Head and Heart

By Dr. Jim Ferguson

Recently, a patient came to me seeking a miracle; and I didn’t have one.  Desperate people often search for a magic medicine or a cure.  I now know what this feels like, and hopefully it will allow me to a more empathetic person and a better doctor.  Sympathy implies concern for another person, and pity may be a component of sympathy.  As an example, I have sympathy for the innocents in the raging wars of the Middle East.  Empathy is different, and involves the projection of yourself into the plight of another, and to consider the world from that person’s perspective.

As I stretched myself to consider my patient’s desperate plea, I tried to walk in his moccasins as the native-American metaphor goes.  I felt his pain, but my empathy did not change the realty for him as I explained the limitations of medical science.  I did advise him that his OTC (over the counter) medications were useless for his problems and potentially harmful when used as a false hope of a cure rather than following the recommendations of his other doctors.

Perhaps people resort to herbs, neutraceuticals, and avant-garde remedies because they have lost trust in doctors and science.  Since the Enlightenment, man has put increasing faith in objective reality, and since the Renaissance, western civilization has increasingly negated a spiritual reality.

You may recall the chemical laetrile, falsely labeled as a vitamin, and used some years ago as a purported treatment for cancer.  This agent is not a vitamin and is useless as a cancer therapy.  It fact its generic name is amygdalin and it is poisonous.  This is a classic example where unscrupulous people play upon the fear and desperation  of patients.

Science does not have all the answers – I’ve repeatedly said so in this column.  However, we are rational creatures and should use this gift to discern truth from quackery.  As I visit my doctors for follow-up medical care I reiterate that it’s hard to be objective about yourself or loved ones.  This is why doctors are advised to see and follow the advise of their physicians, who hopefully are applying science to guide them in their recommendations.  A major tool of medical science is a clinical trial.  These carefully constructed experiments endeavor to find effective drugs and therapies, and to avoid patent medical remedies that may be ineffective or harmful.

Our bodies operate by chemical reactions and chemical reactions are facilitated by proteins called enzymes and co-factors like vitamins.  Logically, you want the optimal amounts of enzymes and vitamins to insure health.  Furthermore, illnesses  can cause deficiencies of necessary factors making things even worse.  An example is a malabsorption syndrome where disease in the intestines leads to inadequate vitamin absorption or protein loss.  A common vitamin problem is a deficiency of B12.  This can occur from malabsorption and must be treated with monthly shots.  Additionally, vegan diets do not have enough B12 and over time lead to deficiency and health consequences.

The metabolic activity of cells is the process of oxidation where carbohydrates, proteins and fats are burned to produce energy that is stored or used immediately.  The very fact that your skin is warm is due to cellular metabolism.  Humans are energetic because we burn fuels (food) rapidly by utilizing oxygen (oxidation).  During the process wastes are produced and then eliminated.  A by-product of cellular metabolism is what scientists call free radicals or reactive oxygen species (ROS).  Normal levels of these ROS stimulate cellular growth and signal the need for repair of damaged cells.

It has long been thought that accumulation of metabolites (wastes) can be harmful, and may even play a role in the development of cancer through genetic damage and neoplastic (tumor) transformation.  Consequently, studies have been done to see if antioxidants such as vitamins A,C, and E might prevent cancer or limit its spread.  Surprisingly, antioxidant vitamins in clinical trials were found to be useless in cancer, and, in several studies of high dose vitamin therapy, made things worse.

The question is, why are dietary antioxidants and vitamins unable to reduce the incidence of cancer or its burden?  A recent paper in the New England Journal of Medicine (NEJM) purports to answer some of these questions.  It is known that cancer cells grow uncontrollably and produce large amounts of ROS in the tumor mass.  Normal control mechanisms are gone in cancer cells and adaptive mechanisms allow the tumor cells to tolerate high levels of ROS through increasing local antioxidant properties within the tumor.  These adaptive mechanisms also allow tumor cells to rapidly repair cellular damage wrought by high levels of ROS.  If these scientists are right, dietary antioxidants are understandably useless in cancer.  Furthermore, dietary antioxidants can theoretically hinder distant cellular control mechanisms and promote cancer metastasis.

To the non-scientist this may seem confusing, but it points out how important it is to base therapy decisions on science rather than laetrile or the latest gimmick.  As a conservative I recognize that it is a person’s right to try unapproved therapies in otherwise hopeless situations.  However, as a doctor I am required to speak the truth in love and protect my patient from manipulation in their hour of vulnerability.  It is a sacred trust.  My job is to try and make things understandable so that patients and families can make valued decisions.

A story in Mark’s Gospel (ch. 9:16-27) brings us back to paragraph three and resonates with me.  A man once brought his son to Jesus and described what we would now diagnose as epilepsy.  In those days understanding of disease was different than it is now.  The desperate father asked Jesus to take pity on him and help his son if he could.  Jesus replied that “everything is possible for one who believes.”  The father movingly said, “I do believe; help me overcome my unbelief.”

This story is important because it emphasizes the limits of man’s knowledge, and the poignancy of desperation.  Furthermore, I believe it challenges the notion of where we place our trust, and encourages faithfulness.  Today we would treat the boy with anticonvulsant medications.  Two thousand years ago the treatment was a humble heart and trust in Providence.  Perhaps we post-moderns would be better off if we didn’t limit ourselves to either/or choices and used both our heads and our hearts in all situations.

 

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