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Where is the Evidence?
Posted by Dr. Ben Kim
Every once in a while, I receive requests for references to back up some of information on self health care that I provide throughout this web site. If a post doesn't have citations for published studies, some people refuse to consider its contents. Believe it or not, some of these folks get downright ornery about this issue.
My response is two-fold:
First, I encourage everyone to learn as much as they can about human anatomy and physiology. The more you know about your design and how all of your organ systems work together to preserve your health, the better equipped you'll be to make choices that support your health.
I suppose the three giant endnotes that could sit at the bottom of every page of this web site are Guyton's textbook on Human Physiology, Robbins' text on Pathology, and Lehninger's textbook on Biochemistry - these books provide a comprehensive look at how your body works, from the cellular level all the way up to your organ systems.
Second, I like to point out that the science of human health is vastly different from the science of non-living and non-thinking entities. For example, when drawing up engineering plans for a bridge or writing the code that makes a web site work, skilled engineers and computer programmers can work their way to their desired outcomes one step at a time. They may have to go through some trial and error, eliminating options as they go along and coming up with creative ways to address unique challenges, but ultimately, their problem solving occurs within a matrix that is governed by mathematics and physics.
Your body is also governed by mathematics and immutable laws of physics. The difference between your body and the Golden Gate bridge is that your body is constantly being affected by your thoughts and emotions. The endless stream of neurotransmitters, hormones, and other biological compounds that are produced by your thoughts and emotions makes it impossible for any physician to fully understand your needs and prescribe a guaranteed fix for whatever ails you.
We call this the mind-body connection, and it's arguably the most overlooked determinant of human health.
My Awakening to the Mind-Body Connection
When I began chiropractic school in the suburbs of Illinois, I was consumed with anxiety about how I was going to pay for my education. Being from Canada, I didn’t have access to the same student loans that my fellow American students had. The Canadian government loaned me and other Canadian students studying abroad approximately eight thousand Canadian dollars per year, barely enough to cover tuition and dormitory fees for a third of each year.
At the time, my parents were struggling to build a young Korean Presbyterian church in Toronto and were unable to help me with more than a couple hundred dollars of grocery money every four months. I was extremely blessed to receive an entrance scholarship that took care of half of my tuition costs each semester, but I still needed to find a way to come up with about three thousand dollars every four months to pay my way through school.
Early in my first semester, I discovered that the best work opportunities on campus were a few coveted fellowship positions, one in each major department. These fellowships provided a stipend worth a few thousand dollars each semester, just what I needed. The problem was that these positions didn’t come up very often, only when a current fellow was ready to graduate.
During my first two semesters, I worked as an assistant in the biochemistry lab and did some private tutoring in neuroanatomy. These part time jobs were enough to buy a few essential textbooks, but the balance owing on my tuition and dormitory bills got scarier by the month. I never spent more than twenty-five dollars per week on food. My staples were potatoes, white bread that was thirty-three cents a loaf, peanut butter, pasta with tomato sauce, frozen cheese pizzas that were two bucks a piece (good for two meals), and whatever fruit was on sale each week at ten cents per piece (Thank you Jewel Osco in Lombard, IL).
In the beginning of my third semester, I was elated when the anatomy department announced that a search was on for a new fellow who would take the place of the current fellow when he graduated. Given my academic record at the time, I was extremely hopeful of getting this position. I spent the next few days scurrying around the main building and library, getting together reference letters and polishing up my resume as I prepared my application.
To this day, I cannot remember how I found out that I did not get the position. All I remember was how crushed I was in receiving the word. I literally couldn’t eat anything for a day and a half, thinking that I had lost a golden opportunity to pay my way through school. Within days, I came down with a viral infection that had me in bed with a fever, sweats, excruciating lower back pain, and extreme weakness. Even after I recovered about a week later, I felt sluggish, weak, and depressed.
I was still feeling down and unhealthy a few months later when I learned that the research department was taking applications for a new research fellowship position. Almost instantly, my disappointment vanished as I went after this new position with gusto.
Within days, the head of the research department called me to her office, where she announced that I was hired. Unbelievable! For a full year, my mind and heart had been consumed with getting a fellowship position. I had regularly dreamt about being a fellow, paying my tuition and dormitory bills, and even squirreling away a few dollars each month.
As I sat in that office doing my best to look calm, I felt like I just won the lottery. When I got out of the meeting and a few meters away from the clinic, I broke into a sprint, yelping and punching at the air. I'm sure I looked like a first class ninny.
When I reached my apartment, I called my folks, out of breath, and blurted out the amazing news. My parents were incredibly happy, of course, which fueled me into an even greater frenzy. At one point, I remember smothering my face in my pillow and hollering as loud as I could – I was incapable of containing my excitement
Up until that moment in my life, I had never felt that kind of gratitude. I think that my joy was enhanced by the devastation I had felt just a few months prior.
Years later, I was able to think back to both moments - the feeling of ultimate defeat and the feeling of ultimate triumph – and realize how much power my emotions had over my physical health. When my dream was crushed, I felt like a five to ten car pileup. When my greatest hope became reality, I felt like I was almost floating around campus, able to accomplish anything and be compassionate to the nastiest of people. At a relatively young age, I experienced the power that my emotions have over my physical well-being.
Your Mind-Body Connection is ON at All Times
Here's the thing: it's not just the big ups and downs that affect your health via your mind-body connection. This connection is on at all times.
Every thought and emotion that courses through you influences your health. Your thoughts and emotions affect blood flow, the strength of your immune system, healing capacity, and every other aspect of your physiology.
You can see evidence of this undeniable connection between your ongoing emotions and your health in everyday life. Ever woken up from a bad dream, covered with a thin coat of sweat? Nothing but your dream – thoughts and emotions – caused a series of chemical reactions that resulted in real physical change: production of sweat from your sweat glands.
Have you ever had your mouth water at the thought of eating a particular food that you had a strong craving for? How about saliva production at the thought of drinking a large glass of cold, tart, super sour lemon juice? Clearly, your thoughts and emotions are capable of causing physical contraction of your salivary glands.
What about the obvious physical changes that occur in your body when you feel sexually aroused? Again, mere thoughts and emotions creating a ripple of physical effects throughout your body.
In recognizing how real and powerful this ongoing connection is between your emotions and physical health, can you see how regularly eating a large green salad with a resentful or depressed spirit is not conducive to supporting your best health?
The Limitations of Scientific Research
Getting back to the issue of references to scientific research, should you ignore health information that isn't footnoted with studies that are published in indexed and peer-reviewed medical journals?
Only you can make this decision for yourself. Personally, I don't need health information to be footnoted with published studies to consider its merit. To judge the value of any new health information that I come across, all I require are logic and my knowledge of human anatomy and physiology. And when I don't know enough about the human anatomy and physiology involved with a particular health issue, I educate myself until I am confident that I have enough knowledge to make a logical assessment of the issue at hand.
My approach to assessing health information was largely shaped by experiences that I had in the world of medical research during my undergraduate (University of Toronto, Clinical Sciences Division of the Institute of Medical Sciences) and graduate (National University of Health Sciences) years of schooling.
When I was a research fellow at the National University of Health Sciences, I was intimately involved with a randomized control trial that was designed to evaluate the effect that chiropractic adjustments had on primary dysmenorrhea, also known as painful menstruation. A randomized control trial (RCT) is a type of scientific investigation that is meant to reduce or eliminate bias; RCTs are considered to be the most reliable form of scientific evidence in modern medical research.
The dysmenorrhea study assigned subjects - all women with primary dysmenorrhea - to one of two groups: the first group received a series of "sham" treatments, while the second group received a series of spinal manipulative treatments. The women received their weekly treatments without being told which group they were assigned to, and filled out a series of questionnaires to subjectively rate the effectiveness of their treatments.
My involvement with the dysmenorrhea study allowed me to make the following realization:
When dealing with human subjects, even the most meticulously designed and conducted randomized control trials fail to account for the ongoing impact that thoughts, emotions, and interaction with other humans have on overall health.
In the dysmenorrhea study, it was obvious to me that a significant determinant of how the women felt about the effectiveness of their treatments was the manner in which the attending physicians and research assistants interacted with them. We can all relate to this, can't we? All of us know how reassuring it is to be cared for by a doctor who has a warm bedside manner, just as we know how upsetting it can be to be handled by an uncaring physician.
All scientific studies that involve human subjects are at the mercy of this huge, uncontrollable variable. Even if a study involves something as simple as giving its subjects one of two pills, the effect of taking any pill will always be influenced by the subject's thoughts and emotions surrounding that moment. And the subject's thoughts and emotions will always be influenced by his or her circumstances and interactions with others before, during, and after treatment.
Doctors are well aware of the impact that your thoughts and emotions have on your health. They even have a term for it - it's called the placebo effect, which is defined as the healing effect of a "sham" therapy.
A study published a few years ago in the Journal of General Internal Medicine found that out of 466 faculty physicians at Chicago-area medical schools, 231 of them reported that they had prescribed placebos in clinical practice. Reasons for prescribing placebos included:
To calm a patient down.
To respond to demands for medication that the physician felt was unnecessary.
To do something after other treatment options had failed.
I find it unfortunate that while many people are aware of the power of the placebo effect, they have a tendency to forget about it when it comes to evaluating medical research.
Here's another important realization that I made during my years as a research assistant and fellow:
Medical researchers at colleges and universities are under significant pressure to receive grants to carry out their research and have the results of their research published in indexed and peer-reviewed medical journals.
I think it's naive to believe that the pressures that researchers face to meet these objectives don't influence some of their findings, the way their findings are presented, or if their findings are even presented to the public.
To give just one example of how medical research and guidelines may not always be in your best interest, think back to the summer of 2004 when a panel of expert physicians lowered the "safe" level of LDL cholesterol from 130 to 100 mg/dL, and even recommended that people at high risk of developing cardiovascular disease aim to lower their LDL level to 70. This modification in the medical standard of practice for assessing and addressing blood cholesterol levels caused an estimated eight million Americans to instantly become candidates for cholesterol-related drug therapy.
While this "medical news" was covered by all major media outlets and news wires, only one newspaper, Newsday, reported that most of the physicians who were responsible for establishing the new recommendations had conflicts of interest; almost all had received money – mainly in the form of grants or honoraria - from at least ten drug companies. These financial disclosures were not reported by the National Cholesterol Educational Program, which was the source of the new medical treatment guidelines for cholesterol.
So how do you know what information to trust to help you with your health? Hopefully, you are open to the possibility that the size of the footnote section of health articles does not correlate with how reliable they are. This is not to say that footnotes are useless. There are excellent researchers and research papers in our world, and footnote sections can acquaint us with them.
But on a practical level, when searching for answers to your health questions, rather than spend time researching each footnote and assessing the validity of the original research in question (not forgetting the uncontrollable mind-body-connection element), I suggest that you consider doing what I mentioned above: educate yourself on relevant details of human anatomy and physiology until you are confident that you have enough knowledge to make a logical assessment of the health information that you are considering.
As you put into action the steps that make the most sense to you, you must continuously observe your progress and be open to making adjustments until you experience the improvement that you're looking for. Keep trying, observing, and adjusting as necessary. Because what works for some people may not work perfectly for you. And if you find something that works for you, continue to observe and be open to making adjustments, because what works for you today may not necessarily work for you as you go through different phases of life and healing.
This is what it means to be your own best doctor. No one can understand and take care of your health better than you can, because only you live with all of your thoughts, emotions, and life experiences.
Most importantly, as you search for answers to your health challenges and take measures to improve your health, I encourage you to be hopeful. If you commit yourself to the belief that you cannot get better, then so it likely will be. If you embrace the attitude that regardless of how unfortunate your circumstances are, you have power to improve your situation with your thoughts, emotions, and behavior, you may just create what some people call a spontanteous remission, and what others call a miracle.
The quality of your health and life begins with your thoughts, which govern your emotions, which create the juice that coats all of your cells. What kind of juice you manufacture moment-to-moment is almost entirely up to you.
I'll bring this post to a close with the following suggestion:
Whenever you feel your thoughts and emotions going to the dark side, be it rage, jealousy, resentment, pettiness, or self pity, to change your momentum, ask yourself any of the following:
Who do I love most in this world?
Who in this world cherishes me?
What brings me joy?
If I knew that I only had a week left on this planet, what would I do?
What am I grateful for?
Really think about your answers to any of these questions.
Allow your soul to marinate in your answers.
Breathe your answers in and out.
Feel them at a cellular level.
This is how you and you alone can create health-enhancing juice anytime and anywhere. Enjoy it, and know that no supplement, drug, or surgical procedure can help you in this way.
How often should you do this? As often as possible, I say. To make this a morning and nightly ritual isn't such a bad idea. As Aristotle told us, "we are what we repeatedly do."
And that's just about all I have to say to those who need references to scientific literature to make decisions regarding their health care. Hope this jumble of thoughts is helpful to at least one person out there.
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