The Cure Within

A book I must get hold of - Anne Harrington's The Cure Within: A History of Mind-Body Medicine.

Here's a review.

Some BBC and Science Blog articles

A note of some pages of relevant research mentioned by the BBC:

How emotional pain can really hurt:

New brain scanning technologies are revealing that the part of the brain that processes physical pain also deals with emotional pain.

And in the same way that in some people injury can cause long-lasting chronic pain, science now reveals why some will never get over such heartbreak.

Autism parents 'infection risk'

Caring for children with developmental problems such as autism or Down's syndrome can weaken parents' immune systems, research suggests.

Researchers at Birmingham University found they had a poorer immune response to a vaccine against pneumonia.

Anti-depressants' 'little effect'

New generation anti-depressants have little clinical benefit for most patients, research suggests.

A University of Hull team concluded the drugs actively help only a small group of the most severely depressed.

Drugs for ADHD 'not the answer'

Treating children who have Attention Deficit Hyperactivity Disorder (ADHD) with drugs is not effective in the long-term, research has shown.

A study obtained by the BBC's Panorama programme says drugs such as Ritalin and Concerta work no better than therapy after three years of treatment.

The findings by an influential US study also suggested long-term use of the drugs could stunt children's growth.

It said that the benefits of drugs had previously been exaggerated.

Stressed parents 'make kids ill'

Parents with stressful lives may be making their children as well as themselves vulnerable to illness, research suggests.

A University of Rochester study, reported by New Scientist, found sickness levels were higher in children of anxious or depressed parents.

It also found links between stress and immune system activity in the children.

'Healthier hearts' for cat owners

Cat owners appear to have a much lower risk of dying from a heart attack than their feline-spurning counterparts, a study suggests.

Researchers looked at nearly 4,500 adults and found that cat ownership was related to a 40% lower risk of suffering a fatal heart attack.

And some stories from Science Blog,

Abused kids lose two years quality of life

Childhood maltreatment—which includes physical, sexual and emotional abuse and neglect—has been linked to an increased risk for ailments ranging from heart disease, obesity and diabetes to depression and anxiety. Corso said there are two reasons why. First, childhood maltreatment increases the likelihood of unhealthy behaviors such as smoking, substance abuse and sexual promiscuity. And recent studies suggest that repeated exposure to the stress caused by maltreatment alters brain circuits and hormonal systems, which puts victims at greater risk of chronic health problems.

Stress cuts blood flow to heart in patients with gene variation

University of Florida researchers have identified a gene variation in heart disease patients who appear especially vulnerable to the physical effects of mental stress — to the point where blood flow to the heart is greatly reduced.

Fear that freezes the blood in your veins

"The blood froze in my veins" or "My blood curdled" – these common figures of speech can be taken literally, according to the latest studies. Indeed, more literally than some of us would like. For it turns out that intense fear and panic attacks can really make our blood clot and increase the risk of thrombosis or heart attack.

Immune system may target some brain synapses

A baby's brain has a lot of work to do, growing more neurons and connections. Later, a growing child's brain begins to pare down these connections until it develops into the streamlined brain of an adult.

Now researchers at the Stanford University School of Medicine have discovered the sculptor behind that paring process: the immune system.

Theoretical Medicine and Bioethics

I've only just realised that I have access to the journal Theoretical Medicine and Bioethics, a treasure trove of interesting articles. For example from Volume 19, Number 3 / June, 1998 we have Norbert Paul:

Incurable suffering from the “hiatus theoreticus”? Some epistemological problems in modern medicine and the clinical relevance of philosophy of medicine.

And from the next issue, Volume 19, Number 4 / August, 1998, we have Edmund Pellegrino

What the Philosophy Of Medicine Is.

Essential reading when I finally get around to preparing my Philosophy of Medicine course.

Our Genes are Not Our Fate

Dean Ornish tells us in 3 minutes how lifestyle matters.

Two items

Posting has been terribly thin of late. I've swung back for a time to my mathematical phase.

We have sold the translation rights to the book to publishers from four countries - Finland, Japan, Portugal and Brazil. The Portuguese edition - Porque Adoecemos? - looks like this.

Mind, the mental health charity, shortlisted us for their Book of the Year.

The Risks of Football

A report into the risks of watching football:

Ute Wilbert-Lampen et al. Cardiovascular Events during World Cup Soccer, The New England Journal of Medicine, Volume 358(5): 475-483, Jan 31, 2008.

Viewing a stressful soccer match more than doubles the risk of an acute cardiovascular event. In view of this excess risk, particularly in men with known coronary heart disease, preventive measures are urgently needed.

and BBC report.

Interesting to see that immune system cell functioning is suggested as a possible mechanism. From our research, this struck us as highly relevant in many cases of chronic heart disease.

It's also worth thinking about why people get so emotionally involved in football matches. Perhaps Nick Hornby's Fever Pitch offers the best insight from fiction.

Anger and wound healing

We've discussed wound healing before. Now more interesting research from the laboratory of Kiecolt-Glaser in Ohio State University.

Gouin, J.-P. et al., The influence of anger expression on wound healing, Brain Behav. Immun. (2007) doi:10.1016/j.bbi.2007.10.013.

Abstract:
Certain patterns of anger expression have been associated with maladaptive alterations in cortisol secretion, immune functioning, and surgical recovery. We hypothesized that outward and inward anger expression and lack of anger control would be associated with delayed wound healing. A sample of 98 community-dwelling participants received standardized blister wounds on their non-dominant forearm. After blistering, the wounds were monitored daily for 8 days to assess speed of repair. Logistic regression was used to distinguish fast and slow healers based on their anger expression pattern. Individuals exhibiting lower levels of anger control were more likely to be categorized as slow healers. The anger control variable predicted wound repair over and above differences in hostility, negative affectivity, social support, and health behaviors. Furthermore, participants with lower levels of anger control exhibited higher cortisol reactivity during the blistering procedure. This enhanced cortisol secretion was in turn related to longer time to heal. These findings suggest that the ability to regulate the expression of one’s anger has a clinically relevant impact on wound healing.

They conclude

...this is the first study showing that difficulty in anger regulation can lead to delayed healing. Furthermore, an exacerbated cortisol response to stress appears to explain the relationship between lower anger control and wound repair, although other physiological pathways may mediate the association between anger regulation and healing.

Media report here.

Whitehall Revisited

More on the health of Whitehall Civil Servants (article, BBC report):

This study adds to the evidence that the work stress–CHD association is causal in nature. We demonstrate, within a population of office staff largely unexposed to physical occupational hazards, a prospective dose–response relation between psychosocial stress at work and CHD over 12 years of follow-up. We confirm, during the same exposure period, the plausibility of the proposed pathways involving behavioural mechanisms, neuroendocrine and autonomic activation, and development of risk factor clustering, represented by the metabolic syndrome. Further, those who are older (and are more likely to be retired and less exposed to work stress) are less susceptible to the work psychosocial effect, presenting a coherent pattern in our findings. This study demonstrates that stress at work can lead to CHD through direct activation of neuroendocrine stress pathways and indirectly through health behaviours.

This is part of the Whitehall II study, which I've mentioned before. Long-term, large-scale, prospective studies of this kind are, of course, very welcome. But naturally we'd like to see these balanced by lifelong individual studies, so that we can get beyond the non-specificity of the stress construct.

The New Black

Apparently, 44 is the age at which we're most vulnerable to depression. That gives me 6 months to put up the defences. Something I might do is to (re-)read Darian's book - The New Black: Mourning, Melancholia and Depression - which appears on Thursday.

The publisher's (Hamish Hamilton) blurb:

What happens when we lose someone we love? A death, a separation or the break-up of a relationship are some of the hardest times we have to live through. We may fall into a nightmare of depression, lose the will to live and see no hope for the future. What matters at this crucial point is whether or not we are able to mourn.

In this important and groundbreaking book, acclaimed psychoanalyst and writer Darian Leader urges us to look beyond the catch-all concept of depression to explore the deeper, unconscious ways in which we respond to the experience of loss. In so doing, we can loosen the grip it may have upon our lives.

Pain and fortitude

Yesterday I went under general anaesthetic for the first time, to have a dental cyst removed. While waiting to be called to the theatre I read these comforting words by the great Oxford philosopher, R. G. Collingwood:

I would go so far with the hedonist as to say that anything good is pleasant. Any activity which I definitely choose to go in for, so far as my experience goes, yields me feelings among which there is pleasure, And I will add that although the pleasure sometimes comes as a surprise, a by-product which I had not expected, this happens more and more rarely as I become more and more experienced and acquire (as I hope I do acquire) more and more savoir vivre. Experience of life teaches me to expect the unexpected; in this case, to expect that I shall get pleasure out of things which, if I had been less experienced, I should not have thought likely to prove pleasant. A child may undergo dental surgery and find little in it except pain; when more advanced in years, he will find that bearing the pain gives him a curious and seemingly perverse but unmistakable pleasure; still later, he may learn to expect and reckon on the pleasure. This is not masochism. It is not a pathological enjoyment of merely being hurt. Being hurt is one thing; fortitude under pain is another. So the masochistic enjoyment of pain is one thing; the pleasure of finding that a certain degree of pain does not destroy one's fortitude is another. (pp. 426-7, 'Goodness, Rightness, Utility', The New Leviathan, Clarenden Press 1992)

With modern anaesthetics and pain-killers, in my case little fortitude was required.

Shadows in Wonderland

From the press release of a book coming out next month:

When television producer Colin Ludlow is admitted to hospital for an operation, he expects to be home in ten days. In the event, he ends up staying for five months, nearly dies on several occasions, contracts MRSA and is still recovering from his operation more than four years later.

His perceptive and frightening new book - said to be ‘memorable’ by The Bookseller - Shadows in Wonderland: A Hospital Odyssey is a moving account of how Ludlow pieces together the shattered fragments of his life and seeks to make sense of them again.

Shadows in Wonderland does not only recount Ludlow’s personal struggle for his health in many poignant passages:

“In the days following my surgery, I have a series of unexpected complications and my temperature soars. Eventually I am carted off to the hospital’s Intensive Therapy Unit where I spend several days unconscious on a ventilator. I have a second operation and then suffer massive internal haemorrhaging. Over one tumultuous weekend, I am given 45 units of blood in transfusions. Eventually, the doctors decide to try a rare clotting agent in a desperate attempt to staunch my bleeding, and Anna is told that if this fails to work by the second dose then there is no further hope for me. My children respond to the warning of my imminent death with storm-hardened calm. They are used to grim news by now.”

The book also takes a philosophical and questioning journey through chronic illness as Ludlow explores its wider significance. It is the record of a quest - which we all face - for health and wholeness in a fractured, disjointed world.

In the account of his blistering experience with chronic illness and the NHS Colin Ludlow manages to write masterfully and credibly about the institution, the culture and its history. With its amalgam of one man’s heart-rending experience within the NHS and its illuminating, witty digressions on the place of hospitals and health within Western society, Shadows in Wonderland enlarges our understanding of how it feels to become a long-term hospital patient.

Colin Ludlow also runs a blog.

Placebos and body shape

My friend John Baez pointed me to an interesting news story. This reports research on the effects of explaining to hotel maids that they do more exercise than the recommended daily amount. The odd thing is that many such workers' bodies don't reflect this physical activity, and at the same time they report themselves as doing little exercise. When one randomly selected group had the truth explained to them, there was a decrease in their weight and waist-to-hip ratio - and a 10 percent drop in blood pressure.

Naturally, one might think that this information must have altered other aspects of the maids' lives. Perhaps they were now behaving in a healthier way. An expert is wheeled in to suggest this must be so as the placebo effect only alters subjective aspects of health.

With all the evidence available (some touched on here, here, and here), could it be that the belief that placebos only effect one subjectively is a defense against the troubling thought that language can have an effect on our body?