“To Every Thing There Is A Season”

Probably most of us know the title phrase from The Byrds’ cover of the Pete Seeger song usually referred to as “Turn, Turn, Turn.”

Well at least the older of us  know it thus; older still, know this from Ecclesiastes. Those who are Bible literate of any age will recognize the phrase. “…A time to kill, and a time to heal…”

The whole passage from Ecclesiastes is remarkable. My purpose here is to remark on that detail of …a time to heal.

As those of you who have read many of my posts know, I urge attention to rhythms, cycles: biology, human biology, cannot be understood without attention to rhythms, cycles…without paying attention to seasons. From the temperate climates north, the seasons are sensed by the change in the length of the daylight and of the temperature. What you may not have noticed is the change in the color of the light. It too has a seasonal cycle. Winter light is a colder blue, a thinner blue. Even when it is brightest it is a thin blue. There are technical ways to describe this change in the color temperature but for now I only want to refresh your memory of winter skies and their color.

Whatever the geological history of continental shift and genetic drift over the thousands of years of human history, and whether we have the pigment of a tropical ancestry or the absence of pigment of men from the North, our biology is deeply driven by light, its color and temperature and how we adapt to it.

Environmental temperature is the easiest to talk about so I will give that brief attention before I turn to the role of light in our biology and health.

Remember that as our mitochondria generate energy there are many intersecting and interacting metabolic variables, including genetic predisposition, that determine the allocation of that energy to thermoregulation, for example keeping us warm, and to other muscular and metabolic needs like running or hunting or sleeping. The body allocates, directs, energy to these two functions, to others as well, but for now to these two roles. How well it accomplishes this allocation varies: women are always cold and men are always hot. At least something nearing this is true if I am to believe what dozens of couples, and my wife, tell me. If the thyroid hormone levels are low we feel cold; another element in thermoregulation and energy allocation. I don’t want to spend too much time on this but keep in mind that there are deep biological systems at work, and evolved or derived to do the amazing thing of making our entire body adaptable to varying temperatures. Pointing out that Polar Bears have fur and that many equatorial peoples are tall and thin as a way to shed heat doesn’t change my point. Deep biological systems are available and serve deep needs of health and healing in all of us.

As I mentioned what I really want to talk about is light.

There is fascinating chemistry associated with the human body’s ability to detect color, too much of a diversion for me just now, but be clear that the body has developed very sophisticated systems, and not merely the eye, to detect chromophores, the parts of molecules that make them emit visible colored light energy, and that those detection systems are not there just to enhance our appreciation of sunsets, though they do that very nicely.

If I were a better poet or perhaps novelist, I could paint a verbal picture, blurred as the picture, the story is told of movement over thousands of years of mankind through the mountains, valleys, the long treks near starvation, the wonderful summer evenings when well fed in good company, smiling without guile, fear or plans; only happy to be alive because that is not often assured and so loved for the moment when it just is. That picture, even for those blind who were not born so, is sketched in colors, in outlines of contrast and blending colors.

As we have been hewn out of the possible by time, and remain one with the earth rather than cast off as the chips of that time-driven hewing and thus lost as a species to the evolutionary  past; as that has happened nothing was lost, there was no excess of the possible that did not contribute to our survival. The night when we slept was when we were healed and prepared for the next day’s life and death struggle or another day of rest. The change in the light, the herald of fall  coming, was our signal to seek out those biologically necessary foods, rich in chromophores, colorful foods, that would help us survive the winter. The historically original blueberries were hardy fruits of fall, of cold places. They are brightly colored, rich in chromophores, and very nutritious. Our deep biology knew that; we used to seek out the raucous palette of colored foods. We eat white food now and become sick.

Well even this diversion is not what I wanted to talk about, though it illustrates my main point about the importance of light and of the color of light. Food and our need for colorful foods and the amazing meshing of evolutionary and biological necessity is part of my point; but only part.

What I am trying to make clear, to emphasize, is the role of sleep and its need to correspond to the light and day of sun and moon, of short summer nights and longer winter ones. What I am trying to make clear is that we live out of season with the lights of Spring and Autumn at our peril, we are tempting the terrible evolutionary fate of extinction, when we ignore the deep biological rhythms driven by change in the color of the sky.

The nearly funny, no hilarious, truth is we are like a foraging, raging bear preparing to hibernate. But we don’t know when to start or where to begin or what to eat or when to fast, when to run and when to walk, and being so tempts that fate not only for our species but for each of us in this mortal life.

For those of you looking for a simple list of do’s and don’ts this will have been one of my more frustrating blogs. For those of you who are trying to discover how to live in this world, to be healthy in this world and to be happy in this world this blog alludes to the deeply technical and points to where to find practical direction. Pay attention. The color of the light matters.

Smile, Have Fun, God Speed,

Dr. Mike

P.S. Are you sure you need those sunglasses?

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Ghostwriter

Yes, yes…long time, no see.

I may have mentioned that over the years several, ‘many’ depending on how you want to define that, several people have asked me to write a book about my approach to medicine.

Well one of those who asked year after year when I was going to write a book and finally realized I wasn’t going to decided he would in my stead.

You don’t even need to hyphenate the two words ‘ghost’ and ‘writer’ as they have passed unmolested into the vocabulary as a single word; that is how common the employment of ghostwriters has become.

Now, I have one!

I wind up spending hours and hours working with this most pleasant of men and he is making me do the work a writer needs to do anyway; that is, think about what he wants to communicate.

As Hamlet would say, did say: “Aye, there’s the rub.” I communicate best with graphs, concepts, guidance, conveying my care for my patients in non-verbal ways, iterative testing, diligent reading of the research literature, all the while experientially jaundiced about the pollution level in medical literature and advice and thus skeptical enough to dig deeper than headlines for the guidance I offer my patients. I hope, more than know, that there are other docs out there of whom all of that could also be said.

In any event only now am I being forced to organize in words how my work proceeds.

I want to introduce some of the schemata I use to examine and incorporate protocols into my practice and advice.

When I developed the software program I use in my practice, now dubbed KumarEHR (this title derives from the work Kumar, my associate, went through to get our system certified with one of the national labs) my main almost metatheoretic idea was that in biological systems trends were more important than single time-point numbers; thus the software was a graphing system where various lab variables could be put side-by-side to check for correlations, to probe for causative links and to make visible trend effects of behavior changes.

OK, ‘trends’ matter more than single numbers. Seems obvious but conventional medical practice pays only lip service to this idea.

Next was that you could assess biological age, much more important than chronological age,  by understanding the nexus within a matrix of local, regional, systemic effects on plumbing, wiring and chemistry.

Simple: wiring=nerves, plumbing=vascular system, chemistry=hormones, neurotransmitters, interleukins and the like.

‘Local’ is nanometer to millimeter scale, ‘regional’ is millimeter to centimeter scale and ‘systemic’ is centimeter to meter scale.

Now you can easily guess why I need someone else to write the book; already this seems too abstruse to be of use. Still with this schemata in my head I can read, scan and use or reject tons of basic science and clinical level science and incorporate it within my medical practice in an ongoing manner.

It helps me not get carried away with treatments that are only assessed at the local level, beta-blockers are a good example of how following my assessment principles led me away from this terrible class of drugs decades before they were recognized as suspect by the profession. The concept led me to know there was no such thing as a local injury, the beginning of an atheroma, ‘heart blockage,’ for example and that there had to be systemic signals; now known as BNP, CRP, IL-6, etc. and so on.

Unfortunately I could go on and on about how this technique led me to my exercise protocols, dietary guidelines, the value of spiritual discipline, massage and relaxation and the harm of almost all supplements.

Yes, I did say ‘unfortunately,’ because that ‘going on and on’ is what I would do if I were to write the book, but the brave good man who is writing it has an editor’s eye and a gift for levity that I lack. You will love the book. When I have his permission he will no longer be a ghostwriter but a writer in full.

Just an update.

Smile, Have Fun and God Speed,

Dr. Mike

PS The title of the book is “Renewal.”

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The Seat of The Soul

Our mortal destiny is out there; out among the distant stars. We will travel there and thrive there. I can know this  because I know something about the biology of man. And thus we will need to talk about the soul, about spiritual things. About health.

The phrase ‘seat of the soul’ is historically most ascribed to Rene Descartes. His most developed idea of this ‘seat’ was in his work “The Passions of the Soul.” This was a serious work of neuropsychology. Remember this was circa the middle of the seventeenth century. The notion that the soul had a material home within the body is ancient; hundreds or thousands of years B.C such a notion could be found in many cultures. Continue reading

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Become A Physician Become A Liberal, Become A Healer Become A Conservative

That is, at least for some, a provocative title for a medical post.

Avoid, no matter how tempting, broadening my remarks to a general theory of politics.

As young medical students, even if we sat in the back and sometime read the newspaper, we still showed fealty to the lecturers; to our mentors. It was obvious that they knew more than we did about physiology, anatomy, endocrinology; biochemistry not so much as that was a ‘hard science’ of clear rules and little room for interpretation. Continue reading

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Free Speech, The Flexner Report and Why Your Doctor Cannot Tell You The Truth

An anecdote:

When I had the large clinic, Tempus, one of my managers came up with the idea of doing radio advertising. OK, why not? He had a clever name for the campaign: “Undo Type Two.”

These were 15 second radio spots so not a great deal of medical information was conveyed beyond Tempus knew how to “undo type two.” Well, not only does the state have the power of life and death over its citizens it has an almost more unnerving power; the power to remove a professional’s license to practice his profession. Well, someone ‘turned me in’ to the medical board for daring to claim to be able to cure diabetes. For reasons more nefarious than I wish were the case we found out that an official at the regional offices of the American Diabetic Association was the source of the complaint.

Things worked out fine but I will admit that while I do not fear free climbing outrageously exposed lines on mountains and cliff faces I do fear the power of the medical board and its bureaucratic capacity to blunder through the lives of doctors trying to do their job. Now this was over 10 years ago and the idea of a physician advertising was a little uncomfortable for me then, still is in some ways, but there was nothing even remotely questionable about the claims Tempus made. Still, one disgruntled individual had the power to threaten my livelihood.  Hold that thought.

Continue reading

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