Friday, September 21, 2018

Food is medicine


I have been reading about nutrition and diet a lot lately. In fact, I have always belonged to the ilk of people who think & practice that if one is exercising and eating clean (no junk food, no refined carbohydrates like chocolate pastries, cakes, coke, chips, GARBAGE like this) then there is not much attention to be paid to the knowledge and wisdom of food. Not any more, I am transforming. Well, the process has already started and I am loving it. Now before you jump to label me as a “Vegan” I want to make it clear that I am really not a great proponent of all this labelling farce that happens all over the world in all categories imaginable. (Someone just told me Section 377 got revoked in India. Well yeah! Good thing! In fact, its a watershed! Too bad that people’s uniqueness is categorized into some abbreviations for ACCEPTANCE. Nightmare!) Anyway, more on that in a later post. 

So yeah, I have been reading a lot on nutrition , the wisdom and healing power in nutrition and diet.The more I am reading, the more my ignorance is coming to surface and the more connected I feel to the natural state of things we ingest to survive. I am reading Dr. T.Colin Campbell, the man behind the China Study, Dr. Caldwell Esselstyn (heart disease can be cured by whole-plant based foods), Dr. Neal Barnard (I am totally inspired by his presentation abilities), Dr. Anthony Lim, Dr. Goldhamer, Dr. Dean Ornish(The God of nutrition wisdom), Dr. Brenda Davis and a lot many others who are actively working to spread the word about the benefits of WHOLE PLANT BASED FOOD (WPBF). The interesting thing is that most of these happen to be physicians, doctors, trained in medical colleges to treat the symptoms of a disease using a drug, like prescribing statins, metformins, lupitor, Xanax, prednisone (there is no end really, isn’t it?). These doctors have become converts courtesy to the results of the meticulous research done by them in the domain of treating chronic diseases. And when they speak, you listen. You listen even when the Coke industry blames lack of exercise for obesity and not the products it produces in trillions to literally kill the people. You listen when the sugar industry blames the Fat industry and the Fat industry blames the sugar industry. A classic case of passing the buck, if you will. 

FOOD IS MEDICINE


When doctors speak, we usually listen (there have been moments when I have not.). But when they say about going the natural way to heal our body, then it would be a disaster if we dismiss their claims as misleading and dreamy. Why? Because they are doctors, they thrive on patients and when they show you the direction of preventive medicine and natural healing mechanisms, they are actually doing us a favor. They are being real doctors. Lowering down of cholesterol, Blood pressure regulation, lowering down of HBA1c (Glycated hemoglobin) is not happening in a utopian world where there are elixir type drugs, but it is happening right in front of us. Although all attempts are being made to hide these highly scientific studies, who has been able to contain the truth anyway? Now I am not asking you to be blind followers, but I am asking you to have an open mind and read the literature out there. To start with, you can google the names I have listen above and that will help you in making your decisions yourself. 

I am also absolutely not disregarding the use of drugs, I respect doctors. They have saved my life multiple times!  If on Friday night you eat some poisoned food and complain of vomiting and nausea in the middle of the night, you got to have a drug to save yourself from dying! Perfectly normal. But there is a deeper issue in sight here. We are facing an EPIDEMIC of obesity, diabetes, cancer, poly-cystic ovarian syndrome (PCOD) , hypertension, insulin resistance and these are all what? Yes, these are lifestyle diseases and yet we are not paying attention to lifestyle that we are following. Dr. Greger, I forgot to mention his name above, another pioneer in this movement of WPBF says clearly, “If it is a disease of lifestyle, it needs to be treated by lifestyle”. Such simply put, indeed! 

But there is one thing that has been hanging on my mind ever since I began reading, more reading about the magic of nature in healing us by annihilating the root cause of the disease. What is that? It’s a question. The question is this, “Why do negative forces win so much and so often in hoodwinking the public by selling the items they claim are healthy?” This question has been doing rounds on my mind a lot and that is the reason I wrote this post at the first place. I thought to myself the answer to this question. An answer came, “May be we do not have sufficient information which can help us make choice”, “May be we do not make any attempt to gather that sufficient information which can help us make a better choice” or “May be we have fallen prey to as what Dr. Goldhamer says, ‘a pleasure trap’”.  But I really feel that we as public have made markets for GARBAGE FOODS (I am really sorry, I could not think of a better name) to thrive in market. We have fallen prey to them, be it sugars in sodas, in chocolates , cheese in pizzas, salt in potato chips, PROTIEN in meat and eggs and justify their increased consumption on a daily basis. But see what it is doing to our brains, to our arteries, to our kidneys, to our hearts and to our SOUL? To prevent this infiltration of unhealthy foods in the market around, it is our responsibility to make wiser decisions, to resolve to make our own food. Cooking allows us to connect to food and to really appreciate the hard work of the farmers that has led the food to end up on our plates. How can these negative forces win when we do not create breeding grounds for them? 

Now I know, we crave taste. For a long time I used to think that overweight and obese people are lazy people but now I have transformed in that thought as well. When I see someone working hard in gym to shed those extra stones, I get it, I get that it is extremely hard to maintain an optimal body weight, let alone lose some and be healthy. If there is one thing that is clear on my mind, it is the discovery that fitness is a journey and that it is not an easy one, but an achievable one, a doable one. And guess what? Fitness is an everyday decision, we have to work every day to ensure that we are healthy and fit – no shortcuts sorry! But again, it is a personal decision. No one wants to become fat, sick and nearly die and everyone wants to eat and enjoy food. But we have to ask ourselves a question. 

“Should I compromise my health for the sensation this food will provide my taste buds which will not even last?”

I want every single one of you to be healthy because I love you. We have been given this precious human birth, let us live it responsibly and help our brothers and sisters along the way in their endeavors.

Thursday, November 23, 2017

The Enigma of Healthy Living



The more I think about changing the health of people, more specifically, adults, I always fall back to the importance of their upbringing in childhood in my own self-conversations. I always wonder, what if these adults were brought up to be healthier in their lives, to make decisions which catered to their physical and mental well-being as they were growing and were taught from the beginning the discipline of leading healthier lives and making healthier options. Invariably when I try to find answers to these questions, I fall back to my own childhood years growing up in my home with my parents. My father was very particular about food that came in our house, he took extra care of the nutrition the family had and loved experimenting with food – all this he used to do for his family and to inculcate among his children the good eating habits. As a child, I cannot recall even once if I ever had “gol gappe”, “samosas and jalebis” used to come once in a month on Sundays when father felt like pampering us, but it was not a regular affair. What was uber regular was his ritual of buying loads of multi-colored vegetables every Sunday; back then it was trauma for me because I was the one who was supposed to wash all of them and arrange neatly in the fridge. But today, I understand very clearly the significance of his every action. Every morning, after waking up, he used to ensure that I and my brother drank 2 glasses of water, did some light exercise and on Sundays he just threw us out of home into the big stadium area to go for running/jogging. The most beautiful of memories are the times when he used to accompany us, three of us used to jog in the stadium and later relax doing long-jumps. All this I very vividly remember. We did not have shoes, we did not think they were important, chappals were enough. During evenings, me and my friends used to play games like cricket, badminton, hide and seek, jumping, border-border. Power cuts were very common in Delhi during my school years, we did not have an inverter and majority of my friends also did not have it; so when electricity used to go out, we used to play again (if father did not take English translation interviews or mathematics verbal quiz), games which could be played in little light.

We purchased our first motorcycle when my brother entered in college, my father got it for him. For himself, he had used bicycle to go everywhere; in retrospect I know it was not so much a decision to stay healthy but to save money, yet I also believe somewhere that my father ensured his regular activity by cycle. But this was not the only way by which he ensured his health. As a growing up child, I have seen my father exercising at home. I fondly remember the moments when on his biceps me and my brother used to hang like clothes on a wire; his arms were so strong that we could use them as swings and behave like monkeys. I also remember the times when he used to ask one of us to stand on his toes so that he could do, what today I know as, crunches. I have seen my father exercising every single day growing up and my mother doing Yoga and breathing exercises. I had the first pizza of my life in my third year when my junior took me to Dominoes; I did not like it (it was her favorite pizza, I still remember the name: Mexican Green Wave). After that I never had pizza. I used to eat McVeggie and McAloo Tikki burgers when I was in college, but that was occasional and eventually lost its charm to me on its own I guess. Never have I had craving for pizza or burger, I have seen a lot of people having that. 

When I look at my life, and when I look back I can clearly see that our father was making us health conscious by acting the way he was. He is in CRPF and has undergone strenuous training in unfriendly terrains and I can only hypothesize that he observed that exercise changed him. We are from a farming family, so needless to say, he had always been active yet I feel that the more organized exercise regime in CRPF training led to cementing the importance of being healthy and, most importantly, strong in life in him. I can see today how consciously he has nurtured his both children, my sister happened much later (she is 13 years younger to me) and I believe me and my brother teach her by our actions. The crux of the matter is that I have grown up in a household in which proper health conduct was emphasized, in which we never had junk food  (only on school picnics, mother used to cook chowmein), drinking water was heavily stressed upon and most importantly being outside of home for good one hour was the protocol. After dinner, our family used to go on long walks inside the CRPF camp where we used to stay. In morning we woke up early (5 am) and after reaching school I used to play handball during the assembly times; I was in the handball team of the school. So, I can see clearly how active I have seen people around me and I have had opportunities to be active myself; I love sports, I love all games till date. Today I do ask myself, if that is what has influenced “being healthy” as one of the core values of my life. But I do not find much intersection, my reason to lead a healthier life is inextricably tied to my vision of creating a healthier world but I do have lots of gratitude to my father. He inculcated in me and my brother healthier eating habits and the discipline of restraining and that I believe is much more important than exercising daily. The closest of memories are drinking sweet lime juice every time we went out with our parents; we never asked for a chocolate, chaat or samosa, we always asked for juice and we were really small children making healthier choice back then. My father’s presence was impactful and today is all the more impactful. 

In essence then, I wonder why my father ensured that it was imperative to be active, why he exercised every single day despite his tight schedule and job responsibilities, how he stood first every time there used to be running competition among his entire team and day after day, how he woke up every morning at 4am. I have some very big shoes to fill but I think I can barely manage to fill 0.01% and if I can do that, I’d feel accomplished. Today I do realize the importance of all his activities, his healthier way of living and that strengthens me because he was my current age when I saw him doing all this. Activity had its own place but proper, clean, nutritious food was the most important decision of our household. My mother always fed us the best food with loads of salad, fruits, milk and dry fruits. In fact, my dad made a mixture of all dry fruits and used to serve it to us every morning before we left for school; according to him, it was good for brain development. How much extra care he took for us is unfathomable and makes me so much more humble towards him. 

So, I do believe that my growing up years at my home with my parents have played a remarkably striking role in guiding my health habits. Even in college and now in job, I have never seen myself making poor health choices for a prolonged period of time. That way, my parents have planted in my psyche the seed of making healthier eating options. In the realm of exercise, when I look back, I understand my father’s attempt to make us active and health conscious – to be honest, we never liked those Sunday morning running events, it was hard work to do that but we did it nevertheless. And today it makes a lot of sense to me. 

Hence, I do understand that upbringing has some role to play in how health conscious a child becomes as he grows into an adult. I also feel that friend circle has a huge role to play as well in determining the extent to which someone is health conscious. Apart from this, adults usually become conscious about their physique when they want to become more presentable or desirable in public, but this is more like an episodic conscientious behavior which can often disappear after obtaining the object of desire or gaining fulfillment. 

All this self-rumination leads me to believe that targeting school going children and college going students for planting the seed of conscientious healthy living might go a long way in determining their respective health curves as they age. Behaviors can be easily integrated into the growing up years of an individual, not to say that they cannot be altered in future.

Health and well-being is definitely not as simple as it seemed to me when I had started three years back on this well-thought of journey of becoming a researcher in Public Health. It is labyrinthine and mysterious and it is about making conscious healthy decisions every single day.

Few Cartoons on health 




 

Saturday, September 16, 2017

CANCER AND PERSONALITY

This post is replicated from the book, "The Diseases of Civilization". 

The idea that cancer is brought on by worry and grief dates back to classical times, and it has often been confirmed by observation. Among the commonest causes of breast cancer, Sir Astley Cooper, the leading surgeon of his time, remarked in 1845, are grief and anxiety. "Much has been written on the influence of mental misery, sudden reverses of fortune, and habitual gloominess of temper on the deposition of carcinomatous matter", W.H. Walshe wrote in his treatise on cancer the following year. It had never been demonstrated, Walshe admitted, that mental disquiet was the cause, but that the two were often found together was undeniable. "I have myself met with cases in which the connection appeared so clear that I decided questioning its reality would have seemed a struggle against reason".

In his lectures to students at the Royal College of Surgeons a few years later, James Paget, although admitting that he was talking of a general impression for which he could not provide factual evidence, emphasized the significance of mental distress in connection with cancer. "I do not at all suppose that it could of itself generate a cancerous condition of the blood, of that a joyous temper and prosperity are a safeguard against cancer; but the cases are so frequent in which deep anxiety, deferred hope and disappointment are quickly followed by the growth or increase of cancer that we can hardly doubt that mental depression is a weighty addition to the other influences that favour the development of the cancerous constitution."

And in 1885 the American surgeon Willard Parker expressed the view that there were "the strongest physiological reasons for believing that great mental depression, particularly grief, induces a predisposition to such a disease as cancer, or becomes an exciting cause under circumstances where the predisposition has already been acquired".

By that time, however, it was considered heretical to attribute organic disease to emotional disturbance. The most that was allowed was that "nerves" might be involved. As late as 1925 the British Medical Journal accepted that nervous influence must indirectly be regarded as of great importance in the production of cancer. But the belief was growing that cancer must have a single causal agent, probably a virus, and although doctors continued to observe that patients who had "the will to live" might survive longer than those who "turned their faces to the wall", this was not considered to be of much significance for the purposes of research into the origins of the disease. Even those doctors who preached the psychosomatic theory, applied it to cancer more cautiously than to other disorders, and the first major textbook on the subject, Psychosomatic Medicine, referred only to the emotional problems of patients after they had been diagnosed as having cancer. 

From time to time, however, signs of dissatisfaction with the prevailing orthodoxy were apparent. In 1957 Sir Heneage Ogilvie, Consulting Surgeon at Guy's Hospital and editor of the Practitioner, put forward the startling proposition that medical science should cease to look for the anaswer to the question "Why do so many of us get cancer after the age of 48?" and concentrate on the real problem: "We all have cancer at 48. What is the force that keeps it in check in the great majority of us?". From his own observation, Ogilvie had come to a conclusion which he presented in form of an aphorism - though, as PAget had done, he admitted he had no factual evidence to back it. "The happy man never gets cancer". In his experience the instances where the onset of cancer "followed almost immediately on some disaster, a bereavement, the break-up of a relationship, a financial crisis, or an accident, are so numerous that they suggest that some controlling force that has hitherto kept this outbreak in check has removed".

Isolated attempts were being made to test this hypothesis. In 1952 some disciples of Franz Alexander in Chicago reported that, in a study of forty cases of breast cancer, among the major psychosocial characteristics were sexual repression and an inability to express and discharge pent-up feelings of hostility. And from the records of personality tests on people who had subsequently died of cancer, a New York doctor, Lawrence LeShan, and a research psychologist, Richard Worthington, reported three years later that they found "startling similarities in their personality configurations and in their life histories". Four features constantly recurred: the loss of an important relationship prior to the development of the tumor; the inability to express emotions successfully; unresolved tensions concerning a parental figure; and sexual disturbances. 

The next step was to check these retrospective findings with living cancer patients, and the Ayer Foundation agreed to provide the necessary funds. But no hospital or research centre in New York would allow LeShan to talk to cancer patients on his own, a laborious task, and for the next fourteen years he used whatever opportunity arose to take case-histories of their lives and lifestyles. These confirmed the earlier findings- in particular, that the onset of cancer frequently occurred following the loss of some important emotional relationship. There also, he found, appeared to be some connection between the personality-types of cancer patients and the duration of their survival between the cancer diagnosis and death. 

Surprisingly, in 1959 LeShan's paper was accepted for publication by the Journal of the National Cancer Institute, which had shown no inclination to include such heresies before; perhaps because 1959 was a time of self-doubt in medical circles, when for the first time for many years the physician's and the surgeon's methods came under worried scrutiny, notably in Dubos's Mirage of Health. That year, in his presidential address to the American Cancer Society, Eugene Pandergrass echoed Ogilvie's opinion. Pendergrass had seen how cancer patients might remain well for years following treatment; "then an emotional stress, such as the death of a son in World War II, the infidelity of a daughter-in-law or the burden of long unemployment seem to have been precipitating factors in the reactivation of their disease which then resulted in death." There was solid evidence that the course of disease in general was affected by emotional stress: in search for ways of controlling tumor growth, therefore, it was his hope "that we can widen the quest to include the distinct possibility that within one's mind is a power capable of exerting forces which can either enhance or inhibit the progress of this disease". 

But how could research provide evidence of a personality component in cancer, of a kind which would be accepted as scientific? Sir Julian Huxley had pointed the way: if there were a genetic basis for psychosomatic difference, he had written in his Biological Aspects of Caner (1958), a psychosomatic component was predictable. It was left to the behaviourist Professor Hans Eysenck to follow up the clue, his research establishing the existence of a difference in proneness to cancer between extroverts and introverts. 

Another researcher was exploring the territory by a different route: the Glasgow physician David Kissen, who ran the only unit in Britain specifically designated to undertake psychosomatic research. His interest in the subject had been aroused during research into the possible relationship of emotional stress to the onset of TB, in the course of which he had investigated the effects of smoking, not simply because it could be an alternative explanation but also because he thought that smoking might prove to be a part of "the emotional configuration of the tuberculous", as he put it. In a trial with two groups, one consisting of TB patients who had suffered a relapse, the other ob TB patients who had not, Kissen found there was no difference in their smoking habits. But with the help of a questionnaire Kissen confirmed LeShan's findings: there were significantly more cigarette smokers among those in the fifteen-to-twently-four age group who had had emotionally stressful experiences before the onset of their TB, and TB patients in general who reported such stressful experiences smoked appreciably more than those who had none to report. The link, in other words, was not just between smoking and relapse, but between smoking coupled with an emotional stress factor and relapse. 

Might this not also be true of lung cancer cases? Kissen provided patients attending chest clinics in three hospitals with a questionnaire, to be filled in before diagnosis. They were asked, among other things, for information about earlier illnesses, particularly in childhood; about recent emotional problems of a kind which occasioned stress, and about how they handled such problems. After they had been diagnosed they were divided into two groups: 161 patients with lung cancer; 174 controls. The patients with lung cancer, Kissen found, had had more childhood illnesses, and a significantly higher proportion of them "admitted to a conscious tendency to conceal or bottle up emotional difficulties". Summing up the results of his research in 1964, Kissen suggested that, if the view were accepted that lung cancer has a number of risk factors, including both exposure to cigarette smoke and a particular personality type, "it would appear that the poorer the outlet for emotional discharge, the less the exposure to cigarette smoke required to induce lung cancer". 


Kissen went on to ask if ways could be found to apply the knowledge gained from his research to help people to avoid lung cancer? People with cancer-prone personalities, he suggested, should be helped to break the smoking habit, and to be on the safe side they might contemplate moving from town to country, to reduce the impact of urban carcinogens. But it would also be a valuable exercise if a study could be made of cancer patients in general who had been treated for the disease, to see whether any form of psychological aftercare improved the chances of survival-care which, he pointed out, could in any case be valuable, by helping patients to handle the emotional problems which arose as a result of the diagnosis and the treatment. 

Upto this point Kissen's and LeShan's research had attracted little attention in the leading medical journals and when, in 1963, the New York Academy of Sciences sponsored a conference on "unusual forms and aspects of cancer", the psychosomatic aspect was not among the subjects listed for discussion. Kissen wrote to the Executive Director of the Academy, Eunice Thomas Miner, suggesting that the omission had been unfortunate because the opportunity had been missed "to draw the attention of scientists and clinicians to the important but much neglected area". Surprisingly, he did not receive the usual rebuff or polite evasions; Miner tactfully replied that the subject was sufficiently important in its own right to merit a separate conference, which was duly held. In 1965 the publication of the proceedings in the Academy's Annals, and of Eysenck's meticulously-documented Smoking, Health and Personality, made it difficult for the medical establishment to ignore the issue any longer. 

Eysenck did not deny that there might be a carcinogenic element in cigarette smoking, but he provided a mass of evidence to show just how flimsy the grounds has been for jumping to the conclusion that the connection must be causal. If it were, why should nine heavy smokers out of ten survive into old age without contracting lung cancer? "Cigarette smoking is neither a necessary nor a sufficient cause of lung cancer", he concluded. He was not even certain that it was a contributory cause; on his reading of the evidence, the more likely culprit was atmospheric pollution. 

Eysenck's case was not welcomed by the medical establishment; still less was the implication that the missing link might be psychological. Yet the evidence could not lightly be dismissed. The National Institute of Mental Health gave a grant to George L. Engel, the Professor of Medicine and Psychiatry at Rochester University in New York, to study the relationship of emotional stresses to the onset of cancer and other illness, and newspapers began to publish articles on the subject. "Could the mind be a cause of cancer?", the medical correspondent of The Times inquired; scientists might still scoff at the idea, "but the wise clinician is studying it with sympathy and interest". Even the Lancet unbent sufficiently to take a respectful look at Kissen's findings, concluding that, although it might be premature to accept them, it was important that the investigation should continue: "in our state of ignorance about the origins of cancer we cannot afford to disregard them". 

Unluckily, Kissen himself could not continue his research. Although he contributed papers to the New York meeting, he was not well enough to attend, and his death in 1968 at the age of 52 removed a man whose "precision of methodology and objectivity", as the Medical Officer had described few months earlier, had won the respect even of those who felt uneasy about his excursions into little-explored psychosomatic territory. Kissen had done his best to make clear that, when he used the term psychosomatic, he used it with precision. Psychosomatic, he always insisted, implied an interaction of the psychological and the physical; it did not mean that the psychological caused the physical for which "psychogenic" was the correct term. The two coexisted, having varying degrees of importance in different types of illness and in different individuals. Kissen wanted to emphasize this, he explained in his paper to the New York Conference, "because it has been my experience in discussions of psychosomatic topics with some physicians, and even with some psychiatrists, to find hostility to the psychosomatic approach in the mistaken belief that the absence of, or minimal references to, somatic factors imply a denigration of somatic factors in favour of the psychological. It is important that such misconceptions should be cleared up". 

But they were not cleared up-again, largely because the structure of the medical profession made such clarification difficult. Cancer specialists had been taught that the mind and the emotions played no part in the process by which cancer began, or spread, a view they continued to teach their students. They rarely saw evidence in their special journals which might upset their preconceptions, and where such evidence was referred to, as in the Lancet, it was invariably accompanied by a warning about the need for further research. With few exceptions, such as Ogilvie and Pendergrass, cancer specialists tended to be temperamentally immune to ideas of the kind which Kissen's work prompted. They might still be prepared to accept the possibility that the "will to live" could delay the inevitable termination, but they could not see what they, as specialists, could do, other than give reassurance to help prolong the survival period. And even if they were prepared to accept the possibility that a cancer-prone personally existed, they could claim that the concern rested not with them but the psychiatrists. Soon after Kissen's death, his unit ceased to function as a separate entity. 

His findings, however, have since been confirmed. In 1975 H.H.Greer, a psychiatrist at King's College Hospital in London, reported that, using Kissen technique of giving personality tests before diagnosis to women with breast tumors, and then dividing them into two groups according to whether the tumours were found to be malignant or benign, he had found that two-thirds of the cancer patients had described themselves as controlling their emotions, some to an extreme extent-"never, or not more than once or twice in adult lives, have they openly shown anger"; whereas only a third of the control group were in this category. Yet so little attention did such work receive that when, in 1976, a symposium was held in NY on ways by which cancer might be prevented, papers on research projects similar lines were a novelty - this being the reaction to the paper from Claus and Marjorie Bahnson of Jefferson Medical College, Pennsylvania. At the earlier New York conference they had described "repeated findings that cancer patients tend to deny and repress conflictual impulses and emotions, to a higher degree than do other people"; now, they reported that they had been able correctly to identify which patients had, and which did not have, cancer, in eighty percent of cases, simply by examining the answers the group had given to a questionnaire about their life experiences and emotional problems. 

If epidemiological research had revealed that, say, two out of three of a group of cancer patients had had a lifetime preference for tea at breakfast, while two-thirds of the controls had always drunk coffee, work would have immediately begun to isolate the carcinogen in tea-leaves. Research into cancer-prone personalities offered no such prospects, and the prejudice remained against psychosomatic research as such as Theodore Miller noted in his James Ewing Lecture to the Soceity of Surgical Oncology in New York in 1977. When he had mentioned to his wife that he proposed to talk about psychophysiological aspects of cancer, Miller - Professor of Surgery at Cornell told his audience, her reaction had been to warn him that he "had better not go around saying that cancer is a psychosomatic disease", and he was well aware that "trying to convince the members of this society that cancer has a psychosomatic basis would be like trying to convert a bunch of lions into a life of vegetarianism". Nevertheless he found a couple of 100 references in the medical literature to the relationship of personality and the emotions of tumor growth, and because he had himself realized that only patients who were optimistic about their prospects benefited from surgery, he would no longer operate on any patient "who expresses the fear that he would not survive in the operation". He had also found that recurrence of cancer often followed a year or so after some emotional crisis. The influence was not necessarily exercised by some abstract ghost-in-the-machine creating the cancer: the psychosomatic effects could be connected with hormonal activity. However it might operate, "we have enough evidence to warrant further investigation and application, both in the laboratory and in the clinic". 

As Miller had realized, what was remarkable about the evidence for a cancer-prone personality type was its consistency, whether its source was a life-time of observation or epidemiological research. Summing it up in 1977 Kenneth Pelletier, Director of the Psychosomatic Medicine Center at Gladman Memorial Hospital in Berkley, California, listed the most common emotional risk factors: a severe disturbance in childhood, leading to a sense of loss and insecurity, and a subsequent disposition to bottle up feelings- particularly of hostility. In middle life, such people might achieve healthy relationships, fall in love, and enjoy a stable marriage; often they are regarded by their friends "as exceptionally fine, thoughtful, gentle, uncomplaining people". But when their stability is again threatened, by marital or work problems, the death of a spouse of retirement, the old self-doubt returns. "With a high degree of predictability, such individuals are found to succumb to cancer within six months to a year". 

Impressive though Pelletier's documentation was, it had no more effect on the medical profession than had Kissen's pioneering work, and the only attention that had received in any of the leading medical journals, Greer lamented in a paper in Psychological Medicine in 1979, had been the single Lancet editorial thirteen years earlier. His comment at least goaded the Lancet to go over the ground again in another editorial, but this time with a difference. 

The research in the 1960s had been primarily designed to discover what connection, if any, there might be between personality types, stress-inducing occasions, and cancer. In the 1970s the emphasis had shifted to finding ways to apply the knowledge gained in order to exploit it for prevention and treatment: in particular, seeking to stimulate the imagination along the lines of Schultz had pioneered with his form of biofeedback half a century earlier. The "Simonton husband and wife time", the editorial explained, were trying to stimulate their patients' imaginations, training them to "picture their tumors being overcome by the body's defences". A few years earlier such a notion would have been referred to only excite derision, but the discoveries in connection with biofeedback, and the subsequent revelations about the influence of the emotions on hormonal and biochemical processes had bred caution.

Saturday, July 22, 2017

"On Living and Dying Well" : Reflections on the Panel Discussion

On 19th July 2017, I attended a Panel Discussion held at TERI, Bangalore. The theme of the discussion was: "On Living and Dying Well:Important questions and conversations between generations". The discussion was scheduled to start at 6:30pm in evening; I reached TERI at 6:50pm. (I should have started earlier). 

The auditorium at TERI was jam-packed, it was a small auditorium. Cautious not to disturb the already seated people by walking in between the chairs, I carefully ensconced myself on the stairway, adjacent to the row end making self comfortable on the carpet. There were old people all around, adults, ladies, men, grandparents; basically I was the youngest, second only to a small kid. Quickly after coming I began to make sense of what the speaker (Mr. Kishore S Rao) was purveying. Slowly, I began to understand what was being discussed, not completely but I could make out what the discussion was about. The discussion reminded me of Atul Gawande's book - "Being Mortal". Yes, the talk was about "End of Life Care", EOLC. 

There was discussion on "Advanced Directives". I had heard the term for the first time. For those who do not know what that is, allow me to put a brief definition: "An advance directive is a document by which a person makes provision for health care decisions in the event that, in the future, he/she becomes unable to make those decisions." For more please read: http://www.patientsrightscouncil.org/site/advance-directives-definitions/ .There were discussions on "withholding" and "withdrawing" care. Simply speaking, the panel discussion was about questions of health care and health when we become old. There were questions floating all over like: "Who will take decisions on a person's behalf when he/she is no longer able to?", "In which cases should the treatment be stopped?", "What decision should be taken at the most critical moments?", "How would I want to die, with six tubes in and two tubes out or I'd rather die consciously while suffering?", "What to do when the family is pressing for a ventilator and the doctor feels otherwise?", "What to do if the two sons of the father are divided on the decision to be taken, what does the doctor do then?", "What about patient autonomy?", "What to do if the person is Christian and his partner Muslim and he knows that there is going to be an altercation on the mode of last rites after his departure?". These are just few of the many questions that formed a vast nebula in the auditorium. I was quietly trying to make sense of all that was being said, questioned and posited. I never knew this discussion was so important. 

There was also a categorical suggestion that parents must discuss "How I'd like to die?" with their children, stating clearly what they want and much more clearly what they do not want. The speakers mentioned that one must discuss without any hesitation with their family members about their deaths, about degree and mode of treatments in their twilight years, about medical intervention or no medical intervention etc. One of the speakers also mentioned that in his discussion with his children he told them, "I do not want to be put on a ventilator. Keep us comfortable. Let us depart peacefully". He alluded to a text in literature whose import is something like this, "Dear Lord, bless me in such a way that when I leave I am conscious, conscious so that I can thank you one last time as I start for the Heavenly abode". Profound! That really sent some sort of vibration inside of me - "keeping Lord's name on lips as the lips prepare to freeze forever". I never knew such kind of discussion is important, I am not sure if I really feel that even now. But there is one thing that really does seems congruent to my line of thought, the fact that at the most vulnerable point of life in someone's life, when the person is physically weak, emotionally vulnerable, may be too much of lancets, tubes, machines and a struggle to save the person might defeat the purpose and only emaciate him further spiritually. One must be allowed to die with dignity. 

"Dying with dignity" reminds me of my grandfather who passed away when he was around 67 years of age. He was admitted at AIIMS, and one evening my doctor called my father and told him that he can be taken back to his village for he will not survive any longer. My father immediately acted on it,  me and my brother were having exams during that time in school. It was hardly two days after my father and grandfather had reached our village in Bhopal that my mother got a call from my father. Our grandfather had died surrounded by all family members in the village, all kith and kin, far and near ones, the entire community was around him as he bid good bye to all of us. The next moment we were in train on our way to Bhopal, four of us, me, my brother, our infant sister and our mother. Devoid of having seen or felt what a grandmother's love looks like, our grandfather also left us before we could make sense of what having a grandfather really meant. But he wanted live, that's what he kept on saying to my father, "Pappu, save me". As much as my father would have wanted to, he could not, it was terminal cancer. He died with peace and with the name of Lord on his lips. This is the closest I have been to death so far. I never had tears in my eyes back then we he left, but every time I think about him in my growing years it is hard not to have wet eyes and a choked throat. 

So, in a way panel discussion was an important lecture which I could not have missed. It also talked about adults having discussion in their families about institutionalization for care. Often due to a, "false sense of guilt" in Indian society or the fear of what society would say, people dread sending their parents to old age homes. There was a discussion on that also. It is tough to arrive at a universal consensus on this for every case is different, but the speakers had stated that rather than be led by society one must be led by the preferences of person in need of care/help/medical support. One of the speakers was a General Surgeon (Dr. Srinagesh Simha), who was very articulate in the way he made the audience understand the nuances of "End of life care". His one statement reverberates in my mind even now, "Doctors should treat the patient and not the relatives' anxieties". Often times, relatives and the close family members create a difficult situation for the doctor in which he feels paralyzed to take the decision, this should be avoided and the doctor trusted. Given the critical moment of the situation, rather than fighting or exhibiting, "who cares more", the time is to take decision with an objective mind such the patient's dignity is maintained. Mr. Kishore narrated an incidence in which the patient's worry was not whether he'll be able to live further but his deep fear was that the family will be divided on the decision as to which religion to follow for the last rites. He was a Christian, while his wife a Muslim. In India this is a BIG problem and a BIGGER debate.  This dilemma was skilfully handled by the doctors; the two families were asked to come at disparate times to see the patient after he died. There are many other stories and many other issues and confusions regarding EOLC, every case is different.

The speakers also mentioned that their experiences tell them that poor people are still easy to handle as compared to the rich ones. The poor men believe in what the doctor says and acknowledge them, while the rich ones can be imposing, disrespectful and a threat sometimes so much so that the doctor can be coerced to take the action those rich ones are commanding in order to prevent jeopardizing the hospital and his practice, lest there should be a case filed against him. In such situations the doctor is on the horn's dilemma. 

Thus, the panel discussion was a good investment of my evening. I did learn a lot and now I acknowledge that discussion about death is important. I have many times asked myself, "How I would like to die?" even before I attended this lecture (there are times when we do think about our death and deaths of our close ones), and surprisingly there has always been one answer. I would want to die peacefully, as swiftly as the sun rises amidst the darkest hours of the night, as naturally as the petals of a flower bloom in the sunshine, as happily as I am today that I am alive and breathing, walking, writing, talking, seeing, hearing and feeling. I would like to die peacefully and quietly in my research chamber surrounded by books and my diaries, with the thought of my parents in my heart.

This post would be incomplete if I do not thank Uma Chandru due to whom I could attend this lecture, thank you Uma. You teach me how important unconditional knowledge sharing is.

Disclaimer: The thoughts presented in the article are personal and do not bear any association with any Organization, Person or Community. Corrections and amendments are always welcome.

Monday, June 26, 2017

Cross-questionings

This blogpost is inspired from an article I read in the May-June 2017 issue of the magazine "Diabetic Living". The article led me to deep introspection and there were a number of points that stoked the ego of the fitness-freak in me and also stimulated the advocate of physical activity in me. Some facts stipulated in the article left me bewildered and some left me with questions many in number. Few seemed incredible and the rest scientific and concept-wise knowledge imparting. 

The title of the article was - WEIGHT LOSS SURGERIES : What you need to know now. 
I will take the article statement by statement and express my personal opinions, few statements of course. These are not meant to offend anyone or disrespect the contributors of this information in this magazine, but these are my views that came up to me as I read the article. One can assume that my opinions are manifestations of my curious nature to know about the labyrinth of diabetes. 

According to the American Society for Metabolic and Bariatric Surgery (ASMBS), surgery can improve type 2 diabetes in 90% of patients and cause remission of type 2 diabetes in 78% of them. 

Ok. So far so good. I wonder however, the implication of this independent claim. Since we know multiple ways in which the diabetic condition can be improved in people, wouldn't it have been more information-giving to readers had a comparison been presented? A table may be? 

In fact, weight loss surgery is now considered a standard treatment option for people with type 2 diabetes based on a joint statement of 45 international professional organizations. (some big organizations name list)

Interesting! Standard treatment option for people with type 2 diabetes!! Is it considered standard for it fetches huge money or because of its fast-forward nature of treatment or for the sustenance of the solutions? Am I the only one who feels an analogy of chemotherapy here? 

Bariatric and metabolic surgeries have become more common, given the success rates in helping people lose weight and improve their diabetes. For some morbidly obese people with diabetes, surgery is the best option. But research is also beginning to show it could also help people with prediabetes or type 2 diabetes in less-dire circumstances.  

Okay, let's go line by line here. The first line states that the surgeries are becoming more common, given the success rates in helping people lose weight and improve diabetes. Where are the success rates of lifestyle interventions? "Common" is a very abstract term. Diabetes is a serious issue and sending out the message that "surgeries are becoming common" to people who live in apprehension with diabetes , much worse, who cannot afford surgeries, what about them? This headlong advocating of surgeries is a recipe for people forgetting that their health is in their hands and in wise decisions. Besides, should not we be working with people to prevent them from becoming "morbidly obese" rather than broadcasting in broad day light that surgery is the best option for those who already are morbidly obese? Isn't there a lack of focus here? In a way the second lines seems to be saying that, "Go on, become morbidly obese, there is nothing to fear, you can always get a surgery done". I mean, why such a subtle promotion of surgeries? I would want to know the statistical comparison which led to this conclusion of "best option". And the most insidious sentence is the last one. Until now, surgery was limited to people with "morbid obesity" and now it intends to lay its hands over prediabetes and diabetes for which research is abound citing the benefits of lifestyle interventions. But I know, I think I understand why such "quick-fix" solutions steal all the limelight away. It is not rocket science! They steal away the limelight because people are looking for fast solutions, to get rid of their conditions, to get rid of the health outcomes that took some time to manifest and they want to obliterate it within few hours in operation theatres. People and their propensity to get immediate gratification is driving these surgeries. Now, I know, everyone wants to get cured fast, it is human and I do not question the nature of this feeling, I respect it. However, would not it be wise to save all that money and rather invest it in your healthy eating before you become morbidly obese & ready to go under knife? Healthy eating costs much less than the cost of operations and surgeries, isn't it? And No! We do not want surgeries to annex prediabetes, please. That would be too much of medically uncalled for intervention. 
In fact, these procedures and surgeries may be offered to more people in the future, says Suneil Koliwad, M.D., Ph.D., assistant professor in the Diabetes Center at the University of California San Francisco. Obese people are experiencing improvements in blood sugar control right after surgery. This suggests that the surgery itself, not just the subsequent weight loss, can help people with their diabetes. 

So, that is what Diabetes Research Centers at UCSF are doing? Curative research? How many people can pay for these procedures and surgeries? Much less than those afflicted with diabetes. "Right after the surgery" improvements - the main driver for the bariatric surgery operations! I believe we have become so hedonistic when it comes to food that we are okay with coming under knives and reduce our weight rather than exercise some restrain and discipline and let the weight manage it itself. Appalls me, terribly. The kind of message that is being conveyed is unsustainable, threatening to the health economy of the nations and might seem to provide some soothe in short term but is not at all helpful in making the 19 years old kids active whose activity levels match those of 60 years old. Do I smell, "inverse care law" here?
Some experts now suggest people with diabetes could still benefit from the surgery's effect on their blood sugar levels, even if they don't meet the obesity requirements currently recommended for surgery. 

Is this good news? Or is it a bait to attract helpless people, those fearing diabetic neuropathy, diabetic nepropathy, diabetic retinopathy or amputations? Would not it be more sustainable and promising to teach people , "how to fish rather than giving them a fish"? We cannot grow treating the symptoms, we have to attack the root cause and the root cause lies in the behavior of people. Behavioral change is more challenging but sustainable. We need to promote those stories !! Where are they?

Also consider the importance of good postoperative care. It's vital to a surgery's success, including resources such as support groups to help you cope with side effects and to teach how to eat appropriately. You will have to eat differently for the rest of your life. 

This is an interesting sentence. I wonder  we never paid attention to pre-operative precautions, interventions (well not that much as surgeries) and if we had may be we could have a clause that, "If you do not see changes in this amount of time, we will go ahead with surgery". "How to eat properly", when a man or a woman can follow this advise after the operation or a surgery, can't he/she be counseled to do exactly the same before surgery? Won't that be more effective and save his finances? But yeah, medical industry thrives on sickness. 
The magazine left me with loads of information. But it also left me with a lot of fodder to ponder upon. And now I know what I have to do. Research on Metabolic and Bariatric surgeries!! 

As for those who read this post, I just want to say one simple thing: 
"If Exercise were a medicine, it would be have been the most expensive one. It's time to take ownership of your health"

Love & Blessings.