Category Archives: Health

Phantoms of Pain

One of the more interesting lessons from modern neuroscience and psychology is, I think, the idea that we don’t perceive reality as much as we create it. By this I don’t mean that there is no real reality and that “it’s all in our heads, man” but rather that we get incoming sensory data through our eyes, ears, nose, etc. and our brain then assembles that data into something we can subjectively experience. Of course, sometimes the assembly isn’t perfect—that’s what hallucinations, tricks of light, etc. are.

I was thinking about how certain kinds of pain are perceived differently than most perceptions. With most perceptions we can kind of check one sensory organ’s take on things by comparing it with another. For example, I hear an owl and look up and, yep, there’s an owl. My sight backs up my hearing. Or I see a coffee cup and reach out and grab it. My touch backs up my sight.

With certain kinds of pain, however, this isn’t possible. I feel some internal pain and… well I can’t “double-check” whether it’s real in any way (aside from going to the doctor and having him do an x-ray or something but even that is no guarantee. And the pain is likely gone by that point.) Internal aches and pains are sort of floaty sensations that come and go on a whim. It’s hard to validate them.

Thus I wonder if many of these pains are hallucinatory in some sense. I recall an article in the New York Review of Books where the author reported getting a call from his doctor that he might have cancer in his ribs. As he waited a few days for confirmation, he started to feel pain in his ribs. As it turned out, he didn’t have cancer. That pain seemingly was created by his brain based on the possibility that he had cancer.

At the site Slate Star Codex, a related observation is made.

I’ve been focusing a lot lately on the idea of the Bayesian brain and its input channels. Some input channels, like vision, are high-bandwidth; we get so much data about the real world that (optical illusions and PARIS IN THE THE SPRINGTIME signs aside) we usually see pretty much what is really there.
Other channels, like pain, are low bandwidth. This is why the placebo effect works – we get so little data about how much pain is coming from different parts of our bodies that even our strongest percepts are wild guesses, where we fill in the gaps with predictions and smooth away conflicting evidence. If our predictions change – ie we know we just got morphine and morphine lowers pain – then the brain will happily change its guesses. This would never happen with vision – I can’t use the placebo effect to make you think an orange crayon is blue – but pain is low-bandwidth enough that it works.

This would also seem to tie in with V.S. Ramachandran’s treatment for phantom limb pain.

Can we hack our way to affordable medicine?

We are, of course, in the middle of a possible Obamacare recall, and the subject of health insurance is in everyone’s minds. It struck me the other day that we wouldn’t really need health insurance if medical care was simply cheap. I mean really, really cheap. Like, what if cancer drugs were 20 bucks for a six month supply? What if eye surgery was 150$?

Is such a thing possible? Beats me; I basically made those numbers up. But it does strike me that in this age of automation and AI, as well as easy distribution of information, there must be ways to drive the cost of medicine down. I keep hearing about robotic surgery, for example. Could we use deep learning technology to enable robot surgeons to learn from each surgery they perform thereby becoming better and better surgeons. As a result, training a new surgeon would not be a matter of pushing some human through eight years of school, but simply copying a program. (I’m aware it’s more complicated than I make it seem, but I don’t think the idea is crazy.) Could we at least have this as an option, so that a doctor could say, “we need to cut your tumor out. You can pay this human surgeon 100 grand to do it, or use the robo-doc for 10 grand. (Again, I’m making these numbers up.)

And let’s consider drugs. Drugs are expensive. I started wondering how hard it is to reverse engineer drugs these days. Not hard, it turns out. What’s stopping people from reverse engineering any drug and putting the recipe online (probably on the “dark web”), allowing people to mix their own versions? Well, mainly that it’s illegal. But if I had to chose between no medicine and illegal medicine I’d chose the latter.

I’m aware that there are numerous ethical and philosophical dilemmas with what I’m proposing here. I’m mainly wondering, “could this happen? Will it happen?”

It many ways this all ties in with the transhumanist movement. Transhumanism is about hacking technology (computer and biological) to improve health humans. I see no reason it can’t be done to improve sick humans.

The future of intelligence inequality

A few posts back I discussed Charles Murray’s interesting idea on the increasing role of intelligence in society. As I explained it:

[I]n earlier eras, having a bit more intelligence wasn’t that much of an advantage. If everybody was farming or doing manual labor you didn’t get much economic benefit from having an IQ of 120. But in the 20th century, being smart started to pay off big time. The rise of computers, complex physics, complex financial products etc. meant that having brains equalled power and money.

As a result, according to Murray, we’ve seen the rise of the intellectual class: smart people, usually coastal, who have segregated themselves off from the stinking, steaming masses (my words, not his.) You could reasonably make the case that the election of Donald Trump was the revenge of the great unwashed against the intellectual class.

So why should we really care? Well, many people question whether this disparity is about to get a whole lot worse. If we are on the verge of a genetic engineering revolution then the intelligent class many soon be able to become a whole lot more intelligent (and healthier, and better looking, etc.) This Vox interview with a science historian gets to the crux of it.

Well, let’s put it this way: If only rich people have access to these technologies, then we have a very big problem, because it’s going to take the kinds of inequalities that have been getting worse over recent decades, even in a rich country like ours, and make them much worse, and inscribe those inequalities into our very biology.

So it’s going to be very hard for somebody to be born poor and bootstrap themselves up into a higher position in society when the upper echelons of society are not only enjoying the privileges of health and education and housing and all that, but are bioenhancing themselves to unprecedented levels of performance. That’s going to render permanent and intractable the separation between rich and poor.

Currently, we might have a situation where some poor kid struggles to get through his computer coding class whereas a rich kid who got a Mac on his 4th birthday and had a personal tutor for years sails through it. In the future that poor kid is struggling against a rich kid who had his DNA genetically altered for high IQ (and had all the other stuff too.)

Good fucking luck, poor kid.

The vindication of John Sarno

A while back, I spent a lot of time on this blog discussing the theories of Dr. John Sarno. Sarno argues that a lot of pain, specifically back pain, is psychologically induced. This argument is obviously contentious and goes against the conventional wisdom of back doctors. Being a fan of Sarno’s ideas, I was intrigued when I saw the following headline on Vox.com

Doctors finally admit drugs can’t fix most cases of back pain

In the article, we learn that the American College of Physicians has come around to the conclusion that drugs don’t really help lower back pain, even though this type of pain is very prevalent. That, in and of itself, doesn’t really give any credence to Sarno’s claims. But check out these two paragraphs.

Obesity, being overweight, smoking, depression, and anxiety have all been linked with lower back pain. But the cause is usually more complicated. “Our best understanding of low back pain is that it is a complex, biopsychosocial condition — meaning that biological aspects like structural or anatomical causes play some role, but psychological and social factors also play a big role,” said Chou, who wrote a big evidence review that helped inform the new ACP guideline.

For example, in patients who have nearly identical results from an imaging test like an MRI, those who are depressed or unsatisfied with their jobs tend to have worse back pain than people who aren’t, Chou said. Partly for this reason, doctors don’t generally recommend doing MRIs for acute episodes of low back pain, since they can lead to overtreatment — like surgery — that also won’t improve health outcomes.

I imagine Sarno is feeling pretty vindicated right now.

(BTW, I wrote about other observations that MRIs often lead to unnecessary surgery here.)

Blood harvest

I thought I would get a little more informed about the state of life extension technology and dug up this Guardian article on various drugs and techniques being investigated. This section stands out.

One of the more unusual approaches being tested is using blood from the young to reinvigorate the old. The idea was borne out in experiments which showed blood plasma from young mice restored mental capabilities of old mice. A human trial under way is testing whether Alzhemier’s patients who receive blood transfusions from young people experience a similar effect. Tony Wyss-Coray, a researcher at Stanford leading the work, says that if it works he hopes to isolate factors in the blood that drive the effect and then try to make a drug that does a similar thing. (Since publishing his work in mice, many “healthy, very rich people” have contacted Wyss-Coray wondering if it might help them live longer.)

As I age, I often find myself looking at the supple bodies of young people and musing on how I would like to drink their blood. It’s good to see I’m not alone.

The last sentence in that quoted paragraph touches on what got me thinking about this. In some sense, death is the great equalizer. Are we about to enter an era where income inequality will correspond with lifespan inequality? Technically, I think we are already there though the disparity is minimal.

It seems a near certainty that in the future the aged wealthy will be kidnapping young people off the streets and harvesting their blood.

It’s Alive! Alive!

Lately I’ve been exploring this idea that we don’t know what consciousness is. I considered the the possibility that consciousness could be some kind of “force.” My theory was that when this force travels through a complex network, like our human brain, it/we/something experiences what we call subjective consciousness.

I also asked: could this force simply be electricity (or the electromagnetic force?) It seems all too simple and rather Frankenstein-ian. I’ve done a bit of reading and the consensus seems to be “no” though I need to read more.

One of the articles I read had some juicy tidbits on past experiments of applying electricity to the dead.

WIRED: What Happens If You Apply Electricity to the Brain of a Corpse?

In 1802, Aldini zapped the brain of a decapitated criminal by placing a metal wire into each ear and then flicking the switch on the attached rudimentary battery. “I initially observed strong contractions in all the muscles of the face, which were contorted so irregularly that they imitated the most hideous grimaces,” he wrote in his notes. “The action of the eylids was particularly marked, though less striking in the human head than in that of the ox.”

In 1803, he performed a sensational public demonstration at the Royal College of Surgeons, London, using the dead body of Thomas Forster, a murderer recently executed by hanging at Newgate. Aldini inserted conducting rods into the deceased man’s mouth, ear, and anus.
One member of the large audience later observed: “On the first application of the process to the face, the jaw of the deceased criminal began to quiver, the adjoining muscles were horribly contorted, and one eye was actually opened. In the subsequent part of the process, the right hand was raised and clenched, and the legs and thighs were set in motion. It appeared to the uninformed part of the bystanders as if the wretched man was on the eve of being restored to life.”

Narratology

Lately, I’ve become interested in the concept of narratology. Wikipedia conveniently defines it.

Narratology refers to both the theory and the study of narrative and narrative structure and the ways that these affect our perception.

As I see it, the theory of narratology lists the components of stories (themes, characters, archetypes, etc.) and also describes how stories guide or distort our perception of reality.

It’s the second part that interest me most. It’s the idea that we see the world around us and try and fit it into a narrative—a story to make sense of it all.

This certainly relates to politics and you see it now in the Trump era. Some people look at Trump and a defender of the little guy who will disrupt the corrupt powers that be. Others see a rising fascist who may destroy democracy. Obviously both groups have access same information, the same surrounding reality. How can they come to such disparate conclusions? (Additionally, both sides are manufacturing facts to support their narrative.)

This is where narratology comes in. I believe we have a story in our heads and we force what we see to fit into that narrative.

What do all good narratives need? A good guy and a bad guy. Someone to root for and someone to hate. The different groups have forced the emergence of Trump into their narrative.

(You might be asking me: what do you think of Trump? Check out my latest acid logic article for the answer. In general, I’m wary about him but doubt he’s the end of civilization.)

On a side note, I think narratology is related to health. I’m reminded of a story a friend of mine told me about his grandfather. The man walked into the ER one day, convinced something was wrong with him. He demanded the doctors check him out and they did, wearily reporting that everything was fine. The grandfather insisted it wasn’t and died that night. (I realize this anecdotal story doesn’t really prove my point, but it’s all that comes to mind right now.)

So where do these narratives—these story templates with which we generate our interpretation of reality— come from? Maybe they are, on some level, embedded in our biology. I’m pretty unclear on how this could be possible but Jung, among others, believed it. (I think he did; I’m not an expert.)

Or maybe narratives evolve and are passed culturally through Richard Dawkin’s “memes.”

For the most part, I’m wary of narratives. I think they blind us to the true nature of reality, causing us to make heroes and villains out of what are basically flawed if perhaps unusual and exceptional people. For the most part, I think our narratives fail us. (You can see this especially in numerous conspiracy theories that arise and are easily debunked yet still earn followers.)

More good news for wine and coffee lovers

A while back I began pointing out news reports that touted the health benefits of wine and coffee and other often slandered drinks. Frankly, those reports started coming so fast and furiously that I lost interest. But I recently stumbled across this report that argues wine and coffee have benefits specific to how they relate to our gut bacteria. Specifically…

Foods like fruits, vegetables, coffee, tea, wine, yogurt and buttermilk can increase the diversity of bacteria in a person’s intestines. And that diversity can help ward off illness, said Dr. Jingyuan Fu, senior author of one of the studies.

Now another idea I’ve talked about is the idea that carbs are bad. The report notes…

On the other hand, foods containing loads of simple carbohydrates appear to reduce bacterial diversity in the gut, Fu and colleagues found. These include high-fat whole milk and sugar-sweetened soda.

That’s a bit of an odd statement about milk. To my understanding, milk’s “high fatness” has nothing to do with its carb content which appears to be the problem. But I could be wrong.

Also advised: be wary of antibiotocs.

Johnson added that medicines can have the same effect, and antibiotics actually can kill off some important strains of gut bacteria. “One dose of an antibiotic may disrupt your gut bacteria for a year,” he said.

Now, I’m the first to admit that we don’t really understand the gut biome and they may be reversing all this advice in a few years, but this is what’s being said right now. And as an avid coffee and wine drinker, I couldn’t be happier (unless I had more wine.)

The new heroin epidemic?

I caught a bit of the final Democratic primary debate last night. One question popped that I was not expecting, asking what the nominees would do about the heroin epidemic.

I wasn’t aware we were in the middle of a heroin epidemic and I remember being underwhelmed by the numbers present in the last one, during the grunge-filled 90s. So what are the details? This CNN article says…

In general, drug overdose deaths have been on the rise for the past two decades, but the number of deaths from heroin use is up by 39%.

That means 5,927 people died after using heroin in 2012 and that number jumped to 8,260 deaths in 2013. Those are the latest numbers available.

And to give context…

For perspective: The number of people dying after abusing drugs is higher than the number of people killed in traffic accidents.

Well, waitasec… they mean the total number of people dying from any type of drug (not just heroin) is higher than traffic fatalities? That’s what I will presume though they never in the article actually provide that number.

Of course, if you know me, you know I feel the “let’s compare fatalities from X to traffic fatalities” to be disingenuous as traffic fatalities have gone down substantially in recent decades. (Check out the graph titled “Trends in Automobile Fatalities” on this page.) As I always say, we ought to celebrating that auto fatalities have gotten so low as opposed to using the new lower number to make comparisons.

One final ironic point made in the CNN article. Efforts to prevent people from getting legal opioids may be what driving them to heroin.

Federal, state and local governments have been cracking down on illegal prescription drug sales with some success, according to the Journal study. That may have a connection to the rise in problems with heroin.

Law enforcement has shut down many pill mills. Governments have created rules that tighten prescription practices. Drug manufacturers have been creating more abuse-deterrent versions of their drugs.

All this effort to stop prescription drug abuse has made it much more of a challenge for addicts to get their drug of choice.

That may mean they turn to heroin, a drug that gives users a similar kind of high, but can be cheaper and now may be easier to get, according to the Journal study.

The Sarno-Sacks connection

It’s been a while since I’ve written on the theories of Dr. John Sarno who argues that much of physical pain and distress is caused by the upset mind. (I have to concede I don’t really believe in a “mind” anymore, at least as an entity in any way unattached from the brain, but the word will have to do.) I’m reading through Oliver Sacks’ autobiography and he makes some rather Sarno-esque observations. Sacks started out working at a migraine clinic and had a patient who had recurring migraines every Sunday. Via a pill, Sacks managed to banish the migraines. But they were then replaced with asthma. He offered to give the patient something for the asthma, but…

“No,” he replied. “I’ll just get something else…”
“Do you think I need to be ill on Sundays?”

I [Sacks] was taken aback by his words but I said, “Let’s discuss it.”

We then spent two months exploring his putative need to be ill on Sundays. As we did, his migraines got less and less intrusive and finally more or less disappeared. For me, this was an example of how unconscious motives may sometimes ally themselves to physiological propensities, of how one cannot abstract an ailment or it’s treatment from the whole pattern, the context, the economy of someone’s life.

This kind of talking cure is exactly the sort of thing Sarno recommended to his patients. It’s always interested to see these ideas mention by a different source.