Thursday, March 31, 2016

Zika Update

The Centers for Disease Control have issued a couple of updates on the Zika virus. The first concerns travel to Zika-infested areas, and a study finds that the mosquito that spreads the virus, Aedes egypti, is not active at higher elevations. Researchers mapped new cases and found that they occur at elevations below 2000 meters (about 6,500 feet). If your travel plans take you to higher elevations in Zika-affected countries in the tropics, your risk of Zika is low to non-existent. Extraordinary mosquito protections are not necessary because the cooler, drier climate of mountainous zones. In a second report, the CDC has approved a test to screen blood donations. This will be of great help in countries affected by the virus, because it will improve the safety of blood transfusion. The virus does linger a bit after the infection clears. In a related notice, the CDC recommends that pregnancy be delayed for about 2 months after travel to Zika-affected areas. However, the real connection of the virus to microcephaly (small infant head with mental defects) remains elusive.

Sunday, March 27, 2016

Our Response to Lyme: Medical

When Lyme first appeared in the latter half of the 20th century, we treated it with antibiotics, and that was that. Late-stage cases did occur, and we figured that out, and then we treated that antibiotics too. But not everyone got better--at least right away. These were cases that people started calling "chronic Lyme disease."

Like a lot of chronic diseases that medicine doesn't seem to quite have a handle on, the world of Lyme disease sufferers developed a parallel medical world full of "Lyme doctors" who prescribe immense doses of oral and intravenous antibiotics, alternative practitioners advocating various protocols using herbs, nutritionals, multiple homeopathic remedies, and other methods. I hear reports from people that suggest that sometimes these work for some people. But as I tell my students: Every modality has cured every disease--at least once. Meaning: just because it worked once for someone else doesn't mean you can rely on it to cure you. That's one of the weird things about human biology and medicine.

So the trick is to figure out what modality is going to work most of the time.

So far, I've only found a few modalities that will. Traditional Chinese medicine (TCM) and classical homeopathic medicine are two general systems that work. Dr. Andrew Weil, the physician and writer about all things alternative, notes in his book Health and Healing that there are only a few methods of medicine that are broad and systematic enough to serve as true alternatives to traditional Western medicine. TCM and classical homeopathy are two of the few. Most other modalities are more complementary to the healing process. Some modalities, like Western medicine and naturopathic medicine, are broad, but they don't have a coherent theory to provide the systematic structure of diagnosis and treatment that could more reliably address conditions that are not so straightforward.

Post-Lyme treatment syndrome (PLTS) is one such condition.

PLTS is believed to be caused not by lingering B. burgdorferi infection, and not by so-called co-infections with Babesia and other related germs. Rather it is believed to be a perverted immune system reaction to the infection in the first place. In this way, the symptoms of PLTS are really a crazy immune system reaction. We see parallels in syphilis, HIV, and even type 1 diabetes, multiple sclerosis, and Guillain-BarrĂ© syndrome--in these latter three cases, the diseases seem to emerge after even a simple viral infection causes the immune system to attack the body's own pancreatic cells and nerve cells, respectively.

Our response to these types of problems, using Western medicine and many alternative approaches, is to try to cobble together a treatment that fits within our rudimentary understanding of things. An example would be trying ever-increasing doses of antibiotics, over ever-longer durations of treatment, despite known side effects of such medications. Another example in the alternative world could include various supplements. Often I have observed such patients to be on literally dozens of supplements! That just can't be good for a person's health (and it's not good for their wallet either).

Both classical homeopathy and TCM begin with the assumption that one doesn't need to know what specific features are malfunctioning, deficient, or excessive, so much as they rely on understanding the pattern of these features that are made visible to the practitioner through the pattern of the patient's symptoms. In this way, we recognize that each person's "imbalance" is unique, and simply fits into a pattern that we already know. Find the pattern, find the cure.

It's not that some nutritional supplementation, exercise, or even medical drugs aren't needed ever in such cases. It does mean that one ought to view the system--the person--as a whole that is responding in every cell of his or her body to the imbalance imposed by the accident of the infection, and that each person's reaction can fall into one of hundreds of patterns of imbalance.

Next: Our response to Lyme (and things like it), as a society.

Monday, March 21, 2016

Spring has Sprung...and so has Lyme Disease

I have a student this semester who is working on her senior project. The subject is Lyme disease.  Part of the assignment is to study community resources that are available for people who suffer from the health problem the student is investigating. As one can see from the map, Lyme is a common concern here in the northeast, although it does occur everywhere.
Lyme Disease in Northeast U.S. (Courtesy CDC 2014)
My student has been exploring the world of medicine that operates behind the scenes of what we commonly think of as "medicine" and medical practice.Just Google "Lyme Disease" and you'll get a lot of hits. Many are mainstream pages, like WebMD, the Centers for Disease Control, and Mayo Clinic. But there are also dozens of alternative sites such as My Chronic Lyme Disease Journey, Lymeinfo, and many discussion boards in which sufferers, clinicians, and healers talk about the condition and its effects and its cure. I recently read my student's midterm journal report, and indeed she has found herself deep in the middle of this complicated, confusing world. I think it must be even more strange for professionals, like my student, an RN getting advanced degree, who are used to living in the world of "legitimate" medicine, a world run by doctors and hospitals, a world with an accepted view of biomedicine, a world that tends to marginalize those who advocate alternative viewpoints.

Two Stories of Lyme

The first story has to do with what Lyme disease is and what it does. The second story is about our response to Lyme. My student's experience this semester touches on both.

What Lyme Is and Does

For a long time we thought that Lyme, like other bacterial diseases, would respond simply to antibiotic treatment. That is, you get bitten by a deer tick. You get the rash, maybe a fever or some joint pains. We give you doxycycline or something, and you get better. However, Lyme, like syphilis, comes from a family of bacteria that tend to stick around. Like syphilis, there are "tertiary" or late-stage Lyme cases. Any disease can be beaten by the human immune system, but there are some against which the immune system doesn't always do so well. Examples include syphilis, Lyme, HIV, hepatitis C, hepatitis B, and others. Yes, there are cases in which all of the foregoing diseases have been cleared or cured by the genetics and immunity of certain individuals (how about that!)--but in general, this group of infections requires a bit of help from antibiotics or antivirals.

So Lyme--Borrelia burgdorferi--is a little corkscrew shaped bug that gets into a variety of tissues, especially joints, and if untreated and uncleared by a person's immune system, becomes a source of chronic, low level inflammation, which can eventually cause really serious problems: arthritis, weakness, brain fog, and even heart problems. The treatment for every stage of Lyme is antibiotics, usually a course lasting anywhere from 10 days to 4 weeks, depending on the duration, and on which authority's recommendations are used. Late-stage Lyme can last decades to a lifetime.

Next installment: Our Response to Lyme

Saturday, March 12, 2016

Materialist Science as a Model Obsolescence

I'm reading Richard Dawkins' 1976 classic The Selfish Gene. In that era, Darwin's theory of evolution was 117 years old. On The Origin of Species marked a revolution in our understanding of the fundamentals of biology, how life organized and developed over eons. Of course, a molecular description of genetics would require another century to fully mature (Watson and Crick's modeling of DNA), but between Greek and Roman notions of heritage, Gregor Mendel's experiments in plant inheritance, and Darwin's theory of selection, we got a lot worked out. There were competing theories of speciation and inheritance, but in the end one model explained things better than the others.

As I proceeded in my reading, I found myself reading related material, you know, looking things up and cross examining Dawkins' work. In his Wikipedia article I learned that Dawkins' is an ethologist--someone who studies animal behavior under natural conditions--and is an outgrowth of the scientific orientation of naturalists like Darwin. I won't go into Dawkins' thesis in detail here, since I'm mostly interested in this particular book in terms of its historical significance. Simply put, he argued for the primacy of the material of inheritance as the driver of evolutionary success. That is: Genes are (most of our) destiny. The "selfish" bit? He admits that he felt it made a punchy title that gets across his argument that genes are themselves the basic unit of evolutionary success and that such success is "self-ish", and he didn't mean this in a teleological way.

I actually don't find this notion in conflict with my own views of biology (mostly).

As I looked up one thing after another during my reading of Selfish and came across Rupert Sheldrake, who happens to be close in age to Dawkins', and a link to whose work you'll find in my webpage under "My Influences". 

This made for fun reading, since Sheldrake is considered by some (like the authors of his Wikipedia article) to specialize in "the paranormal" although Dr. Sheldrake seems content to consider himself a biologist. I say fun, because the authors of that article don't assign Sheldrake to "nonsense" and only a little bit to "pseudoscience" (unlike the Homeopathy entry, which is heartily given both labels). It was fun because one gets a glimpse of the controversy surrounding the work of Sheldrake, the back and forth between the Materialists and the New Vitalists.

Vitalism is a very old notion in biology and in medicine in particular. It's the notion that we are more than just material. Clerics and mystics called this The Soul. But others had various names for it, and the idea of vitalism doesn't depend on religion for its proposed existence. Vitalism is a key piece of homeopathy: without it, homeopathy doesn't exist. Vitalism also fits into a host of other medical systems and techniques such as acupuncture, faith healing, Ayurveda, healing touch and others. To keep it simple, think of vitalism as describing a kind if energy. In Chinese medicine, for example, it is called "qi"(chi). 

So vitalism kind of died out in the 20th century. Materialist explanations were just too successful as our methods and instrumentation became more and more powerful. Examples include advanced experimental methodologies, statistics, electron microscopes, functional MRI, and so on. 
However, all of this was still within the scope of Thomas Kuhn's "normal science", that realm of socially acceptable scientific investigation and natural philosophy that forms the box we're all supposed to remain within. It is a model that is essentially "materialist", meaning that phenomena can be explained through the agency of material acting on other material. Put another way, it means that the universe can be explained exclusively through a model that relies on atomic and chemical reactions, and known energies, such as electromagnetic energy, gravity, and radioactivity.

I mentioned functional MRI earlier. Today it's a technology that is used to explore brain function in neuroscience. Results from such study have been interpreted to mean that all consciousness arises from the brain, and that volition--origination of thought, free will--may be illusory. The late neuropsychologist Klaus Grawe wrote that a thought arises before we are aware we have thought it. More pointedly: we believe we think of things but in reality our brain generates thoughts and we believe we originated those thoughts. Having a thought precedes being able to will it.
If that's really the case, then there is no free will--all thought is kind of predestined. Alternatively, we're mostly pretty random beings, stuck in our behaviors, which seem to arise willy-nilly from our neurons. Admittedly, this model would explain a lot of things about people, but it does mean that our self-awareness is an illusion, our will is not our will at all. It's connected to something, but not to our intention.

And here's a bit: it's a materialist view of nature. It fits very well into normal science, although it seems rather bleak. To be fair, Grawe's book, Neuropsychotherapy: How the Neurosciences Inform Effective Psychotherapy, was certainly an effort to bring hope to people suffering from mental health problems! Still, it seems rather bleak that we have no essential will and that everything still devolves to the "substance".

So, back to Dawkins and Sheldrake. Dawkins and others subscribe to a logical positivist view of the world which argues that there is a single, objective reality, and that reality is materialistic (which includes the known, currently measurable energies I summarized above). Sheldrake and others--and I include myself here--argue that too many loose ends have accumulated. These loose ends are not described by the current model. Sheldrake's "morphogenic field" gives form to organisms, and subtly influences phenotype. Homeopathy, I argue, is a "weak" medicine, but one that gets at a subtle and as-yet-unmeasured field that helps to regulate living organisms. However, like judo, a small effort in just the right way can have large effects.

The late Martha Rogers was a nurse-theorist who proposed that humans are energy beings, that our material selves are temporary manifestations of our selves, and that death itself is a passage to a higher "vibrational" state. In graduate school, I reviewed the experimental evidence for her theory and found it wanting. To some this solidifies the materialist view. I would argue that it simply means that Rogers' theory is not accurate in its present form. Loose ends pile up in the box of normal science. Those loose ends call for alternative ways of explaining our world. The hypotheses that attempt to explain them are many: subtle energies, psi energy, morphogenic fields, and so on. Natural experiments abound: Reiki, homeopathy, acupuncture, and many people exploring "paranormal" phenomena like extrasensory perception, out of body travel, and so on.

Why this seems to make the Materialists angry is a matter I will attempt in my next installment.