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Mind-Over-Matter In Medicine

[Recently] I came upon a Jan 24 op-ed, “A Fighting Spirit Won’t Change Your Life” by Richard Sloan, Ph.D., of Columbia University’s psychiatry department. Somehow I’d missed this worthwhile piece on the sometimes-trendy notion of mind-over-matter in healing and medicine.

Sloan opens with aftermath of the Tucson shootings:

…Representative Giffords’s husband describes her as a “fighter,” and no doubt she is one. Whether her recovery has anything to do with a fighting spirit, however, is another matter entirely.

He jumps quickly through a history of the mind cure movement in America: From Phineas Quimby’s concept of illness as a product of mistaken beliefs — to William James and “New Thought” ideas — to Norman Vincent Peale’s 1952 “Power of Positive Thinking“ – to more current takes on the matter. These ideas, while popular, are not reality-based.

In his words:

But there’s no evidence to back up the idea that an upbeat attitude can prevent any illness or help someone recover from one more readily. On the contrary, a recently completed study* of nearly 60,000 people in Finland and Sweden who were followed for almost 30 years found no significant association between personality traits and the likelihood of developing or surviving cancer. Cancer doesn’t care if we’re good or bad, virtuous or vicious, compassionate or inconsiderate. Neither does heart disease or AIDS or any other illness or injury.

*Am. J. Epidemiol. (2010) 172 (4): 377–385.

The New York Times printed several letters in response, most of which point to pseudo-evidence on the matter. All the more reason to bolster public education in the U.S. — people won’t be persuaded by charismatic, wishful thinking about healthcare.

It happens I’m a fan of Joan Didion’s. I was so taken by the “Year of Magical Thinking,” in fact, that I read it twice. Irrational responses — and hope — are normal human responses to illness, disappointment, and personal loss. But they’re not science. It’s important to keep it straight.

*This blog post was originally published at Medical Lessons*

Magical Thinking Of The Week: The Anti-Inflammation Diet

Alternative medicine practitioners love to coin magic words, but really, how can you blame them? Real medicine has a Clarkeian quality to it*; it’s so successful, it seems like magic. But real doctors know that there is nothing magic about it. The “magic” is based on hard work, sound scientific principles, and years of study.

Magic words are great. Terms like mindfulness, functional medicine, or endocrine disruptors take a complicated problem and create a simple but false answer with no real data to back it up. More often than not, the magic word is the invention of a single person who had a really interesting idea, but lacked the intellectual capacity or honesty to flesh it out. Magic is, ultimately, a lie of sorts. As TAM 7 demonstrates, many magicians are skeptics, and vice versa. In interviews, magicians will often say that they came to skepticism when the learned just how easy it is to deceive people. Magic words in alternative medicine aren’t sleight-of-hand, but sleight-of-mind, playing on people’s hopes and fears.

A reader has turned me on to another magic word I hadn’t known about. It’s called the “Inflammation Factor”, and is the invention of a nutritionist named Monica Reinagel. Like most good lies, this one builds on a nidus of truth.

Inflammation is a medical term that refers to a host of complex physiologic processes mediated by the immune system. Inflammation gets its ancient name from the obvious physical signs of inflammation: rubor, calor, dolor, tumor, or redness, heat, pain, and swelling. As the vitalistic ancient medical beliefs bowed to modern science, inflammation was recognized to be far more complex than just these four external characteristics. In addition to being a response to injury and disease, the cellular and chemical responses of inflammation can cause disease. For example, in asthma and food allergies, a type of immune reaction called type I hypersensitivity elicits a harmful type of inflammation. Coronary heart disease, the biggest killer of Americans, is believed to have a significant inflammatory component.

But nothing in medicine is perfectly simple. For example, corticosteroids, which can be used effectively to treat the inflammation in asthma are not effective against the inflammation in cororary heart disease. It’s just not that simple.

But while inflammation may not be that simple, people can be. People want easy answers, and quacks are happy to step in to provide them.

So Ms Reinagel has invented a diet, available for sale in a book called The Inflammation Free Diet Plan. Her premise is that inflammation is at the root of all major diseases, and that your diet can affect inflammation, thereby improving your health.

While the hypothesis is intriguing, each step of the argument has problems, leading to an invalid conclusion.

Inflammation is the root of all disease

No, it’s not. “Inflammation”, which is actually refers to a lot of different processes, plays an important role in many diseases. But not all inflammation is the same.

The most important factor in fighting inflammation is the food you eat every day.

Um, no. If you have a staph infection on your arm, your eating habits will not change the amount of heat, pain, swelling, or redness. The kernel of truth here is that diet can affect various measures of inflammation, such as C-reactive protein (here is one of many examples). There’s a long leap between this fact and the conclusion that diet can “stop inflammation”.

The benefits of reducing inflammation are immediate as well as long term. You’ll notice that your skin looks younger, your joints feel better, and your allergy symptoms improve. At the same time, when you reduce inflammation, you also reduce your risk of heart disease, Alzheimer’s disease, cancer, osteoporosis, diabetes, and other complications of aging.

It’s a very long walk from the claim that reducing inflammation is “a good thing” to proving that your particular diet reduces inflammation and thereby improves health . A hypothesis is not true simply because it sounds pretty.

Who wouldn’t love a magic book that would prevent and cure all illness? Perhaps you’ve noticed that these books come along every few months. None of them ever has the one true answer. Life is much more complicated and beautiful than any magic book. It may be a lot more difficult to commit science than to commit quackery, but in the end it’s a lot more satisfying and a lot more useful.

_________________________
*”Any sufficiently advanced technology is indistinguishable from magic.” –Arthur C. Clarke’s Third Law

*This blog post was originally published at Science-Based Medicine*

James Randi And The Psychology Of Magical Thinking

skepticsjamesrandiJames Randi, perhaps better known as “The Amazing Randi” has spent most of his life performing magic shows. In 1996 he created the James Randi Educational Foundation (JREF) designed to expose the fraudulent claims made by psychics, faith healers, and snake oil salesmen. The ultimate goal of the JREF is to create a new generation of critical thinkers – people who will not be hoodwinked by the aforementioned hucksters.

I had the good fortune of interviewing Mr. Randi briefly at the recent conference known as “The Amazing Meeting.” I was eager to pick his brain about human behavior and magical thinking. This is what I learned…

Randi identified certain groups of people who seem to be more susceptible to magical thinking and/or belief in the paranormal. According to him, the top two are:

1. News reporters. Although at first I wasn’t sure if Randi meant that reporters like a good story versus they believe a good story – he told me that in his experience, they were some of the most gullible people on earth. In fact, they were more interested in implausible stories than true ones – and Randi said that the more fantastical his explanation for phenomena, the more likely they were to believe it and write about it.

2. Academics. This surprised me since I assumed that this group would actually be less susceptible. Randi suggested that they are more likely to be taken in because they are single-minded about phenomena. They are over confident in their ability to understand how things work, and when something cannot be explained in their framework, they’re willing to attribute it to the paranormal.

Who are the least susceptible? Children. Why? Because they are simple thinkers, and harder to distract. The art of magic is in distraction of the sophisticated mind. Children tend to be very concrete, so they don’t expect things to happen with hand-waving and flourishes. They keep their eye on the coin (or other item being transferred from hand to hand), and are more likely to know where it is at all times.

To wrap up our short interview, I asked Randi if he could explain why people believe in magic, fantasy, and the paranormal? He responded simply:

Ultimately it’s not about intelligence or lack thereof. It’s about people not wanting to accept that life is random, suffering is inevitable, and there is no good reason for bad things happening.

What do you make of Randi’s observations?

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