Friday, January 28, 2011

Placebo should be the Gold Standard

"Placebos should be the gold standard," says Melanie Thernstrom, author of The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering

When placebos work, there are no side effects.

A recent study of a commercial drug that reduces the frequency of hot flashes in menopausal women showed that while the drug did help slightly more women than a placebo, that the women who took the placebo did not have a return of the hot flashes when they stopped taking the pills, but the women who took the drug went back to their pre-drug state.   In other words, if the placebo works, the problem is solved permanently.

Now there's an even more exciting study. At Harvard Medical School, people who have irritable bowel syndrome were divided into two groups. One group received no treatment. The other group was given placebos. The bottles were labeled Placebo. The people who were given these pills were told they contained no active ingredients.

"For three weeks, the patients were monitored. By the end, researchers reported, 59 percent of the placebo-takers re-ported adequate symptom relief, but only 35 per-cent of the others re-ported such relief. Al-so, on other outcome measures, placebo-takers were found to double their improvement rates to a degree roughly equiv-a-lent to the effects of the most powerful medications for the condition."

Another study showed that a common knee surgery is no better than a placebo:

In the study, 180 patients with knee pain were randomized into three groups. One group received debridement, in which worn, torn, or loose cartilage is cut away and removed with the aid of a pencil-thin viewing tube called an arthroscope. The second group underwent arthroscopic lavage, in which the bad cartilage is flushed out. The third group underwent simulated arthroscopic surgery; small incisions were made, but no instruments were inserted and no cartilage removed.

"During two years of follow-up, patients in all three groups reported moderate improvements in pain and ability to function. However, neither of the intervention groups reported less pain or better function than the placebo group. Indeed, the placebo patients reported better outcomes than the debridement patients at certain points during follow-up. Throughout the two years, the patients were unaware of whether they had received real or placebo surgery." 

I find all this fascinating because I'm at an age when surgery and prescription drugs are common answers to common health problems.  I'd like to see guidelines for situations in which placebos should be tried before anything else.  Since time alone cures many ills, people should be given a choice that doesn't involve surgery or pills.    

Wednesday, January 26, 2011

I Win the Lucky Ditz of the Day Award

I live in a high crime neighborhood. I know better than to do what I did today.

I rode my bike to morning yoga.  I had my purse in my saddle bag – It had the usual – money, ID, a credit card.  As I rode, it began to snow.  I considered skipping yoga for fear that I wouldn’t be able to ride my bike afterwards. First ditzy act – I biked without checking the forecast first. If I went home now, I’d be able to put my bike in the living room and take the bus to my job.  But the snow was light – it might stop, or at least not build up very much during class. I pulled my trusty plastic sack out of my saddle bag, and tied it over my bike seat. I locked my bike to the traffic pole. Then, I hurried into the yoga center. I left my saddle bag, with purse zipped inside on my bike. I didn’t even think about it.

After class, when I gathered my things, my saddle bag wasn’t where I usually put it, near my jacket. I reviewed my earlier actions – I had no memory of removing the saddle bag from my bike. Surely by now, somebody else had done the honors.

I opened the door to the yoga center planning how I was going to replace my ID, buy a new saddle bag, call the credit card company – and WOW AMAZING – the snow had stopped. There was no build-up. I’d be able to ride for the rest of the day.  And – DOUBLE WOW, DOUBLE AMAZING – my saddle bag was still on my bike. It was still zipped.  I opened it. My purse was still inside.  I didn’t bother to open the purse until I took the saddle bag inside at my next stop.  Everything was still in it.

I win the Lucky Ditz of the Day Award.

Sunday, January 23, 2011

Yoga Bit Me

I did yoga in college for my PE requirement.  I loved the stretching and improving my balance. I loved how it made me stronger without competition or team sports.

When I graduated college I did yoga on my own for a while, mostly the sitting and all-fours poses. When I married and had children, I stopped doing even those postures.  For a while my girls were interested in yoga (or I wanted them to be, so I enrolled them in classes.) And I took yoga classes again. I discovered I much prefer doing yoga with a teacher who can correct me, than doing it on my own with a book.

My girls lost interest and I stopped doing yoga again.  I swam. I biked. I did exercises that don’t require correction or discipline.

That went on for about 30 years.  Then I got hit by a car while biking, and I needed rehab.  My physical therapist suggested yoga.  Yes. I had loved yoga.  I called a local yoga school.  Yoga had changed in 30 years. Yes, it’s supposedly a 5000 year old practice.  But now, nobody teaches “yoga.” There are many varieties of yoga.  For rehab, the school recommended Iyengar yoga. This kind uses props. Blankets, blocks, straps, ropes on the wall.  The props allow students to feel the stretch even when they can’t get close to the official posture.

Again I loved yoga and found value in having a teacher who could correct me.  

My Sunday teacher suggested I also study with her teacher.  Her teacher suggested I practice at home – not just a few days a week when I’m in class.  

I got a book that described all the niceties of each posture – where to stretch, where to balance. For my first time, I tried standing poses on the mat. Those are the exercises at the beginning of the book. The author of the book clearly thought standing poses were the place to start.

I was doing triangle pose and I lost my balance.  When I got up, I was in pain.  I went to my chiropractor who did what he could. He said I had a slipped disc.  I’m lucky I wasn’t in a pretzel posture when it happened.  I just looked like a sideways C.  He gave me exercises to help the disc slip back into place. And he had me come for adjustments several times a week for the next few weeks.

I’m better now. But I’m wary of standing yoga postures.  They bit me.  I still love sitting postures and all-fours postures.  

Yoga was supposed to help me heal. Now I’m healing up from yoga.  

Supposedly the Hindu gods inspired the creation of yoga.  The endearing thing about the Hindu gods is that they are fallible.  I guess it’s no surprise that their yoga isn’t perfect either.    

Thursday, January 20, 2011

Free Speech Has Changed

I was looking for an uplifting movie about free speech and triumphing over odds.
The movie Frances, starring Jessica Lange, looked like it would provide what I sought. Netflix describes it this way:

“Jessica Lange (nominated for the 1983 Best Actress Oscar) delivers the performance of her career as Frances Farmer, the notorious 1930s movie star whose impassioned opinions and outspoken behavior created scandal throughout the industry.”

In fact, while the movie has a fascinating opening, most of it is a downer about Frances Farmer’s miserable life.  Still, the opening scenes in which Miss Farmer, age 16, won an essay contest for “God Dies,” are fascinating. 

Free Speech has changed.

An essay on that topic today would probably not be selected as a winner even at the classroom level.  Not because of how well it was written, but because of the topic.

Our nation has become too divided to give respect to such an opinion.

The essay opens:
“No one ever came to me and said, "You're a fool. There isn't such a thing as God. Somebody's been stuffing you." It wasn't a murder. I think God just died of old age. And when I realized that he wasn't any more, it didn't shock me. It seemed natural and right.”

It continues:
“Sometimes I found he was useful to remember; especially when I lost things that were important. After slamming through the house, panicky and breathless from searching, I could stop in the middle of a room and shut my eyes. "Please God, let me find my red hat with the blue trimmings." It usually worked. God became a super-father that couldn't spank me. But if I wanted a thing badly enough, he arranged it.

That satisfied me until I began to figure that if God loved all his children equally, why did he bother about my red hat and let other people lose their fathers and mothers for always? I began to see that he didn't have much to do about hats, people dying or anything. They happened whether he wanted them to or not, and he stayed in heaven and pretended not to notice. I wondered a little why God was such a useless thing. It seemed a waste of time to have him. After that he became less and less, until he was…nothingness.”

And, it concludes:
“I felt rather proud to think that I had found the truth myself, without help from any one. It puzzled me that other people hadn't found out, too. God was gone. We were younger. We had reached past him. Why couldn’t they see it? It still puzzles me.”

I think this is a well-written and well-reasoned essay. I don’t agree with it, but there’s nothing in it that I find offensive.

There are lots of ways in which a religious person could use this essay as a jumping off place to discuss God.  This kind of discussion was still possible in the 1960's.  But today it has become too scary to be mentioned in public.

I don’t see what good freedom of speech or freedom of religion are if they’re going to be censored by public fashions.

Free speech is only useful, when we have the freedom to say what other people don’t want to hear.  

In the movie some audience members didn’t like what Frances said. Some told her she was going to hell.  But nobody said they were going to send her there personally.  They believed in a God who could fend for Himself.

When free speech is censored or curtailed, our children are not being taught how to think.  Thinking is the key to solving problems and creating a better future.  

What has happened to change our taboos?  It used to be unacceptable to openly discuss breast cancer because you had to use the word breast. Society wasn’t divided on the subject. Sex was not an acceptable topic for discussion.  Philosophy was a valid topic, particularly if you were smart. Now people can openly discuss sex, but not the core concepts of philosophy. 

Freedom of speech should be big enough for all topics. Not talking about philosophy is just as dangerous as not talking about breast cancer.  We need both to ensure that we have healthy bodies and healthy minds.

Saturday, January 15, 2011

Nonsense Words

The most famous use of nonsense words in the English language is from Shakespeare’s “Much Ado About Nothing”

Sigh no more, ladies, sigh no more;    Men were deceivers ever;
One foot in sea and one on shore,
    To one thing constant never;
        Then sigh not so,
        But let them go,
    And be you blithe and bonny;
Converting all your sounds of woe
    Into. Hey nonny, nonny.

The words “nonny nonny” have no meaning, but are probably meant to remind the listener of the word nonsense.

Another nonsense example comes from Lewis Carroll in his poem “The Walrus and the Carpenter.”

"The time has come," the Walrus said,
"To talk of many things:
Of shoes--and ships--and sealing-wax--
Of cabbages--and kings--
And why the sea is boiling hot--
And whether pigs have wings."

This time, the nonsense comes from recognizable words arranged into sentences that have improbable meanings.

In both cases, the intent is to influence the behavior of the listener.  In the case of “hey nonny nonny” the idea is to get women to give up on men ever being sensible.

In the case of the Walrus and the Carpenter, the characters are using the syntax of sensibility while saying things they should know are not true.

I think fear lies at the root of both these nonsense examples.  Shakespeare’s ditty focuses on the Fear that men can’t be constant to their women or their careers.  And Lewis Carroll takes the idea a step further – he fears that men can’t be constant to the truth.

The biggest problem with fear is that it makes us feel helpless.

Recently, at a Chinese restaurant.  My fortune cookie read: “Fear is just excitement in need of an attitude adjustment.”

That seems to me to be a piece of true wisdom.

Much of our lives are taken up with actions we perform habitually that have their roots in fear.

We have magical gestures like knocking on wood, or not stepping on a crack. Some people even say “knock on wood.”

We have loyalty oaths for people who hold jobs with the government, as if lying would be impossible for someone who was not loyal.

And we have the ritualistic recitation of the Pledge of Allegiance in schools and in meetings.

The Pledge was originally written in 1892 for two purposes:
1) to honor the 400th anniversary of the landing of Columbus on the North American continent.
2) to sell flags. In other words it was an advertising slogan.  It sold 25,000 flags. It was recited at the 400th anniversary celebrations of Columbus landing. And for 6 years, that was the end of it.

Then the US declared war on Spain, and wanting to do something supportive, the New York State legislature decreed that school children would recite the pledge daily.  19 Other states followed suit.

The motive was fear.  It was similar to my neighbor who wears a special shirt during Eagles games because she’s sure they’ll lose if she doesn’t wear it.  We know, realistically, that school children reciting the pledge, or saying “hey nonny nonny” will not affect the outcome of a war.  But nonsense words take root. And people fear giving them up.

These rituals are not harmless. The Pledge has contributed to the destruction of the very things it praises about America.  The Pledge says that this country is Indivisible.  Bellamy was referring to the Civil War which ended only a few decades before he wrote this poem.  But there are other ways to divide America.

The Pledge has been used as a reason to divide students in America’s classrooms. Jehovah’s Witnesses are forbidden by their religion from saying the pledge.  These students are excluded from the classroom, sometimes forced to stand out in the rain, or attend detention. This is the opposite of Indivisible.

Freedom of Speech includes the right NOT to speak.

As Supreme Court Justice Robert H. Jackson said in 1943, "To believe that patriotism will not flourish if patriotic ceremonies are voluntary and spontaneous instead of a compulsory routine is to make an unflattering estimate of the appeal of our institutions."

And America is not a land of “liberty and justice for all.”  The Innocence Project has used DNA evidence to free over 250 people from jail, some of whom served over 30 years for crimes they did not commit.  Liberty and Justice for all may be our ideal, but it is not a fact.

The Pledge was made law out of fear and it has not made this country safer or free-er.

As recent episodes of terrorism have shown us, it is individual people who are terrorists – not countries.  Nonsense words will not protect us.  I suggest we say the words we really mean at times and in places where they can be effective.

Monday, January 10, 2011

Hooping to the Right

In 1958, it took me months to save up the $2 for a hula hoop. I mowed lawns for $35 cents. I baby sat. I saved the pennies my mom gave me for the gum machine at the grocery store. $2 was a LOT of money.

When I finally got it, I took it with me everywhere so I could practice.  Spinning that hoop around my waist didn’t automatically make it stay up.  At a park, some kids who didn’t have a hoop attacked me and stole it.  Then they got into a tug of war and put a kink in it. Once it was damaged, they didn’t want it any more. A little tugging and it was round enough to spin again.

After that I only practiced at home. Hooping was the first normal thing I'd ever wanted to do, that other girls do.  Forget Barbies or playing with make-up, or boys.

I spent more time practicing spinning that hoop than I did doing my homework. And since my mom wouldn’t let me play until I was done with my homework, I mastered the art of concentration. If you really focus on your homework, you can get it done while there is still daylight, unless the teacher has really piled it on.

In a few weeks, I mastered spinning the hoop around my waist.  I learned to add an extra push with my hips and send the hoop up, over my shoulders. From there I could stick a hand inside the hoop beside my neck, and raise it over my head, switch hands, and drop it back down to my waist.  I learned to work it down over my hips, catch it at my knees, and work it up again. I learned to spin in circles inside the hoop, and to walk around the block while the hoop whirled about my waist.

All the while, my hoop spun to my left.  I never thought about it. I just spun it that way.  As later my politics spun to the left.

I don’t remember when or why I stopped playing with that hoop.  I do remember there were decades when I never saw them in stores any more.

And when they came back, I bought one, brought it home and tried to show my husband how much fun it is to spin a hoop around your body.  I couldn’t do it any more.  I’d thought hooping was like biking – once your body learns, it never forgets.  But it wasn’t so.

Apparently I wasn’t the only one.  A few years ago, adult hoops came on the market. Instead of weighing a few ounces, the new ones weigh a pound or more.  And it’s not enough just to keep it spinning any more.  Hula Hooping is  a sport, it’s a dance, it’s something they teach at the gym.

Last Wednesday night I tried an adult hoop with pretty metallic stripes.  The hoop stayed up. I spun it for an hour in class. I learned to pick it up with a hand behind my back and raise it over my head. I learned to spin it around my body like wings. And I almost made it home before the pain kicked in.  Spinning to the left, means that the left hip does most of the work. My left hip got hit by a car. It doesn’t want to play that game any more.

So, this morning I tried to spin the hoop to my right.  It kept falling, like that hoop did back in 1958.  But when I was done practicing, I wasn’t in pain.  It’s just a matter of more practice.  And I’m sure my politics aren’t attached to that hoop. Hooping to the right won’t make me stop being a liberal.

Friday, January 7, 2011

It Wasn't Broken After All

Last night, while I was cooking dinner in my microwave, it just quit. Light went out, the tray stopped turning. Poof. Good thing I was cooking in glass, so it was easy to transfer to the real oven.

I did the obvious. I checked the circuit breakers in the basement. I unplugged and replugged it. That puppy wouldn’t spin.

Then I started planning meals – what would I make for dinner?  I’m spoiled. I have the freezer section of my fridge packed with little plastic boxes of portioned meals. When I cook, I plan to fill between 2 and 6 boxes for future meals. You can’t put plastic boxes in a regular oven, or even into a pressure cooker.  I was going to have to thaw the food, transfer it to an oven-safe container and heat it the long way.

How would I make my morning cocoa?  I decided to use the double boiler.

I ride my bike or take the bus.  Neither is a sensible way to transport a microwave.  All the easy-to-get-to appliance shops have gone out of business. It’s much easier to order from the web than risk slipping on the ice carrying a heavy bulky box.

Reluctantly I went online, found a model I liked and ordered it.  Not a planned expense. This microwave was only 3 years old.  I’m used to getting 15 years out of a microwave – kind of like a hot water heater.  But I’m addicted to the quick and easy modern kitchen: microwave, blender, electric mixer.

I truly felt I’d be roughing it until the new microwave arrived.   I would have to go back to the cooking ways of the previous century, or even 2 centuries ago.

Then in the morning, I decided to give the microwave one more try.  It worked!  

I called the webstore and cancelled my order.  

Tuesday, January 4, 2011

I Quit Coffee to Save My Husband's Life

My husband was about to start his senior year in college. The Vietnam war was raging.  He came from a middle class town where at least half the young men went to college.  He thought his draft board would at least let him finish. Confidently, he sent in the paperwork showing he had passed all his Junior Year classes and had enrolled for his Senior Year.

I had a dream that he was going to get a IA draft classification in the mail.  Not a student deferment. The dream was so vivid, it felt like a glimpse into the future.  I’d had glimpses before and they usually came true.  I went to the library to find out what other exemptions were available.  

Recent surgery could get you a postponement of up to 6 months.  A crippling disease could get you an exemption. And a child could get you an exemption.  That was something I could try.  I could try to get pregnant.  All I had to do was stop taking birth control pills.  And from my reading, I should stop drinking coffee if I wanted to become pregnant quickly.

Coffee was my one adult vice. I don’t drink alcohol, or smoke anything. I don’t wear make-up. I don’t consider sex to be a vice.  And I’d recently been given a lovely shiny new coffee machine.  Plus I worked at a restaurant where I could have all the delicious fresh coffee I wanted while I worked.  All of that was nothing compared to allowing my husband to be drafted and sent to Vietnam where I was sure he’d be killed.

I told my husband about my dream.  He didn’t believe me.  He was entitled to that student deferment. He had studied hard, he had paid his tuition for the next term.  He was sure he’d be allowed to graduate.  And maybe continue his deferment while he went to graduate school and worked on a Ph.D..  But he was interested in starting a family.

So, I quit drinking coffee.  Two months later, I was pregnant. And a week after that the letter from my husband’s draft board arrived.  1A.  We sent them a copy of my positive pregnancy lab test.  8 months after that we sent them a certificate of live birth.  My husband received a father’s exemption from the military draft.  

He helped with the middle-of-the-night screamies and diapers. We took on a lifetime commitment earlier than we had originally planned, in order to save his life.  It was literally a case of now or never.  But I seriously question why the government put pressure on draft-age young men to start families when they are in college. I fail to see where that serves the country. Then again, I fail to see where any of the wars the US has been in during my adulthood have served the country.

My husband continued drinking coffee. I never had the urge to pick up the habit again.  I’ve had a few cups socially over the years – but the addiction is gone.  I’d much rather have a cup of herbal tea.

When my husband was in the hospital recently they didn’t serve him coffee. He was amazed to see that his blood pressure was normal. And he wasn’t constipated.  When he got out of the hospital, he quit coffee.  He even quit caffeinated soda pops, which had never appealed to me.  He quit coffee to save his own life.

Sunday, January 2, 2011

Going to Yoga With a Cane

As I worked my way down the icy sidewalk, slowly, with my cane, a woman about my age offered to help me.  I thanked her, and continued on my way.  She turned in at the yoga studio and was closing the door when I arrived.  Her eyes expressed surprise to see me enter as well.  Am I the only person in history to go to a yoga class using a cane?

I can’t bike there – the streets are clogged with snow and ice.  I don’t dare walk without my cane. It’s not just my hip. The sidewalks are slick with ice where people have shoveled, and mounded with snow where people have not.  The buses have been rerouted because of the snow and ice, so they no longer go near my house or the yoga studio.  If I’m going to go to yoga class, I’m going to walk there. And if I’m going to walk there, I’m going to need my cane.

In class, I did all the balance poses up against the wall.  When I lost my balance, I bumped the light switch.  Embarrassing, yes.  But no pain. No slipped disk. No bruising.

Yoga isn’t just for the young and fit and flexible.