Renegade Neurologist

From NYTimes.com:

The American economy is having what doctors call an acute episode.

Employment won’t throb. The circulation of capital remains weak. Industry is breathing, but barely. And if we can agree on anything one year into this mess, it is that there is little we can do when the patient arrives already this bad.

That is why the talk now is so often of prevention. Prevent the next crisis through health insurance and a green-energy sector, the American president says. Prevent it by cutting spending and nurturing personal responsibility, American conservatives retort.

But the truth is that politicians, and not just in the United States, are rarely willing to invest in a problem that hasn’t occurred. Consensus and action are easier to come by after a 9/11 or a Lehman Brothers than before. Problems in the embryonic, soluble phase don’t interest us; and those that do interest us are often too big to solve.

Which is where acupuncture comes in.

Western medical practices have attracted similar criticisms in recent years, for an emphasis on intervening in disease rather than preventing it beforehand and promoting quotidian well-being. But in health, unlike politics, an alternative approach called wellness has emerged, focused on investing in health before it breaks down.

What can wellness tell us about our present economic malady? As it moves from fringe to mainstream — with wellness programs in the health care reform proposals now in Congress, wellness manifestos on the best-seller lists and a U.S. Army wellness program that asks soldiers to introspect and meditate — I asked experts about the approach’s core tenets and how they might be applied to the body politic.

Nip it in the bud. Wellness argues for cultivating health a little every day, not just restoring it during calamities. We increasingly accept that it is better to monitor a diabetic’s blood sugar with regular clinic visits than to amputate her limbs. We accept that businesses can avoid costly cancer treatments by encouraging workers to stop smoking. But in our political life, we prefer to wait until things reach the emergency room.

We barely regulate financial markets for years, thinking regulation oppressive, until we are compelled to nationalize private firms. We avoid expensive investments and controversial new methods in public education, then pay the price in lower social mobility and vast prison populations. We neglect building roads and bridges and Internet highways, fearing the cost, and then reap the much greater costs of whole regions falling off the economic grid.

“With a lot of social problems, we’re not sure how to prevent it, and therefore we don’t spend money on it, because we always have a lot of other priorities,” said David Cutler, a Harvard economist who has advised both the Clinton and Obama White Houses on health care.

Go to the roots. Western medicine tends to fight symptoms, whether suppressing coughs or flooding the brains of the depressed with serotonin. Wellness is interested in underlying causes. It is inclined to see an infertile woman, for example, as a stressed woman rather than a woman with defunct ovaries, and may suggest that she eat and work differently rather than take ovary-manipulating pills.

In public policy, a symptom bias rules. A housing crisis? Enact a tax credit! Bank failures? Bail them out!

There is nothing wrong with such steps — except for what they leave out, as most economists will tell you.

Even amid all this action, we have virtually ignored the complex weave of issues beneath the issues: meager savings, a debt addiction, a congenitally spendthrift political system, an almost pathological craving for stuff. And, with our topical cures, we should not be surprised to see new symptoms of the old maladies appearing: insurance again being packaged into derivatives, bonuses again soaring on Wall Street.

“We treat symptoms, and we do not look at the causes of the symptoms,” Deepak Chopra, the famed alternative-medicine and wellness guru, said when asked to extend the wellness metaphor to the economy. “We are totally at this moment looking at it in a reductionist manner. The reductionist manner is a bailout. And somehow that’s supposed to solve the problem, whereas the problem occurred because we were thinking reductively.”

Look within. Wellness sees the causes of and remedies for ailments as lying within us. Avoid infection by building immunity. Defeat disease by eating foods that help the body heal itself.

With the economy, we look everywhere but within. It’s the fault of greedy Wall Street bankers. It’s Washington’s fault. Bush’s fault. Obama’s fault. Greenspan’s fault. Somebody fix it!

But what about us? Why can’t we acknowledge that it was us who bought all those unaffordable houses, us who listened to that zero-gravity financial “advice,” us who bought and bought and never kept a rainy-day fund? And why, in solving the problem, do we expect the state to create substitute dynamism instead of renewing the culture of decentralized dynamism that made the U.S. economy so vital to begin with?

“Conventional medicine is very unbalanced in placing all its emphasis on external interventions rather than looking to advance that internal capacity to maintain healing,” said Andrew Weil, founder of the Arizona Center for Integrative Medicine and the author of several books on wellness. Likewise with the economy, he said: “Instead of simply identifying external threats and developing weapons and strategies against them, we should instead identify and strengthen immunity and resistance.”

A politics of wellness would transcend party. It would emphasize the up-front investments that Democrats like in order to achieve the long-run fiscal solvency on which Republicans insist. It would fulfill the liberal belief in a positive role for government in maintaining well-being but would honor the conservative conviction that government’s chief role is to help the social organism heal itself. It would acknowledge, with the left, the complex lattice of cultural and institutional influences that govern a society’s well-being, while emphasizing, with the right, the limits of what any external healer can do.

Think wellness in these hard times. The most urgent problems, after all, may be the ones we haven’t had yet.

From NaturalNews.com:

Chinese herbs may work better and have fewer side effects for endometriosis treatment than conventional drug therapies, according to a new review of previous studies, carried out at Southampton University in the UK and Beijing University of Chinese Medicine.

Researchers re-examined two studies in which more than 130 women suffering from endometriosis participated. In the first study, sufferers were given the hormonal treatment gestrione, or herbal therapies, for three months following surgery to remove endometrial patches. In the second study, Chinese herbal treatment was compared with another hormone drug, danazol, for three months with no surgery.

Chinese herbs were found to relieve post-surgical symptoms more effectively than the conventional hormone-based drug therapies, with a nearly 96% success rate of complete symptom relief, as compared to only 10% with danazol. The herbs caused virtually no side effects, while a significant number taking hormone medication suffered increased period pain and irregular periods, acne, fatigue, weight gain and evidence of liver damage.

Women taking the Chinese herbal treatments were also 10% more likely to become pregnant following surgery than those taking prescription medication.

The original studies were carried out in Chinese hospitals, where the use of herbal treatment for endometriosis is routine. The review was headed by Dr Andrew Flower and published in the Cochrane Database of Systematic Reviews.

“These findings suggest that Chinese herbs may be just as effective as certain conventional drug treatments for women suffering from endometriosis”, said Dr Flower.

“This may mean that Chinese herbal medicine is more suitable for long-term use.” [1]

Conventional treatments for endometriosis include anti-inflammatory drugs and painkillers, as well as hormonal manipulation therapies and oral contraceptives. However, hormonal treatments are known to increase the risk of breast cancer, while surgery carries the risk of bowel perforation.

The current study is not the first in which natural therapies have shown themselves to be effective in the treatment of the condition. A 2007 study using the bark of the French maritime pine tree, known as Pcynogenol, was found to decrease symptoms of endometriosis by 33% when used for nearly a year after surgery. In the study, patients took 30 mg capsules of Pycnogel twice daily for 48 weeks immediately after morning and evening meals. The treatment was found to have reduced all symptoms from severe to moderate within four weeks. [2]

Vitamin combinations have also been shown to be an effective therapy for endometriosis. Also in 2007, Italian researchers enrolled 234 women to assess the effectiveness of nutrition versus drug treatment for six months after surgery.

Both the nutritional treatment, which included vitamins (B6, A, C and E), minerals (calcium, magnesium, selenium, zinc and iron), omega-3 and omega-6 fatty acids, as well as probiotic bacteria preparations, and the drug treatment were found to be effective in reducing menstrual pain, pelvic pain and pain during sexual intercourse. However, only the drug treatment was found to increase the risk of bone thinning and menopausal symptoms. [3]

[1] Flower A et al. Chinese herbal medicine for endometriosis. Cochrane Database of Systematic Reviews. 2009; Issue 3.
[2] Kohama et al. Effect of French maritime pine bark extract on endometriosis as compared with leuprorelin acetate. J Reprod Med. 2007 Aug;52(8):703-8.
[3] Sesti et al. Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III-IV. A randomized comparative trial. Fertil Steril. 2007 Dec;88(6):1541-7.

From LATimes.com:

Reporting from New York — It was 8 a.m., and the subject was death.

A 55-year-old man was wasting away from lungcancer and cirrhosis. His weight was plummeting and his brain was swelling. But he was in denial, refusing to discuss hospice care or consider a “do not resuscitate” order.

A bright pink vase filled with yellow mums sat near the window, belying the grim task facing the healthcare workers at Beth Israel Medical Center who had clustered around a conference table.

“This has been really sad,” said the Rev. Robert Chodo Campbell, a large man with thick brows who was wearing what appeared to be a cross between a judo outfit and hospital scrubs. He told the group that when faced with a similar case in the past, he had decided to disclose his personal battle with alcoholism to the patient — also an alcoholic — in hopes of spurring a conversation that might help ease the man’s mental anguish and prepare him for whatever lay ahead.

“Is that a good technique?” asked a doctor, sounding slightly incredulous.

A psychologist interjected. “In this case, it could have been a gift,” she said. “Psychologists don’t disclose anything. Chaplains operate under a different set of rules.”

And Chodo operates under a different set of rules than most chaplains as he spreads the spirit of Buddhism through the halls of Beth Israel, a 1,368-bed medical center in Manhattan. “If it seems appropriate in the moment and one is sure of one’s motives — the well-being of the patient — then why not?” the Zen chaplain asked.

According to the American Hospital Assn., about 68% of public hospitals have a chaplaincy program. But few have Buddhist monks, and none compares with the program at Beth Israel — where more than 20 Buddhist chaplains and chaplains-in-training offer bedside meditation, interdenominational prayers and other assistance to pregnant women, dying cancer patients and even stressed hospital workers.

“There is one rabbi and two Catholic priests. They’re great people, but the rabbi sees Jewish patients. The Catholics anoint the sick. Then there’s everybody else,” said the Rev. Koshin Paley Ellison, co-founder with Chodo of the New York Zen Center for Contemplative Care.

Last year, Chodo and Koshin began bringing students into the hospital as part of the country’s first Buddhist chaplaincy training program accredited by the . “We’re really trying to create a cultural shift,” said Koshin, who like Chodo uses the name given him when he took his vows to become a Buddhist priest.

Advocates say the availability of alternative treatments is crucial at a time when millions of Americans are struggling to pay for healthcare. Instead of relying on drugs and hospitalization, the Zen center encourages stress- and pain-relief through meditation, breathing exercises or simple conversation. Even if such methods cannot provide a cure, they can make patients more comfortable. And the Zen chaplains are able to spend more time with patients, time that busy doctors and nurses often cannot spare.

“We focus on listening,” said Bob Allen, a chaplaincy student who has spent much of his training time on Beth Israel’s oncology floor.

Not everyone, however, has welcomed him.

“I just started eating!” Allen recalled one patient yelling when he entered his room on a recent day. “I’m Jewish! Get out!”

In the tranquil manner that is pervasive among the Buddhist chaplains, Allen put a rosy spin on the patient’s reaction. For someone facing death, throwing an unwanted visitor out of the room “can be empowering,” Allen said. So if it made the sick man feel better about his situation, that’s a good thing.

Some doctors too are skeptical about so-called integrative medicine, the melding of alternative care with traditional Western medicine.

Teaching relaxation and pain management is good, said Dr. Bruce Flamm, an obstetrician-gynecologist at Kaiser Permanente in Riverside, who has been an outspoken critic of studies suggesting prayer and spiritualism can heal the sick. But, he said, encouraging patients to pursue “kooky” approaches with no scientifically proven benefits would be a problem.

Flamm said integrative medicine programs reflected the competitive nature of the healthcare industry. Some mainstream medical centers, he said, have introduced alternative approaches in hopes of “trying to recapture some of those patients that are veering off.”

“You can get your chemotherapy . . . and also get your acupuncture and therapeutic touch and reiki healing,” Flamm said, drawing a picture of one-stop shopping for the ill. “The question is, is that really ethical?”

Beth Israel’s Zen chaplains say they are careful in approaching patients and would never dream of countermanding a doctor’s advice. But their differing approaches are clear.

During one meeting at Beth Israel, Koshin suggested that a severely diabetic 63-year-old woman who refused insulin might benefit from a visit to the alternative-care facility that is affiliated with the hospital and offers treatments such as herbal medicine and leeching.

A doctor disagreed. “She needs really good medical care to get her diabetes under control,” the physician said.

So Koshin gently pushed his own theory that the woman might become “more compliant” if she received some sage advice from practitioners at the holistic center.

The discussion was left at that.

During a recent round of visits on the oncology floor, Allen, the chaplain-in-training, knocked lightly on patients’ doors before entering. He moved silently into their rooms and sat beside them, ignoring TVs blaring pop music or squeals from “The Price is Right.”

On this day, the patients included a Burmese man with nasal cancer who had requested time with a Buddhist chaplain. The patient appeared weighed down by the white sheets atop his slender frame. “You seem very tired. Do you feel bad today?” Allen asked the man, who requested that his name not be published. The patient nodded. He was too sick to eat, but he wanted to practice breathing exercises to relieve his pain.

He struggled to sit up in bed. Then he closed his eyes as Allen coached him in a soothing voice. “Take a nice, deep, cleansing breath,” Allen said. “Blow out all that toxin from your face, your nose, your eyes, so you can bring peace and calm to yourself.”

Next, Allen visited Victoria Exconde, who was facing breast cancer surgery. A Roman Catholic from the Philippines, Exconde broke down in tears as she discussed her condition and the difficulty of going through it without her late husband by her side.

The two then recited a Christian prayer together.

“Thank you, father,” Exconde said.

“You don’t have to call me father,” Allen replied good-naturedly as he got up to leave.

Supporters of the Zen chaplains program say the monks’ presence brings a calming influence to the often frenetic hospital floors, and that patients, for the most part, are open to them.

“I think a lot of it has to do with the fact that a lot of our patients don’t really know what a Buddhist monk does,” said Terry Altilio, a social worker in Beth Israel’s palliative-care department, which focuses on relieving suffering of seriously ill patients. “For a lot of patients, there’s a curiosity and an openness you don’t necessarily see with rabbis, priests, etc.”

The Zen chaplains do not limit their services to patients.

Koshin recently accompanied a Catholic priest to tend to a couple whose infant had died at the hospital, explaining that “the priest didn’t want to go alone because he’d never been with a dead child.”

During morning rounds, when medical teams gather to discuss their cases, the chaplains sit in. In the case of one 30-year-old Chinese man with cancer, Chodo advised that they needed to be careful because in Chinese culture, “you don’t normally discuss death in front of the patient.”

Once a week, Chodo visits the Robert Mapplethorpe Residential Treatment Facility, part of Beth Israel’s AIDS treatment program.

Most of the patients, whose harsh lives show in their tired eyes and bodies, have spent time in prison or on the streets.

But here they were, sitting in a dark room, chanting the lotus sutra while having their heads massaged. As Chodo’s soothing voice filled the room, their chatter gave way to dreamy murmurs.

“When I meditate, it takes me to some beautiful places, even though I’m from Brooklyn,” said Kevin, one of the center’s residents, ticking off his visions of paradise: Paris, Rio, Jamaica.

George, another resident, asked everyone to remember the 228 souls lost when an Air France jet vanished over the Atlantic Ocean. The crash was a reminder of how life can be cut short without warning, Chodo said, urging those around the table to be kinder to themselves each day — perhaps by having one less cigarette or doughnut, or making one less trip to Starbucks.

Then he cleared the room so he could meet privately with Rafael, an AIDS patient whose clothes hung from his once-buff frame. Rafael wept as he spoke of his fiancee in the Bronx, who no longer visited or returned his calls.

Chodo held his hand and simply listened, saying nothing.

After a few minutes, Rafael thanked Chodo and shuffled back to his room.