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Monday, March 14, 2016

.alt.dx/px/tx: What about "Mind-Body Medicine"?

Well, yeah. As a life outlook generalization, if you don't believe you can achieve "x," you likely won't even try. But, what of the broad implications for health and for recovery from injury or disease? To what extent (if any) is "mind over matter" a valid and useful concept in health and health care? To what extent is anything labeled "alt." -- anything not easily reducible to an ICD-10 code for efficient conventional inclusion into an EHR -- dismissible as "quackery" or simple ignorant wishful-thinking fallacy naivete? These questions became more than epistemological abstractions for me roughly 20 years ago with my late daughter's cancer dx and
...our experience thus far with the quackery end of the alternative therapy spectrum, a distribution of propositions whose opposite terminus abuts the breadth of mainstream clinical research and practice, where methods as yet"unproven" but more logically reasonable and promising vie for acceptance by the medical establishment. In the middle lie tougher calls: does shark cartilage really shrink tumors, functioning as an angiogenesis inhibitor? (one skeptical journal article called it "the laetrile of the 90's") Hydrazine sulfate? (also reported on extensively in the mainstream clinical literature and generally-- though not uniformly-- dismissed as 'ineffective.') Nucleotide Reductase? Plant oils? Blue-green algae?

All of these unconventional therapeutic assertions-- many of which would prove to be merely unproductive, outlandish, maddening distractions-- would have to be checked out while also slogging through the vast archives of mainstream clinical literature, a quest that would take me through the most recent three years of month-by-month National Cancer Institute (NCI) hepatoma citations. Also, I began ... keyword-searching the Medline indices for anything related to Sissy's condition that might prove useful...
"alt.medicine" stuff spans the gamut from every imaginable bozo goop concoction tx to "healing and the mind." Again, from my One in Three essay:
Healing and the mind
Recall Bill Moyers' PBS series and popular book of the same name. Spanning both the alternative and mainstream spectra are the somewhat overlapping domains of "immunotherapy" and "psychoneuroimmunology." Proponents of these approaches to therapy theorize that malignancies-- in addition to the more mundane panoply of human ailments-- can take hold only in the presence of a compromised immune system. One must strengthen the immune system for long-term healing to take place. Conventional medical treatment, it is argued (and not without substantial merit) focuses far too often on combating symptoms rather than curing root causes, and chief among the root causes of disease are the dietary, psychic, and other lifestyle imbalances so widespread in our culture.

Investigations here take one through the myriad contending "healing" dietary regimens that crowd the book chain shelves. Acupuncture and medicinal herbs also employed in the effort to restore immunological balance. Dr. Andrew Weil's recent best-seller Spontaneous Healing covers these areas in quite some detail, as does Jean Carper's more recent Miracle Cures. In the Adam Smith-redux "powers of mind" camp along with Moyers' work, the likewise best-selling publications of Drs. Bernie Seigel and Deepak Chopra are surely familiar to those who frequent Barnes & Noble, Borders, or their bookstore brethren. And, renowned writer Norman Cousins recently reported on his work in psychoneuroimmunology research at UCLA in Head First: The Biology of Hope and the Healing Power of the Human Spirit. Dr. Cousins and his UCLA colleagues undertook to put the previously disparate and frequently anecdotal evidence of psychological factors in healing to the test of rigorous scientific scrutiny, concluding that physiological effects indeed do frequently arise from psychological causes, for better or worse, and that research should continue in earnest in the area of psychoneuroimmunology.

All of these works and many more, some by now dog-eared, awash with highlighter residue and freighted with sticky-notes, line my bookshelves aside the ever-accruing mounds of NCI, Medline, and countless other internet cancer information downloads I cyber-mine for nearly every day...
I enthusiastically cut my methodological teeth in the mid/late 1980's in a forensic-level radioanalytical lab in Oak Ridge, and have subsequently long been an irascible hardass for the scientific method and critical thinking. Nonetheless, I came away from Sissy's illness and death not knowing in many ways what to believe anymore.

A chronic, low-grade background epistemic ambivalence that lingers to this day.

Is western reductive science the only way of knowing? (We call that "scientism.") I am reminded of something I wrote in my 2009 post on another of my blogs, "The U.S. health care policy morass."
Several years prior to being diagnosed with fatal liver cancer, my daughter also had encounters with non-western medical diagnostic assessments, one of which might well have saved her life (and this father's now permanently broken heart) had she not blown it off. As I wrote in my "1 in 3" essay, ruminating on this aspect of "alternative medicine":
It was, after all, a Santa Monica Chinese practitioner of acupuncture and herbal medicine, one Dr. Yi Pan, who first called Sissy's attention to a problem with her liver several years prior to her HCC diagnosis. She'd been referred to him by a girlfriend for attention to a menstrual problem. Dr. Pan had a diagnostic acumen requiring no x-rays, CT scans, or blood tests. Yet, the internet medical fraud site dismisses traditional Chinese medicine as "ineffective," as do many other critics of alternative practices.
Tragically, Sissy summarily discounted his prescient admonition. I can only speculate wistfully on the implications of our having known three years earlier.
Indeed. Indeed.

I bring up the foregoing only to pose some questions I ask myself all the time. To what extent is our potentially bankrupting dependence on crushingly expensive and ever more "sophisticated" medical technology at least in part a function of our enslaving cognitive enfeeblement wrought by reliance on such technologies? Would we have ICD-9 or CPT "dx" ("diagnosis") 3rd-party payor billing codes through which to encapsulate (and reimburse for) the (accurate, as they were) evaluative encounters of a Yeshi Dhonden or a Yi Pan?

The answer to the latter question is an unequivocal "no".
[Note. Re: "cognitive enfeeblement," see my review of "The Glass Cage."]
I guess a broad ".alt" concern today goes to "how much of our three trillion dollar annual NHE do we continue to waste on the 'woo'?" How much of "patient-centered care" will comprise indulging patients' OTC/DTC-buttressed magical thinking?

From "The Values and Value of Patient-Centered Care."
"[P]hilosophically, patient-centered care is an approach to care and perceived as the right thing to do. Taking this view, behaviors associated with patient-centered care, such as respecting patients’ preferences, should be justified on moral grounds alone, independent of their relationship to health outcomes."

Among my stash of new reads:


One weekday morning last summer, I was in the local park. It was a cheerful south London scene, with kids splashing in water fountains and playing soccer on the grass. I perched on the edge of the sandpit with two other mothers, clutching sunscreen and rice cakes as we watched our children build lopsided castles with brightly colored plastic spades.

One of the women, a bright, articulate mom I had just met, was explaining how a homeopathic medicine had cured her of longstanding, debilitating eczema. “I love homeopathy!” she said. As a scientist, I had to protest. Homeopathy is effectively water (or sugar pills) in fancy bottles— any active substance in these treatments is diluted far beyond the point at which any single molecule of the original could possibly remain. “But there’s nothing in homeopathic remedies,” I said.

My new friend looked at me scornfully. “Nothing measurable,” she replied, as if I were slightly dim for not grasping that its healing properties are due to an indefinable essence that’s beyond scientists’ reach. And in those two words, I felt that she summed up one of the major philosophical battles in medicine today.

Stacked up on one side are the proponents of conventional, Western medicine. They are rational, reductionist and rooted in the material world. According to their paradigm, the body is like a machine. For the most part, thoughts, beliefs and emotions don’t feature in treatment for a medical condition. When a machine is broken, you don’t engage it in conversation. Doctors use physical methods— scans, tests, drugs, surgery— to diagnose the problem and fix the broken part.

On the other side is, well, everyone else: followers of ancient, alternative and Eastern medicine. These holistic traditions prioritize the immaterial over the material; people over conditions; subjective experience and beliefs over objective trial results. Rather than prescribing physical drugs, therapists using acupuncture, spiritual healing and reiki claim to harness intangible energy fields. Advocates of homeopathy aren’t concerned that their remedies contain no physical trace of the active ingredient, because they believe that an undetectable “memory” of the drug somehow remains.

Conventional medicine still has the upper hand in the West, but alternative medicine is embraced by millions of people. In the U.S., the wonders of spiritual healing and reiki are regularly discussed on television news. As many as 38% of adults use some form of complementary or alternative medicine (62% if you include prayer). Each year they spend around $ 34 billion a year on it, with 354 million visits to alternative medicine practitioners (compared with around 560 million visits to primary care physicians). In London, where I live, mothers commonly put amber necklaces on their babies in the belief that this gemstone has the power to ward off teething pain. Intelligent, educated women reject crucial vaccines for their children and, like my friend, embrace treatments that make no scientific sense. Not surprisingly, scientists are fighting back. Professional skeptics on both sides of the Atlantic— debunkers like James Randi and Michael Shermer; scientist bloggers like Steven Salzberg and David Gorski; the biologist and author Richard Dawkins— aggressively denounce religion, pseudoscience and especially alternative medicine…

I’m all for defending a rational worldview. I believe passionately in the scientific method: I have a PhD in genetics and medical microbiology, and I spent three years probing the inner workings of cells at a top London hospital. I believe that everything in nature can be studied scientifically if we ask the right questions, and that the medical treatments we put our trust in should be tested in rigorous trials. The skeptics are right: if we abandon science for wishful thinking we might as well be back in the dark ages: drowning witches, bloodletting and praying that God will save us from the plague.

But I’m not sure that simply dismissing alternative medicine is the answer. In my work as a science journalist, I encounter not just those who are cured by modern medicine but those who aren’t: patients whose lives are devastated by gut problems or fatigue yet are dismissed as not having a “real” condition; people suffering from chronic pain or depression, prescribed ever-higher doses of drugs that create addiction and side effects but don’t solve the underlying problem; cancer patients who receive rounds of aggressive treatment well past the point at which there’s any reasonable hope of extending their lives.

And I regularly come across scientific findings— sometimes making headlines but often buried in specialist journals— suggesting that intangible, immaterial treatments can have real physical benefits. Patients hypnotized before surgery suffer fewer complications and recover faster. Meditation triggers molecular changes deep inside our cells. And as we’ll see in the first chapter of this book, if a treatment works no better than placebo that doesn’t mean it doesn’t work— simply believing you have received an effective remedy can have a dramatic biological effect. The mothers around me using amber bracelets and homeopathic pills aren’t ignorant, or stupid; they know from experience that these things genuinely help.

So although I believe that the alternative medicine advocates are deluded with their talk of water memory and healing energy fields, I don’t think the skeptics have got it completely right either. I started to write this book because I wondered whether they, along with conventional doctors, are missing a vital ingredient in physical health; an omission that’s contributing to the rise of chronic disease and sending millions of sane, intelligent people to alternative practitioners. I’m talking, of course, about the mind...

Marchant, Jo (2016-01-19). Cure: A Journey into the Science of Mind Over Body. Locations 65-104. Crown/Archetype. Kindle Edition. 
The Science Based Medicine people wasted no time in (relatively mildly) jumping on her case.
The publisher sent me a review copy of the book and I read it. I was expecting to hate it, but I was pleasantly surprised. I enjoyed reading it. I found it fascinating. I found myself agreeing with much of what Marchant says, and I was intrigued by some of the recent research she reports that I was not yet aware of. Preliminary studies, to be sure, but thought-provoking. The book challenged me to think more deeply about placebos, alternative medicine, and patient comfort. - Harriet Hall, MD
Jo Marchant's book brought to my mind another I've had in my stacks for more than 40 years.

Nel mezzo del cammin di nostra vita
Mi ritrovai per una selva oscura...

On the first day of Christmas, my allegedly true love gave to me a silver pillbox. Infuriating. It was true, of course, that gentleman of finance consumed pain easing pills, traveled with them, and even offered them to each other, but then, there was a lot of pain around.  fund managers chewed absently on antacids,  wondering where the last hundred million went so quickly. When you met them, they might offer you one, as if proffering a cigarette or a Life Saver. A high risk, high stress profession, wrote one psychologist in a paper. The University of San Francisco offered a course for clergymen, a laboratory in pastoral ministries, course #261, to "communicate with persons with unusual needs… Such as the sick, the aging, broken families, alcoholics, ethnic minorities, homosexuals, stockbrokers." No wonder drug companies had such nice profit margins, and sold at such high premiums.

Two gallants of my acquaintance wrote one of the best short reports I have ever read. The University portfolio they managed was down by a little over $200 million. (Do you know how long it takes to raise $200 million?) They remained fully invested, they said, because things were so bad they thought they could get no worse. "The light we saw at the end of the tunnel," they said, "was a freight train coming the other way."

Some people disappeared from the money business, and some disappeared right off the planet, ahead of schedule. If somebody had a heart attack, we said, oh sorry, when will he be back in the office? It was certainly a statistical aberration when I lost my panel, the investment strategy panel I moderated at the annual convention. My panelists were in their 30s and 40s and not fat and they liked their work, so statistically they should have not exited with one heart attack, one also attack, and one something I forget. We recruited another panel without even a moment of silence for our fallen comrades. Very cool, very macho, the show must go on.

I think what I had in mind when I began my research was that I would do some research on health. I would leave my nine foot teak desk, my phone with all its buttons lit up, and my totally filled in month at a glance calendar, go find some answers, and be welcomed back to the business community, like the first Arapaho who came back to his horseless tribe with a Pawnee Pinto. Look, fellas, now we can go twice as fast. I thought this might take a couple of months but well worth it, very important. (I could return the silver pillbox with the appropriate insult.) There was something else, Misty, unarticulated, in this program. One of my convention panelists had told me what his plans were, just as soon as he had enough time and enough money. He certainly had enough money, but he had had time back when he thought he didn't, and then he didn't.

The first physicians I consulted in this venture had all the same symptoms as my compatriots. We have to take it easier, they said wisely. Then they would answer the phone, rubbed their eyes, and say, yes, they would cover further buddy until midnight. And then they would say, what's happening, my Gawd, my stocks are down 40%, we may have to sell our ski condominium unless we raise our fees.

I would not have believed, at the outset, that I would be spending any time with exotics like Tibetan llamas and which doctors and gentlemen who had beards and wore funny close. I did not have a beard and I did not own any funny close. I would not have believed that I would ever sit in a room chanting a Sanskrit syllable, or drawing a lotus in the air with a $1.98 G. Shirmer recorder.

Minds. Trouble is mine's, not organic medicine, not some germ that comes flying through the air looking for home. This is Dr. Hans Selye, 68 years old, the distinguished Dean of stress medicine. Stress is "a physiologic response inappropriate to the situation." Misfired signals between mind and body. The physiologic response is the caveman's response when the shadow of the pterodactyl falls over him. Adrenal secretions increase and muscles tense and the coagulation chemistry gets ready to resist wounds. Fight or flight. But what Pterodactyl is this? They tell you: the market is down 20 points, or the vice president wants to see you, or, this whole operation is going to be shut down and moved to Chicago. Blam, pterodactyl time. Gives you, says Dr. Selye, headaches, insomnia, high blood pressure, sinus, ulcers, rheumatism, cardiovascular and kidney disease. And more. One from column A, one from column B. Some people have a pterodactyl every day. Why? An imbalance says Dr. Selye, an imbalance.  in what? In living. Western medicine doesn't extend its authority there, except to say take it easy, take off some weight, watch your diet.

So: lots of explorers have headed west by going east, saying, there must be a better way, and that was how this venture in — what? It's hard to define, some sort of psychology or awareness, maybe. That was how it began. Nonexistent pterodactyls flapping their great wings over fallen security analysts.

Some of my opening questions were:

Could we really learn to control her internal processes with our heads instead of with pills? (If true, I made a note, sell drug companies.)

Could we learn to pop ourselves into an alpha state? What is an alpha state? What happens if we succeed?

If someone can't hear and they have one session with a psychologist and 15 minutes worth of hypnotic induction, and suddenly they say, "I can hear!" What just happened in their brains?

What about all these claims for meditation? What do they mean by meditation? (I had just read an article in a technical journal.)

Is it true that a Sanskrit sound has a different effect on your head than one in English? (I don't know where I got that one.)

The field was not well marked. For example, in the great pharmacology textbook The Pharmacological Basis of Therapeutics, Goodman and Gilman — it has the same lock on its feels that Samuelson does in economics — three phrases begin to recur when you get to the effects of mind, or the interaction of some substance and the mind. The etiology is unknown. We don't know the cause. The site is unknown. We don't know exactly where it happens. The mechanism is unknown. Where not exactly sure how it happens.

Unknown, unknown, pictures of elephants and white space in the middle of old maps of Africa.

 at one juncture I sent a careful letter to an official in the national Institute of mental health in suburban Washington. I wanted to know, in this instance, about placebos — sugar pills — and I detailed all of my references in the work done so far, and asked: where can I go to find more? Who is doing work in this field?

"You are," the answer came. "The field is open. Please let us hear from you when you finish."

In an unmarked field, it is easy to wonder. Why on earth would I ever have read six years worth of the British medical Journal called Brain? Sheer inertia. I looked up one article on consciousness and then — look, the editor of Brain is Lord Brain. If you sent him a postcard, addressed only "Brain, Brain, London," would it get there? Was his name Brain already, or did he take "Lord Brain" as a title because he was the editor of Brain? Let's see what goes on here in Brain's Brain. (He did not have to turn to the back for the answer. The distinguished neural physiologist Lord Brain, now deceased, was born Russell Brain, and the postcard  "Brain, Brain, London" would have reached him, but faster if you added "Harley Street" and the zip code.)

It occurred to me that all the answers were not in Brain or even in medicine as we know it, fabulous as it is. There is a case in one of the journals about a Nigerian princeling in London who got sick and depressed, about two generations ago. He sent home for the witch doctor, since the Harley Street crowd couldn't do much for him. The which Dr. chanted whatever witch doctors chant, gave him a magic extract of a plant, and the Nigerian recovered. The magic extract came from a plant called Rauwolfia Serpentina, named by a French botanist.

A generation went by, and Western medicine sought to control high blood pressure and to calm people with tranquilizers. The detail salesman from the big drug companies, CIBA and Riker and Squibb, fanned out to doctors and hospitals with their great new drugs, and one of the great new drugs was reserpin, called Serpasill or Rawwiloid or Raudixin, depending on the drug company. And what did reserpine come from? Of course Rauwolfia Serpentina. The drug companies found it and wrote it up in learned journals and analyzed it; the which Dr. didn't have any journals, he got it from his daddy, who got it from his daddy, who was one hundred years ahead of CIBA and Riker and Squibb, and he was late because  Ayurvedic medicine in India knew Rauwolfia when the ancestors of the Harley Street crowd were staining themselves blue.

I had to go back to school. I brought certain abilities as student and the willingness to be an utter fool, to make up for naïve skepticism. Some of the customs had changed. I knew the dorms were coed, but when did they make the bathrooms coed? One evening in a movie theater near the University of California campus in Berkeley, the following conversation took place in the seats behind me:

She: say, I dig George.

He: Hmmmmm...

She: I mean, I really dig George's bod.

He: (a grunt)

She: why don't we have a threesome or a fivesome some time?

He: okay.

Often I felt a stranger in a strange land, or an anthropologist with a new tribe. What happened to the even numbers?

Strange schools, sometimes. Some trips, you go to Abercrombie and Fitch to get your mountaineering boots or your fishing vest. I had to buy tie-dyed jeans, because my new classmates were staring at my suit and tie.

I followed where the trail led. I met more Nobel Prize winners then I knew were there. I met biofeedback technicians who said people could train control of their heartbeats. I met meditators who said meditation was more restorative the densely.

And: an astronaut who had a mystic experience on the way back from the moon. A pro quarterback who could send signals to his wide receiver by telepathy, or something like telepathy. It blue-eyed British witch doctor, apprenticed in Lesotho or Botswana, who could attract liens by sent; Manhattan traffic gave him a tic, I had to help him across the street.

And: Masters of martial arts, aikido and kung fu, who said those arts read patterned brains. Bushels of psychiatrists and pecks of gurus. A gentleman who could push a knitting needle through his arm, command the blood to stop, and it would. Another gentleman who could smoke a cigar and send his mind to Jupiter and Mercury, simply by having it clear.

Some of it gets very far out. That was a phrase I learned from my new classmates. Far out.

There is a peculiar characteristic to this field. It is never easy to explain, and it is impossible to photograph...
LOL. A great book. The snark-daddy forbear of Michael Lewis, this "Adam Smith" guy. Another snip, apropos of Jo Marchant:
No one doubts the effect of mind on body to some extent, and the extent varies with the believer. George Bernard Shaw said he considered Lourdes a blasphemous place because they kept there all the crutches and wheelchairs of the people who walked away, but among these items was not one wooden leg, one glass eye, or one toupe.

Stuart Alsop said, "there are mysteries, how above all the mystery of the relationship of mind and body, that will never be explained, not by the most brilliant doctors, the wisest of scientists or philosophers."

There is a reason we are so sketchy on minds, and that is that we perceive the world through whatever paradigm we live in, and our present paradigm is sketchy when it comes to "mind."
[Powers of Mind, pg 19]
'eh? Not much has changed since 1975 on that front.

Had to read all that stuff in with Dragon. No Kindle edition.

apropos (?): Who wrote this?
“Physical concepts are free creations of the human mind, and are not, however it may seem, uniquely determined by the external world. In our endeavor to understand reality we are somewhat like a man trying to understand the mechanism of a closed watch He sees the face and the moving hands, even hears its ticking, but he has no way of opening the case. If he is ingenious he may form some picture of a mechanism which could be responsible for all the things he observes, but he may never be quite sure his picture is the only one which could explain his observations. He will never be able to compare his picture with the real mechanism and he cannot even imagine the possibility of the meaning of such a comparison.”
Albert Einstein, 1938.

Is it too early to start drinking?

I got that here, out of another old book from my stacks (you can now actually get this one in Kindle format):

I dropped a few lines into Photoshop.

Click to enlarge. Pretty much sums up my take on "spirituality." Is there a "supreme being"? Well, yeah, necessarily -- "that which is. Even that which is not is part of that which is."

None of which mandates an irascible anthropomorphic white-bearded old coot in the sky. Note the lower case "supreme being." That was not an accident. Just denoting the infinite noun, absent any religious ideology.
"The most preposterous notion that H. Sapiens has ever dreamed up is that the Lord God of Creation, Shaper and Ruler of all the Universes, wants the saccharine adoration of His creatures, can be swayed by their prayers, and becomes petulant if He does not receive this flattery. Yet this absurd fantasy, without a shred of evidence to bolster it, pays all the expenses of the oldest, largest, and least productive industry in all of history." - Heinlein, The Notebooks of Lazarus Long
BTW, see my "speculation on the afterlife" post.


I finished this book yesterday. Wow.

"The quest to discover how life works and why it matters." Highly recommended. It spans the gamut, from molecular biology / "omics" to aggregate ecosystems, replete with some riveting science history. Stay tuned.

Also on tap, in light of my renewed initiative to tie off documenting the loose ends regarding my daughter's death.

When Ann Neumann’s father was diagnosed with non-Hodgkin’s lymphoma, she left her job and moved back to her hometown of Lancaster, Pennsylvania. She became his full-time caregiver—cooking, cleaning, and administering medications. When her father died, she was undone by the experience, by grief and the visceral quality of dying. Neumann struggled to put her life back in order and found herself haunted by a question: Was her father’s death a good death?

The way we talk about dying and the way we actually die are two very different things, she discovered, and many of us are shielded from what death actually looks like...

...death in contemporary America is much more complicated than we think. Medical technologies and increased life expectancies have changed the very definition of medical death. And although death is our common fate, it is also a divisive issue that we all experience differently. What constitutes a good death is unique to each of us, depending on our age, race, economic status, culture, and beliefs. What’s more, differing concepts of choice, autonomy, and consent make death a contested landscape, governed by social, medical, legal, and religious systems...
Waiting for the Kindle price to drop from the rather high $25.99 (I have a lot of books to continue to buy). As next-of-kin caregiver I've had to attend the deaths of my daughter and both of my late parents. And, now, at the age of 70 and having just had my own turn in the cancer dx/tx barrel, issues of mortality (in addition to staying down in the Health IT tech weeds) are a bit more on my mind.

More to come...

1 comment:

  1. It’s good to know about Acupuncture therapy. I too have severe shoulder pain and don’t get relief with medicines. After reading this post I am thinking to try acupuncture therapy and will visit a local Mississauga acupuncture clinic for treatment soon.