Archive for the ‘medicine’ Category
acupuncture promotion in australia
I tried to find a picture of the chi energy system online, but guess what, nothing to be found. Here’s a chi-reflexology map instead – from the Australian College of Chi-Reflexology, no less!
On the ever-reliable US-based NeuroLogica blog, Steven Novella reports on an interesting case of acupuncture promotion here in Oz, via Rachel Dunlop. As Novella reports, acupuncture has been studied many times before, and Cosmos, our premier science mag, did a story on the procedure a while back, reporting no evidence of any benefits except in the notoriously vague areas of back pain and headaches.
Not surprisingly, lower back pain was one of the conditions that supposedly benefited from acupuncture, according to media hype about the latest study. The trouble is, this study was being reported on before being published and peer reviewed, which, to put it mildly, is highly irregular and raises obvious questions. The Sydney Morning Herald is the offending news outlet, and Dr Michael Ben-Meir the over-enthusiastic researcher. As the article points out, Ben-Meir is already a ‘convert’ to acupuncture, having used it for some time in acute cases at two Melbourne hospitals. That’s fine, if a bit unorthodox, but it doesn’t accord with other findings, and there are therefore bound to be questions about methodology.
One of the obvious difficulties is that acupuncture can hardly be applied to patients without them knowing it. It’s a much more hands-on and ‘invasive’ experience than swallowing a tablet, and this will undoubtedly have a psychological effect. It seems to me, just off the top of my head, that acupuncture, with its associated rituals, its aura of antiquity and its oriental cultural cachet, would carry greater weight as a placebo than, say, a homeopathic pill. But in fact I don’t have to speculate here, as there is much clinical evidence that injections have a greater placebo effect than pills, and big pills have a greater placebo effect than small ones. So it doesn’t greatly surprise me that people will report a lessening, and even a dramatic lessening, of acute pain, after an acupuncture treatment, however illegitimate. I presume there are illegitimate treatments, because the ‘key meridional points’ where the needles are applied are precisely know by legitimate acupuncturists, and they apply their treatments with rigorous accuracy.
Well, actually there’s a big question as to whether or not there are any legitimate acupuncturists, because acupuncture is based on an energy system known as ‘chi’, which supposedly has meridional points at which needles can be inserted quite deeply into the skin, but there’s no evidence whatever that such an energy system exists, let alone about how such a system might function – for example, its mode of energy transmission (whatever ‘energy’ might mean in this case). Considering that we know a great deal about the autoimmune system and the central and peripheral nervous systems, it seems astonishing that this other bodily system has gone undetected by scientists for so long, and especially in recent times, with our ultra-sophisticated monitoring devices. When you look up ‘chi, sometimes spelt ‘qi’ or with other variants, you’ll find nothing more specific than ‘energy’, ‘life force’ or something similar – nothing corpuscular or in any sense measurable by modern medicine. Even so, researchers into acupuncture have come up with an attempt to measure its efficacy by comparing it to ‘sham acupuncture’ in clinical trials. Sham acupuncture uses the ‘wrong’ meridians and the ‘wrong’ depths to which the needle goes.
But herein lies an obvious problem. Sham acupuncturists insert needles only millimetres deep, while real acupuncturists put their needles between one and three or four centimetres deep: ‘Depth of insertion will depend on nature of the condition being treated, the patients’ size, age, and constitution, and upon the acupuncturists’ style or school’, according to an acupuncture site I visited at random. These are rather wide parameters, but the point that interests me is this. If you don’t put your needle in deep enough, you won’t make contact with the chi that needs to be stimulated or other wise modified to heal the patient. So goes the rationale, surely. It’s like, if you don’t put the needle for a standard vaccination in the right place, you’ll miss the vein. But veins are clearly real. If you go dissecting, you’ll find veins and arteries and nerves and muscle and fat and so on. But you won’t find chi. Yet, apparently it does have real existence. It’s between one and four centimetres down, according to real acupuncturists, depending on the above-mentioned variables (and no doubt many others).
So we can’t actually see it, or find it on dissection, but it’s locatable in space, vaguely. Or is it that chi is everywhere in the body but the right kind of chi, the bit that’s causing the pain and needs to be treated with needles at certain precise meridional points, is at a certain distance from the surface of the skin?
It all begins to sound a bit like theology, doesn’t it?
Here’s the ‘take-home’ for me. If you read about treatments that ‘work’ but you get virtually nothing about the mechanism of action, as is the case, for example, with homeopathy and acupuncture, be very skeptical. In the end I’m not impressed with clinical trials that show a ‘real effect’, even a startling one, because I know about regression to the mean, and I particularly know about the placebo effect. I want ‘proof of concept’. In this case proof of the concept of chi and of meridians. I’ve heard homeopaths defend their pills on TV recently by claiming that, ‘whatever the mechanism, clinical trials consistently prove that this treatment works’, and I can’t be bothered chasing up those clinical trials and testing their legitimacy, I go straight to the concepts and processes behind the treatment – the law of similars, the law of infinitesimals, and don’t forget succussion. These concepts are so intrinsically absurd that we needn’t bother looking at the clinical data. If there are positive results, they haven’t been produced by homeopathy. The fact that homeopaths themselves are largely uninterested in the mechanisms is a dead giveaway. You’d think that the law of infinitesimals and the law of similars would surely have myriad applications far beyond their current ones. They would revolutionise science and technology, if only they were real (and they’d also render obsolete much that we currently know).
The same goes for acupuncture, and chi. If this bodily system were real, and chi could be captured in a test tube, and its constituents examined and isolated under a microscope, how revolutionary that would be. How transformative. Chi pills, chi soap, chi breakfast cereal…
Ah but I’m thinking like one of those limited westerners, so modern, so smug, so lacking in the insight of the ancients…
bronchiectasis – the story so far
I’m sorry I’ve not been as polyphiloprogenitive (yeah) in my posting lately, with health issues both mental and physical, and work commitments having an impact. So, now I’m going to mix the personal and the general in this glimpse into the complexities of public healthcare.
I’ve been trying for some time to get a proper diagnosis on lung and airways problems that have been plaguing me for some 30 years. Today, a young doctor summarising my condition after a blood test, an x-ray, a CT scan, a bronchoscopy, a biopsy, and a series of lung function tests, used (in passing) the term ‘bronchiectasis’, not for the first time. It was first used a few weeks ago, in the radiologist’s report on my CT scan, and that was the first time I’d heard the term.
Anyway, the analyses and the reports are now done with, and the only treatment offered is a three-month course of broad-spectrum antibiotics, a half-tab a day, to try to clear up some current bugs and give me a fighting chance for the future. The antibiotics may also act as anti-inflammatories, slightly and temporarily relieving the problem of my dilated airways, but there’s no permanent solution, no cure.
Here’s what the USA’s National Heart, Lung and Blood Institute has to say about bronchiectasis:
Bronchiectasis (brong-ke-EK-tah-sis) is a condition in which damage to the airways causes them to widen and become flabby and scarred. The airways are tubes that carry air in and out of your lungs. Bronchiectasis often is caused by an infection or other condition that injures the walls of the airways or prevents the airways from clearing mucus. Mucus is a slimy substance. It helps remove inhaled dust, bacteria, and other small particles from the airways. In bronchiectasis, your airways slowly lose their ability to clear out mucus. The mucus builds up, and bacteria begin to grow. This leads to repeated, serious lung infections. Each infection causes more damage to the airways. Over time, the airways can’t properly move air in and out of the lungs. As a result, the body’s vital organs might not get enough oxygen. Bronchiectasis can lead to serious health problems, such as respiratory failure, atelectasis (at-eh-LEK-tah-sis), and heart failure.
This makes for very grim reading. It sounds like a slow, overall decline is inevitable, though I’m not feeling too pessimistic, perhaps because it hasn’t sunk in yet. There’s little point in trying to pinpoint the initial infection or set of infections that set the ball rolling. My latest doctor, at the Adelaide Chest Clinic, suggested a series of infections when very young, most likely in my earliest childhood, set the stage for the present situation, but that surely is the wildest speculation, with no detailed medical history to go on. Or rather, no medical history at all really. I do remember my mother saying she was worried about my health as a young child because I was so skinny, but I don’t recall that I had any lung or airways problems.
This medical journey has been interesting. I don’t really have a regular doctor, and generally avoid regular visits, in my male way, but when I need to go I visit the Hindmarsh Medical Clinic nearby, and take whatever doctor’s available. So when chesty complications arose after I got what I think was a dose of the flu late last year, I took myself to this clinic to get what I usually get when this happens, a dose of antibiotics. It was the first time I’d been to a doctor about this in a few years. I’ve been on a bit of a health and fitness kick, losing a lot of weight and engaging in regular, if low level, exercise. I like to think these efforts have helped me even with my bronchiectasis, because before that I was having to take antibiotics at least once a year for quite a few years. And before that, I would just put up with what I called ‘the wet webs’, which would wax and wane in terms of hampering my life.
However, they always did hamper my life, affecting my self-confidence, increasing my self-consciousness. I’d avoid people and crowds, worried about my breath and my tendency to break into coughing fits, or have my voice caught in the webs mid-sentence, resulting in intense and embarrassing throat-clearing. But I was also worried about the effects on my throat, which would catch at the slightest hint of cigarette smoke, dust or ‘funny air’. My experience with food and drink, too, has sometimes been a problem. Nothing worse than having a cough explode out of you when your mouth is full of lamb korma (spicy food is a ticklish subject) or your host’s best French champagne. Also, any not-quite-right cuisine would give me a ‘furry tongue’ feeling, a tell-tale first sign of a full-blown, phlegmy infection.
Anyhow, it was only after some years of putting up with this that I betook myself to a doctor, on an occasion when the phlegminess wouldn’t clear up by itself and was clearly getting worse. That was my first experience of antibiotics, and they seemed to always do the trick, so I began to rely on them, all the while reflecting on tuberculosis and consumption and marvelling that the modern world of antibiotics had saved me from the fate of Keats, Balzac, the Brontës, Chekhov, Lawrence, Kafka, Orwell and so many others, known and unknown – that of more or less drowning in my own phlegm.
So it was a bit of a surprise when, back in December and January, I found that the little magic pills didn’t work any more. I was prescribed two separate, different batches, both ineffectual. So the doctor organised a blood test and an x-ray. The blood test indicated that I was becoming anaemic, and the x-ray indicated a cloudy, indeterminate patch in my upper right lung. The Hindmarsh doctors were now slightly more animated about my condition. I was questioned closely about my medical history, especially my smoking history. I was a light smoker in my youth and gave up in my mid-twenties, over thirty years ago. The doctor sent me for a CT scan, which, depending on what resulted from it, might be followed by a colonoscopy. He was particularly concerned about the anaemia, which was unlikely to be caused by poor diet.
To over-simplify, there are 3 main types, or causes of, anaemia. First, there’s blood loss, either of the rapid kind (haemorrhaging caused by an accident or major trauma) or the slowly leaking kind, which can have a variety of causes, including cancer. Second, there’s destruction of the red blood cells (hemolysis), which also has many causes, such as bacterial infections. The third is deficient red blood cell production. I now presume my anaemia was of the hemolytic type, but my doctor probably worried about blood loss as a result of bowel or colon cancer, though I didn’t have much in the way of gastrointestinal symptoms.
So I went off for my first ever CT scan, a fascinating experience in itself, and a few days later, once Hindmarsh had received the radiologist’s report, I made an appointment to discuss the findings. When I arrived the receptionist gave me a copy of my CT scan and the radiologist’s report, which I read in the waiting room. It was pretty hard to digest. First it reiterated the finding of the x-ray – ‘ill-defined shadow right upper lobe on recent chest x-ray – pulmonary mass’. Then the radiologist, a Dr Ron Edwards, presented his own findings:
There is extensive abnormality in the right lung more marked in the upper lobe with dilated, thick walled bronchi consistent with bronchiectasis, evidence of mucus plugging and areas of confluent parenchymal density, the appearance is thought to be that of inflammatory change most probably allergic bronchopulmonary aspergillosis. The left lung is fully expanded and clear. No pleural abnormality is seen on either side. There is no hilar or mediastinal mass or lymphadenopathy. No abnormality is seen in visualised upper abdominal organs.
Conclusion: Extensive abnormality in the right lung particularly the upper lobe consistent with inflammatory change most probably allergic bronchopulmonary aspergillosis although correlation with history and clinical findings is suggested.
At first I thought this doctor just liked parading his polysyllables, but then I was prepared to give him the benefit. I’d try to tease it all out and look up the key terms on the net when I got home, and meanwhile my Hindmarsh doctor might further enlighten me.
The doctor in this consultation wasn’t my usual one, and his response to the radiologist’s report was ‘eh? I can’t make head nor tail of this’, which was kind of reassuring, but after a few minutes of examining it and looking up other references, he recovered enough to say that the next step was a visit to the Adelaide Chest Clinic for a probable bronchoscopy to try to get clarification or confirmation of the finding. He told me that aspergillosis was a fungal infection which generally required long-term antibiotic, or rather antifungal medication to clear it up. The good thing, though, was that there was no sign of cancer. I asked whether the aspergillosis, if that’s what I had, might be the cause of the anaemia, and he said, ‘oh yes, most definitely’.
So I went home, looked up as much as I could on the net, and waited to hear from the chest clinic. I soon received a letter which gave me an appointment time for six weeks later, and which pointed out that this was a consultation only. I was annoyed at the long delay, especially as my cough and my phlegm problems weren’t getting any better. Yet somehow the idea that I might have a fungal infection (and I now imagined I could feel the spores in there when I sucked air into my lungs) gave me a strange hope, as if shifting this gunk, with whatever difficulty, would solve all my bronchial problems once and for all. I read, too, about bronchiectasis, but preferred to banish it from my mind.
Eventually, consultation day at the chest clinic arrived. The doctor, a brisk young fellow of Asian appearance but with an Aussie accent, immediately asked to see the CT scans I’d brought with me. He pronounced them ‘rather alarming’ and proclaimed that I wouldn’t have been kept waiting for six weeks like this had he seen them before. The doctor’s note hadn’t prepared him for this. He beckoned me over to look at the scans pegged to the screen – ‘no, no, closer, look… This cloudy mass here, most unusual, and only in one lung. See this lung? That’s how a lung should look. But this, this… Mmmm, I don’t know… we’ll have to have some further tests.’
I already knew this, but again I was somehow reassured. If this cloudy stuff could be removed, my lungs, or rather, my lung, might be returned to its pristine state and I’d be cured.
But it seemed to me that he wasn’t aware of the radiologist’s report. I had it with me, and I mentioned the possibility of aspergillosis. To my surprise the doctor waved away the report as I started rummaging in my bag for it. He looked quite disdainful in fact. ‘We can’t tell what it is, that’s why we’ll need to do a bronchoscopy, and take some material out of the lung..’
He then began to question me on my medical history, especially my history of smoking, just as my Hindmarsh doctor had. When he asked me about how long I’d been having these throaty infections, I talked about my term ‘the wet webs’, which I’d been using since the eighties, but he cut me off, seemingly bored or irritated by this flight of fancy. He asked me about exposure to chemicals or any other potentially damaging agents, but I couldn’t enlighten him. In fact, when I began to tell him about a dodgy, salt-damp-ridden flat I’d rented more than 20 years ago, and which I’d since considered might be a factor in my ill-health, he again cut me off as if it was obviously irrelevant. Finally, he took me through the process of a bronchoscopy and a lung function test, scheduled for a week and a fortnight’s time respectively.
At the end I had to ask, ‘so do you have any real idea what this infection or blockage of the lung might be?’ He shrugged, ‘It could be one of many things. It could be aspergillus. It could be cancer – but I don’t think it’s cancer. The biopsy should clear this up for us.’
It wasn’t really until after this consultation was finished that I looked back on it with some irritation. I was particularly annoyed that this doctor had waved away the radiologist’s report. Why? Was there some rivalry between radiologists and chest clinicians as to the reading and interpretation of CT scans? If so, should there be? Surely radiologists look at these scans day in day out, perhaps over many years. Or – who knows? – maybe this report was by a young radiologist keen to impress, and the clinician had seen too many over-ambitious reports that missed the mark completely. In any case, I’d taken the report seriously, enough to familiarise myself a little more with bronchiectasis, aspergillosis, hilar and mediastinal mass, parenchymal density, and lymphadenopathy. And I don’t think these efforts were wasted. Even after a brief perusal of this report, my Hindmarsh doctor was able to assure me that I didn’t have cancer. But the clinician, having dismissed the report sight unseen, had again raised the cancer spectre. Surely this was highly irresponsible – though I was quite confident that cancer was a non-issue.
So next on the agenda was the bronchoscopy, which from my perspective was a non-event. I arrived at the hospital at about 8.30 and was released around midday. This was my first experience as a hospital patient since an ear operation as an eight-year-old, nearly fifty years ago. I’d been told of the risks, of course, which included pneumothorax or a collapsed lung as the worst case scenario, and I was nervous of hospital infections and the like, but all seemed to go well. In fact I was amazed at the magic of modern anaesthesia, because at one instant I was on an operating table with three medicos about me chatting and faffing about with tubes, and in another instant I was back in the ward, coughing and spluttering just as before, and it seemed only half an hour or so had passed. So I’d both lost and recovered consciousness instantaneously, and surely a whole book could be written about the science involved in this, and if one has been written I’d love to read it.
The aftermath was interesting though. I felt quite chirpy on being given the all clear at about midday, and we had a pleasant meal in the hospital canteen, on a balcony overlooking the botanical gardens. But by the time I got home I was feeling quite drained, and I slept on and off for the next 24 hours. I took several days to recover the old circadian rhythm. Nine days later I was back at the hospital’s thoracic unit having a lung function test, and later in the afternoon I had another consultation at the chest clinic. It was another doctor this time, a tall kindly-seeming young man who appeared to be an intern, from his general sense of unease and uncertainty. He clearly knew nothing about my case, and sat staring at some records on his computer while I waited faux-patiently. Finally he excused himself, saying he needed to consult with his boss. He returned, seemingly a little more sure of himself. He told me, as I’ve already related, that I had damaged airways, probably incurred as a very young child, and this has led to me having regular infections over the years. This would likely continue, because bronchiectasis was a difficult, essentially untreatable condition. I pulled him up on the term, saying I’d done some research on it, to which he replied, ‘Well then you’ll understand that there’s nothing more we can really do.’ I asked then about the white cloudiness in my lung, which I’d hoped could be particularly targeted. He just shrugged, as if to say it was just another one of my regular infections. I took from this that there was no sign of aspergillus after all. ‘What we can do, which should help in the short run, is prescribe for you some’ – and here he mentioned a drug of some sort, which I didn’t catch – ‘which you should take at a half-tab a day for the next three months, and that should clear up any existing bugs in your system. I’ll arrange that with your doctor, and you won’t need to come back here again.’
I felt that I’d been politely, if rather awkwardly, dismissed, and I left the consulting room in something of a daze. I took a wrong turning, and after walking down a winding corridor I found myself suddenly at the entrance to the clinic, having by-passed the reception area where I came in. I stepped outside, vaguely wondering if I was supposed to have paid some money or signed some forms, but I had no desire to turn back.
I felt something like futility, that these past few weeks had taken me nowhere. I had a diagnosis of sorts, but bronchiectasis, I knew, was an often undiagnosed and somewhat neglected condition. There was nothing sexy about it. It wasn’t life-threatening like tuberculosis or pneumonia, though it would probably be the death of me in the long run. It wasn’t of course a disease in itself, rather a facilitator of disease and infection. What frustrated me, as I reflected on the situation over the next few days, was that nobody had been straight enough with me to say ‘you have bronchiectasis, this is your prognosis – within broad parameters – and this is how you might manage your condition in future…’
I’d spoiled myself. I’d been reading one of Oliver Sacks’s recent works, The Mind’s Eye. I’d read Sacks before, and I’d been very impressed with his manner and his reflections on seeing him at Adelaide Writers Week a few years back. But I couldn’t help but notice the difference between his medical practice in good old New York City and my experience in good old Adelaide. It seems that most of Sacks’s patients not only have unusual and trend-setting neurological conditions, they also seem to be overwhelmingly talented musicians, writers, artists or fellow physicians, most of whom seem to end up becoming his BFFs and regular swimming partners. Filthy lucre never gets mentioned, of course, but it’s all a long way from my experience as a nonentity on the national health scheme, where I have to deal with an array of medicos none of whom even know me by name.
Of course I’m lucky that I get to have highly trained doctors anaesthetising me, pulling bits out of my lungs, and using sophisticated machines to light up my chest cavity or to measure my lungs’ functionality, all at very little cost to myself, but in the end there’s a condition I have, barely referred to by my doctors, with is untreatable and largely uninteresting, and I just have to live with it. Of course I should get my flu shots regularly, but no doctor has given me this advice. The fact is, I’ve learned much more about my condition through the internet than through the medical system, and that suggests my future direction. Go to reliable websites, obtain all my own medical records as far as I’m able, and become as self-reliant as is medically possible.
I’m lucky, too, that I don’t feel sick. I have the occasional coughing fit, and a more or less regular cough, but it isn’t painful and it isn’t getting appreciably worse. My situation seems to have stabilised, and I’m able to go to work regularly and do a reasonable job. I do feel tired more than I would like to, but that might be age, or it might be a psychosomatic reaction to the knowledge that I have some kind of blood-loss (i.e. not iron-deficiency) anaemia. In his book The Heretics, Will Storr summarises recent findings about the placebo effect:
A 1998 study by researchers at the University of Hull found that up to 75% of the effect of brand-name antidepressants such as Prozac might be down to placebo; Professor David Wootton of the University of York has written of one estimate that indicates that ‘a third of the good done by modern medicine is attributable to the placebo effect’; while an acknowledged world expert, the University of Turin’s Professor Fabrizio Benedetti, has gone so far as to say that ‘Placebo is ruining the credibility of medicine’.
To me, this is all more fascinating than disturbing, but it’s obvious to me that these psychological effects work both ways – if you’re told that you’re anaemic, and that physical fatigue is one of the symptoms, you’ll surely slow down more than if your anaemia is unknown to you. What’s more I have no idea how anaemic I currently am, just as I have no idea whether my bronchiectasis is severe or mild.
I saw my original Hindmarsh doctor a few days ago, almost two weeks after my final visit to the chest clinic. He hadn’t received any word from the clinic about antibiotic medication, but he had received some kind of interim report from them. To my surprise, there were signs of mycology in the lung, and it seemed they were still in the process of analysing the data, or at least that’s what my doctor surmised from the lack of communication about treatment. On this occasion I grumbled a bit more than I usually do about the slowness of the process towards treatment, and the lack of clear communication about my condition. I asked about medical records, and the doctor was quite happy to facilitate that, though I sense that I’ll have to keep on about it to make it happen. I also mentioned my anaemia, and whether I could have a blood test to see if it was improving or worsening. I also complained of slightly darker and strong-smelling urine, so blood and urine tests were arranged on site immediately. Interestingly, after the blood was taken (and I was surprised by how much was taken out) I walked home – a 15 minute walk – and immediately conked out, falling asleep at about 4pm and waking up at about 11.30 the same night, which again disrupted my sleeping patterns for a while. Yesterday I received a call from reception at Hindmarsh. Apparently some word has been received from the chest clinic, so at last I’m to have some medication, I hope.
So that’s the story so far. Interesting thoughts on perception and reality, though. Having only recently learned about mycology and aspergillus, I became more or less convinced that I was indeed suffering from a fungal infection. I could feel it in my lung. Hard to describe the sensation, but something cold and vaguely furry, spore-like. Of course I knew that the information about aspergillus was infecting my perception, and yet…
And then, at my final consultation at the chest clinic, I was led to believe that there was no aspergillus. I was to take a broad-spectrum antibiotic, not an anti-fungal, and that might or might not clear up the bugs in my system. So what was I to make of my perceptions?
Enough, though, for now, as this blog post has gone on long enough, and I’ve not posted in a long time. There will be more though on this subject, as I’ve been to the doctor again, and have obtained some interesting medical records, and the mycology question is still unresolved.
spirituality issues, encore
a mob of didges, right way up
To me – and I’ve written about this before – the invocation of the supernatural, the ‘call’ of the supernatural, if you will, is something deeply psychological, and so not to be sniffed at, though sniff at it I often do.
I’m prompted to write about this because of a program I saw recently on Heath Ledger (Australia’s own), an understandably romantic, mildly hagiographic presentation, in which a few film directors and friends fondly remembered him as wise beyond his years, with hidden depths, a kind of inner force, a certain je ne sais quoi, that sort of thing. As both a romantic and a skeptic, I was torn as usual. The word ‘spiritual’ was given an airing, unsurprisingly, though mercifully it wasn’t dwelt on. I once came up with my own definition of spirituality: ‘To be spiritual is to believe there’s more to this world than this world, and to know that by believing this you’re a better person than those who don’t believe it’. This might sound a mite cynical but I didn’t mean it to be, or maybe I did.
Anyway one of Ledger’s associates, a film director I think, told this story of the young Heath. A number of friends were partying in his apartment when he, the director, picked up a didgeridoo, which obviously Ledger had brought with him from Australia, and attempted to play it, but not knowing much about the instrument, held it upside-down. Heath gently took it from him and corrected him, saying ‘no, no, if you hold it that way it will lose its power, the power of the instrument and its maker,’ or some such thing. And the seriousness and respectfulness with which this young actor spoke of his didge impressed the director, who considered this a favourite memory, something which caught an ‘essence’ of Ledger that he wanted to preserve.
I’ve been bothered by this tale, and by my ambivalent response to it, ever since. It would be superfluous, I suppose, to say that I don’t believe that briefly holding a didge upside-down has any permanent effect on its musical power.
It’s quite likely that Ledger didn’t believe this either, though you never know. What I’m fairly sure of, though, was that his respectfulness was genuine, and that there was something very likeable, to me at least, in this.
All of this takes me back to a piece I wrote some years ago, since lost, about big and small religions. I was contrasting the ‘big’ religions, like Catholicism and the two main strands of Islam, with their political power in the big world, often horrific in its impact, with the ‘small’ religions or spiritual belief systems, such as those found among Australian Aboriginal or some African societies, who have no political power in the big world but provide their adherents with identity and a kind of social energy that’s marvelous to contemplate. My piece focused on the art work of Emily Kame Kngwarreye, whose prolific and astonishing oeuvre, with its characteristic energy and vitality, clearly owed so much to the beliefs and practices of her ‘mob’, the so-called Utopian Community in Central Australia, between Alice Springs and Tenant Creek to the north.
Those beliefs and practices include dreaming stories and totemic identifications that many western skeptics, such as myself, might find difficult to swallow, in spite of a certain romantic appeal. The fact is, though, that the Utopian Community has been remarkably successful, in terms of the usual measures of well-being, and particularly in the area of health and mortality, compared to other Aboriginal groups, and its success has been put down to tighter community living, an outdoor outstation life, the use of traditional foods and medicines, and a greater resistance to the more destructive western products, such as alcohol.
This might put a red-blooded but reflective skeptic in something of a quandary, and the response might be something like – ‘well, the downside of their vitality and health, derived from spiritual beliefs which have served them well for thousands of years, is that, in order to preserve it, they must live in this bubble of tribal thinking, unpierced by modern evolutionary or cosmological knowledge, and this bubble must inevitably burst.’ Must it? Is there a pathway from tribalism to modern globalism that isn’t entirely destructive? Is the preservation of tribal spiritual beliefs a good thing in itself? Can we take the statement, that holding a didgery-doo upside-down affects its spirit, as a truth over and above, or alongside, the contrasting truths of physical laws?
I don’t know the answer to these questions, of course. Groping my way through these issues, I would say that we should respect and acknowledge those beliefs that give a people their dignity, and which have served them for so long, but perhaps that’s because we’re feeling the generosity of someone outside that system who’s unlikely to be affected or to feel diminished by it. These are, after all, small religions, from our perspective, not the big, profoundly ambitious religions intent on global domination, with their missionaries and their jihadists and their historical trampling of other belief systems, as in Mexico and South America and Africa and here in Australia.
Of course there’s the question – what if those small religions grew bigger and more ambitious? Highly unlikely – but what if?
what is autism and what causes it?
The term ‘autism’ was coined in the 1940s by two physicians working independently of each other, Hans Asperger in Austria and Leo Kanner in the USA, to describe a syndrome the key feature of which was a problem with interacting with others in ‘normal’ ways. Sounds vague, but the problem was anything but wishy-washy to these individuals’ parents and families, and over time a more detailed profile has built up.
The term itself is from the Greek autos, or ‘self’, because those with the syndrome had clear difficulties in interpreting others’ moods and responses, resulting in a withdrawn, often antisocial state. Autistic kids often avoid eye contact and are all at sea over the simplest communication.
Already though, I feel I’m saying too much. When describing autism, it’s common to use words like ‘often’ or ‘sometimes’ or ‘some’, because the symptoms are seemingly so disparate. Much of what follows relies on the neurologist V S Ramachandran’s book The tell-tale brain, especially chapter 5, ‘Where is Steven? The riddle of autism’.
Autistic symptoms can be categorised in two major groups, social-cognitive and sensorimotor. The social-cognitive symptoms include mental aloneness and a lack of contact with the world of other humans, an inability to engage in conversation and a lack of emotional empathy. Also a lack of any overt ‘playfulness’ or sense of make-believe in childhood. These symptoms can be ‘countered’ by heightened, sometimes obsessive interest in the inanimate world – e.g. the memorising of ostensibly useless data, such as lists of phone numbers.
On the sensorimotor side, symptoms include over-sensitivity and intolerance to noise, a fear of change or novelty, and an intense devotion to routine. There’s also a physical repetitiveness of actions and performances, and regular rocking motions.
These two types of symptoms raise an obvious question – how are the two types connected to each other? We’ll return to that.
Another motor symptom, which Ramachandran thinks is key, is a difficulty in physically imitating the actions of others. This has led him to pursue the hypothesis that autism is essentially the result of a deficiency in the mirror neuron system.
In recent years there’s been a lot of excitement about mirror neurons – possibly too much, according to some neurologists. A mirror neuron is one that fires not only when we perform an action but also when we observe it being performed by others. They’ve been found to act in mammals and also, it seems, in birds, and in humans they’ve been found in the premotor cortex, the supplementary motor area, the primary somatosensory cortex and the inferior parietal cortex. It’s easier, however, to locate them than it is to determine their function. Clearly, to describe them as ‘responsible’ for empathy, or intention, is to go too far. As Patricia Churchland points out, ‘a neuron is just a neuron’, and what we describe as empathy or intention will likely involve a plethora of high-order processes and connections, in which mirror neurons will play their part.
With that caveat in mind, let’s continue with Ramachandran’s speculations on autism and mirror neurons. First, we’ll need to be reminded of the term ‘theory of mind’, used regularly in psychology. It’s basically the idea that we attribute to others the same sorts of intentions and desires that we have because of the assumption that they, like us, have that internal feeling and processing and regulating system we call a ‘mind’. A sophisticated theory of mind is one of the most distinctive features of the human species, one which gives us a unique kind of social intelligence. That autism would be related to theory-of-mind deficiencies seems a reasonable assumption, so what is the brain circuitry behind theory of mind, and how do mirror neurons fit into this picture?
Although neuro-imaging has revealed that autistic children have larger brains with larger ventricles (brain cavities) and notably different activity within the cerebellum, this hasn’t helped researchers much, because autism sufferers don’t present any of the usual symptoms of cerebellum damage. It could be that these changes are simply the side effects of genes which produce autism. Some researchers felt it was better to focus on mirror neurons straight-off, as obvious suspects, and to see how they fired and where they connected in particular situations. They used EEG (electroencephalography) as a non-invasive way to observe mirror neuron activity. They focused on the suppression of mu waves, a type of brain wave. It has long been known that mu waves are suppressed when a person makes any volitional movement, and more recently it has been discovered that the same suppression occurs when we watch others performing such movements.
So researchers used EEG (involving electrodes placed on the scalp) to monitor neuronal activity in a medium-functioning autistic child, Justin. Justin exhibited a suppressed mu wave, as expected, when asked to make voluntary movements. However, he didn’t show the same suppression when watching others perform those movements, as ‘neurotypical’ children do. It seemed that his motor-command system was functioning more or less normally, but his mirror-neuron system was deficient. This finding has been replicated many times, using a variety of techniques, including MEG (magnetoencephalography). fMRI, and TMS (transcranial magnetic stimulation). Reading about all these techniques would be a mind-altering experience in itself.
According to Ramachandran, all these confirmations ‘provide conclusive evidence that the [mirror neuron] hypothesis is correct.’ It certainly helps to explain why a subset of autistic children have trouble with metaphors and literality. They have difficulty separating the physical and the referential, a separation that mirror neurons appear to mediate somehow.
A well-developed theory of mind which can anticipate the behaviour of others is clearly a feature of understanding our own minds better. In Ramachandran’s words:
If the mirror-neuron system underlies theory of mind and if theory of mind in normal humans is supercharged by being applied inward, towards the self, this would explain why autistic individuals find social interaction and strong self-identification so difficult, and why so many autistic children have a hard time correctly using the pronouns ‘I’ and ‘you’ in conversation. They may lack a mature-enough self-representation to understand the distinction.
Of course, tons more can be said about the ‘mirror network’ and tons more research remains to be done, but there are many promising signs. For example, the findings about lack of mu wave suppression could be used as a diagnostic tool for the early detection of autism, and some interesting work is being done on the use of biofeedback to treat the disorder. Biofeedback is a process whereby physiological signals picked up by a machine from the brain or body of a subject are represented to the subject in such a way that he or she might be able to affect or manipulate that signal by a conscious change of behaviour or thinking. Experiments have been done to show that subjects can alter their own brain waves through this process. Some experimental work is also being done with drugs such as MDMA (otherwise known as the party drug ‘ecstacy’) which appear to enhance empathy through their action on neurotransmitter release.
So that’s a very brief introduction to autism. Hopefully I’ll come back to it in the future to explore the progress being made in understanding and treating the syndrome.
how to tackle obesity
A little over a year and a half ago I started getting worried about weight gain. I didn’t like the way I looked, I hated seeing photos highlighting my tubbiness, but I loved food, cooking and eating it, especially the latter. I also preferred to take a fatalist line. Both my parents were slim in youth, especially my mother, and then developed a middle-aged spread. It was inevitable, you got older, your metabolism slowed, you slowed, you didn’t do the sporty outdoor things you used to, and you developed a sophisticated interest in and love of food that, in spite of the extra bulk and the gastric ailments, made life so much more je ne sais quoi than in your tenderfoot days. Genetics and the Zeitgeist are against you, so relax and just roll with the fat.
And yet, vanity was prevailing upon me to cut a more dashing figure before it was too late, and I was certainly keen to live longer. My weight had gotten up to 83.5 kgs, and I’m a shorty, at around 167-168cms, so according to that rough guide, the BMI, I was about half a kilo below being officially obese. So I decided to cut down on eating so much. No planned or organised diet, just plain old calorie restriction. I wanted to get down to under 80kgs at least, in the short term, and after that, well, just one day at a time as the cliché has it. if I could get my weight down to the mid-seventies that would be fantastic, but difficult, and unlikely.
Well, fast forward to the present, and my weight fluctuates daily between 68.5 and 69 kgs, and I’ve moved completely out of the overweight category to normal. Digestive and gastric problems almost completely gone, more energy, and above all a level of pride at my self-discipline that’s beyond price. It was a long slow road, but a fascinating one, and it was nothing but calorie restriction, and a daily handful of exercises out of the CSIRO heart book that did it. You watch, I’ll be struck down by a heart attack or bowel cancer tomorrow.
Anyhow, considering my pretty well seamless experience of gradual weight loss, I’m interested in an article in the most recent Skeptical Inquirer magazine which takes a look at the obesity issue and asks the question – is ‘energy balance’ really the problem, and the solution?
Don’t worry, I’m not talking about new-age energy derived from crystals or pyramids, I’m talking about the balance between calories consumed and calories burned off. Basically, the prevailing wisdom is that we eat too much (especially of the wrong kind of food) and exercise too little, and this imbalance causes obesity. It’s a prevailing wisdom that’s worked for me – though it’s difficult, as I’m now constantly at myself to forgo that piece of food and to get up and move around more. And there will be no end to that vigilance, till the day I die or give up caring.
Even so, I would be very sceptical of a silver bullet approach to this problem, though of course I recognise that calorie restriction just doesn’t seem to work for a lot of people, mainly because they just aren’t able to permanently change their behaviour. And of course many would argue that cutting down their food intake drastically would reduce their quality of life too much. The Skeptic’s Guide folks were saying in their last episode that their late mate Perry would probably prefer to die at twenty, scoffing down a hamburger, than live on 1600 cals a day. That’s a bit extreme, but you get the drift.
I’m not a calorie counter, and I’ve no idea of my basal metabolic rate, but I’d roughly guess that around 1600 cals a day is what I’m down to, and I’d also guess that the reason I’ve been able to change my behaviour is because it wasn’t so ingrained in me in the first place. I was a really skinny kid who was an almost unmanageably finicky eater. I hated almost all vegetables, and many different kinds of meat, and my mother had a terrible time, apparently, trying to find nutritious foods that I would eat. As I got into my teens I was pretty active and sporty and I really didn’t think about food much, though my childhood sensitivities about the stuff gradually faded. What spoiled me – though some would look at it very differently – was a job I took on in my early twenties as a kitchen hand in a prestigious French restaurant. The alimentation there was to die for, and the experience h my attitude to food, and the cooking thereof, for better or worse. Add to that the inevitable slow-down as sporty youth has been left behind, and my working life, such as it’s been, has tended more towards the sedentary.
So it’s a far cry from the battle facing the childhood obese, who’ve laid down heavy neural pathways connecting fatty, sugary foods with well-being and pleasure, or so I imagine. Or had them laid down by their nasty fatty parents. I seem to have recovered psychologically something of the more active spirit of my youth, actually managing to keep, largely, to a regimen of simple exercises – no gym fees – and some not-brisk-enough walking (I really do seem to have laid down an abundance of neural pathways for dawdling), as well as managing to switch off, largely, the lazy snacking-grazing habits of my latter years.
But to return to the article ‘Obesity:what does the science really say?’. There’s some argy-bargy, but it doesn’t really contradict the energy balance approach, as I see it, it just supplements and modifies it with more detailed knowledge about hormones, sweeteners, refined foods and the like.
Okay, the sugar issue has become a major bone of contention. Here’s a quote:
Pediatric endocrinologist Robert Lustig (2012) agrees that adiposity is a hormonal predicament. In his new book, Fat Chance, the child obesity expert indicts simple, super-sweet sugars as the chief culprits, arguing that sucrose and high-fructose corn syrup corrupt our biochemistry and render us helplessly hungry and lethargic in ways fat and protein do not. In other words, Lustig insists that sugar-induced hormonal imbalances cause self-destructive behaviours, not the other way round.
Australia’s fabulous Cosmos magazine had a headline article, ‘Toxic sugar’, late last year which particularly targeted the previously under-rated fructose as a major public health hazard. Obviously, if Cosmos is featuring this view, it must be right, though the article was nuanced and highlighted the debate as much as any particular position. Anyway, think fructose, think fruit, right? Well, yes and no. Fructose, of course, is found in sweet fruit, but how many kids gorge on sweet fruit these days, when they can drink litres of soft drink instead? High fructose corn syrup (HFCS), used in soft drink and many other products, is the major source of fructose in modern western diets – particularly in the US. It’s this intake that’s led to the huge rise in a particular type of liver disease, non-alcoholic steatohepatitis, as well as childhood diabetes. Fructose is ‘sweeter’ than glucose, and is added to many products because it makes them sell.
Fructose differs from glucose in that it doesn’t stimulate a direct insulin response from the liver. Lustig contends that understanding insulin is a major key to understanding obesity and a host of ailments which together constitute ‘metabolic syndrome’. Table sugar is made up of both fructose and glucose, though the fructose can go largely undetected, because it’s only glucose that we measure when we check blood sugar levels.
But really, how complicated and debated all this stuff is. Other researchers point out that, though teenagers might drink copious quantities of HFCS-laced soft drink, most adult intake of fructose is not enough to be problematic. In my own case, I don’t eat as much fruit as I’m supposed to (which is how much?), and I haven’t had a sweet tooth since childhood. In the sugar bowl in my kitchen, the raw sugar has turned hard as a rock for lack of use (I don’t get many visitors), and the same goes for the big jar of sugar in my cupboard. Still, the last time (in fact the only time) I had my general blood chemistry checked out – 18 months ago, when my weight was at its highest – my triglyceride levels, and my LDL cholesterol levels, were slightly raised. I suspect most of my sugars were obtained from starchy foods, particularly bread, which I’ve cut down on quite a bit. Carbohydrates such as bread, potatoes and pasta – all favourite foods of mine, but all of which I’ve cut down on sharply in the last 18 months – are made up of complex glucose-containing molecules, which are broken up by the digestive system to allow glucose to enter the bloodstream.
In any case, it’s easy for me to say how I tackled obesity, or the threat of it. My approach was fairly casual. I ate less, really quite a lot less, but particularly targeted carbohydrates and processed foods. Processed foods are a worry in two ways – they take up far less energy to consume, and they come with added sugar. As one researcher puts it, we just don’t require any extra sugar in our diet, our bodies produce enough of it for all our requirements. I’ve never really measured calories, I’ve just gone on gut feeling, pun intended. I have no way of objectively measuring my health – I don’t have the technology available to me. It’s funny, your body is like a ‘black box’. I’ve no idea right now of my blood sugar levels, my levels of insulin, leptin, cortisol and other vital hormones mentioned in the material I’ve been reading. I don’t know how my electrolytes are faring or whether there’s too much fat accumulating around my organs. All I’m able to measure is my weight. Even my greater feelings of well-being are entirely subjective. I could well be fooling myself. Still, in spite of the debates among dieticians and obesity researchers, the consensus is clear, and it seems they’re arguing more and more about less and less. Avoid fatty foods and sugary foods, perhaps especially the latter, because they play havoc with your hormonal system, creating addictive behaviours and insulin resistance. Generally eat less, and enjoy what you eat more, and keep up with moderate, regular exercise. An active life, both physically and intellectually, will help break the habit of psychological dependence on food. Try to get your ‘rushes’ and to feed your ‘satisfaction centres’ from some other source than food. Not very scientific, I know, but it worked for me – he added with a smug little smirk.
stress and resilience: what rats are telling us
I recently read that when you go to the dentist, an almost archetypal stressful experience, your stress will be massively diminished if the dentist tells you, before picking up the drill and attacking your enamel, exactly what he or she plans to do and why. It’s a finding that can surely be safely extrapolated to many other experiences in life, and, perhaps obscurely, it reminds me of the famous story by Franz Kafka, The Trial. K is arrested one fine morning, and he doesn’t know why and he never finds out despite his best efforts, and then he’s executed (excuse the spoiler). A classic literary exploitation of the horror of stress. It reminds me also of how our co-op was treated by its government regulating body, but more of that in later posts.
Kelly Lambert, a veteran stress researcher and rat-lover, describes our growing understanding of the impact of stress and how it might be avoided and treated as one of the most important developments in modern medical and health science. In The lab rat chronicles Lambert displays a pragmatic and down to earth view of stress and depression, with an emphasis on prevention and action rather than ‘treatment’ and medicalisation, which I heartily endorse, while always recognising that there are complex psychological factors that can weigh against individuals taking charge of their lives.
Lambert’s intriguing rat stories serve multiple purposes, of which altering the common view of rats (as pigeons sans wings) is not the least. She teaches us, I think, that we can and have learned a great deal from experiments with animals, and especially rats, but we need to treat them with respect – and can ultimately learn a lot more from them if we do. Among the things they can teach us about are resilience, endurance, reciprocity, social capital, healthy living and self-reliance, and no kidding. But it’s the subject of stress, and building up a resistance to it, that most concerns me here.
Our stress responses are of course necessary and valuable. They motivate us to save ourselves when under attack, or to perform the unpleasant task we must do as part of our job (the prospect of being sacked concentrates the mind wonderfully). Yet the negative physiological effects of stress are the same, whether you’re facing a charging elephant or an angry supervisor. So how do we maximise the motivating force of the stress response, while minimising the negative impact? How do we make ourselves more resilient?
My account here will be abridged – stress is a very complex subject, and I most certainly won’t be giving a full account of it. The first thing is to be aware of stressful situations, of the type I described at the top of this post.
Interestingly, the term stress as applied to humans, other animals and plants, is of very recent coinage, and it’s actually a misapplication from engineering. According to Lambert, in the 1940s, a famous researcher, Hans Selye, began injecting rats with a hormone extract to observe their responses. He noted a heap of immediate negative reactions including swollen adrenal glands, shrivelled thymus glands and stomach ulcers, and was keen to write them all up, but felt he needed more baseline data, so he tried the same experiment, this time using a saline solution to inject the rats with – a placebo, effectively. What he found was the same heap of negative responses. How could this be? It eventually dawned on him that his rough handling of the rats in order to inject them, as well as chasing the scared rats around the cage and dropping them from a height as they squirmed to get out of his hands – all of this was the cause of the adverse reactions. Selye was so intrigued by this that he ditched the hormone extracts and began running experiments to test the rats’ physiological responses to adverse events, deprivation, novel scenarios and the like. This was such a new direction in research that Selye had to find terminology from another discipline to describe the state of mind of the rats as evidenced by their physiological and hormonal responses. He found what he thought he needed in the literature of engineering, with its twin terms stress and strain, but, being a Hungarian reading in English, he appears to have misunderstood that the term stress was applied in engineering to the causal factors operating on, say, a bridge, while strain was a description of the effects of those factors on the strength and durability of the bridge. In any case, psychology had been gifted a new term, one which has been a major feature of psychology and mental and physical health research ever since.
As the evidence mounted for serious negative effects on subjects exposed to events now deemed ‘stressful’, more consideration was given to variation within the findings, so as to better understand resilience in the face of stress. Work done with rats exposed to novel scenarios has shown that the responses vary on a spectrum from neophilic at one extreme to neophobic at the other. That’s to say, when placed in a new environment, the neophilic rats will be happy to explore it, while the neophobic ones will exhibit avoidance and a degree of inertness. Another way to categorise them is ‘bold’ and ‘shy’, and whereas bold and risk-taking creatures (it’s almost inevitable to think of teenage male humans) can create their own physiological problems, such as broken limbs or death by misadventure, the evidence in rats is that they live longer, on average, than their risk-averse fellows. The research also indicates that having the right temperament, or somehow building it into our natures, is key to coping with the day to day stresses that can accumulate in affecting our health in a host of ways.
So how do we enhance boldness or neophilia – in just the right measure – to cope with the slings and arrows? And why is it that some rats and people are more neophilic than others? Not sure that I can provide clear answers to these questions, but let’s come back to them after looking at the rat studies.
First, we’ve all heard of homeostasis, right? It has something to do with maintaining your body temperature and internal environment within certain parameters regardless of what’s going on outside. Fine, but studies of stress and responses have added a new, related term, allostasis, to the physiological lexicon. Allostasis is not so much about stability as about appropriate bodily change in response to external stimuli. For example, if you suddenly consume a heap of chocolate, as I’ve been wont to do, you’ll be hoping that your body’s insulin-producing response is timely and appropriate. Neuroscientist Bruce McEwen, adapting another engineering term, introduced the concept of allostatic load, a reference to the strain on the body when it fails to adequately cope with a stressful experience, whether it be heavy lifting or the deaths of loved ones. Both the general concept of stress and the concept of allostatic load were developed by researchers observing the responses of rats.
McEwen injected rats with the stress hormone corticosterone for 3 weeks, and then looked for changes in the hippocampus, an area which contains many glucocorticoid receptors, implicated in stress-related responses. The hippocampus is a region essential for spatial learning and memory; it would stand to reason that stressors and memory need to be associated for effective response. The added corticosterone had the effect of reducing the connections and size of the neurons in the region. How did this downsizing affect memory and learning?
McEwen first tried to replicate this effect on the hippocampal neurons by means of stress. So instead of corticosterone injections, he placed the rats in a ‘Plexiglas restraint tube’ for a couple of hours a day for 3 weeks. The physiological changes were similar to those induced by the hormone injections.
Another stress experiment was tried by Lambert to see how quickly the brain could be affected. Rats were housed in cages with adjoining running wheels, and their food schedule was restricted to one hour of feeding a day. The rats responded by becoming more, rather than less, energetic, running frenetically and showing all the signs of stress first noted by Hans Selye – swollen or shrivelled glands and stomach ulcers – and shrinking of neurons in the hippocampus. But the shrinking of neurons in all these experiments was reversible, and Lambert considers that this shrinking is probably an energy-saving manoeuvre of the brain. Brains take up a lot of energy, and may react to increased hormone production by downsizing to prevent overload.
Returning to the temperamentally bold and shy rats, I’ve noted that the shy ones have shorter lives – 20% shorter on average. Not surprisingly, the bold rats’ hormones returned to base levels more quickly after stress than their shy kin (and often they were actual kin). Clearly, having a more exploratory nature, within limits, is more adaptive than being exploration-averse. Freezing and worrying over novel scenarios isn’t a healthy option.
Lambert and her students became interested in pig studies in which piglets, held on their backs for a brief period, reacted either by struggling to escape or by holding still. The struggling piglets were labelled proactive and the apparently passive ones were labelled reactive, but a second test showed that some of the piglets changed tactics. Lambert’s group tried the experiment with rats. They found that some rats were extremely active, some extremely passive, and some switched tactics from one test to another. The last group was labelled as variable or flexible copers. The question was, had this group learned something between the first and second test which had made them change their behaviour?
After the tests, the rats were put through an activity-stress program in which they were given a restricted feeding schedule and then were given a choice between running on a wheel or resting. The proactives and the flexible copers ran more than the reactives. The levels of stress hormone were measured in each group. The proactives had more elevated stress levels than the reactives, but, quite surprisingly, the flexible copers had considerably lower stress levels than both the other groups.
In another simple test with the same rats, clips were placed on the rats’ tails to see how long they would persist in trying to remove them. The flexible copers persisted longest, and generally interacted more with novel stimuli.
The rats were then tested for how they coped with more chronic and unpredictable stress, of the kind that might be compared with serious economic downturns as experienced in the US recently, not to mention Greece, Ireland and other countries. The rat equivalents were strobe lighting, tilted cages, vinegar in their water, and predator odours. What was found with these and other tests was that the flexible copers’ brains produced higher levels of neuropeptide Y (NPY), a neurochemical associated with resilience (special forces soldiers produce a lot of it). The flexible copers also had the highest levels of corticosterone, which assisted them in maintaining a constant state of readiness to meet changing challenges.
So, how to turn rats – and people – into more resilient, flexible copers? Perhaps a bit of training might be required. An experiment was conducted in which the profiled rats were assigned to two groups, a ‘contingent training’ group, in which reward was contingent on effort, and a control ‘noncontingent training’ group, the trust fund rats. It was expected, or hoped, that the passive and more stressfully active rats in the contingent training group would, feeling an enhanced sense of control over their environment, increase their NPY levels and generally behave in more resilient ways. The contingently-trained rats, regardless of their coping profiles, all performed better at trying to get rewards (froot loops!) out from inside a cat toy (the task was impossible, but they were being tested on persistence). So far so good. Next, the rats were asked to perform a swim test, which I won’t describe here, but the results were excellent for the flexible copers, who improved their performances even more (and had higher levels of the hormone DHEA, associated with resilience), but the other two profile groups didn’t improve. A disappointing but not entirely surprising result.
A more interesting result came out of the control group. The flexible copers in that group, after a regime of easy benefits, reduced their willingness to make an effort when confronted with the need to do so to gain rewards in subsequent tests. I’ll quote Lambert here at some length:
Instead of having no effect on the coping responses, the trust fund condition erased the advantage typically shown by the flexible copers. The lack of a predictable contingency formula accompanying the presentation of life’s sweetest rewards reset the behavioural computations underlying the rats’ motivation to work for their rewards. They were now characterised by less flexibility in their responses and a shorter tolerance for work that didn’t immediately produce a reward. Had we systematically spoiled our rats? Once again, animals that were more sensitive to associations between effort and consequences would likely be even more affected by the trust fund noncontingency condition; after the fact, it all made so much sense.
So what can we take from these complex but often striking findings? Of course it goes without saying that we’re not rats, but I also like to think it goes without saying that these findings are highly relevant to humans, and all other mammals. Above all we find that removing us from a state in which we have to strive for rewards tends to make us slothful, intolerant and complacent – ‘spoiled’. A term which now has added resonance. How we build in that resilience in the first place is another question – it might be that very early experiences in which we’ve made positive connections between effort and reward, strongly reinforced from time to time, make for a kind of ‘natural’ resilience which we wrongly consider innate. This has always been my suspicion, that the earliest experiences, even in the womb, can set a strong pattern, which is what we’re talking about when we note that a baby seems to have already a set character, whether timid or ebullient, from birth. That character, when it is ‘resilient’, can be spoiled, so that’s something to watch out for. And as to how a set character which is non-resilient can be transformed into a flexible coper, that’s a tougher problem, as you’d expect.
What I like about Lambert’s approach is that she’s always looking for how we can improve our well-being without resort to medications, ways of positively altering our hormone regulation system through behavioural change, rather than through resort to pills. As she points, the use of anti-depressant medications has sky-rocketed since the mid-nineties, as have diagnoses of depression and related disorders. Something’s definitely wrong here. You’re not likely to increase resilience with pills. The good thing is that more and more researchers are coming to realize this, and looking to behavioural change, from exercise to social interaction to the creation of challenges and rewards, for the answers.
natural remedies, bogus cures, regulation and government – a mish-mash of preliminary observations
aka quackology monthly
Well, having just completed the onerous task of ‘debating’ William Lane Craig, it’s time to refresh with something new, and local – or at least national. Or perhaps local, because one of the leading writers behind this story is Tory Shepherd, who writes for Adelaide’s Advertiser and The Punch, and who is always excellent on pseudo-science, religion and many other issues, as well as being a far more entertaining writer than myself, as for example in this enjoyable but thought-provoking article on alcohol and anti-social behaviour (but don’t bother reading the comments, they’re mostly depressing, and give me the distinct impression that most people who comment on news articles are rather sad, angry souls who nobody else would want to talk to after five minutes).
Shepherd has recently written this piece on proposed new federal laws to deregister bogus medical treatments with the Australian Register of Therapeutic Goods. The opposition has provided in-principle support, which is great, as it might allow a smooth path to legislation in late June. However, if the opposition sniffs a vote in opposing it, there could be trouble. I’d like to keep an eye on this one. She also wrote this interesting piece in early February, about setting up a quackometer-style website to expose medical frauds, though I felt a bit confused about how it might work, funding-wise, and I can’t quite believe that quack peddlers would fall into the trap of getting listed on such a site. They’re pretty canny operators.
Let’s look, though, at the proposed legislation and why the government’s trying to act. Shepherd quotes Dr Ken Harvey, of LaTrobe Uni, a public health advocate and campaigner against bogus treatments, as welcoming the move, but with warnings about loopholes and various ways and means for the companies pedalling these products to dodge regulators (and there’s considerable concern about the rise of ‘fatblaster’ products, where big money can be made, and where the claims made are pretty extraordinary). I haven’t kept up with these issues, but a bit of research into Dr Harvey reveals these treatment peddlars to be more than just sneaky. The director of a company called Sensaslim Australia Pty Ltd, manufacturers of a completely bogus ‘slimming spray’, tried to bring a lawsuit against Harvey for defamation, citing a ridiculous amount of money. The whole thing eventually collapsed as more of the company’s shonkiness was revealed, but not before having caused much distress to the doctor. Shades of the Simon Singh case. But this case and others have highlighted weaknesses in the way the Therapeutic Goods Administration deals with the ever-increasing number of dodgy cures in the market-place.
The Australian Register of Therapeutic Goods (ARTG), which comes under the Therapeutic Goods Administration (TGA), which in turn comes under the federal government’s Department of Health and Ageing, is a compulsory register for anyone wanting to sell therapeutic goods (defined on the TGA website) within Australia or for export. A click on the website tells me that some 25 products were registered yesterday (March 28), and if that’s an average day, that’s an awful lot of products – thousands per year. There’s a lot of info on the TGA website relating to counterfeit medicines and complementary medicines, a lot to get my little head around, but I note they have a two-tiered system in which a medicine or device has to be either registered or listed. Heavy-hitting stuff, including all prescription medicine, has to be registered, which means going through an assessment process for quality, safety and efficacy. Most OTC medicines have to be registered, as well as some complementary medicines, but within the registration process is another two-tiered system, ‘high risk’ and ‘low risk’. Clearly the more low-risk the treatment, the less it will be scrutinised, but this means that treatments which are ineffectual but without evident risk, such as homeopathy, irridology, reflexology and the like, get through the system with minimum if any scrutiny largely due to their inefficacy. They do no harm, so they’re ‘okay’. What needs to be strengthened is the scrutiny of goods that just don’t do what they claim to do. There also needs to be an active recognition that dodgy products are harmful precisely because of their false claims, so that unsuspecting consumers buy them instead of more genuine products. The new legislation will provide stiff penalties for false and misleading information, as well as deregistration, which in effect would be an official ban on sale. Does this mean homeopathy might be banned in Australia soon? Don’t hold your breath on that one. One way that the homeopathy industry flies under the radar is by avoiding claims on its labels, and relying on word-of-mouth and its reputation, especially among the ‘new age’ and generally disaffected-with-mainstream-medicine crowd, to maintain sales. My (minimal) research suggests that this ‘medicin douce’ is listed rather than registered, and the TGA probably doesn’t have the resources or teeth to verify low-risk listed products for efficacy.
However, there are other government agencies such as the ACCC (Australian Competition and Consumer Commission) and the NHMRC (National Health and Medical Research Council) ready to do their bit in protecting consumers. The NHMRC is currently reviewing the effectiveness of homeopathy in a systematic ‘review of reviews’, and will be asking for public feedback in mid 2013. This will be part of an overview of various CAM modalities, with a view to possible changes to the government rebate on private health insurance for natural therapies. Interesting, but with the slowness of this process, and the likely demise of this government come September, we can’t expect too much.
curiosity, the ineluctable correlate of scepticism
During a recent gathering with neighbours I found it hard to keep my cool when someone told me recent evidence had come out supporting reflexology’s credentials as a healing technique. Expressing just a touch of scepticism, ho ho, I got the irritated response that ‘science doesn’t know everything’. I’ve already treated that ‘criticism’ in my introductory ‘fountains of good stuff’ podcast, transcribed here, but I feel the need to go further in dealing with this odd line of attack, because it annoys the shit out of me.
‘Science doesn’t know everything’ is one of those semantically not-quite-right phrases that reminds me of the half-opaque lines of Ringo Starr (examples are ‘tomorrow never knows’ and ‘it’s been a hard day’s night’) that tickled Lennon and McCartney into basing songs around them. Science isn’t a sentient being as far as I’m aware – and if it is I hope it’s not a supernatural one – so there’s no chance of it ever ‘knowing’ anything.
I’ve already had a rough go at defining what science actually is in the aforementioned ‘fountains’ intro, but any definition should, IMHO, be light and provisional rather than hard and fast. Certainly it’s about reliable knowledge, and the means of arriving at it, but it’s also, as many have said, about a way of thinking, a way of life. A way of life characterised by, and fueled by, curiosity and wonder. And what better words can there be, in our language?
Science is about questions rather than answers, and so the questions that come to mind when I’m told that ‘they’ve found’ that reflexology really works are questions like – ‘Really?’ How does it work? So there really are connections between zones on the soles of the feet and the pancreas, the gall bladder, the eye, the lungs, etc etc, as the theory suggests? Are they direct connections, or do they work through the peripheral nervous system? What, precisely, is the cellular pathway? Are the signals communicated electrically or chemically? What, if any, are the messenger molecules? If they’re not felt, through the nervous system, via the brain, but are more directly connected, so that only a third person (i.e. a trained reflexologist) can detect the connection, why would such a system have evolved? What possible evolutionary benefit would such a bizarrely non-neurological system provide? Curiouser and curiouser.
I did ask my neighbour if she could provide more details about the actual study or studies supporting reflexology, and she promised to do so, but that hasn’t happened. Well, fine, it was all very informal and semi-drunken. I’ve googled myself for recent studies supporting reflexology, but I’ve come up empty. If anybody out there has evidence – obviously non-anecdotal – to contribute to this vital debate about the future of medical knowledge, I’d be very interested to hear about it.
The fact is, though, that our knowledge of the human body and how it functions, and goes wrong, is burgeoning. And the more we know, the more we have to learn. That’s to say understanding just keeps generating more questions, so that, paradoxically, we now know more and at the same time less than we’ve ever known before, and so it will continue. That’s the fuel of science – the not knowing, the wonder. There are today thousands of labs, studying intracellular molecules, nanoparticles, subatomic forces, retroviruses, glial cells, genes, etc etc, all of them fueled by this hunger to know. And all these researchers are well aware of, and delighted by, the fact that knowing will just lead to more questions, more research, more puzzlement and wonder. It truly seems to be a self-sustaining system. I find it invigorating and exhilarating. I also find it rather amazing that all this research, particularly in medicine, has accounted for the fact that we, in the west, have increased our life expectancy by 2.5 years in every decade, in extraordinarily linear fashion, since the mid-nineteenth century. That’s to say, since the regularisation of medical training and the universal acceptance of the germ theory of disease, among other things.
Which brings me back to reflexology and other forms of so-called complementary medicine. The ‘science doesn’t know everything’ remark, whatever can be made of it, seems to be arguing that Herr Science, that burly, self-absorbed, Germanic (i.e. barely comprehensible) autocrat, should stop being so smug and should listen to the wise practitioners of tried-and-true folk medicine, coz they might learn summat, en it?
Au contraire, I say.
To me, all the smugness is on the side of reflexologists, iridologists and homeopaths, and their supporters. Not to mention evasiveness, defensiveness, and, worst of all, lack of curiosity. All that can generally be gotten out of these people are ‘It works!’, ‘It worked for me!’ ‘You should try it!’ ‘How can you condemn it without even trying it?’ and of course ‘science doesn’t know everything!’ – and when you try to pin these people down about the mechanisms involved in such treatments – that’s to say, the field in which curiosity comes to play – just sit back and watch the obfuscations and contradictions pile up.
To focus more closely on reflexology again, I’ve presented the same ‘foot map’ as I did in my last post on the subject. Note, for example, that there’s a tiny zone on each foot, just below the middle toes that corresponds to the eyes. Unfortunately the map doesn’t tell us whether the zone on the left foot corresponds to the left eye, the right eye, or both, but hey, details details. What I’m curious about, for now, is – where did this map come from, and how does it compare to other reflexology maps? Presumably, if reflexology is true, then each reflexology map would be the same – just as modern maps of the human brain would be more or less identical in every one of the thousands of neurophysiology research labs worldwide. The zones won’t be shifting around according to different practitioners, right?
However, it should also be pointed out that, if every reflexologist is working from the same map, it doesn’t follow that reflexology is true, any more than the fact that a thousand priests are preaching from the same bible proves that the bible is true. They could all be working from copies of an original map which was the imaginative invention of a single ancient, or not-so-ancient, healer (or quack, or well-meaning but deluded Believer).
So let’s have a look at another map:
This zonal map comes from a Thai tourism site which presumably intends it be some harmless R & R for jaded westerners and a boost to the local economy. Good luck to them, I say, but the actual map – if you can ignore all the colours and shapes, which tend to obscure rather than illuminate the ‘zones’, is roughly similar to the one at the top of the post. It’s more detailed, and more ambitiously labelled, including zones associated with the gonads, and ‘insomnia points’ on both feet. However, there are some glaring and one might say pretty vital contradictions. In this coloured map we find a zone for the heart on only one foot (I don’t know if it’s the left or the right, because I don’t know if we’re supposed to be looking at the feet from above or below), just above centre and to one side. On the other map there are two zones for the heart, one on each foot, just above the instep. If we look at these zones on the coloured map, they refer to – the parathyroid glands! A pretty serious discrepancy, I would’ve thought. Possibly even fatal.
And of course there are other discrepancies and vagueries. The more carefully you look, the more you find. So how do we resolve these problems? Do we look at more maps and try to come up with ‘consensus zones’? Do we research all the maps to uncover the most authentic? And by what criteria?
Well, here’s another map:
Again this one is in general agreement with most zones on the other maps. It plumps for the ‘thyroid area’ instead of the more specific ‘parathyroid glands’ and the completely different ‘heart’ on the other two maps, and it adds the ‘buttocks’ at the heel, of which there’s no mention in the others, but overall there’s a sense that these might come from the same source.
So is this an ancient Ayurvedic or Chinese source? Well, the Thai tourism brochure mentioned above actually quotes from a Chinese source, but it clearly refers to simple massage, not anything so complex and extraordinary as reflexology (a term apparently invented by one Eunice Ingham in the 1930s, renaming it from zone therapy, a term and a ‘theory’ devised by one William Fitzgerald in around 1913). The only ancient source who actually comes close to hinting at anything like modern reflexology is the Roman medical writer Aulus Cornelius Celsus, whose writings are thought to be derived from the Greek Hippocrates. In his De Medicina, he writes this:
Much more often, however, some other part is to be rubbed than that which is the seat of the pain; and especially when we want to withdraw material from the head or trunk, and therefore rub the arms and legs.
It ain’t much, and no ancient ‘zonal maps’ are extant, and I very much doubt if any ever existed. References to any complex and precise ancient teaching about zones in the hands, feet or anywhere else connecting with organs or glands in the body are totally unsubstantiated. It’s likely that the various more or less related modern zonal maps are loose reproductions from the imaginative writings of Fitzgerald, Ingham and other early twentieth century enthusiasts.
So, my curiosity and scepticism have brought me to a dead end, really. There’s clearly little interest, either from supporters or detractors, in spending money on rigorous trials to evaluate a practice that seems incapable of even providing a mechanism or pathway for its working. It would be hard to work out what to test, and supporters of the practice could easily explain away null findings by arguing that the wrong maps were used or that the zones were rubbed clockwise rather than anti-clockwise, or without sufficient skill, or conviction even. And when all else fails, and the lack of any scientific evidence becomes impossible to ignore, these unsceptical and incurious believers can always just shrug and say, ‘well, science doesn’t know everything…’
on appetite suppressants
just add water and you get stuffed, apparently
The ‘obesity epidemic’ has been big news in the west for some time now. Increasing affluence, increased food production, the popularity of junk food and sugar-laden soft drinks, the pressure of advertising, not to mention the popularity of computer games and activities that exercise only the finger muscles, all have contributed to the rise and rise of western flab, and associated health problems.
Naturally, all sorts of solutions, of varying quality, are being offered, from lap banding to any number of diets, from crash fads to the more or less scientific. Clearly there’s the potential for a lot of money to be made in this area. Crisis can always be spelt as ‘opportunity’.
So it was with some interest that I noted an ad on TV the other day, from the company Swisse. From memory [that very unreliable source] it featured an attractive thirty-something woman, telling us of her busy day and how it was important to stay in trim, and recommending the use of Swisse ‘appetite suppressant’ pills. She also mentioned that the pills, or their active ingredients, were derived from a cactus plant which was used for this purpose for thousands of years by the natives of wherever the cactus grew. I don’t think the location was specified.
Well, I fell to wondering. A pill that suppresses your appetite, so that you’re less hungry and therefore eat less on a daily basis. Isn’t this the solution to the obesity crisis? Well, maybe not the solution, as there’s still the matter of what you eat, and how active you are, but certainly a general purpose appetite suppressant would be a great weapon in the fight against flab, and probably the primary weapon. Surely this is nothing short of sensational. Worthy of headline news at least.
So let’s see what I can learn about this appetite suppressant and how it works. As a seasoned researcher, I accessed that unmatchable research tool, google, and clicked the first link to come up in the list under ‘Swisse appetite suppressant’. It took me, of course, to the Swisse website, where I found a useful summary, from their perspective:
Swisse Ultiboost Appetite Suppressant contains Slimaluma®, a premium quality ingredient to help reduce hunger levels. Slimaluma® is a naturally derived extract of the cactus plant which has been used for centuries in India for its appetite suppressant qualities when food was scarce. Swisse Ultiboost Appetite Suppressant can be used to help control hunger levels and is best combined with healthy eating and as part of a regular exercise regime.
The advice at the end is admirable, though I do wonder whether people who engage in healthy eating and regular exercise are in need of an appetite suppressant. Healthy eating presumably already excludes over-eating. I was also interested in, and on reflection, slightly disturbed by the offhand remark ‘when food was scarce’. After all, to take away or reduce the pangs of hunger when you’re hungry, or even starving, is a bit like giving a painkiller. It reduces the symptoms but doesn’t solve the problem. It could even exacerbate it, when you consider that feeling hungry is nature’s or evolution’s way of telling you that you need to eat. I wondered how such a product could translate to use in an over-indulgent food-abundant society.
In any case we now find that the cactus plant hails from India and that the active ingredient extracted from it is called ‘Slimaluma’. So how effective is Slimaluma and how does it work?
My search took me to the website of Gencor Pacific, the makers of Slimaluma, and here’s what they have to say:
SLIMALUMA™ is a proprietary standardized extract of Caralluma Fimbriata, an edible plant used for centuries in India as a famine food and appetite suppressant. Gencor Pacific has developed a unique patented process to extract the essential constituents of the whole herb without chemical alteration to any of the key constituents, ensuring that the full benefits of the herb are delivered in concentrated form.
Caralluma fimbriata
Sounds impressive, and there’s more. They describe the results of clinical testing of the product, which is a great sign at least:
SLIMALUMA™ has undergone two double blind, randomized, placebo controlled human clinical trials, one in India and the other in California, USA. Many participants experienced significant loss in appetite and some lost inches off their waist and hips. Participants also experienced reduction in body weight and body fat.
They then link to a more detailed description of the studies and their findings, which again is excellent, and much more than we’ve learned to expect from the sellers of ‘natural’ health products. However, for obvious reasons it would be unwise to simply accept the description and interpretation of the studies of a health product by the makers of that product. So we need to look at more than one, possibly multiple descriptions and interpretations of the studies, and at whether other studies have been conducted.
So let’s look at clinical trial number one. It was conducted at the Division of Nutrition, St John’s National Academy of Health Sciences, Bangalore India during January to August 2003, and it involved 50 subjects. The Wikipedia article on Caralluma fimbriata [and I find Wikipedia quire reliable on these matters in spite of its reputation in some circles] reports on this trial rather differently:
In a small clinical trial conducted in India, modest benefits of Caralluma fimbriata extracts were observed. In the study, 50 overweight individuals were given either a placebo or one gram of extract each day for 60 days. Compared to the placebo group, individuals receiving the extract showed no significant change in body weight, body mass index, hip circumference, body fat or energy intake; however, both appetite and waist circumference were reduced
The difference in these descriptions of the same trial naturally demands that we examine those descriptions more closely. In Slimaluma’s description we’re told that ‘many’ participants experienced ‘significant loss in appetite’. Two questions here – first, how many is many? Fifteen, thirty-five? What about a percentage? And second, how do you measure ‘significant loss of appetite’? Weight loss and BMI are easy to measure objectively, but not appetite loss. I can only imagine that it’s measured through reporting, which, however unreliable, can at least be measured against the reporting of the placebo group. So, while the term ‘significant’ here is a bit tricksy, let’s accept that there was discernible appetite loss. Fine, but the findings were that this change did not lead to reduction in ‘energy intake’, meaning that the Slimaluma consumers didn’t eat less, in spite of having reduced appetite. An odd finding. Not only that, they didn’t reduce body weight or BMI, though there was a reduction in waist circumference. In other words the results seem to be all over the place, and of course the Slimaluma manufacturers only reported, and hyped, the positive findings.
The Indian study was quite small, and its results were hardly definitive. Shannon Moffett, in her book about the brain, The Three-Pound Enigma, which I just happened to be reading today, makes a general statement about research which fits nicely here:
..when you make a generalisation from the sample you study to the population at large, there is a chance – bigger or smaller depending on factors like the size of your sample compared to the size of the population as a whole, how well you controlled for other variables, and so forth – that the trend or trait you observed is characteristic only of that sample and not of the population at large
I seem to remember Steven Novella saying that 50 was an okay number for a study of this kind, if a bit on the small side. It would certainly be useful if it was backed up by further research, but really the initial findings are so underwhelming that further funding might be hard to find. One might expect that there would be some weight loss for the whole group over the six-month research period, as they were all obese and knew they were being studied for weight loss. They were advised not to change their diets, but it’s likely they would have. I haven’t been able to find the precise data on the study, as it’s behind a paywall [why?], but there was a further study done. However, it involved only 26 subjects, only 7 of whom were given placebos. This study only lasted for four weeks [an absurdly short period, it seems to me, given the notorious ‘rebound effects’ of people on diets]. As presented in this Gencor gloss on both studies, it produced ‘excellent’ results, but the sample was too small and the research period too short to produce reliable data.
The gloss mentioned above does attempt some science on the action of Caralluma fimbriata’s phytochemical constituents – pregnane glycosides, fIavone glycosides, megastigmane glycosides and saponins – in suppressing appetite, but I can find very little in the mainstream literature on these specific phytochemicals. The fact is, there’s very little scientific evidence for the efficacy of this product, and the Wikipedia article mentioned above makes this very important point.
Various diet pills claiming to contain Caralluma fimbriata extracts are marketed for weight loss. However there is no independent evidence to suggest that the amount of extract found in these products is sufficient to obtain the same results as the clinical trial. The FTC cautions against the use of “miracle diet” products.
This is a major problem with all so-called allopathic products. There is no control or oversight to their manufacture, as there is with all prescription medication. And, let’s face it, if these appetite suppressants really were efficacious, they would become prescription treatments. That’s what happens with evidence-based medicine. So chuck out those pills, eat less, eat healthily, and make sure you get plenty of exercise. There really is no alternative.
What is reflexology?
I have to say I began to write this piece without the slightest inkling of what reflexology might be.
So now I know it’s about feet, and other bodily parts – mostly extremities – and how they have zones which correspond to internal organs. Presumably applying pressure to these zones cures things. Very big in Denmark, apparently. It’s generally promoted by its adherents and practitioners as an ancient healing system, but little seems to be known of its origins, though this quote from one Aulus Cornelius Celsus, a follower of Hippocrates, is suggestive:
Much more often, however, some other part is to be rubbed than that which is the seat of the pain; and especially when we want to withdraw material from the head or trunk, and therefore rub the arms and legs.
So how can rubbing these zones have an effect on ‘corresponding’ organs? Well it seems there’s a lot of dissension and just plain vagueness about all that, but one common theme is that qi, the Chinese life force, provides the connection. As to the existence of qi, that’s another question, but needless to say it’s an empirical question, for it could only exist in a real sense, not in some supernatural, unlocatable and unmeasurable sense.
However, we needn’t worry about any dodginess, because the Reflexology Association of Australia [RAoA] has a website, with a link to the independent research done to prove its bona fides as a treatment.
Well actually, no, the link only takes you to the email address of the same RAoA. The website also has a left sidebar of links, including one to research, but that one’s greyed out, and doesn’t link to anything. Interesting. You’d think reflexologists would want to be promoting research into their practice, considering how effective they claim it to be. One of the other links is to ‘reflexology articles’, and it takes us to seven linked essay titles. The first is a very brief piece called ‘Importance of A&P [Anatomy & Physiology] and Clinical Medicine for Reflexologists’. Here’s how it begins:
As with any evolving profession, in the beginning, there were very few practitioners who had much knowledge of how the human body worked as the ‘hands on’ practise of working the feet was passed on by family members and anyone else who was interested in learning for their own benefit. As long as they knew where the points were on the feet for specific parts of the body this was considered sufficient at the time. Besides, there were very few avenues and incentives available for people to learn Anatomy & Physiology for their own continuing knowledge.
So we learn that reflexology, in spite of claims to its antiquity, is ‘an evolving profession’, though presumably we could say the same about medicine generally, so there’s not much meaning n the phrase. The Biblical phrase ‘in the beginning’ doesn’t cast much light either. Could be a generation ago, or several thousand years ago. What we do learn is that family knowledge has been passed down as to ‘where the points are on the feet for specific parts of the body’, though sadly we get no details as to these points. Why not throw in an example or two. I mean, it’s not a secret – is it?
In any case, nowadays, there’s a clear avenue for the study of anatomy and physiology. It’s called a medical degree. But that’s not what this article’s author has in mind. She simply claims that it would be a good idea for reflexologists to be up on modern clinical terminology, and even writes about a high standard of knowledge, but nowhere does she explain how this standard is to be achieved. The ‘Certificate of Clinical Reflexology’, unit descriptors of which are downloadable from this website, is made up of some 20 units, of which only three or four actually deal with reflexology as an application of medical knowledge. The others deal with business and admin matters, or such general subjects as ‘Personal Wellness and Self-care’ or ‘Work effectively in the health industry’. I’ve carefully perused those few essential units, and they provide no training in general anatomy and physiology whatsoever. Considering that the central claim of reflexology – that certain pressure points in the foot and elsewhere correspond to the organs of the body – is a clear claim about physiology, this omission is more than slightly disturbing.
But let me return to the article quoted above, to seek enlightenment. Here’s another little quote:
Even though, in most circles, Reflexology is considered to be working with body energy, it is extremely important to have a very sound knowledge of the human body to improve the practitioner’s ability to understand client problems and therefore fit the pattern of working to fit the problem.
Now do you get it? What we have here is an enunciation of the principal of complementarity. You see, another term for naturopathy is complementary medicine. That’s because these alternative treatments are complementary to mainstream treatments. It’s essential to understand mainstream anatomy and physiology so that you can ‘fit your pattern of working to fit the problem’ as defined by mainstream medicine. Not that reflexologists are riding on the coat-tails of mainstream medical practitioners – heaven forfend. After all, they’re working with ‘body energy’, not with just bodies, as anatomists and physiologists do.
So what is this body energy? Well, that may depend on the philosophical approach that guides your reflexological practice. And there are plenty of approaches to choose from. The unit entitled ‘Reflexology framework practice’ has this:
Philosophies relating to reflexology may include:
• TCM Five Element Theory
• Yin / Yang
• Indian chakra system
• Interaction of mind-body systems
• Holographic Theory
• Quantum Mechanics of Healing
• Polarity
And presumably they may also include much else. Clearly reflexology is deeply philosophical, possibly impenetrably so. In fact, I really feel too over-awed to continue.