There is an extremely interesting article in the month’s Archives of General Psychiatry, which was picked up by the media that examined how marital stress effects healing.

Most people now accept that the mind has powerful effects on the body, though as recently as the 1970s this was still regarded as rank heresy by many in the medical community. This new study is important for our understanding of the relationship between stress and physical health, and gives us further insights into how we can help ourselves stay well.

The study was done at Ohio State University and examines 42 married couples. Each person was given small skin lesions, and the startling finding was that in hostile couples, the wounds healed 60% more slowly than they did in non-hostile couples. The investigators even identified an inflammatory mediator called interleukin-6 (IL-6), as the biochemical link between hostility and slow wound healing. IL-6 levels are linked to long-term inflammation, which is in turn implicated in a number of illnesses, including diabetes mellitus, arthritis and cardiovascular disease.

A thirty-minute disagreement with a spouse could push back wound healing for 24 hours. The skin is the largest organ in the body and is exquisitely sensitive to stress: just thing of blushing and getting zits when under stress. So it is difficult to extrapolate from these findings in the skin, to try and predict what would happen with healing of internal organs. But we do have enough information already to say the following:

1. Allowing yourself to become involved in an argument may have long-term physical effects on you.

2. Some years ago I worked with a group of fine people who did just one thing that I did not like: they were wedded to the idea that it is a really good idea to vent your feelings. They would go as far as allowing patients to hit walls and other inanimate objects. I was never keen on this, feeling that expressing a lot of negative emotion could be counter-productive. After a patient broke bones in his hand after striking the wall, I quietly put an end to the practice. This new research indicates that I was correct to do so.

3. If you are going to have surgery, it is a good idea to be in a calm and peaceful frame of mind.

4. Stress is often unpredictable so it is a really good idea to be engaged in some ongoing stress management practice, so that you are better able to deal with the "slings and arrows of outrageous fortune," as Shakespeare put it over four hundred years ago. Clearly this doesn’t mean that you have to walk around like a burned out hippy on Quaaludes. Unless you really want to…. The best techniques that I know of for dealing with stress are the Sixty Second Peace Technique, Qigong and Yoga Breathing. If you have your own method, then stick with it. Otherwise you may want to check out some of the materials that I have written and recorded.

Technorati tags: stress, marriage, arguments, healing

The debate about a possible relationship between smoking cannabis and developing mental illness - in particular schizophrenia - has been going on since the 1960s. For a long time it looked to many people as if "Cannabis psychosis" was a myth. But I’ve never been so sure. I have seen too many people who have smoked a lot of cannabis and then become psychotic.

The whole issue is now becoming clarified. We have known for years that cannabis can precipitate psychosis in people already suffering from mental illness, but over the last five years, a series of papers  (article 1, article 2, article 3 -there are many more) from Scandinavia have looked at young army conscripts and found an association between the number of times that they had used cannabis and their subsequent risk of developing schizophrenia. If they had smoked more than 50 times by the age of 18, their risk of developing schizophrenia was as much as six times higher. A new study from Cambridge in England has found that repeated use in children is also associated with a 2-3 fold increased risk.

I once talked about some of this data at a meeting in Northern California and had a "vigorous" debate with some indignant colleagues who claimed that cannabis was perfectly safe. Perhaps it is in well-adjusted adults, but I’m not so sure.

And this new research raises a number of important points:

1. The cannabis that is now used by young people is much stronger than that which was on offer in the 1960s and 1970s, and is sometimes also adulterated with other substances.

2. The age at which cannabis is smoked appears to be crucial: the data suggests that it is a problem if used during the vulnerable period of brain development that occurs during early and mid-adolescence.

3. Can we say that the cannabis is having a causal role in triggering mental illness? The answer is that we can no more prove it than prove that smoking causes lung cancer. In my book Healing, Meaning and Purpose I discuss the myth of "uni-causality," the idea that there is one cause for an illness. Apart from trauma, there are extremely few examples of one illness being caused by just one deranged gene, one missing nutrient or one external toxin. There will likely be genetic, social and environmental factors that will together determine whether or not cannabis could cause psychosis.

4. Could this just be self-medication? People taking cannabis to try and treat their symptoms? That is possible, though we then have to ask why we are not seeing a similar relationship with any other substances like alcohol or Ecstasy.

5. Finally, there is some recent evidence that one of the key active ingredients in cannabis, tetrahydrocannabinol (THC), can disrupt the normal development of the microtubules that guide the development of neurons in some regions of the brain.

The moral of the story? Cannabis isn’t good for you, and it can be REALLY BAD for people during the vulnerable period of brain development.

Addendum Dec. 22, 2005:  Hot off the presses!  Another article on cannabis and schizophrenia. 

Technorati tags: marijuana, mental illness

Many of us have been wondering if the so-called genetic revolution is ever going to bear fruit? When are we going to see some practical benefit from billions of dollars and the years of research by thousands of scientists?

On December 13th 2005, Dr. Francis Collins, the head of the National Institutes of Health’s Genetics Program, announced a bold $100 million pilot project to try to begin to unravel the genetic makeup of some common cancers. The plan is to try and speed the understanding of the diseases, so that new treatments may be developed.

We have already discovered numerous genes that can play a role in initiating cancer: in causing a cell to become malignant, to keep it growing and then to spread. Some tumors run in families, but many do not. And even in families with strong histories of cancer, it is by no means inevitable that an individual will develop the disease. As I have said many times, "biology is not destiny."

This new program is to be applauded: understanding the genetic component of cancer is an essential step toward better treatment, but it is equally important to recognize that an understanding of the biochemistry of the disease is but one aspect of understanding it. We also need to consider environmental and psychological factors, which all come into play. I have known some of the more militant geneticists who insist that the whole of human health and wellness will be comprehensible in terms of genes: why some people smoke all their lives and do not get lung cancer, while some non-smokers die of the disease in the forties. Or why some people have high-risk cancer genes, but that these are balanced by genes that endow them with a robust psyche that prevents them from succumbing to the disease.

I have had endless discussions with some, and although I respect their position, I think that they have only half of the answer. One of the big breakthroughs in recent years has been the understanding that genes in the brain do not so much determine your personality, but instead they give you a predisposition to how you react to changes in your environment. Genes are a lot less fixed than we used to be taught.

So this initiative is great, but don’t think that it is going to come up with all the answers.

For this we also need to be aware of the psychological, social, subtle and spiritual aspects of illness. For it is by considering all of these and understanding that illness has meaning and purpose for us, that we can achieve health and healing.

Technorati tags: genetics, cancer, healing and meaning

I am sure that you have seen all those credit card advertisements with the tag line: "What’s in you wallet?"

I was thinking about this a couple of days ago when I heard about the husband of a friend of ours who had been in a really nasty motor vehicle accident which left him with several broken bones. After a few days he started to develop problems with his breathing and the family noticed that he was bruising and hemorrhaging from his scars. Yet some of his lab values appeared to be "normal." Fortunately, I was able to offer some advice, and his recovery is now back on track.

But the case reminded me that many physicians have not been taught the value of looking at laboratory values as a whole. Too often we see computer-generated sheets that highlight the "abnormal" values. Yet this is not quite right. First, however good the equipment, laboratory values are never totally accurate. There is always an associated measurement error. This is like those political opinion polls where the expert tells us that the error is + 3%. So if candidate A has 47% and candidate B has 50%, you cannot tell who is winning. Maybe candidate A really has 50% and candidate B really has 47%. Let me give you two clinical examples. I have seen a young doctor who wanted to give someone a blood transfusion because their hemoglobin had fallen by one gram, without realizing that the lab error was + 0.5. So when I asked him to repeat the measurement, there had actually been no change. And I have seen countless people get worried because someone’s temperature has gone up by a degree or two, even though this is within the normal measurement error, and is, by itself, quite meaningless.

And that leads me to the second point: an elevated temperature, or a low hemoglobin, is simply a guide; it is one part of the whole gestalt that we use for diagnosing and monitoring illness. It is wrong to treat a lab value.

Third, when we look at lab values, we are interested in the overall pattern, rather than one result here or there. So I might have a sheet of results in front of me without a single highlighted value, and yet be able to discern a pattern that points toward a specific illness. An individual’s blood chemistry can tell an eloquent story: if you know how to read it.

A fourth point is that for many laboratory tests, there is no such thing as "normal." We use what are known as "reference ranges." Blood levels that have been measured on a lot of apparently healthy people, that are lumped together and used as average reference value for that population. Any deviation is regarded as "out of range," but it does not necessarily mean that it is abnormal. If we go and do another reference range in China or Africa, we may get entirely different results. I once dealt with a large number of patients from some islands in the Caribbean who had two apparent problems: many of them has been misdiagnosed with a condition called acromegaly, a condition in which adults begin to produce large amounts of growth hormone. It can be a nasty illness, and it was apparently responsible for the death of Earl Nightingale, one of the early leaders of the personal development movement. The thing was that amongst these islanders, elevated growth hormone levels were normal and caused no ill health. Second, many ran high levels of an enzyme called creatine kinase that is commonly used to diagnose myocardial infarctions or heart attacks. So we could not use the enzyme for diagnosis in these people unless we saw an extra big change. And that’s an important reason for measuring hormones, chemicals and temperatures: not just to get one-off values, but to monitor change. Once again bearing in mind that any measurement will likely have some level of inaccuracy associated with it.

This last point about reference ranges is exceedingly important. I have seen countless people who have been diagnosed with "subclinical" thyroid or adrenal problems because the treating clinician was not familiar with the interpretation of endocrinological investigations. In a later entry, I am going to discuss why many endocrinologists have become a little skeptical about so-called illnesses like "adrenal exhaustion" and "sub-clinical hypothyroidism."

Technorati Tags: laboratory tests,  medical diagnosis, disease

Homeopathic medicine has now been in use for over two centuries since its basic ideas were rehabilitated by the German physician Samuel Hahnemann. And its essential concepts have always seemed strange to anyone with any scientific training. The central idea is that people have a life force that, if disturbed, can lead to illness. The second idea is the "doctrine of similars, " or of "like curing like." If you peel an onion, then your eyes and nose may start to run. So one treatment for a person with runny eyes and nose might be onion. The third peculiarity of homeopathy is the use of super-dilute remedies that are prepared in a very precise way. There is a nice summary article of some of the basic ideas.

There is an important principle in scientific research which sometimes gets forgotten: there are many different types of study and one of the most fundamental of errors is to mix up pragmatic (does it work?) and mechanistic (how does it work?) experiments. Pragmatic studies usually follow on from clinical observations, and even if something is shown to work, it can take years to work out the mechanisms. Aspirin would be a good example: it was used in various forms for over a century before it was discovered how it worked.

In August of this year the Lancet published an article on homeopathy that has been taken to signal the end of homeopathy. In fact in an accompanying editorial, there was a call for homeopathy to be abandoned, altogether. However, in the three months since then, a number of us have been through the Lancet study very carefully, and have found some snags in it. So far the Lancet has chosen not to publish responses to the article, and the authors themselves have, as of now, refused to disclose exactly which studies they analyzed. This is highly unusual, and should give pause to gleeful skeptics who have taken this one study to be the death knell of this form of treatment. Worse yet, the folk who have dismissed homeopathy based upon media reports of the study, without examining the original.

As examples of some of the astonishing problems identified in the Lancet publication: there was no clear statement of aim. This is normally required before you even begin a piece of research. The investigators first look at every homeopathic study that they could find and then decided which studies to include. This is again a very unusual way of doing things. And then there are a lot of questions about the statistical analysis. We all know that you can use statistics to prove almost anything that you want to, and the debate about the appropriateness of the methods used is going to go on for a very long time. 

The next time that somebody tells you that homeopathy is now a dead duck, tell them that the study is still being discussed. And as I have said on previous occasions, we do not make progress on the basis of one single paper. Even Watson and Crick’s model of the structure of DNA had to be confirmed before it was accepted, and going back further, some of the brilliant insights of Albert Einstein were not confirmed for almost fourteen years. But this study has already led to the Swiss Government deciding to reduce reimbursement for homeopathic treatment.

I have also seen some violent criticism of a six-year study involving around 6,500 patients who attended the Bristol Homeopathic Hospital in England.  This was a simple naturalistic study that asked a simple question: of all the people who visited the hospital, how many felt better afterwards? This is the kind of audit that is being done all the time to see how people have got on with a hospital or a treatment. It does not "prove" or "disprove" homeopathy, it just asks people how they feel. And most said that they had benefited. To criticize it for not being randomized or placebo controlled is a bit like going to an Italian restaurant and complaining that they don’t serve Chinese food!

Homeopathy is no "cure all," but I will not abandon it unless we get some far more impressive data than that from the Lancet paper, for not only have I seen it work in patients and in animals with monotonous regularity, but because behind the scenes, we have been seeing more and more research coming not from patient studies, but from physics and cell biology laboratories, that seems to be giving the specialty a firm theoretical footing.

I shall continue to report both the positive and the negative studies as they are published, and offering guidance about how we can use different forms of treatment in combination.

Technorati tags: homeopathy