The Source of Healing

Washington Lovefest

Woodson Merrell, M.D. — Wed, 04 Mar 2009 04:00:00 +0000

I’m still high from events that took place in Washington D.C. last week, of which I was lucky enough to be a part. There were two seismic occurrences, interrelated and yet separate, that bode well for the future of healthcare. First, the venerable Institute of Medicine of the National Academy of Sciences held a Summit on Integrative Medicine and the Health of the Public; and second, some of my colleagues and the nation’s leaders in integrative medicine, Drs. Weil, Oz, Ornish and Hyman, took a break from the Summit and went to Capital Hill to explain why integrative medicine is the best viable model for improving the health of Americans. By all counts Congress loved the idea. And the Summit finished with Senator Tom Harkin stopping by to give the closing address along with his blessing for the integrative model. In the span of a few days, America’s medical horizon grew a lot brighter.
    A quick definition for those of you who don’t have a clue of what I’m talking about. Integrative medicine is an approach to medical practice that emphasizes the partnership between doctor and patient, and utilizes an evidence basis to determine the best of indigenous medicine, complementary/alternative practices and conventional therapies individualized to each person’s needs. Integrative doctors (of which there are now hundreds in the U.S. and twice as many being trained by integrative programs at more than 30 top medical schools) look at the whole person, not just the disease, and we consider the emotional, spiritual, dietary, environmental and lifestyle influences that affect health and healing.
    Integrative medicine has blown open the old aphorism “Take two aspirin and call me in the morning.” With us, for example for someone who feels like they’re getting sick, it’s more like take three Chinese herbs to boost your immune system, a homeopathic remedy to reduce the symptoms, drink Echinacea tea, do breathing exercises to reduce stress on the body, eat immune-boosting foods, get eight hours of sleep and take tomorrow off to strengthen your system. If that doesn’t work, call me in the morning and we’ll try a few other things (perhaps acupuncture, a vitamin shot, bodywork) before we even consider pharmaceuticals that probably won’t help the problem and may even prolong it.
    With a healthcare system modeled on integrative medicine we’d have a lot fewer people on Lipitor and a lot more people eating well for life. We seek to empower our patients to take care of themselves. Integrative medicine can take more time than conventional medicine, it requires educating the public, expanding physicians’ knowledge bases, and it means getting to know your patient. But by shifting the model from disease management to wellness management integrative medicine will save money, which is why Congress (and by all indications the Obama administration) is now keenly interested and committed to moving forward.
    The integrative model seeks to prevent or reverse diseases before they require catastrophically expensive pharmaceutical or surgical interventions. Dean Ornish put it very succinctly before Congress (echoing a recent Wall Street Journal opinion piece he co-wrote with Andy Weil, Deepak Chopra and Rustum Roy): "Last year $2.1 trillion was spent on medical care, with 95% of it spent treating disease after it occurred. Many of these diseases, including heart disease, diabetes, prostate and breast cancer, and obesity account for 75% of these health care costs, although studies show they are preventable and reversible through lifestyle changes." (thanks to Alison Rose Levy for this quote.) Being a glass half full kind of guy, I find Dr. Ornish’s statistics to be incredibly inspiring. Over $1 trillion dollars currently spent primarily on pharmaceutical and surgical management of chronic illnesses could be spent to prevent or reverse these same problems---mostly via simple life-style choices.
    Obama proposed over $600 billion dollars to reform our healthcare system. While there will be intense wrangling between entrenched interests who have much to lose, and new era advocates who see a brighter horizon, there is no doubt that change is coming soon. There’s a high probability now that integrative medicine will be the cornerstone of providing an evidence-based preventive and wellness centered healthcare system. Something as simple as making fresh fruits and vegetables available to schoolchildren all day long (started as a pilot project by Senator Harkin in 2002) is now a significant part of President Obama’s new budget. By providing the nutrition to change the way every cell in the body works, this sort of spending will begin to have a big impact on the health of future generations.
    By focusing on prevention and reversal of disease through lifestyle measures (a fundamental principle of integrative medicine) we can free up needed financial resources for providing universal care and finding cures (new and important tools) for our many yet unsolved medical mysteries including cancer, autoimmune and neurological diseases. Integrative medicine provides a very doable and inspiring model for universal care and national wellness. This real change toward a deeply humanized, patient centered, lifestyle based integrative medical model will take us out of what I’m convinced we’ll look back on as the medical dark ages, when we had the highest per capita spending on healthcare while remaining mired at 37th place in global health. What happened in Washington was no less than a giant step toward the sustainability of health and wellness for Americans.

Teflon Undermining Fertility?

Woodson Merrell, M.D. — Tue, 10 Feb 2009 16:03:47 +0000

In this winter of our discontent, when the investment advisor next-door, a Midwestern governor and even something as innocuously middle-American as peanut butter have been unmasked as potential threats, I've got another wolf in sheep's clothing to add to your list - nonstick pans. A serious environmental hazard to your health and fertility may be right under your nose when you scramble your eggs in the morning. The non-stick surface on pans releases a chemical when heated, pefluorooctanoate (PFOA), that appears to have toxic effects on the liver, immune system and reproductive organs. Now the latest research points to nonstick pans as one explanation for declining fertility in America, which is currently at historic lows (in vitro octuplets notwithstanding).

Evidence has been building about the dangers of Teflon and its relatives, Scothguard and other industrial chemicals in the class known as perfluorinated chemicals (PFCs.) The controversial manmade molecules widely used in consumer products have been associated in the lab with the growth of testicular, breast, liver and prostate tumors. The PFC family of chemicals is also classified by the E.P.A. as probable hormone disruptors, with the potential for producing wide-ranging hormonal effects considered harmful to women's reproductive systems, though both the E.P.A. and F.D.A. have so far caved to corporate arm-twisting and declined to ban them from use.

This month a new study from the Department of Epidemiology, School of Public Health at U.C.L.A. added credibility to this suspicion. Looking at a database of more than 40,000 women (in Denmark, where they also have PFC and fertility problems), researchers uncovered a remarkably strong association between blood-levels of these chemicals and infertility (measured as time to pregnancy from attempted natural conception). In the study the odds of infertility increased from as much as 70% to 134% for the women with PFC blood-levels found in the general population. While government regulators seem to greet this news with a big yawn, I just can't accept this strong a suggestion of risk. I recommend throwing away the pans...today!

You may ask how did these toxins get inside of us all? (About 95% of Americans, according to the Centers for Disease Control, have these pervasive industrial chemicals floating around in our blood streams.) Back in the Seventies, when better living through chemistry was the battle cry, these versatile, carbon-based chemicals (that persist in the environment and can stay in your body's fatty tissues for years) were grandfathered into the food supply with scant safety data.

Since then they've been put to use in everything from pots and pans to upholstery, carpeting, fire-proof pajamas and food packaging. We've been inadvertently consuming them for decades (PFCs are so pervasive they are even detected in drinking water.) I'm most worried about the nonstick pans because heat has been shown to release the chemicals into food.

For some time now scientists have suspected PFCs are toxic and have methodically continued to study them, uncovering some alarming reproductive trends linked to the exposure. Six years ago researchers working for the manufacturers themselves found that levels comparable to those of PFCs in the bloodstreams of many Americans correlated with lower birth weights, decreased pituitary size and decreased overall growth in lab animals.

Typically, industry apologists will tell you that any chemical (even water) given at a high enough dose can make you sick or even kill you. What's incredible is these harmful results were recorded at exposure levels that mimic the casual exposure to PFCs that environmental regulators consider to be acceptable in humans. To date no one has conducted the research to make the leap from growth trends in animals in the lab to humans.

But this discovery of the potential impact on children's ability to grow from incidental exposure to a ubiquitous industrial pollutant set off a tussle between the industry (mainly 3M and Dupont) and environmental regulators over proprietary research and company documentation. Ultimately it resulted in a promise (not a legal mandate) by companies to phase-out these chemicals by 2015. There's little evidence as to whether or not this phase-out is actually happening. And, by the way, anything manufactured in China is under no such promise.

So now, along comes this very well designed and provocative study from U.C.L.A., published in the February issue of the prestigious medical journal, Human Reproduction, showing a strong correlation between the chemicals in non-stick pans and infertility. As the U.C.L.A. researchers point out in their study, there has been a remarkable decline in fertility rates in the U.S. (increased age of people trying to get pregnant being a partial contributor). We are now among the least fertile nations on the planet, with about 20% of couples struggling with infertility.

What you can do is toss out the pans. What your government will do to protect you is uncertain. Last month, two of Bush's last acts were to give Dupont a deadline extension for submitting required Teflon safety research and increase the allowable amount of PFCs in drinking water in 9 states (including Washington D.C.) The good news is Obama's nominee for EPA chief, Lisa Jackson, is currently EPA commissioner of New Jersey, where PFC limits are 10 times lower than Bush's new limits. She may very well reverse his ruling, so there's hope for a cleaner world. In the meantime, you can remove the biggest source of this toxin from your own space by tossing out the nonstick pans.

But don't plan on buying new nonstick pans touted as "greener". The inside scoop on these is that they are as unhealthy as the old ones (read an update on these new pans). Best course of action would be to avoid non-stick pans altogether, and, perhaps, take cooking lessons!

Be Like Barack

Woodson Merrell, M.D. — Tue, 27 Jan 2009 20:10:59 +0000

At a time when there is so much to admire in our new President, here's another aspect to applaud: Barack Obama's lifestyle is a perfect model of energy generation. He's accomplished a herculean task over the past year; achieving more than many of us could hope to in several iifetimes. Looking at his lifestyle from the point of view of a physician, it's no mystery to me where he gets his incredible mojo. Just look at his actions over the past week as an example.

Over the inaugural weekend, in what had to be some of the most intense days of his life Obama found time to exercise, do community service and attend religous services; he didn't drink coffee or alcohol (two beverages many of us would be tempted to lean on in hectic days), his inaugural luncheaon eschewed inflammation-causing red meat for fish and poultry and he spent time with family. By all accounts this was not atypical behavior for Mr. Obama. Even during the most brutal days of campaigning he said exercise was his coffee, rarely missed a day at the gym and proclaimed his favorite snack to be pistachios and fruit. This is exactly how a person needs to live in order to constantly generate and replenish their energy.

If you are beginning to feel like Obama is superhuman and impossible to emulate, think again. Everyone can achieve this level of energy generation one step at a time. This is exactly the kind of lifestyle I advocate my book and 21 day plan, The Source. For more than a decade I have researched the science of energy generation in order to help my patients with fatigue, and designed my plan for energy generation so that anyone can expand their physical and mental resources and have more vital energy.

During the swearing in, many people marveled at Obama's calm. Well, remaining calm in the face of stress is a sure sign that a person is a master of energy generation. Not only did Obama appear to stay in control of the stress that most likely accompanied the highly charged situation of having the nation's eyes on him, but he gave some wonderful clues as to how he does it. In his speech, Obama asked us to deepen our lives with service and selflessness. It's exactly that sort of giving to others that brings energy into one's life.

A calm and abiding spirit, wholesome non-inflammatory foods, exercise, spirituality, a cleaner environment, love and forgiveness are the pillars of health. If you want to begin on the path of positive energy on which Barack Obama has traveled such a great distance, you can. Take a look at my book, follow the 21 day plan, and begin to feel energy flowing back into your life.

Belief Meds

Woodson Merrell, M.D. — Tue, 20 Jan 2009 18:14:06 +0000

The placebo effect-or achieving medicinal benefits from the mere thought a treatment will work-is a hot-button issue these days. People expressed shock last summer when more than half of doctors surveyed in the U.S. admitted to using placebos on their patients. The docs anonymously owned up to prescribing medicines like ibuprofin, antibiotics and sleeping pills with no known impact on a person's condition, telling the patient, "Maybe it will help"-knowing full well that the "maybe" was the real medicine. See the New York Times for the ensuing ethical outrage. I'm outraged too, but for different reasons: I'm happy to hear doctors are using the placebo effect, it's a wonderful mind/body tool that should be used, but they are going about it in the wrong way!

The mysteries and potency of the mind/body connection are perfectly encapsulated in the very real existence of the placebo effect. Placebos often perform almost as well as active drugs in clinical trials, and threaten to undermine the credibility of drug research (read a summary of the latest research). Placebos produce measurable results any fan of the movie What the Bleep Do We Know? will appreciate: thoughts have been shown to trigger the release of painkilling endorphins, and of tremor-reducing dopamine in people with Parkinson's disease. The phenomenon is stronger for some conditions and medications than others; diazepam often doesn't work for anxiety unless you know you're taking it and morphine works significantly better when a person knows it's being administered to alleviate pain. There's even talk of using the placebo effect to reduce the needed dose of some painkillers-a worthy goal, but by no means the most exciting potential application for placebos.

What's fascinating about the placebo effect has nothing to do with drugs; the big news-and what should be the focus of research-is the amazing untapped potential for using the mind to heal. I'm upset my colleagues in internal medicine would actually consider giving drugs like antibiotics with potential serious side effects as a way of tricking their patients into using the placebo effect. Why not simply teach a patient to use biofeedback or meditation to improve a medical condition with the power of thought? (See Chapter One of my book, The Source, for many more ideas on how to do this.) While most of us are not yet ready to use thought therapy instead of a needed medical treatment, I encourage all of my patients to use their complex and beautiful mental powers to help their body return processes to normal.

I love recent work on the placebo effect by my friend, researcher Ted Kaptchuk of Harvard Medical School. In April he published a study of Irritable Bowel Syndrome comparing three groups: one group received sham (or fake) acupuncture, which is an ideal model for a placebo treatment; a second group was given sham acupuncture (the placebo) combined with lots of care and attention from medical practitioners; and the third group was simply placed on a waiting list for the study. Both placebo groups improved more than the waiting list group, but the improvement in the placebo group who felt listened to and cared for by medical practitioners was so dramatic it was equivalent to positive trial results for drugs commonly used to treat the condition.

This study comparing placebos truly demonstrated the healing power in the doctor-patient relationship, as well as the potential for one's perception and feelings about the quality of medical care to produce positive physical changes. Perhaps it's not just your mind that works as a placebo, but the energy others put into the treatment that confers its potency. Kaptchuk suggests scrapping the idea of placebo and thinking in terms of "contextual healing," which refers to the healing produced by what takes place during the clinical encounter when you are sitting in your doctor's consult room discussing your treatment plan.

Doctors have the potential to plant a seed of healing with positive thought. The controversy shifts if you think of the placebo in those terms. It should be considered inadequate if a doc doesn't take advantage of the placebo effect by encouraging patients to use their minds to increase the chance of a positive outcome. On the flip side we know negative comments (nocebos) can make people worse. Shame on docs who go negative!

There are creative ways to use the mind to heal, and mindful ways to interact with people who need to utilize every resource at their disposal to get better. Let's use placebos, but let's think of them as healing vibrations set off by positive thought patterns, not fake pills that trick the patient into feeling better. My New Year's resolution: to empower every patient's treatment plan with a placebo and a prayer.

Medicinal Friendships

Woodson Merrell, M.D. — Tue, 13 Jan 2009 16:14:06 +0000

Dark moods, bad news and catching colds and flu: It turns out that moods and behaviors (like eating, drinking and smoking) can "infect" social networks to a much greater degree than psychologists have previously imagined. Harvard medical sociologist Chris Christakis working with data from the Framingham Heart Study (which has been collecting health data of members of a town in Massachusetts since 1948) recently found that if a good friend who lives within a couple of miles of you suddenly becomes happy, your chance of becoming happy skyrockets by more than 60%. Perhaps even more surprising was Christakis' finding that a person's chance of becoming obese increased by 57% if one of their friends' became obese! And get this, his research found obesity in a sibling had less impact than a friend's unfortunate turn toward corpulence (sibling obesity only raised the chance of the same by 40% and an obese spouse had even less impact, increasing the risk just 37%).

Christakis' and other's research strongly point to friendship as the key to power of an emotional contagion. This is to say that in a month when people are prone to getting sick, feeling down and gaining weight, it would be wise to seek out the company of friends who are bucking the trend and feeling pretty good (by leading healthy lives)-even if you continue to be a good friend to those who are experiencing trouble.

This new spate of research from sociologists and others nicely dovetails with the idea of interconnectedness, which is at the heart of my views on integrative medicine. The basic concept is that you can use the energy of other people and leverage the interconnected nature of the human spirit to increase your energy and your ability to heal and stay well. This is one of six aspects of health and healing discussed in my book (which includes my 21 day plan for energy and weight loss), The Source (Free Press, 2008):

In Chapter 6 I explain how the influence of others may work: "Where most of us see empty space separating one living thing from another, physicists have shown all these empty spaces to be filled with energy that allows for continuous sharing of energy and information across space...This very real energetic web tying together all matter allows for a cause and effect relationship between consciousness (the energy of thought) and healing (the returning of physical processes to normal). The transformative power of our own thoughts and intentions and of the thoughts and intentions of others involves an energetic process that transcends space."

Happiness and health (and their opposite states) are infectious. And while the realities of the struggle of life bring highs and lows to everyone, it's important to be aware of how other people, and most especially your friends, can have very real, subconscious effects on your moods and even your physical health. If you want to lose weight this month join a running club and make friends with other runners. If you want to be happier, you've got to spend at least some time around happy people. It turns out that even the simple act of seeing someone smile is likely to make you smile (scientists call this empathetic mimicry). I for one, after reading the latest research, am going to try to be a source of happiness for others throughout my day in this month and time of gloom. You should try it too!