by Wayne Jonas
CHAPTER 5: COMING HOME
Detecting disease early is a double-edged sword. The benefits of early detection depend primarily on whether there is a safe and effective treatment for the diseases found. This is nowhere more evident than in cancer, where new technologies are finding the disease earlier and earlier. While it is usually good to catch cancer early, what if our body would have normally taken care of an early cancer on its own? Then treatment might do more harm than good. Even as Susan went through one of the harshest treatments for breast cancer there is—three types of chemotherapy, major surgery, antihormonal therapy—the debate heated up about overtreatment and harm from the type of treatments she was getting. See the following opinion and two studies about this ongoing debate:
Narod, S. A., J. Iqbal, and V. Giannakeas (2015). “Breast cancer mortality after a diagnosis of ductal carcinoma in situ.” Journal of the American Medical Association Oncology 1(7): 888–896. See also Winer, E. (May 17, 2017). “Breast Cancer: When is Less Treatment Better?” Dana-Farber Cancer Institute, blog.dana-farber.org/insight/2016/10/eric-winer-less-breast-cancer-treatment. And see also Welch, H. G., P. C. Prorok, A. J. O’Malley, and B. S. Kramer (2016). “Breast-Cancer Tumor Size, Overdiagnosis, and Mammography Screening Effectiveness.” New England Journal of Medicine 375: 1438–1447. Also of concern for Susan was whether treatment might increase the spread of cancer. See Karagiannis, G. S., J. M. Pastoriza, Y. Wang, A. S. Harney, D. Entenberg, J. Pignatelli, V. P. Sharma, E. A. Xue, E. Cheng, T. M. D’Alfonso, J. G. Jones, J. Anampa, T. E. Rohan, J. A. Sparano, J. S. Condeelis, and M. H. Oktay (2017). “Neoadjuvant chemotherapy induces breast cancer metastasis through a TMEM-mediated mechanism.” Science Translational Medicine 9(397).
Other selected references readers may find of interest mentioned in this chapter include (in the order topics are described):
Sternberg, Esther M. Healing Spaces: The Science of Place and Well-being. Cambridge, MA: Harvard University Press, 2009. Already a classic on how space affects our biology and health.
Ulrich, Roger (1984). “View through a window may influence recovery.” Science 4647: 224–225. If you have to go into the hospital, make sure you can see natural views from the window.
Park, B. J., Y. Tsunetsugu, T. Kasetani, T. Kagawa, and Y. Miyazaki (2010). “The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan.” Environmental Health and Preventive Medicine 15(1): 18. A traditional Japanese healing method now opening to the light of science.
Schweitzer, M., L. Gilpin, and S. Frampton (2004). “Healing spaces: elements of environmental design that make an impact on health.” The Journal of Alternative Complementary Medicine 10(Suppl 1): S71–83.
Louv, Richard. Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder. New York: Algonquin Books, 2008. Children need immersion in nature.
The model and components of an optimal healing environment (OHE) were developed by Samueli Institute over a decade and have been researched and described in several articles and books. Some of the main ones are the following:
Jonas, W. B. and R. A. Chez (2004). “Toward optimal healing environments in health care.” The Journal of Alternative Complementary Medicine 10(Suppl 1): S1–S6. The entire issue is on OHE in various specialties.
Sakallaris, B. R., L. MacAllister, M. Voss, K. Smith, and W. B. Jonas (May 2015). “Optimal healing environments.” Global Advances in Health and Medicine 4(3):40–45. doi:10.7453/gahmj.2015.043. An update on healing environments.
Christianson, J., M. Finch, B. Findlay, C. Goertz, and W. B. Jonas. Reinventing the Patient Experience: Strategies for Hospital Leaders. Chicago: Health Administration Press, 2007. Case studies of seven different hospitals and how they created optimal healing environments.
Kashman, Scott and Joan Odorizzi. Transforming Healthcare: Healthy Team, Healthy Business. Cape Coral, FL: Book in a Box. An in-depth study of how one hospital went from a “D” rating to “top of class” by following the optimal healing environment model.
CHAPTER 6: ACTING RIGHT
The importance of a healthy lifestyle is perhaps the most emphasized and familiar aspect of health and healing to readers. We are, in fact, bombarded with self-help books and advice saying don’t smoke, don’t stress, drink moderately, exercise daily, and eat healthier food. For ongoing information about the therapeutic aspects of lifestyle, follow the American College of Lifestyle Medicine, which tracks and summarizes this literature constantly at lifestylemedicine.org. I summarize the essence of this literature in this chapter and in the appendices. The main purpose of this chapter is to show that sustainable healthy behavior is more complicated than just knowing the facts. Behavior must be infused with meaning and the right mind-set to be optimally effective.
Selected references readers may find of interest mentioned in this chapter include (in the order topics are described):
Loprinzi, P. D., A. Branscum, J. Hanks, and E. Smit (2016). “Healthy Lifestyle Characteristics and Their Joint Association with Cardiovascular Disease Biomarkers in U.S. Adults.” Mayo Clinic Proceedings 91(4): 432–442. Less than 3% of the population follows even the top four recommendations for a healthy lifestyle.
Mehta, N. and M. Myrskylä (2017). “The Population Health Benefits of a Healthy Lifestyle: Life Expectancy Increased and Onset of Disability Delayed.” Health Affairs 36(8): 1495–1502. A nice summary of the key healthy behaviors for population health.
Bradley, E., M. Canavan, E. Rogan, K. Talbert-Slagle, C. Ndumele, L. Taylor, and L. Curry (2016). “Variation in Health Outcomes: The Role of Spending on Social Services, Public Health and Healthcare, 2000–2009.” Health Affairs 35(3): 760–768. How priorities in spending that enable healthy behavior compared to health care treatments differentially impact actual health.
Squires, D. and C. Anderson (2015). “U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries.” The Commonwealth Fund. Includes comparisons across developed countries.
Multiple foundations and nations are seeking better ways to deliver health. Here are only a few of the more developed and documented approaches to moving from health care to health and well-being:
Chatterjee, A., S. Kubendran, J. King, and R. DeVol (2014). “Checkup Time: Chronic Disease and Wellness in America—Measuring the Economic Burden in a Changing Nation.” Milken Institute. milkeninstitute.org/publications/view/618.
Robert Wood Johnson Foundation (2013). “Return on Investments in Public Health: Saving Lives and Money.” rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf72446.
National Prevention Council (2011). “National Prevention Strategy.” Washington, D.C., U.S. Department of Health and Human Services. Office of the Surgeon General.
National Center for Chronic Disease Prevention and Health Promotion (2009). “The Power of Prevention: Chronic Disease…the Public Health Challenge of the 21st Century.” Centers for Disease Control and Prevention. See cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf.
The Vitality Institute (2014). “Investing in Prevention: A National Imperative.” thevitalityinstitute.org/site/wp-content/uploads/2014/06/Vitality_Recommendations2014.pdf.
Scottish Government (2016). “Creating a Healthier Scotland.” scdc.org.uk/news/article/creating-healthier-scotland-summary-report.
Singapore is one of the most progressive and effective health promotion cities in the world and includes traditional and integrative health care delivery. See hpb.gov.sg/article/singapore-comes-together-to-celebrate-20-years-of-healthy-lifestyle.
You don’t see what you don’t measure. One of the most comprehensive ways to measure well-being in a country has been done in Canada, and it is paying off. Outcomes are better and costs of health care are significantly lower than its neighbor to the south. See uwaterloo.ca/
canadian-index-wellbeing/ for how they measure health and well-being.
For a summary of the impact of the community health movement in the United States see Norris, T. (2013). “Healthy Communities at Twenty-Five.” National Civic Review 102: 4–9.
For plans for advancing nonconventional medicine globally, see “WHO Traditional Medicine Strategy: 2014–2013.” World Health Organization. See who.int/medicines/publications/traditional/trm_strategy14_23/en.
WHO plans for addressing chronic disease in general is well summarized in Alwan, A. (2011). “Global Status Report on Noncommunicable Diseases 2010.” World Health Organization. See www.who.int/nmh/publications/wha_resolution53_14/en.
The United Nations is also working to address community health globally. See Beaglehole, R., R. Bonita, G. Alleyne, R. Horton, L. Li, P. Lincoln, J. C. Mbanya, M. McKee, R. Moodie, S. Nishtar, P. Piot, K. S. Reddy, and D. Stuckler (2011). “UN High-Level Meeting on Non-Communicable Diseases: addressing four questions.” The Lancet 378(9789): 449–455.
Other key sources of lifestyle and healing information as mentioned in the chapter are the following:
Metzl, Jordan. The Exercise Cure: A Doctor’s All-Natural, No-Pill Prescription for Better Health and Longer Life. Emmaus, PA: Rodale, 2013. Exercise induces healing and keeps us functional and alive.
Johnston, B. C., S. Kanters, K. Bandayrel, et al. (2014). “Comparison of weight loss among named diet programs in overweight and obese adults: A meta-analysis.” Journal of the American Medical Association 312(9): 923–933. It is more important to pay attention that your diet is primarily whole foods and not full of additives or toxins—and that you believe it is healthy—than to worry about its exact composition. This study showed that all the current commercial diets were basically the same when it comes to weight loss.
Studies by Stanford Professor Alia Crum have examined the impact of mind-set on the impact of lifestyle and behavior on health. Mind-set influences all aspect[s] of lifestyle and healthy behavior. See Crum, A. J. and E. J. Langer (2007). “Mind-set matters: exercise and the placebo effect.” Psychological Science 18(2): 165–171; and, Crum, Alia J., et al. (2011). “Mind over milkshakes: mindsets, not just nutrients, determine ghrelin response.” Health Psychology 30(4): 424l; and, Crum, Alia, et al. (2017). “De-stressing stress: The power of mindsets and the art of stressing mindfully.” The Wiley Blackwell Handbook of Mindfulness, 948–963; and, Crum, A. J., K. A. Leibowitz, and A. Verghese (2017). “Making mindset matter.” British Medical Journal 356: j674.
Do gene changes come from the food we eat or the social environment of the eating? See Ordovas, J. M. (2008). “Genotype-phenotype associations: modulation by diet and obesity.” Obesity 16(Suppl 3): S40–S46. doi:10.1038/oby.2008.515.
Giordano J. and W. B. Jonas (2007). “Asclepius and hygieia in dialectic: Philosophical, ethical and educational foundations of an integrative medicine.” Integrative Medicine Insights 2: 53–60. A description of the ancient Greek Hippocratic school of medicine and how it addressed all the dimensions of healing.
Jonas, W. B., P. Deuster, F. O’Connor, and C. Macedonia (2010). “Total Force Fitness for the 21st Century: A New Paradigm.” Military Medicine (Suppl). 175(8). The United States military’s framework for whole systems health and well-being.
Mission: Readiness, Military Leaders for Kids. Report: “Too Fat to Fight: Retired Military Leaders Want Junk Food Out of America’s Schools.” Washington, D.C., Mission: Readiness, 2010. Obesity is a threat to national security.
For current training in healthy cooking for health professionals, see the Harvard program Healthy Kitchens, Healthy Lives at hms.harvard.edu/news/harvard-medical-school-and-culinary-institute-america-launch-healthy-kitchens-healthy-lives-4-20-07.
For information on complementary, lifestyle, and integrative approaches in cancer, see the Society for Integrative Oncology at integrativeonc.org; and, also the book by Block, Keith I. Life Over Cancer. New York: Bantam/Random House, 2009. Dr. Block’s book is the best and most comprehensive overview on evidence-based integrative oncology available for patients.
Pletcher, M. J. and C. E. McCulloch (2017). “The Challenges of Generating Evidence to Support Precision Medicine.” Journal of the American Medical Association Internal Medicine 177(4): 561–562. The NIH needs you to join their whole systems science initiative called Precision Medicine.
Topol, Eric. The Patient Will See You Now: The Future of Medicine Is in Your Hands. New York: Basic Books, 2016. How technology is democratizing health care and putting patients in charge of their health.
CHAPTER 7: LOVING DEEPLY
We often think of love and fear as solely psychological—all in the mind—and as having little impact on the body. This is not true, but the myth persists in the modern mind. When we finally break this misperception, it will crack open whole new dimensions for healing. I use this remarkable but little known experiment on rabbits to show how, despite the objective demonstration that love is as powerful as cholesterol-lowering drugs in preventing heart disease, we have largely ignored the former and made an industry of the latter.
Selected references readers may find of interest mentioned in this chapter include the following:
Nerem, R. M., M. J. Levesque, and J. F. Cornhill (1980). “Social environment as a factor in diet-induced atherosclerosis.” Science 208(4451): 1475–1476. The formal “love your rabbit” experiment described in the chapter.
Titler, M. G., G. A. Jensen, J. M. Dochterman, X-J M. Xie, D. Reed, and L. L. Shever (April 2008). “Cost of Hospital Care for Older Adults with Heart Failure: Medical, Pharmaceutical, and Nursing Costs.” Health Services Research Journal 43(2): 635–655. Heart failure is costly, and the costs are rising.
Berwick, D. M., T. W. Nolan, and J. Whittington (2008). “The triple aim: care, health, and cost.” Health Affairs (Millwood) 27(3): 759–769. The triple aim—simultaneously improving health outcomes, and the quality of patient experience and lowering costs—has become the mantra for value in health care.
Christakis, Nicholas. A. and James H. Fowler. Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives. New York: Little Brown, 2009. Research shows that your friend, their friends, and their friends all have an impact on your health and healing capacity.
Cacioppo, John T. and William Patrick. Loneliness: Human Nature and the Need for Social Connection. New York: W.W. Norton & Company, 2008. One of the best overviews of the science of loneliness and its impact on health.
Farmer, I. P., P. S. Meyer, D. J. Ramsey, D. C. Goff, M. L. Wear, D. R. Labarthe, and M. Z. Nichaman (1996). “Higher levels of social support predict greater survival following acute myocardial infarction: The Corpus Christi Heart Project.” Behavioral Medicine 22(2): 59–66.
How does the physical presence of a person affect the other? The studies on how electromagnetic waves of the heart impact the electromagnetic waves of the brain of persons standing next to each other can be found in McCraty, Rollin. The Science of the Heart. Boulder Creek, CA: HeartMath Institute, 2015. Available at heartmath.org.
Two studies we conducted at Walter Reed Army Institute of Research demonstrated that electromagnetic waves coming off the hands of a healer can increase the energy molecules of cells. See Kiang, J. G., J. A. Ives, and W. B. Jonas (2005). “External bioenergy-induced increases in intracellular free calcium concentrations are mediated by Na+/Ca 2+ exchanger and L-type calcium channel.” Molecular and Cellular Biochemistry 271(1): 51–59; and, Kiang, J. G., D. Marotta, M. Wirkus, and Jonas, W. B. (2002). “External Bioenergy Increases Intracellular Free Calcium Concentration and Reduces Cellular Response to Heat Stress.” Journal of Investigative Medicine 50(1): 38–45. This might be the mechanism for the ancient method of laying-on of hands. More research is needed.
Kemper, K. J. Authentic Healing: A Practical Guide for Caregivers. Minneapolis, MN: Two Harbors Press, 2016. In this book, Dr. Kemper, professor of pediatrics
at The Ohio State University College of Medicine, describes how to use bioenergy healing in day-to-day practice.
Pennebaker, J. W. Opening Up: The Healing Power of Expressing Emotions. New York: Guildford Press, 1997. (Second edition published in 2012.) This book summarizes decades of research showing that by engaging past areas of deep personal and emotional trauma, such as through therapeutic writing, the brain, immune system, physiological function, and even health care needs improve.
Even a single episode of therapeutic writing improves pain (in rheumatoid arthritis) and lung function (in asthma). See Smyth, J. M., A. A. Stone, A. Hurewitz, and A. Kaell (1999). “Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: a randomized trial.” Journal of the American Medical Association 281(14): 1304–1309.
Facing your past traumatic experiences in the presence of loving persons can heal the effects of past trauma in veterans who have gone to war. See Bobrow, Joseph. Waking Up from War: A Better Way Home for Veterans and Nations. Durham, NC: Pitchstone Publishing, 2015. And about those who have not gone to war but experienced trauma nonetheless, see van de Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Penguin, 2014. New discoveries in the healing of trauma are helping to us to understand the fundamental dynamics of healing in general.
Griffiths, R. R., M. W. Johnson, M. A. Carducci, A. Umbricht, W. A. Richards, B. D. Richards, M. P. Cosimano, and M. A. Klinedinst (2016). “Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial.” Journal of Psychopharmacology 30(12): 1181–1197. It appears that psychoactive drugs can open people to their fears, which if then reexperienced in a positive manner can permanently heal anxiety, depression, and other emotional ills. Research is ongoing to see if this approach will also work for veterans with refractory PTSD. I predict it will work.