never asked how he came up with that one. But he did smoke a lot of weed when he was young, soooo … maybe that’s how you get Yimmer.
2. BIOMARKERS. A biomarker is something that assists with diagnosis; it reveals the potential presence of disease. There are several types. It can be your weight or your blood pressure. It can be something seen in an MRI or CT Scan or PET Scan. It can be a detectable, measurable molecule in your blood or urine. With cancer, the tumor may secrete one of these molecules. Jorge Soto, the Mexican scientist, identified these molecular biomarkers that show up way, way before the symptoms do for several different cancers. With early detection, survival rates skyrocket. So biomarkers matter, hence my Dad's excitement.
3. REVIEW ARTICLE. Review articles look at all the studies out there on the subject, hone in on the good ones and give you a digestible summary. They tend to be qualitative or subjective in nature.
4. META ANALYSIS. Meta-analyses, unlike review articles, are more quantitative or numerical in nature. They look at all the studies out there, hone in on the good ones and use advanced statistical methods to combine results and give you some hard numbers to help you see just how legitimate the effect is. (In this case, for you biostats nerds like me, the correlation value, r, was 0.17.)
5. 24% LESS CHANCE. If you "control for" or isolate demographic and psychosocial variables these numbers fall a bit. In other words, if you’re a wealthy patient with lots of friends you’ll do a bit better than optimistic patients without those advantages and much, much better than the average patients (who are neither optimistic nor pessimistic).
6. OPTIMISM EFFECT. I know what some of my fellow nerds are thinking. "This isn't cause and effect! It's just correlations!" Well, yes and no. The meta-analysis did land on an r value, only demonstrating a correlation. The review article, on the other hand, did show several studies that actually made interventions in the experimental group designed to increase optimism, demonstrating a causal relationship.