My So-Called Penis

The placebo effect

Keen eyed readers are doubtless aware that I’ve written quite a bit on the topic of mind-body medicine over the past year, and that I’ve also been been interested to see some discussion of this topic drift into the mainstream media. The current New Yorker has an interesting article on the placebo effect e.g. the idea that a patient’s belief that they are going to feel better actually makes them feel better. The article goes in a lot of different directions and is tough to summarize, but in essence, it seems that in regards to pain there is an identifiable placebo effect. Most interesting is an anecdote told by the author of the article.

Three years ago, a week before Thanksgiving, while I was sitting in my office, my chest began to throb. It was a diffuse pain, but pain nonetheless. I am a middle-aged man with the usual amount of stress (too much) and I handle it in the usual way (denial). My cholesterol and blood pressure are normal, and I exercise regularly and try to eat sensibly. Still, I have read many obituaries of “healthy” men my age who ignore chest pain. So, somewhat sheepishly, I called my doctor and explained the situation, and he told me to come right over.

He conducted a thorough examination, and then we talked. He told me I was fine, that Thanksgiving is often a tense time, and that I should relax. My pain suddenly disappeared.

Now, one anecdote is hardly conclusive. But I’ve been struck by how common anecdotes like this one — stories which share themes of stress and tension causing physical symptoms — are. It’s the classic “I was feeling bad until I got to the hospital” story. It makes me think we are missing something in our attempts to explain pain and disease simply in structural (e.g. molecules, cells and organs etc.) terms.

The author’s anecdote reminds me of an experience I had. Over a decade ago, I was in a car accident that was fairly minor but did result in a painful rib contusion (essentially a bruise) where my ribs had pressed against the seat belt. It took about a month or so before I could laugh or sneeze without stinging pain. And over the years, I’ve occasionally found myself twisting my torso into some strange position and reactivating the pain. It’s as if if that strip of muscle never fully healed.

So, recently, I was lying in bed half awake, and I flopped over into a new sleeping position. This caused that old injury to start hurting, and I thought to myself, “oh boy, here it comes.” At that time, I had been doing a lot of reading the work of Dr. John Sarno, who fundamentally argues that muscles should heal within weeks or months, certainly not years. I actually had the thought, “but hold on… Sarno would argue that this pain isn’t real.” And right before I finished the mental recitation of the sentence, the pain seemingly magically disappeared. I’m not saying it slowly faded over the course of several minutes, I’m saying that within an instant it vanished.

Can LSD save your soul?

The LA Times has an interesting article on recent experiments using hallucinogenic drugs to treat various ailments.

Janeen Delany describes herself as an “old hippie” who’s smoked plenty of marijuana. But she never really dabbled in hallucinogens — until two years ago, at the age of 59.

A diagnosis of incurable leukemia had knocked the optimism out of the retired plant nurserywoman living in Phoenix. So she signed up for a clinical trial to test whether psilocybin — the active ingredient in “magic mushrooms” — could help with depression or anxiety following a grim diagnosis.

… With two researchers at her side, she embarked on a six-hour journey into altered consciousness that she calls “the single most life-changing experience I’ve ever had.”

Let me state the obvious: only the lamest of hippies would not dabble in hallucinogens until the age of 59.

The article continues…

Delany said her “trip” awakened a deep and reassuring sense of “knowing.” She came to see the universe and everything in it as interconnected. As the music in her headphones reached a crescendo, she held her breath and realized it would OK — no, really easy — not to breathe anymore. She sensed there was nothing more she needed to know and therefore nothing she needed to fear about dying.

And that, paradoxically, has allowed her to live.

This notion that hallucinogenic drugs stimulate the experience of an interconnected universe caught my eye, because it’s very similar to the experience neuroscientist and author Jill Bolte Taylor had upon having a left brain stroke. (Details here.) This opens up an interesting question: does LSD operate on the brain in the same way as a stroke? Does it release certain neural networks from the inhibition put upon them by other neural networks? (In Taylor’s case, her more free-flowing nonsequential right hemisphere was released from the inhibitions of the left hemisphere.) Someone should investigate this fascinating question, if they haven’t already.

Original thinking

I’ve talked extensively on this blog about the notion that our physical well-being can be affected by our emotions, particularly negative emotions such as fear, anxiety and guilt. I came across an interesting quote today which shows that I’m not the only person who has contemplated this.

“[Guilt is] a kind of social control mechanism — and it’s very unhealthy. It does terrible things to our bodies. And there are much better ways to control our behavior than that rather extraordinary use of guilt.”

The speaker? Famed serial killer Ted Bundy. His keen insight into the relationship between the mind and body and our health almost makes up for his murder of up to 100 young women.

Sexual biofeedback

Biofeedback is an interesting therapeutic technique that’s been around for decades. As I understand it, electrodes or various monitoring tools are hooked up to a person’s skin, allowing patients to monitor specific facets of their body, such as whether a certain muscle is becoming tense or whether blood pressure is spiking etc. They can then practice specific relaxation techniques and get confirmation that those techniques are making a difference.

It strikes me that men have been employing a variation of this technique for centuries. Often a man will be having sex with a woman, and realize he is about to approach orgasm long before her. Since the dawn of time, men have utilized the practice of mentally reciting meaningless baseball statistics to “talk themselves down” from orgasm.

I’m wondering if the modern tools of biofeedback could be applied here. Let’s say you invite a lady friend over for dinner. After a succulent meal, you retire to the couch, each of you holding a white wine. Candles flicker and light jazz plays on the stereo while your voices murmur quiet conversation. You lean forward to kiss her, her soft lips caressing yours. You reach into her blouse, past her bra, and rub warm, excited nipples. Her hand caresses your neck, her hot breath blows into your ear. Your red, pulsating member is engorged with life, pleasurably running against the inside of your pants. And then you hear it, a shrill robotic voice screeching…

“ALERT! ALERT! THE X 23400D MONITORING SYSTEM REPORTS IMMINENT ORGASM IN THREE MINUTES. SEXUAL EXCITEMENT MUST BE REDUCED! I REPEAT, SEXUAL EXCITEMENT MUST BE REDUCED!”

As a result, you are able to pace your sexual activities for both you and your partner. It’s a win-win.

Wall Street Journal on mind-body medicine

I’ve talked extensively about — and probably bored many people in the process — of my readings on the topic of the mind-body connections to pain. Of particular interest is been the work of Dr. John Sarno. His books, and others in the same vein, indicate that tens of thousands of people (at least) have found significant pain reduction using efforts to calm the mind. These efforts include meditation, journaling, and psychoanalysis.

It’s compelling reading, but of course I’m always thinking, “If this is so great, why don’t I hear more about it?” That may be changing — today’s Wall Street Journal has an op-ed on the topic of treating pain from a mind-body perspective.

How you think about pain can have a major impact on how it feels.

That’s the intriguing conclusion neuroscientists are reaching as scanning technologies let them see how the brain processes pain.

That’s also the principle behind many mind-body approaches to chronic pain that are proving surprisingly effective in clinical trials.

Some are as old as meditation, hypnosis and tai chi, while others are far more high tech. In studies at Stanford University’s Neuroscience and Pain Lab, subjects can watch their own brains react to pain in real-time and learn to control their response—much like building up a muscle. When subjects focused on something distracting instead of the pain, they had more activity in the higher-thinking parts of their brains. When they “re-evaluated” their pain emotionally—”Yes, my back hurts, but I won’t let that stop me”—they had more activity in the deep brain structures that process emotion. Either way, they were able to ease their own pain significantly, according to a study in the journal Anesthesiology last month.

I would say this pain reevaluation technique described above has been my most successful tool in fighting my hand and forearm pain.

Doctors are scum, continued

There’s an interesting article in a recent issue of the New York Times exploring whether MRIs tend to encourage incorrect analysis of pain symptoms.

This doesn’t surprise me; there’s actually quite a bit of research on this topic. Books by the often mentioned Dr. John Sarno referenced the fact that people without back pain who undergo MRIs are often told they have some back deficiency. The book “How We Decide” by Jonah Lehrer also has a chapter on the topic. The history of MRI use, which I’m recalling from memory, is rather interesting. Essentially, people have had back pain for centuries. And when MRIs came on the scene, they were employed on back pain sufferers. The MRIs often showed some “abnormality” — a herniated disc or whatnot — and surgery would be recommended. A bit later — in the 60s or 70s — the medical establishment started using MRIs for stomach ailments like ulcers. Often they would find the source of the stomach pain, and also note something like, “this guy must have massive back pain as well. Look at his herniated discs!” Upon hearing this, however, the patient would say, “I don’t have back pain.”

From the New York Times article:

Dr. James Andrews, a widely known sports medicine orthopedist in Gulf Breeze, Fla., wanted to test his suspicion that M.R.I.’s, the scans given to almost every injured athlete or casual exerciser, might be a bit misleading. So he scanned the shoulders of 31 perfectly healthy professional baseball pitchers.

The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. Andrews says.
…
…scans are easily misinterpreted and can result in misdiagnoses leading to unnecessary or even harmful treatments.

You might ask, “Why? Why would doctors utilize demonstrably false data?” As usual, it’s all about the Benjamins.

The price, which medical facilities are reluctant to reveal, depends on where the scan is done and what is being scanned. One academic medical center charges $1,721 for an M.R.I. of the knee to look for a torn ligament. The doctor who interprets the scan gets $244. Doctors who own their own M.R.I. machines — and many do — can pocket both fees. Insurers pay less than the charges — an average of $150 to the doctor and $960 to the facility.

Atul Gawande reported on this concept — the practice of doctors referring patients for tests that the doctors will gain financially from — in his now famous New Yorker article.

I have some personal experience in this matter as well. As I’ve mentioned, several years ago, I suffered from long-term dizziness and brain fog. A brain MRI was ordered to check for the telltale lesions of multiple sclerosis. A single lesion was found and determined not to be MS, but the doctors were basically incapable of providing an answer. About a year went by, during which I did some Internet research which led me to believe it was an inner ear issue. I went to an ear nose and throat doctor, and he dismissed my argument (incorrectly, it turned out.) He was interested in the brain MRI, but, during the course of the appointment, was willing to accept the findings of the previous doctors (that it wasn’t MS.) But at the very end of our meeting, he said something like, “Why don’t we go ahead and do another MRI just to be safe?”

So, I went ahead and did the MRI (at about $1500 cost to me, and much more to my insurance.) Several days later I called up the MRI lab. To help them find my record, I gave them the name of the doctor. They said something like, “Oh yes, we know him. He’s a frequent flyer.” (Meaning he orders a lot of MRIs.)

I found that suspicious at best. The doctor hadn’t seemed that interested in ordering the MRI until the tail end of the appointment. Had he ultimately decided that no harm could come of it, and his wallet might benefit? I don’t know, obviously. I only know one thing. Doctors are scum.

Oh, and by the way, a neurologist I saw later confirmed that the dizziness WAS an inner ear problem.

On getting old and worthless

For the most part, we tend to think our happiness is tied in with our individual well-being. For instance, I get a new job, or I get a new hot girlfriend, and I get happy. On the flipside, if I discover I’ve got cancer, or my leg gets bitten off by an alligator, I’m unhappy. This is a pretty standard understanding of happiness.

In the past, I’ve referenced some ideas from the realm of evolutionary psychology that would argue our happiness is really determined by how well we meet the needs of our genes. Our genes want to continue their lineage as long as possible. Thus they, using DNA, create brains that reward behaviors that fulfill these goals. Now, for the most part, the goals of the genes and the goals of the individual possessing the genes are pretty closely aligned. If I survive without injury, both I and my genes are happy. If I have sex, both I and my genes are happy — after all, sex is the sole tool genes can use to continue their lineage. (Presuming genes aren’t aware of cloning, sperm donation etc.)

So, loosely speaking, genes and the individual want the same things — to thrive (socially, physically, economically etc.) and to replicate. As a result, behaviors that result in thriving and replicating — behaviors like eating, earning the respect of your peers, and having sex — feel pleasurable.

I’m also always mentioning the main idea of Dr. John Sarno — that a lot of physical pain is really unconscious rage. Now, for the sake of this blog post let’s presume that unconscious rage is generated by the foiling of the shared goals of the individual and the genes. People don’t respect me, therefore I get enraged. I don’t get the job promotion, therefore I get enraged. I don’t get enough sex (hey, who does? HAWHAWHAWHAW!!!) and I get enraged. To follow the Sarno argument, if this rage is mostly unconscious, but threatens to spill over into consciousness, pain will be created to “distract” you.

There’s one problem with these goals of the individual and the genes. Eventually, you will fail to meet them. We all get old, and get to the point where we can no longer really “thrive.” (We certainly can’t have sex.) Are we then doomed to an ever increasing amount of rage as we become more and more impotent? Or, perhaps, does the brain reach a point where it basically says, “okay, I get it, whatever chances we’ve had to thrive and procreate are essentially over, so there’s no point sweating it anymore”? This would explain the fact that older people do seem to generally enter a period where they “mellow out.” They’re happy playing Parcheesi and gardening; they no longer have the drive to aggressively compete. Their rage — unconscious or conscious — seems to dissipate.

And here’s an interesting thing: today I was reading that instances of back pain (the main kind of pain Sarno identifies as the result of unconscious rage) actually decline among people in the 55+ range. If you think of back pain as being a physical ailment, this doesn’t make sense; people’s backs should be getting even crappier as they get older and thus more painful. But if back pain is connected to emotion, and emotion loses some of its teeth as the years go on, a decline is what you’d expect.

Stem cell therapy for Tony Iommi

I was watching “That Metal Show” recently and Black Sabbath guitarist Tony Iommi was the guest. He mentioned something rather interesting: he’s undergone stem cell therapy to replace some of the worn-out cartilage in his hands. (Also interesting: the process was recommended to him by good friend Eddie Van Halen who’d had the same procedure.) I was curious for details and searched online, finding this article.

“I’ve had this problem with my hand and I’ve had this stem-cell treatment on it,” Iommi told the BBC Radio 2 Radcliffe and Maconie Show. “The cartilage [was worn out between] the joints, and the joints [were] rubbing on the joints. It was bone to bone and it was getting a bit painful.”

Iommi has worn a hand guard to protect the injury but after taking painkillers and anti-inflammatories, he has turned to adult stem cells, which can restore defective muscles and help to regenerate cartilage growth. “This is the latest thing, so we’ll see if it works,” he said.

During his appearance, Iommi seemed pretty positive about the results.

The accident hump

It looks like boys, like girls, are reaching sexual maturity earlier and earlier. According to this article, “being 18 today is like being 22 in 1800.”

Of course, being 22 in 1800 was an absolute blast — the powdered wigs, the horse-drawn carriages, the wooden muskets — PARTEEE!

What’s interesting about this report isn’t so much what they know as how they know it. Scientists can track the onset of sexual maturity in boys because that’s when boys are most likely to engage in dangerous behavior and kill themselves.

The accident hump, which also exists among male apes, occurs because young men participate in particularly risky behaviour when the release of the hormone testosterone reaches its maximum. Dangerous and reckless shows of strength, negligence, and a high propensity to violence lead to an increased number of fatal accidents.

I could see an ape falling for that kind of ho-haw, but I’d like to think we humans are smarter. Disappointed again.

Question your body

Naturalists and hippie types often offer up the adage “listen to your body” to people dealing with physical issues. I find that the more I think about this, the more I question this advice.

I’ll give you an example. As everyone knows, I have repetitive strain injuries in my forearms. Lately, due to increased guitar playing, I’ve been feeling it more acutely — essentially aches and pains in my hands, knuckles and arms. So, we can presume this is my body saying, “take it easy.”

Last Friday, I did a solo acoustic guitar performance. The day of the performance, my hands were definitely feeling achy, and I felt like my grip strength was low (grip strength being pretty useful when you’re gripping a guitar or guitar pick.) I had pretty low expectations for the quality of my playing at that show. However, once I started playing I was largely unaware of the pain, and played quite well. And I’ve noticed this sort of thing in the past. My suspicion is the excitement of playing live gives me some kind of adrenaline rush which releases painkilling endorphins into my body. And that rush usually lasts into the next day. The aches and pains aren’t gone, but they’re much more manageable.

However, if I’m supposed to listen to my body, which series of “reports” should I be listening to? The pain leading up to the show seems to be saying “take it easy, limit your activities etc.” but the endorphin rush during the show and after is saying “don’t worry about it.”

Now this kind of thing does make sense from an evolutionary perspective. If you’re a caveman fighting off a tiger, and it bites into your arm, the pain shouldn’t so debilitate you that you’re incapable of fighting or fleeing from a tiger. In moments of stress or excitement, you should have some painkillers going through your system. On the other hand, you should feel that pain later, when you’re safe, to essentially learn the lesson to stay away from tigers. But I think the body delivers these messages in a imperfect way. It’s very difficult to know whether certain aches and pains are indicators of horrific damage down the line, or not much at all.