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.

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None Of The Above

I am sure you all remember the multiple choice tests where the last option was ‘none of the above.’ Well, I had my own ‘none of the above’ realization on a recent flight to Kauai to give a health talk.

I had an aisle seat, a long book (“Hemingway’s Boat”; worth a read but troubling) and was settled into my reading when a very nice lady to my left asked, “What do you do?” Tone of voice can convey more than my perfunctory answer, I was kind in my answer: “I’m a doc.”

“What kind of doc?” “I’m a drugs last not first kind of doc.” My short answers were because I wanted to read my book, but as she was sweet I kept answering. This discussion went on long enough that it does not reflect well on either of us and on reflection actually shows me in a worse light than her.

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