I've always been a skeptic. Never one to believe in things that I couldn't see, touch, feel or smell, or things that simply didn't make sense right off the bat. By two, I had decided that Santa was clearly imaginary--that whole billion-presents-on-a-sleigh thing was obviously bogus--and wondered why my parents persisted in pretending otherwise. How gullible did they think I was? When I was old enough to start losing teeth, I simply handed my father the little bicuspid, bloody and wet, and left my hand out for the pre-ordained twenty-five-cent payout. No Tooth Fairy here; no Easter Bunny, no Great Pumpkin: an atheist from day one, no assembly required.
Starting in the mid-1970's, my very un-skeptical mother edited and published a bi-weekly newsletter "exploring the mind/body connection." It was filled with interesting but mostly unsubstantiated articles on how laughter could cure warts or hypnosis eliminate snoring, or the uncanny psychic abilities of parakeet owners. Mostly I thought the stories very silly, being my father's hard-nosed daughter, but as I was quite mercenary even at that tender age, I willingly coded return slips, stuffed envelopes and saved up my ill-gotten gains from the pockets of the starry-eyed subscribers--paid out by my parents in cans of diet soda, which I was allowed to convert to cash once the numbers reached undrinkable proportions.
There was one story that I did lock onto, however grudgingly, and which was repeated quite credibly in article after article over the newsletter's ten-year lifespan: the power of the placebo. If you believe something is going to work, it is more likely to do just that. If, as the story went, you believed you were getting acupuncture to relieve pain in your left elbow, it didn't matter whether the pins were placed correctly by a master acupuncturist or simply jabbed in randomly by an untrained research assistant: those who went in believing it would work for them had positive results, regardless of the "treatment". (How, exactly, does that belief or optimism trigger the physiological process of healing, or at least deliver some relief from the symptoms? I am fascinated.)
In the biopharmaceutical industry, clinical trials are usually conducted with multiple means of measuring efficacy. Patients, generally randomized into two groups sharing very similar characteristics of age, sex, stage of disease and treatment history, will be given either the active drug or a placebo. In so-called "double blind" trials, neither the patient nor the doctor knows who is receiving the real thing, and the coded tracking data is kept under strict wraps by the company or university managing the trial. In the end, various reports are made, the data is unlocked and analyzed from all angles, the FDA advisory panel reviews all the safety and efficacy data and makes its recommendation, and eventually the FDA bigwigs pronounce the official usefulness (or uselessness) of the drug.
Almost invariably, and even in studies of serious ailments, a statistically significant proportion of the placebo group reports an improvement in their symptoms (the placebo group almost always reports negative side-effects, also--a whole discussion unto itself--but at least they believe it's doing something). Doctors also frequently report seeing some improvement in patients whom they believe to be receiving the real drug but who are, in fact, getting nothing more than a cleverly disguised IV saline solution or sugar pill. Even the clinical investigators often find an improvement in the placebo group. So the effectiveness of the medication is necessarily based on comparison to placebo in what I think of as as the chemistry versus optimism showdown, and optimism usually has something good to say for itself.
So it seems that the power of belief, or optimism, or faith in medicine (I refuse to call it hope, as I'm still quite irritated with that word) can, in some people, bring about its own reward. But does it then follow that skepticism could bring about a negative outcome? And if that's the case, how exactly does a natural-born skeptic convert? Is it simply innate, and not to be learned? It truly feels like a hard-wired system for me.
My years in the biopharm industry instilled a lot of faith in the drug approval process, though clearly the ongoing safety monitoring program has left much to be desired and is now being revamped in the wake of recent extremely-rare-but-dreadful reactions to drugs like Vioxx or, a while back, Fen-Phen. I have been a carefully informed consumer of everything from ibuprofen and acetaminophen to generic-versus-name-brand thyroid replacement products, comparing side effects, interactions and clinical efficacy. So I was surprised, to say the least, when I found that neither Lupron nor the generic PIO concoctions are FDA approved for use in ART. And the Prometrium safety sheet specifically warns against its use in pregnant women. Not to mention the fact that the birth control pills I picked up today from a deeply puzzled pharmacist are most definitely not FDA approved for the suspended ovarian animation prior to an IVF cycle.
I realize that these products are part of standard ART protocols, and that, most likely, the only reason they're not FDA approved for such purposes is that the drugmakers don't want to finance additional trials proving their safety and efficacy in such a tiny market when they're already universally used in that setting, regardless. Once a drug's approved for sale, doctors can prescribe it for any condition they deem appropriate, and clearly they're appropriately prescribing these drugs in ART. But that doesn't keep me from wanting to see the data, to know the numbers--I'm left with a vaguely guinea-piggish feeling, though I know I'm in the good company of the tens of thousands who have gone before me.
Guess there's nothing left for it but to try to be optimistic that the drugs will work, that they won't harm me, and take it from there. It's a very, very small leap of faith, I realize, but I really don't have the legs for it. They're much better at walking, sedately and skeptically, from one known place to another.