The Prince's Foundation for Integrated Health
Many of my friends in the United States are not aware of the pivotal role that Prince Charles, the Prince of Wales has played in the development of Integrated Medicine in the United Kingdom and now much further afield.
He was extremely supportive as we were developing this new way of keeping people healthy and treating them if they get sick. He has had to endure a lot of harsh criticism along the way, but seeing the rapid development of Integrated Medicine, particularly in Europe, makes it obvious that it was well worth it.
If you are interested in this field you should find some interesting material at the website of The Prince’s Foundation for Integrated Health.
If you would like to get a flavor for some of the research which is underway, and some of the new ways of thinking about health care, there is a very interesting document that is free to download. It runs to 74 pages and makes fascinating reading.
Enjoy!
Healthcare Blogging Summit
I had the pleasure and privilege of speaking at the Healthcare Blogging Summit in Washington DC yesterday. Here is a short summary with some interesting observations.
It was an extremely interesting meeting which will likely have a major impact on the role of blogs in health care and wellness.
I met many fine and memorable peple and was very struck by one in particular: F. Nicholas Jacobs, who is said to be the first hospital CEO to blog. It was not just what he had to say, but the energy with which he said it.
I wanted to quote something from his blog which is entirely in line with my own thinking about how a place of healing should function:
If you treat people with respect and dignity, with love and a total commitment to their health, it works. They don’t sue you because they know you care about them. They don’t hate you because they know that you respect them. They recommend you to their friends and relatives because they trust you.
As the brain surgeon says: “This is NOT rocket science.” And as the rocket scientist says, “This is NOT brain surgery.” If you put people into a healing environment, they heal. If they are not living in complete terror about the next unknown that is going to happen to them, they heal. In fact, their white blood cells may actually be given a chance to work!
You can wash your hands 24 hours a day, seven days a week, and you should. But… people will still get infections if you restrict their loved ones from being with them, if you treat them like a body part, if you don’t tell them what’s coming next, and don’t give them choices in their care. Instead, one of our senior leaders always says about Windber Medical Center, “We do not make our patients leave their dignity at the door.”
Nick had never heard of Integrated Medicine. He is quite evidently just a smart, kind and loving person who sees the big picture.
We need more people like him.
But here is the good news, there are more people like him that are rising through the ranks in medicine. They are realizing that in the same way that patients should not leave their dignity at the door, a successful administrator or departmental chair does not have to leave behind his or her humanity, caring and compassion.
A New Understanding of Mood Medicines and Cells
We are in the midst of a revolution in our understanding of how many medicines work. Most students are still taught that the key to their actions is simply a matter of binding to a receptor, and then some magic occurs in the cell. But over the last few years there has been a sea change in how we see the actions of many medicines. In many ways the focus on receptor pharmacology is so 1990s.
Several years ago our group and others began to speculate that one of the ways of modulating the interaction of insulin with cells was to modify the characteristics of the cell membrane in which the insulin receptors sit. If we could change the fluidity of the cell membrane, then we could change the sensitivity of the insulin receptor. We also went a bit further and wondered whether high cholesterol levels might be associated with coronary artery disease because it changed the way in which growth factors interacted with cells in the vessel walls.
One of the reasons that fish oils may yet turn out to be helpful in some mood disorders is because they may change the behavior of cell membranes and therefore the behavior of receptors.
I have admired the work that has bee done by Husseini Manji and his group that is now at the National Institute of Mental Health in Bethesda, Maryland. Their interest is in bipolar disorder and there is a very nice update on the group’s work in the journal Biological Psychiatry.
The group is unraveling the ways in which effective medicines work at the cellular level and what actually goes wrong in bipolar disorder. We know that people with severe mood disorders may experience regional impairments of what we call structural plasticity and cellular resilience. This means that the cells find it more difficult to learn and respond to environmental changes. We think that this is why some people with severe mood problems fail to benefit from many medicines and also have so many long-term cognitive problems. So the search is on for strategies that may enhance and maintain the normal connections between neurons. The good news is that there are several new strategies on the horizon.
This notion of impairment in the normal plasticity and resilience of the brain is also why psychosocial approaches are an essential component of successful treatment. When they are coupled to the right medicine as well as the strategies that we employ in Integrated Medicine, the effects can often be very gratifying.
Hostility and Insulin Resistance
Insulin resistance – a reduction in the body’s ability to respond to insulin – is something that should interest and concern all of us. Not only are a third of Americans insulin resistant, with much higher rates in people of African and Indian heritage, but also insulin resistance is the major predictor of the development of type 2 diabetes and of coronary artery disease.
We already knew that stress and certain personality factors, including hostility can be associated with insulin resistance. Now new research from The Cleveland Clinic in Ohio has clarified the association.
The study involved 643 men with an average age of 63.1 years, and the findings are published in the current issue of Psychosomatic Medicine.
The researchers measured the subjects’ urine levels of norepinephrine. Norepinephrine is one of the objective indicators of stress. The researchers used standard rating scale – the Minnesota Multiphasic Personality Inventory and the Cook-Medley Hostility scale – to measure hostility. Insulin resistance was measured using some highly validated methods: the homeostatic model assessment index; 2-hour post-challenge glucose and insulin levels. The study had to be large because some many things can influence insulin resistance: nine other common variables had to be factored in to the analysis.
The study found that there was a statistical interaction between hostility and stress level in predicting insulin resistance. More hostile people do not always have worse insulin resistance, but they do when they are under stress, particularly if it is high level and sustained stress.
The team also found that not all components of hostility are related to insulin resistance. For instance, cynicism is a personality trait that is strongly related to insulin resistance.
We do not know if stress management techniques can reduce the risk of developing insulin resistance in these high-risk people, but it is likely that they will.
Yoga, tai chi ch’uan, meditation, psychotherapy may all be helpful. The best results of all have been to combine one or other of these with homeopathy, flower essences and spiritual counseling. We have little empirical research for these combined approaches, but a great deal of clinical experience that they may be beneficial.
If you notice that you or someone around you has a hostile, cynical way of handling stress, let them know that they are at high risk of developing a physical illness, but that there is a great deal that they can do for themselves before they fall off the cliff.
In Sickness and In Health
I recently talked about the importance of healthy relationships and some ways to establish and maintain them.
Here is an interesting study that was published in the Journal of Personality and Social Psychology.
The research into 111 coronary artery bypass patients showed that the partner’s personality traits played a major role in how well they had recovered 18 months after their operation.
Pollyannas are probably the best sort of significant other when you’re sick. It is interesting to learn that their cheerful chatter might sound like the last thing an ill person needs but it is such a tonic that patients recover much better and faster.
A homeopath, acupuncturist or Integrated Practitioner would quickly identify who would like the Pollyanna and who would not.
What you definitely don’t want is a “generally neurotic and anxious” partner. These spouses increase the patients’ risk of developing clinical depression. Such depression is increasingly recognised as a significant risk factor in causing slow recovery and deaths from conditions such as coronary disease.
And most specialists recognize that depression and anxiety can be catching.
Healthy Relationships are Essential to Your Health
“All of life is relationship.”
–Swami Rama (Indian Spiritual Teacher and Writer, 1925-1996)
When I first started looking at the hundreds of different therapeutic systems that we have on offer, it was striking that they all have at their core the development of a relationship between two or more individuals. One is designated the patient or client and the other the therapist who is helping the patient cure himself or herself. Until the invention of the stethoscope, which was the first step toward separating patients from those treating them, the fundamental nature of a healing relationship was well understood. Sad to say, over the last century and a half orthodox medicine began to minimize the importance of relationship to cure.
Nothing in the Universe exists in isolation: We live in a Universe of relationships. It is inconceivable that anything can exist except in relationship to something else. The entire Universe is made up of integrated systems that function, develop and evolve together. A failure to construct and maintain healthy relationships can be a cause of much distress.
Several years ago I reported some interesting observations. At the time, I was doing a lot of research on diseases of blood vessels. I had developed a laboratory method for taking some of the cells that line blood vessels from volunteers and then growing them in a cell culture dish. We discovered that if we did not have enough cells in the dish, they would all die of “loneliness.”
The exception is cancer cells, which in culture will grow on their own like weeds.
Next, we made an accidental and remarkable discovery. We normally cleared out our cell cultures once a week, but on this occasion I found that I had accidentally nudged one of the dishes to the back of the incubator, where it had been sitting for three weeks. Looking at the cells under the microscope, we could see that they had formed little tubes. Now that might not sound like very much, but it was. The cells had, inside the body of the volunteer, been part of a microscopic tube called a capillary.
To prepare the culture, the cells had been cleaned with all sorts of biochemical treatments to strip them away from everything else so that we would have no contaminating cells. The teaching for years has been that the development of cells and organs is a result of biochemical interactions between different cells of the body driven by the DNA inside the nucleus of the cells. But my cultured cells had no such cells to guide them. How could they “remember” that their role was to make tubes? The most likely explanation is that they are responding to morphic fields. I published the observation in a paper 17 years ago, and others have now replicated it.
It is estimated that at least 80% of our higher cortical functions are directed toward social functions. It is little wonder that failing to use those vast tracts of evolutionary machinery might have sad consequences.
And they do. Social isolation increases the chance of substance abuse and scores of illnesses. And people who have no social supports are much less likely to recover from many major illnesses. On the other hand, being engaged in robust, dynamic relationships provides you with powerful protections against some illnesses.
Relationships are essential to your health.
There are tens of thousands of books on relationships and I have no intention of reiterating material that has been written about a hundred times before.
But based on our principles of physical, psychological, social, subtle and spiritual, let me make these suggestions for constructing and maintaining successful relationships:
- Partnership: As I discuss in Healing, Meaning and Purpose, it is essential to examine every one of your relationships to see if it is a relationship of domination or partnership: is one person dominating and controlling the relationship, or are both people participating equally? And here is the trick. We are not only interested in the relationship between you and another person or persons, we are interested in ALL your relationships, from cell to soul.
- Maintaining wellness: all the people in a relationship should do whatever they can to maintain their physical, psychological, social subtle and spiritual well being. Nobody can avoid everything: life will throw you some curve balls, but it is most unfair to burden a relationship with avoidable health worries
- Responsibility: In the same way that you should not burden others in a relationship with avoidable health problems, you should also not burden them with needless concerns about money or other resources. Arguments about money are one of the main causes of turmoil in marriages, and it is not so much a matter of having insufficient, it is more often a matter of one person being irresponsible.
- Attention: it is essential to give the other person or persons in a relationship the attention that they deserve.
- Acceptance: This can be a hard one sometimes, and I am going to write more about acceptance shortly. Suffice to say that mature relationships require a good dose of acceptance. I have written before about an extreme case in which a woman was lamenting the fact that she could find nobody who matched her ideals in a mate. Her list of non-negotiable requirements in a partner ran to some ten pages
- Kindness: Spontaneous acts of kindness are essential to healthy relationships. If you do not want to offer kindnesses to another person it implies that there is something seriously awry n the relationship. Kindness should not be planned; it should just be part of your normal modus operandi
- Warmth and affection: Spontaneous warmth and affection are signs of a healthy relationship. But don’t think of that as holding hands and signing kumbaya, it also means being aware of the heart, the essence and the soul of the other person or persons in a relationship. If you have not recently shown some real gratitude for the other person, today might be a really good time to start.
- Laughter: Do you and your partner(s) have fun together? Are you able to share laughter and to let go of pretence? It doesn’t mean that you have to spend all day watching Laurel and Hardy or telling each other sidesplitting jokes. It means being able to find a new and healthy perspective on life and to find time to enjoy the lighter side of life.
- Conflict: do you have a healthy way of dealing with anger, conflict and resentment? All three may crop up from time to time, but the key is how you cope with them. It is simply not realistic to follow the advice that you should avoid all conflict. It’s as silly as saying the key to stress management is to avoid stress. You may as well try to avoid gravity. Stress and conflict are universal constants: the trick is learning how to deal with them. In the case of conflict the key – as always – is to communicate and to avoid toxic or corrosive habit patterns
- Listening: Listening to another person is not a matter of sitting back and allowing sound waves to set up vibrations in your auditory nerve: listening is an active learned skill that involves watching, noticing and being aware of every aspect of a communication. (You may be interested in having a look at another piece that I wrote about communication). Listening involves giving space for a communication to unfold and then asking questions and checking to ensure that both people are understanding every aspect of the exchange
- Trust: No relationship can be expected o flourish without a healthy dose of trust. Not just in the integrity of the relationship, integrity of the other person(s) involved in the relationship and trust that what you say or do will not be judged harshly
- Freedom: I have seen more relationships flounder because of a lack of freedom than almost anything else. There is a good reason why freedom is such a powerful political force. For most people, freedom to be themselves and to determine their own destiny is as important as oxygen. Ensure that your relationships have plenty of space to breathe.
“Relationships are the hallmark of the mature person.”
–Brian Tracy (Canadian-born American Author and Expert on Business and Personal Development, 1944-)
Multiple Sclerosis and Stem Cells
If you have been reading my recent posts about multiple sclerosis (MS), you may be interested in an useful resource from the New York Academy of Sciences.
I have the privilege of being a member of the Academy and I’ve been impressed by its increasing efforts to educate the general public. There are regular "eBriefings" that are well written and succinct.
This one on stem cells and MS is timely and encouraging. It is also a good jumping off point if you want to follow up on some of the issues.
The existence of stem cells in the central nervous system has already raised some intriguing possibilities for treatments based on activating and directing them in the brain. The second idea, of dismantling the diseases immune system and replacing it with a new clean one, is not science fiction but part of a concerted effort to reprogram the body.
This is precisley the kind of approach that we advocate when we use "Information Medicine," designed to correct faulty information that produces faulty DNA and ultimately faulty proteins and organs.
Multiple Sclerosis and Integrated Medicine
Although there are some fairly effective conventional therapies for multiple sclerosis (MS), many people with MS explore complementary and alternative medicine (CAM) therapies for their symptoms. The most effective strategies are to combine conventional and unorthodox treatments that address the physical, psychological, social, subtle and spiritual aspects of the illness. This combined approach also avoids the problem of people taking herbs or supplements that may either interact with each other or with conventional treatments.
It is also essential for us to get over the idea that MS is just something to be conquered. That may seem like an odd comment, but the language and the mindset of fighting, battles and warfare can be problematic. Let me explain something that I discuss at length in Healing, Meaning and Purpose.
There have been two distinct approaches to health in the Western medical tradition. The first is that the role of a physician is to treat diseases. That is the way that all my colleagues and I were trained. The second approach is to consider that health is the natural order of things. So in the first case we constantly hear the use of military metaphors: People speak of “a war on cancer,” “killer cells,” “magic bullets,” and the need to adopt a “fighting spirit.” Sadly this aggressive attitude by the medical profession may be at odds with the wishes and needs of an individual, the family and the other people in a person’s life. We have to try to strike a balance between the whole instinct to fight and expressions of healing and acceptance.
In the second case, the philosophy is grounded in the idea that we need to work in harmony with nature. The maintenance of health and well being comes from reestablishing balance and harmony not just in ourselves but also in our relationships with each other, with society and with the entire environment around us.
Some of the most commonly CAM therapies include dietary modification, nutritional and herbal supplementation, and mind-body therapies. There has been a revival of interest among MS researchers about the therapeutic potential of low-fat diet and essential fatty acid supplementation in MS. The research on CAM therapies in MS is still exploratory, but considering peoples’ interest and common use of these therapies, further research in this area is clearly warranted. Many sufferers show “spontaneous” recoveries, so reports of cures with unorthodox remedies are often treated with skepticism.
Diet, Vitamins and Supplements: There have been scattered reports of symptoms improving after the removal of dental amalgam, but there is scant evidence that this is really worthwhile. There is some evidence 1. 2. 3. 4. that polyunsaturated fatty acid (PUFA) supplementation may help MS. There used to be a lot of support for something called the “Swank diet,” but over the years the evidence has not been very good. In a small number of people with MS certain foods can make them worse. This is to expected if there is an autoimmune component to the illness. It is always a good idea to see if there is something that makes a person feel worse. The other important qestion is whether food additives may be causing symptoms. Although this must be uncommon, I have written elsewhere about occasional cases of MS symptoms with all the classical neurological, biochemical, radiological and electrical signs that have improved or become completely better after removing aspartame from the diet.
Physical exercise: Exercise is highly recommended for people with MS, though it is best to avoid it during an attack. There is evidence that over-exertion can actually bring on an attack. There is some literature about the use of Feldenkrais bodywork in MS, but a study from the University of North Carolina failed to find any benefit. T’ai Chi Ch’uan, qigong, yoga and graduated exercise have all been helpful to some people with MS, but it is essential to discuss it with a healthcare provider to see how any one of these fits in to an package of care. There is no published data on the use of Pilates in MS. At least not in any of the languages that I can read. But since it has been shown to improve posture and flexibility, it is logical to think that Pilates might be helpful, and it would be very valuable to see some research on it.
Acupuncture: Although widely used, the research on acupuncture in MS is not yet convincing. Like most acupuncturists I’ve had some good results in treating pain, muscle stiffness and fatigue. I’ve also seen people achieve some remarkable recoveries, but there are two issues: MS is a relapsing and remitting illness. And second, many of the people who did well only did so because they shifted their thinking: acupuncture became the vehicle for their personal transformation rather than a device for removing nasty symptoms.
Homeopathic remedies: Even the most enthusiastic homeopaths have fairly limited expectations of what homeopathy can achieve in MS.
From the point of view of homeopathy there is little point in making the diagnosis on multiple sclerosis because the disease has such a variable course with highly variable symptoms. To a homeopath the diagnosis is not useful: it is the symptoms that are all important. The homeopathic treatment of MS is highly individualized: one of the key items is the timing of symptoms and associated features. Some of the most common remedies for people with MS are:
- Agaricus
- Alumina
- Argentum Nitricum
- Arsenicum
- Aurum Metallicum
- Causticum
- Cocculus
- Conium Maculatum
- Ignatia
- Lachesis
- Nux Vomica
- Natrum Muriaticum
- Phosphorus
- Plumbum
This is not the whole list of homeopathic remedies that we have sometimes found helpful, but it highlights some of the more commonly used ones in people with the symptoms of MS.
Herbal remedies: Many herbal remedies have been tried in MS, and many experts have told me that they have had some good results. There is an important issue in MS called “apitherapy,” a.k.a. bee venom therapy (BVT). Several reports suggest that bee venom may be an effective treatment for patients with MS. But formal trials suggest that although the treatment appears relatively safe apart from itching and swelling of the skin, it does not seem to be helpful.
The best approach is to embrace the best of what conventional medicine has to offer, combine unorthodox approaches and to realize that management of a chronic illness is not about dominating it but learning from it and learning strategies for peacefully co-existing with it.
Alexithymia
There is an important psychological symptom that can cause a great deal of distress, particularly in relationships. It is called alexithymia.
The Harvard psychiatrist Peter Sifneos originally coined the term in 1972 to describe people who had extreme difficulty in emotional cognition. The word “alexithymia” literally means “no words for mood.” People with this problem lacked the ability to understanding, processing or describing their feelings verbally. As a result, most people who have the problem are largely unaware of their own feelings or what they signify. As a result they only rarely talk about their emotions or their emotional preferences, and they are largely unable to use their feelings or imagination to focus and fuel their drives and motivations.
People with alexithymia seem unable to fantasize and many report multiple somatic symptoms. However, alexithymia is also associated with a number of other complaints, such as hypertension, irritable bowel syndrome, substance use disorders, and some anxiety disorders. Their speech is often concrete, mundane and closely tied to external events. So they will describe physical symptoms rather than emotions, and don’t understand that their bodily sensations are signals of emotional distress.
Alexithymia lies on spectrum: regular readers will remember some of our discussions about categorical and dimensional diagnoses. For some people it is little more than an inability to get in touch with their emotions. But at the other end of the spectrum are a number of illnesses in which alexithymia may occur, including schizoid personality disorder, posttraumatic stress disorder, anorexia nervosa or Asperger’s syndrome. It is also much more common in victims of trauma.
Much has been written about alexithymia: a literature search earlier today generated over 8,500 publications.
It is still not clear what causes alexithymia. But this much is clear: in some people, there is a strong inborn predisposition to developing it, while in others it can develop in response to life events such as being raised in a low socioeconomic group with little social stimulation, trauma or chronic stress. For this reason we often talk about primary and secondary alexithymia.
Some neuropsychological studies have indicated that alexithymia may be due to a disturbance to the right hemisphere of the brain, which usually plays a predominant role in processing emotions. Other studies show evidence that there may be a deficit in the transmission of information between the hemispheres of the brain, with emotional information from the right hemisphere not being properly transferred to the language regions in the left hemisphere. Other studies have suggested that alexithymia may be related to a dysfunction of the anterior cingulate cortex a region of the brain involved in the control of attention, empathy, emotion and the anticipation of rewards.
Alexithymia can have some serious consequences. Apart from making relationships very difficult, it is more common in people who have near-fatal asthma attacks or have poor diabetic control. People with a history of alcohol abuse who have alexithymia are more likely to relapse. Alexithymia may predispose people to developing the insulin resistance syndrome.
As you can see, alexithymia can be dangerous: we have to have words for our feelings, or the feelings will express themselves though our bodies. It can predispose us to just about every stress-related illness, and even some illnesses that we don’t normally think of as stress-related. Since alexithymia is all about an ability to express emotions, it can be thought of as a social or informational disease. If we cannot inform others about our wants and needs, and if our minds cannot send us signals to say that something is going wrong, there could be a catastrophe lying in wait for us.
People with extreme forms of alexithymia can be very difficult to help using conventional medicine.
However, many people have minor degrees of alexithymia, and these can be helped by therapies designed to help them express emotions:
- First is to become aware of the problem: I’ve had good success with asking people to keep an emotions “log book:” if they are having odd symptoms, how good are they about having appropriate emotions? I ask them to keep a note of their emotions in response to normal interactions with other people, or while watching television or a movie. If the person feels nothing while watching something really emotional, that can help him or her see that there is a problem. Simply learning to be more expressive can help mild cases: there are an array of forms of psychotherapy that can help.
- In mild cases, we have had some good results with flower essences. There’s not a shred of scientific proof that they help, but clinically they often do. The same goes for two other helpful approaches:
- Homeopathy: there are over a dozen remedies that may help
- Tapping therapies
Music Therapy
Music therapy has been in use for millennia: in the Bible David played his harp to try to ease the suffering of King Saul and there are whole systems of musical healing in the traditional healing systems of China and India. I have commented before on the extraordinary power of music.
Apart from our experience, there is an astonishingly large and diverse body of scientific literature on music therapy, not just to help individuals, but also on possibly improving the performance of health care providers. Many surgeons attest that they do a better technical job if they are listening to music.
This month’s issue of the British Journal of Psychiatry carries an interesting article about the value of music therapy in people with schizophrenic illnesses. Though small, it indicates that music therapy can be helpful, and speaks to the integrity of many components of the nervous systems of people with this large and diverse group of problems.
There is good evidence that music therapy may help with:
- Treatment-related distress in people having treatment for several cancers
- Autistic spectrum disorders
- Calming people who are having cardiac catheterization procedures
- Pain relief
- Distress after total knee replacement
- Pain after leg fractures
- Apathy in people with dementia
- Sleep and heart rate patterns in pre-term babies
This is by no means an exhaustive list: I have found several hundred studies, many of which are quite well designed. There are also several professional organizations such as the American Music Therapy Association.
It is clearly important to choose the right kind of music: I would guess that Metallica is less likely to soothe the fevered brow than Steve Halpern.
Background music can be wonderful for improving the ambience of your home or workplace. But you can also be more focused in your use of music to help or support other types of health and wellness programs.
Select the music that you like: there are now many wonderful programs geared toward using music for healing: I can give you a list of some that I have tested. The good ones will entrain your heart rate, some of your brain rhythms and the subtle systems of your body.
If you can find 20 minutes, the right music listened to while sitting or lying with your eyes closed can be as effective as a short meditation. For this to work well, it is best to use good quality headphones and to allow the music to wash over and soak you like a warm bath, while gradually slowing and deepening your breath.
I’ve also made extensive use of specifically chosen music during massage, acupuncture, yoga, and while practicing t’ai chi ch’uan and qigong. Some purists don’t like using music while doing these activities, but I’ve usually found that music can enhance each type of practice.
Try it and see what you think.
