The Book of Invasions reaches the New World

Wisp of a Thing: A Novel of the Tufa by Alex Bledsoe My rating: 5 of 5 stars

This is a novel which, like its characters, possesses depths that it does not reveal readily to the casual reader. On the surface, this is a straightforward fantasy/adventure novel that is utterly enjoyable in and of itself. The characters are interesting, the pacing is good, there are plenty of surprises, and like its predecessor, The Hum and the Shiver, it draws to an exciting and satisfying climax. I read The Hum and the Shiver in a single day, and, as I promised myself, I extended my time with Wisp of a Thing to three days, not because it did not entice, but because I knew I would have to wait many months for the trilogy's final book to appear, and I wanted to postpone that bleak horizon. On this basis alone, I award the book 5 stars.

At the next level, however, this is a book about the power of words and of song. The protagonist, Rob Quillen, is driven to find the words and the song that will set his troubled soul at rest, and his search unearths a power that threatens the very fabric of Tufa society. I found the first book of the Tufa series through the songs of the band Tuatha Dea, and now I find that through the second book, I find more music from other artists. The loop from music to book and back to music has already introduced me to artists I would have otherwise never heard. I honestly cannot think of another book that has expanded my horizons in such an unusual way. From Rebecca Hubbard's steampunk aesthetic and unearthly vocals, to the haunting, candlelit performances of Jennifer Goree, my playlist has exploded with a new kind of music that I didn't know I was looking for, but now find I can't do without. Sort of like a visit to Needsville, I suppose.

At yet another level, Bledsoe's tale reaches deeper into our pre-historical consciousness. Bledsoe has taken on the task of retelling the ageless battles and unending intermingling between the Tuatha De Danann and the Formorians, within the uneasy truce that the Tuatha made with the Milesians, when they conceded the material Earth to mortal hands. Bledsoe does not hew as closely to the received wisdom as did David Drake in his retelling of the poetic Edda in his Northworld trilogy, but that should be expected, as the Celtic stories themselves are jumbled, overlapping and contradicting, unlike the Edda.

I won't spoil anybody's fun by revealing the subtle meanings that Bledsoe has stowed away in this book, but I would suggest that anyone reading Wisp of a Thing do their homework if they want to enjoy some of the book's hidden richness. Like the characters in the novel, pay attention to the turning of a leaf or the feel of the wind, and greater understanding will be awarded to you.

The trouble with "middle" books in a series is that they often bog down as the author maneuvers his pieces on the board for the denoument in the final books. Bledsoe deftly avoids this problem; while I have little doubt that all the players are in the right place for the last book of the trilogy, there was no sacrifice to the current story. It kept me on the edge of my seat.

With this book behind me, it will be an empty several months until "Long Black Curl" debuts. I guess the only thing I can do is pull out my banjo and pluck out the songs I hear on the wind.

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Coming Home to the Tuatha De Danann

The Hum and the Shiver by Alex Bledsoe My rating: 5 of 5 stars

It's not often -- in fact, it's been years -- since I've read a book in one sitting. Or, rather, several sittings in a single day. But The Hum and the Shiver so enthralled me that I couldn't put it down until I was done.

I sort of backed into this book. A few days ago, I stumbled across this band, Tuatha Dea, who describe their music as celtic tribal gypsy rock. The band's latest album "Tufa Tales: Appalachian Fae" took as its inspiration the series of books of which "The Hum and the Shiver" is the first. I loved the music. I figured how bad could the books be?

This book lives up to the promise of the music, or perhaps for others, it's the other way around. At any rate, this telling of the prodigal daughter's return to her home and her people, and her struggle to reclaim herself, her heritage and reshape her future, is at turns delightful and intriguing. And though it is often difficult for an author to describe the fantastic in a realistic way, Bledsoe handles this task very well.

Bledsoe's evocation of a people hidden away in the Appalachian mountains, maintaining the Old Ways, also rings true to me. I grew up on the edge of Appalachian culture, and I remember as a 16-year-old driving down rutted gravel roads to a barn or a roadhouse with a 6-pack to sit on a picnic bench and listen to awesome banjo picking and guitar playing. This is the world Bledsoe takes as his foundation, and it is not difficult at all for me to see an Americanized Tuatha in such a place.

I enjoyed reading this book immensely, more than any other fiction I've read in years. But I fully intend to take two days, or even three, to read the next book in the series.

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The Last Great Walk, by Wayne Curtis -- a review

The Last Great Walk: The True Story of a 1909 Walk from New York to San Francisco, and Why it Matters Today by Wayne Curtis
My rating: 5 of 5 stars

Taking as his point of departure a transcontinental walk by a 70-year-old man over 100 years ago, author Wayne Curtis takes us on a spritely, interdisciplinary walk on the subject of walking itself.

"The Last Great Walk" is only roughly built around the 4,000-mile perambulation of Edward Payson Weston, a competitive walker during a time when such athletes possessed the attention given to NBA stars today. Instead of trying to recreate Weston's walk, Curtis wisely dovetails his chronicle of America's last great walk with essays on the biology, sociology, anthropology, neurology and the psychology of walking.

And a fascinating journey it is. Curtis escorts us from the La-Z-Boy museum in Monroe, Michigan to the great walking cities of the world, and from the present into shadowy prehistory where a group of primates discovered the advantages of bipedalism on the savannahs -- and spread across the world on their own two feet.

Along the way, we meet the archenemy of pedestrianism, the automobile, and survey the century-old struggle between these dichotomous forms of transportation.

Even for those of us who have stepped outside the car door and thrown away the keys, the effects -- primarily deleterious -- of the automobile on our society are surprising. For the most part, Curtis takes great pains to prevent his book from becoming just another pedestrian's screed by maintaining an even tone and allowing the facts, and the scientists and researchers who have uncovered those facts, speak for themselves. But there are times when he cannot hold himself back.

"Automobiles are the Plato's caves of the modern world," he writes. "From them we see only shadows, the rough outlines of our existence. The map of this world is drawn with fat, cartoonish markers rather than finely sharpened pencils. The detailed lines of the etchings around us are lost, replaced with hulking shapes whizzing by at sixty miles per hour, vague and often amorphous forms, save for the haunting and startingly blue Best Buy sign and the inquisitive yellow eyebrows of the McDonald's arches jutting over distant rooftops."

Walking, on the other hand, is not only transportation, but "can also be like the best sort of daydreaming, a way to explore without direction. The art of the long, aimless walk was accorded uncommon respect and attention across the Atlantic in the nineteenth century. The flaneurs -- from the French word for "one who strolls" -- filled a strange ecological and cultural niche."

As we journey on these paths, we discover how walking is fundamental to our health by giving us a sense of place and by challenging not just our muscles but also our minds.

"Being lost is an essential human condition....Abandoning the experience of being lost is like losing our facility for empathy; it's a central part of what made us human, the bedrock upon which both mobility and mind were built," Curtis writes.

I came upon this book only a few months after I rediscovered the joys of bipedalism myself, and it provided me with the rational underpinnings to my subjective experiences. I now understand why time seems to dilate for a walker, and why certain paths, though indirect to my destination, are far more appealing to me.

I also understand why life feels so much richer now that I am a walker, rather than a driver. As anyone who has abandoned their car can tell you, life gradually moves from flat 2D to a fuller three dimensions with the more footsteps you put between you and your car. Curtis explains the neurology and psychology behind this experience, and what we have lost, as individuals and societies, as we have abandoned walking.

Yet Curtis always returns to Weston's great walk across a country burgeoning with prosperity and on the cusp of transitioning to a car culture. In doing so, Curtis makes a solid case for a return to our pedestrian roots, and why it makes sense personally, socially and economically to do so. Which is why Weston's walk still matters today.


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From pain and cane to freedom.

I am thrilled. Early last winter, a patient walked into my office -- barely. She had suffered from intractable back and leg pain for a year, and was, literally, days away from surgery. Her spinal stenosis was killing her. She shuffled with her back permanently bent 35 degrees from vertical. Straightening up was impossible as it would send jolts of pain down her legs. With her head forced downward, she couldn't see very far in front of her. All she could see was the ground and pain.

We had some great initial success. After her first visit, she cancelled her surgery. After a couple of months, she got rid of the walker. A little bit longer, and she didn't need a cane. Then she started standing upright, taking walks, and talking about getting off all of the pain medications she had been on.

Throughout her recovery and rehabilitation, she would comment on my trike, which I frequently ride to work in lieu of driving or walking. As it turned out, she had once been an avid cyclist, but her back problems had taken that away from her years ago. As she improved, I suggested the trike as a great way of regaining strength in her muscles without risking falling. She loved the idea, but never quite felt ready for it.

"Maybe one of these days," she would say. I could see in her eyes that she wasn't sure that day would ever come.

With a home rehabilitation plan in place and less need for my oversight and treatment, I discharged her from active care early this summer. Today, she came back to see me for a long-term follow-up.

She was doing well, she said. No pain medications for months, she wasn't in pain, and she couldn't believe the amount of energy that had returned since the heavy-duty painkillers had been eliminated from her system. I could see her eyes were bright, she had a liveliness to her step that hadn't been there before, and the color had returned to her face.

As I concluded the visit, she said there was one other thing I needed to know.

"I bought a trike," she said, grinning ear to ear. "It's pink."

I left the exam room with a huge smile of my own. It's patients like her who make this profession rewarding beyond words.

When the clown stops laughing.

The death of Robin Williams has created a worldwide outpouring of sadness and grief that I have not often witnessed. Though we all know how closely linked depression and comedic skill can be, it is still difficult for many of us to fathom how a man that could have given us such great joy could have been so bereft as to kill himself. In Williams' case, it is made even more difficult because his humor was delivered impromptu, directly from his heart and soul. How does the playful, energetic, insightful man that we saw onstage become locked in such despair? To understand, we need to look beyond the trope of the clown with tear-stained makeup and into the blackness that, to a certain degree, we all carry within. Just as there is no yin without yang, there is no joy without despair. But what is often overlooked is that the manifestation of depression is highly variable, and no two depressions are alike. Thus, we cannot approach their management in all the same way.

Some depressions are what I call "contextual depression." That is, they stem primarily from the your attempts to cope with a difficult, albeit temporary, environment. The loss of a loved one through death or divorce, an abusive work environment, severe financial stress -- all of these are situations in which depression begins as an appropriate adaptive strategy, but due to duration, or repetition, it becomes self-destructive and the behavior can continue long after the trigger that caused it has gone.

On the other hand, some depressions may have no obvious precipitating factor at all. This form of insidious depression works its way through you in the form of negative self-talk or the erosion of an impossible perfectionism slowly stripping you of, first, self-esteem, and eventually, hope. Not only is this depression subtle in its appearance to others, you may very well hide it from yourself until it has reached what may appear to be unmanageable proportions.

A third form of depression is a "physiological depression." This is a longstanding, moderate depression which does not have its origins in behavioral or neurological influences at all, but is instead caused by a chronic, debilitating and undiagnosed disease or infection, which in turn creates behavioral changes. Researchers who have watched the behavior of sick animals have noted that the symptoms of chronic, low-level illness are virtually identical to depression: Energy depletion, appetite changes, sleeping changes and behavioral changes which favor energy conservation and protection of vulnerabilities.

While the link between depression and health problems such as MS and back pain are well-known, often overlooked are diseases such as chronic gastrointestinal disease or gland hypofunction whose only visible symptoms are those of depression. Astute investigation on the part of the clinician is necessary to uncover these hidden causes of depression.

All of these forms of depression may be accompanied by substance abuse, creating a feedback loop that increases the severity and complicates the management of depression.

Too often, though, these various causes of depression are overlooked in favor of the cookie-cutter solution of pharmaceuticals. It is true that antidepressants can lift the veil of despair for some people, so the pharmaceutical solution cannot be discounted. But, as several meta-analyses of SSRI drugs have found, the effect of SSRI drugs is much smaller than we are led to believe. This is not news. The first such study was published over a decade ago. "Listening to Prozac but hearing placebo," examined 19 clinical trials incorporating over 2,300 patients, and concluded that SSRIs are primarily placebos.

"Virtually all of the variation in drug effect size was due to the placebo characteristics of the studies," the researchers concluded. "The effect size for active medications that are not regarded to be antidepressants was as large as that for those classified as antidepressants, and in both cases, the inactive placebos produced improvement that was 75% of the effect of the active drug. These data raise the possibility that the apparent drug effect (25% of the drug response) is actually an active placebo effect."

Several follow-up analyses have confirmed this initial study's findings. It is also worth noting that the monoamine theory of depression, which supposedly explains the mechanisms by which SSRI's work, has never been supported by the research.

So these drugs, while they can be invaluable for some people who suffer from depression, are more likely to be expensive placebos for the majority of people. What can you do if you are one of this majority?

The first thing is, see a mental health professional -- and by this, I don't mean a psychiatrist, whose primary skill is in pharmaceuticals, but a therapist, social worker, or psychologist, who can approach depression with a much bigger toolbox than that of the psychiatrist. They can help you develop the insight and skills to help you manage your depression.

Some of these skills include the ability to break down the monolithic wall of despair into more manageable chunks. Recognize and remind yourself that depression is a temporary condition, and you have the ability to influence how long it lasts. You can also reduce the size of your depression by converting generalizations about yourself and your life into specific, limited observations. The thought that "I'm a failure" creates an insurmountable hurdle to overcome -- after all, how could you, you're a failure! On the other hand, recognizing that generalization of failure stems from the fact that you lost your job creates a much smaller roadblock. You may have lost one job, or even several -- but that doesn't mean you cannot find another one.

One of the best ways to shorten the duration of a depressive episode is through physical activity. Though it may seem extremely hard, such simple things as going for a walk or a bicycle ride can change the course of the disease. Physical activity actually changes the neurological functioning of the brain in ways that inhibit depression.

And if you can't help yourself, what about helping others? Perhaps you can't find your way to feed yourself, but maybe you can help out at a food kitchen just a couple hours a week. Research has shown that when we nurture others, we also nurture ourselves. And if you are depressed, such sustenance is the best you can find. Helping others is true soul food.

There are many, many other ways to find your way through depression. And if you are thinking of suicide, reach out for help. It's there. Even if you can't find anything else, call 911.

Dr. Avery Jenkins is a primary care chiropractic physician specializing in helping people with chronic disease. He can be reached at alj@docaltmed.com.

The Doctor of the Future

Watching the news, it is difficult to escape the conclusion that humanity is fast approaching a turning point of great impact. I'm not speaking of ISIS or the Gaza-Israeli conflagration; conflicts such as this are older than history. Rather, I'm referring to the ever-growing polarity of our possible futures. On the one hand, you have a rapidly growing income disparity and a civilization utterly dependent on cheap energy which is about to lose its primary source of that energy; a world that is already so overflowing with people that in even rich, technologically advanced countries, such basic things as readily-available water cannot be counted upon; a food supply that is so trucked-up in technology that it now causes the diseases that proper nutrition once prevented; and a worldwide ecology already in the midst of chaotic change.

On the other hand, you have technology so advanced that robots will soon be able to replace men in dangerous, life-threatening jobs, saving countless lives; the possibility, albeit remote, of extending mankind's territory to other planets; genomic manipulation to the degree that natural selection can be replaced with social selection, and entirely  new species can be created; and artificial environments designed to replace the one that our overpopulation has begun to destroy.

The latter scenario is highly unlikely, except, perhaps, as a time-limited state in the longer progress of the former. We have already passed several points of no return in the alteration of our worldwide ecology, as CO2 levels have passed the 400 ppm mark, global temperature has reached the highest peak of this geologic period and shows no signs of stopping, and we are in the midst of a mass extinction of species. Our technology is nowhere near the point of replicating on any large scale, the vast diversity of the once-living earth, and that is critical to our survival at anywhere near our current population. Anyone who places their faith in unlimited technological progress in a reality circumscribed by limited natural resources is bound to be disappointed.

This shouldn't come as a surprise. From the beginning of history, civilizations have outgrown their habitats and outlived their creative energy, leading to periods of turmoil before another another order arises.

But the cry arises: "It will be different this time!"

Perhaps, perhaps. But not in the way the hopefuls imagine. The laws of physics and biology make it inescapable that we are headed for a post-industrial society of some sort. The only real question that remains is what that society will look like.

Certainly, the cheap transfer of goods and materials will cease. The days of raising chickens in the U.S., sending them to China for processing, and then shipping them back here to be sold will be long gone. With the disappearance of cheap energy, we will primarily be able only to move knowledge, not products, over long distances. Computational devices may remain, as they are less material- and energy-intensive, and can be supported by low-powered, decentralized power grids. Though they require exotic materials, they require them in small amounts, making their continued manufacture a possibility. Large-scale, centralized manufacturing will disappear, and if we manage our affairs right, we can arrive at a safe landing with local economies intact, using local resources for small-scale creation of goods. The post-industrial society, it turns out, will have quite a different flavor than the one first imagined by Daniel Bell, instead being closer to the future predicted by neo-Malthusians.

My interest, of course, is primarily in how this will affect health and health care delivery. A lot will change under this scenario, not all of it bad.

First of all, the changes in the transportation system will yield many positive results. With people walking and cycling more, obesity and many related sedentary lifestyle co-morbidities will greatly decrease. The incidence of diabetes, heart disease and cancers will drop significantly.

With energy-intensive factory farming techniques all but obliterated, a return to local production and harvesting of foods will further enable improved health through better nutrition. Indeed, a cultural shift in this direction has already begun, despite regulatory and economic  roadblocks that have been put into place to protect the Monsanto-dominated paradigm.

A return to a more pastoral and village-centered lifestyle will also be accompanied by a decrease in the anomie of life that is a direct outcome of our currently disconnected, disembodied and overly-embroidered lives. Less depression and anxiety almost always accompanies stronger social networks.

Of course, all of this is predicated on the maintenance of a society relatively protective of both individual liberties and cognizant of the need of our strong social obligations to one another. And it's not all sun-dappled rides on two wheelers through abundant fields of grain, either.

Drug production and distribution will be inhibited, putting those dependent on such drugs, such as insulin-dependent diabetics, at risk. Essential vaccines, such as pertussis and measles, would become scarce. And antibiotics, which are already on the wane would be hard to come by, though as I have previously mentioned, that's not necessarily much of a calamity. Certainly "advanced" medicine, with its exotic potions and technology-dependent surgical techniques, will go by the wayside.

I'll make the argument that, in fact, much of that medicine and technology is largely superfluous. The advanced medicine of the latter half of the 20th century and the first decade of this one has made no impact on human longevity, measured in productive years. Many of the surgeries and medicines that are employed today are only necessary because of the society in which we live. Change the parameters of that society, and these disorders would largely cease to flourish.

What does that leave us with, health-wise? It leaves us with a health-care delivery system which is supported by locally-available resources, and which utilizes low-technology manual interventions. It would also leave us with a health care system supported by a truly interdisciplinary population of healers, unrestricted by practice laws and insurances aimed more at preserving the power and income of a protected class of professionals.

In this health care milieu, there would be more shamans and crones and fewer psychiatric wards, more midwives and fewer cesareans. There would be doctors who know the properties of herbs, where they could be found, and how they could be prepared. Who know the use of food and nutrition to turn on the genes of health. Who know foodstuffs and how to use them to cure disease, and who know the human body and its anatomy, and who can alleviate pain with their hands. Doctors who can continue to work when the lights go out.

The fact of the matter is, the doctor of the future looks very familiar. And as I more frequently walk upon the Old Paths in search of the knowledge that can help my patients, I am increasingly cognizant that the wisdom I gather is not only for the benefit of my patients today, but also for the doctors of the future.

Diseases are just stories we tell ourselves.

  Recently, I was explaining to a patient the difference between her diagnosis from a western mainstream doctor, and the diagnosis I had just given her, which emerged from an examination based in Traditional Chinese Medicine (TCM).

"Diseases are cultural concepts," I said. In mainstream Western medicine, certain symptoms, signs, and laboratory tests are grouped together because it makes sense to congregate them given that view of the body. We clump that fact pattern together, call it a disease, and give it a name. Eastern medicine may likely have no analogue, not because the disease had not been "discovered" by TCM doctors, but because when looking at a person from an Eastern perspective, it makes no sense to clump those findings all in one pile; in TCM, some go in one pile, and some in another, and neither fully replicates the Western diagnosis.

Which is a good thing. One of the greatest failures of western medicine (aside from its obeisance at the altar of Mammon) has been its failure to recognize that a disease is not a creation of biology -- it is a creation of culture.

On the personal level, a disease is, in fact, a story we tell ourselves about ourselves. It is one of the many myths we use to make sense of our lives, to collate and correlate all of the data we collect into a coherent whole, a narrative that relates ourselves to our world sequentially in time and which gives meaning to our lives.

From this perspective, then, it is the doctor's job to provide the story in which the patient immerses themselves. Our important knowledge base is less one of laboratory values and abstruse structures on x-ray than it is the particular narrative in which which each patient can find association.

For example: If I tell a patient that they have arthritis, without any qualifiers, their reaction can vary tremendously. This is because of the associations which that word has in their mind. One patient may immediately think of rheumatoid arthritis, which erodes joints and may leave its victims disabled and wheelchair-bound, fighting constant pain. Another patient may assume I'm referring to osteoarthritis, the wear and tear of joints which eventually effects us all, and may only display as some stiffness and a mild loss of range of motion. I can watch, physically, as they respond to their interpretation, sinking into themselves in resigned defeat or shrugging their shoulders as if to unburden themselves of a fly. Each patient is telling themselves the story which they will be living, and reacting accordingly.

Most people these days are familiar with the concept of a placebo -- a physiologically inactive intervention, such as a sugar pill, that a patient takes and it miraculously begins to heal them. Placebos can be extraordinarily powerful interventions, to the extent of curing people of cancer. The key aspect of the placebo effect, though, is that the patient cannot know that they are taking a placebo.

The cause of the placebo effect is that it is an item that a person can use to change the sequence of their narrative. To understand how that can be so, we must first take a shallow dive into Jungian psychology and the realm of mythology. Joseph Campbell, in his book The Hero With A Thousand Faces, describes what he calls the "monomyth." This is the tale of the hero, who leaves his safe home, fights monsters and giants, faces death (and dies), and then returns to his world and his home as a more complete (healthier) individual. This is a story that exists or has existed in virtually every culture over mankind's history, and regardless of the time, culture or language, all of these heros' journeys have common elements.

This is the journey of individuation that we all undertake during the course of our lives, and it may be a trip that we take several times in several ways. The hero's journey is also the path that many people follow when faced with a disease. I have seen patients replicate this journey many times over the past 20 years, and the pattern I have observed hews closely to the Campbellian outline.

There are several stages in the monomyth. The first is the "call to adventure," which in a clinical setting is best seen as the time of diagnosis. The hero (patient) often resists this call (denies the diagnosis), but after rising to begin his or her journey, one of the first encounters that our hero has is with a supernatural or magical helper, who often gives the hero a talisman or artifact that will aid him in his quest. Again, in the clinical context, the supernatural helper is the doctor (or magician, shaman or priest in other cultures), and the talisman in this culture is most likely to be a pill, herb, or chiropractic adjustment.

The exact nature of the talisman is unimportant, as is the factual existence of the powers that it is claimed to possess. What is most important for the hero (patient) is that "protective power is always and ever present within or just behind the unfamiliar features of the world. One has only to know and trust, and the ageless guardians will appear," Campbell states.

This is the power of placebo, and indeed, this is part of the power of every therapeutic intervention, regardless of its physiological properties. In fact, in the case of many interventions, the physiological properties are far weaker than the magnitude of its therapeutic effects. But because these are talismans imbued with protective properties, given to the patient by a figure representing a force stronger than their own, their power is magnified.

What the drug/herb/adjustment is really doing, far more important than chemical or mechanical changes, is giving the patient the power to change the outcome of their narrative. The feared enemy is no longer stronger than the hero and their playing field is now levelled.

Thus, the outcome can be changed, literally, in the patient's mind.

This approach -- seeing the disease process as a story we create, or co-create with our environment, is hardly a novel or new one. It is, however, a largely forgotten one, in a day and age when diagnosis is based primarily on laboratory testing rather than observation and interaction with the patient.

For patients, this realization that our diseases stem, to a great degree, from how we interact with our internal and external worlds can be an initially frightening revelation. One might accuse me of cruelty to suggest that a person with cancer, or heart disease, or even MS, is in some way, responsible for their disease. My words, though, are less the whip of admonishment than they are a call to hope.

Taking responsibility for something is the first step in being able to manage and control it. If a disease is declared genetic (the scientific version of "an act of God"), it becomes something impossible for the patient to overcome, because, who, after all, can defy the almighty Gene? (This approach, by the way, is also a very good way to deify the doctor for his own benefit, but that's a tangent for another day).

If you can claim ownership and responsibility for a disease, then you are simultaneously reclaiming the capacity to change it's course. You are changing the narrative of your disease. You are changing from victim to hero.

Of course, that alone isn't enough. You have to change whatever needs to be changed, behaviorally, mentally, emotionally, in order to change the actual course of your disease, and the talisman given to you by your doctor will only help you so much. The rest you must do yourself.

Any disease, your disease, is just  a story you are telling yourself. And whether the outcome is tragic or triumphant is entirely up to you.

Hey, Dad!

Two simple words  that for nearly two decades I have been unable to speak. Two words that, for much of my life, prefaced any number of of statements and questions, from the sacred to the silly to the profane. The two words that reflected one irrevocable fact that shaped my life more than any other. I had an awesome Dad. And, as a man, in many ways I am just like him. My father was an engineer who liked to tinker with things, figure out how they worked, how they broke and how to fix them. I cannot remember ever having a repairman in the house. I, being the only child with any aptitude for such things, became his gopher (as in, "Avery, go for a phillips head screwdriver")  and learned by observation, as children do. I learned how to rewind transformers, fix a faulty TV, wire a house electrical circuit and fix a toilet. Dad hated fixing toilets. Which is probably why ours broke down so often.

I translated that talent for fixing what's broken into being a doctor. Helping to fix a person is infinitely more complex than diagnosing and repairing a major appliance, but the fundamental mental processes are the same. Questioning, observing, probing, changing something to see what happens -- this is what he taught me. This is what I know.

Dad also had a philosophical bent. When his lifelong employer, AT&T, moved Dad into an executive track, they also sent him back to school. At the time -- the late 50s -- AT&T was promoting many engineers into management, and they saw that the engineer's traditional tech-only training was insufficient to prepare these men for the more complex task of managing people rather than managing circuits. So they created a special one-year school in Philadelphia, where these electrical engineers were submerged in the works of Plato, Kant and Kazantzakis. They studied art, they read literature, they explored classical music.

Dad absorbed it like a sponge, and transmitted that love for the big picture to me. I will always remember our "Culture Hour Sundays," in which Dad would play some music and talk about the composer, or introduce a Big Question, like "Who are you?" and make us discuss it. I thought it was all pretty silly, as a child. But it clearly rubbed off onto me, as I went to a college in which I studied things like the similarities between Cubist art and Einstein's theory of relativity, and read Kant, and Hannah Arendt, and tried to answer the Big Questions, like "Who am I?" I graduated with a Bachelor of Philosophy degree. Dad was proud of me.

Dad was, by his own description, "the man in the gray flannel suit," one of the army of men who, after returning from World War II, went to work in the companies grown large by the demands of the war and changes in technology, and became cogs in the machine of extraordinary economic progress that was America after the war. He was a corporate man, learning to work his will in a bureaucracy unyielding to personal intent.

But within him seethed a man wanting to break free of that bondage, to create that what he would, to be master of his own fate rather than one hand of many on the tiller of a great ship. Somehow -- I have no idea how -- he snuck that into me. In spades.

This was my father's greatest gift to me, or perhaps it was a curse. I'll never be sure. But it became clear to me early on, that I would never become the baby boom generation's version of the corporate man. I was too infected with Dad's questioning spirit and his suppressed demand for independence. I realized in my 20s that I would never be happy working for anyone beside myself. So one day I closed the door on my own budding career in management and decided that I would make it on my own or not at all.

As a father myself, I have tried to emulate my Dad as much as possible. It's still a little too early to tell how I did on that score, but I'm sure my girls will let me know. One has already launched and is, as I write this, achieving orbital velocity. The other is moving inexorably toward the launch pad, and already my heart grows heavy with her impending departure.

When I graduated high school, my parents gave me two gifts which have lasted me a lifetime. The first was a typewriter, through which I found my voice and which was the heart of my first career. The second was a train ticket to Boston, the city in which I found my destiny and that eventually became my second home.

I will never forget, the day after my last class, looking out the window of that train, and seeing my father with tears running down his cheeks and a huge smile on his face as he waved goodbye to his son. Many years later it was my turn to say goodbye, as I held his hand and looked into eyes rapidly fading as a the hemorrhage caused by a massive stroke flooded his brain like a a slow tsunami. I, too, had tears in my eyes and a smile on my face for the man who had given me so much -- had given me the core  of the man I had become.

Hey, Dad, thanks for everything. As long as I live, so will you.

I Am Biped.

Inspired in equal parts by laziness, a fondness for offbeat experimentation, and personal growth, I have been walking to work for the past two months. It's not a very long commute by any standard, a pinch less than a mile, although the 8% road grade is relatively indisputable and I can't quite decide if it is in the wrong direction. As things stand now, I have a sprightly downhill jaunt in the mornings, and an uphill slog at the end of the day. And since it's so short, I've been walking home for lunch as well. Sometimes I insist that the directionality, or at least temporality, of the slope be changed, but at other times it seems perfectly fine. I suppose with regard to the kerfuffle that is local geography, the gods in fact do know their business, and I should leave well enough alone. I started foot commuting by fiat one morning, when bike #1 had a flat tire and Bike #2 was on the repair stand for cable replacement. (Of course, I also have bikes #3 and #4, but we really needn't delve too deeply into my transportational quirkiness here). I have a difficult time justifying using an automobile for such a short distance, unless I'm coupling it with other errands. To me, such sloth smacks of an immorality commensurate with unfiltered Chesterfields,  pool halls and Hudepohl beer.  It also hasn't been that long since I finished reading The Old Ways, a book about walking the ancient paths of the U.K., which seeded my mind with the desire to see what a walker sees and experience the world from a walker's perspective. So I slapped on my office clothes and perambulated my way to work.

Let me note at the outset that I am not unfamiliar with walking, having been an avid hiker and backpacker for most of my life. However, I've never really integrated walking into my daily life to any great degree. So while the physical act was familiar and comfortable, the psychology of walking to places to which I once would only have cycled  proved to be entirely novel.

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If you search the term "walking" on DuckDuckGo (that's a search engine like Google only without the massive invasion of privacy), the top ten results are dominated by walking as a health measure. Fitness walking, walking your stress away, walking your weight away, walking your heart to health...those are all well-accounted for and seem to be at the top of most pedestrian's minds. Less sought after is information on commuter walking, or utility walking. or walking #justforthehellofit. I suppose as a doctor focused on wellness and prevention, I should be happy about people's interest in being healthy. And it is true that programmed health measures are necessary to help people recover from chronic illness. However, these days, I am much more interested in the integration of exercise into our activities of daily living, as it makes the exercise more effective. I mean, when was the last time you saw someone stay on the treadmill for an extra 10 minutes just for the fun of it? But if you're walking home from work or the store, you might extend your walk that much just to enjoy a beautiful sunset.

Which brings me to perhaps the best reason for putting walking into your life: It fundamentally changes the way you see your world. Call it the time dilation effect. When you walk on a daily basis, your entire perception of time becomes altered. This is very strange, and could be very uncomfortable, for people brought up in car culture. When you go places by foot, you have to account for the time it takes to get there, something we rarely factor in when we travel by car. "Oh, it's only a 10-minute trip," we say. Two or three 10-minute trips later, and all of a sudden a half-hour is gone and you're rushing to pick the kid up from baseball practice on time and you *still* haven't finished all of your planned chores.

Walking forces you to reformat that process. You are impelled to add travel time to your calculations, as it no longer appears negligible. It isn't negligible. It's now 20 minutes to here, 35 to there. So you plan ahead, leave enough time to get there. And then the magic happens. All of a sudden, you're not in a rush. You check your watch once during the trip, yeah, you'll get there on time. The rest of the time, you are focusing on the journey itself -- the heat, the cold, the sun, the wind, the temperature. Instead of being literally bound and locked into a tiny, plastic, unchanging room with windows, you are engulfed by the endlessly changing panorama that is our world. Rather than rushing through your environment far faster than your senses can process it, you are savouring your surroundings. You are shockingly in touch with your environment in a very intimate, comfortable way, especially on routes you frequently walk. I've identified two medicinal herbs growing in the wild on my way to work that I'm going to harvest for making remedies. In a car, or on a bike, I never would have even known they are there. And the smells -- oh, my, does anybody remember what a summer night smells like? Not just when you're on vacation, but every night. And how the smells of the day and evening change throughout the year as plants bloom and die, and streams rise and fall.

The richness of sensory stimulation that occurs when you're walking makes the average automobile seem like a deprivation tank by comparison. Actually, let's be clear about it: An automobile is a roving sensory deprivation device. No wonder we are so eager to fill our cars with technological auditory and visual stimulants. Every time we get into an automobile, we are starving your senses, and we are replacing the sights, sounds and scents of our richer natural environment with the equivalent of sensory junk food.

Speaking of sound, what most pedestrians and cyclists also learn is that automobiles are extraordinarily loud. Road traffic is regularly measured at 80 dB; hearing damage commences at 90 dB. The intermittent traffic along my pedestrian commute highlights the extreme noise of the average automobile. Within seconds, birdsong and peepers are snuffed out by the roar of a passing car, or three. When you are subjected to those extremes frequently, you begin to realize also how damaging it is, not just physiologically, but psychologically, and it is reflected in our culture.

Even within an automobile, the noise level is typically around 70 dB. And what is the logical result of isolating ourselves from our  environment and then filling it to the brim with artificial sights and sounds? If you can't hear your environment speaking to you, then it becomes unimportant. We have replaced the dialogue between ourselves and the world around us with a constant monologue in the echo chamber of humanity. All other voices have been drowned out to the point where most of us do not know how to listen to them even if we could hear them.

No wonder Mother Nature is screaming. We are unable to hear anything less.

So as we hear and see better when we are walking, so are we able to express ourselves more richly. Road rage is, in part, a result of being effectively gagged when we are in our automobiles. We communicate with others only through our brake lights, turn signals, headlights and horns. These are poor tools, effective only at communicating the coarsest of concepts. We can express only our direction of travel and various levels of concern, from a warning (a short beep-beep) to full-on anger (HONK!). Hand gestures, even friendly ones, are often lost to window glare, and you can forget about eye contact. Even if you are able to achieve it, the significance is almost null. Every cyclist and pedestrian can relate more than one incident of making eye contact with a driver before crossing an intersection, then having the driver almost plow into them because they had no idea that the other person was there. Inside a car, eye contact is as meaningless as a friend's description of a blind date.

Communications on foot is a different story entirely, and this was perhaps the first thing that I noticed as I began my bipedal commute. In a hurry, I thrust my body forward and step purposefully; when at ease, when enjoying my trip, I saunter. Between those extremes are shades of mood and attitude. I swagger, I hesitate, I plod through weariness and I walk with pride and strength, each step resounding through the earth. My gate changes with my mood, and with my entire body I can communicate my emotions to the world about me. And, yes, I have even danced from time to time. I had forgotten just how expressive the simple act of walking can be, and it is a joyful relief to be able to communicate so richly and so honestly with the world. Even on a bicycle, my thoughts could not be expressed so clearly as they can when on my feet.

Sometimes I think we have a world turned upside down on its head, where safety is in a speeding machine that kills 30,000 people per year, and danger is being on your own two feet.

It is truly a shame that walking should be such a forgotten activity. To the world at large, walking any distance for purpose rather than pleasure, has been delegated to the realm of the poor and the chastised. Why would anyone walk instead of drive, unless they couldn't afford a car or had their license confiscated for driving once too often after one too many? I'm sure that has been the assumption of more than one person who has driven by me over the past couple of months. I have even been stopped by the police, on the presumption that someone on foot must be engaged in some nefarious activity -- or at least have a couple of priors.

It was late, and dark, and I was slogging my way home. I saw the squad car pass and suddenly whip around in front of me, spotlight full on and blinding me. I heard a car door open and shut. A silhouette approached me.

"Good evening," the officer said. "Where are you going?"

"Home," I said.

"Where's that?"

"The top of the hill," I said.

He blinked.

"Where are you coming from?"

"Work," I said.

"Where's that?"

"Bottom of the hill," I said.

He looked at me. I looked at him. I smiled. He didn't.

"You have some ID?" he asked. I handed him my driver's license.

After fruitlessly checking my record on the computer, he returned from the cruiser and returned my license.

"Be careful," he said.

"I'll be ok," I said. "Just going to the top of the hill."

He shook his head and left.

As encounters with police tend to go, this wasn't unpleasant. But it did shake me loose from my personal point of view and realize how odd, and perhaps how dangerous, what I have been doing on a daily basis must seem.

I truly wish it wasn't that way. Sometimes I think we have a world turned upside down on its head, where safety is in a speeding machine that kills 30,000 people per year, and danger is being on your own two feet. Where comfort is defined by your insulation from your environment rather than your enjoyment of it, where noise is silence and the faster you go the more you have to rush.

Walking has its health benefits, and perhaps as a doctor, I should have written about that. How frequent walks strengthen your heart, clear your arteries, improve your digestion. All true. But the more important benefits of walking cannot be measured by cholesterol values or blood pressure. Walking is exercise for your body, but rest for your psyche. It brings you in touch with the Earth and lets your mind soar with the birds. Being bipedal is one of the most complex tasks we undertake as human beings, and when we cease to walk, we begin to lose our humanity.

Culture, biophobia, and the post-antibiotic era, or why you're going to be just fine without antibiotics.

The FUD* machine went into overdrive a couple of weeks ago, when the World Health Organization breathlessly released a report predicting the imminent apocalypse which will  be upon us as bacteria become increasingly resistant to drug therapies. “The problem is so serious that it threatens the achievements of modern medicine,” the organization said, adding that when standard treatments fail,  infectious disease deaths will skyrocket and the risk of contamination will create epidemics.

There's only one problem with WHO's conclusions. They ignore 10,000 years of human history during which, without the aid of modern medicine, the human race not only survived, but thrived. As a species, we achieved our precarious (and overrated) dominance on this planet long before what we today call medicine arrived on the scene.

The CDC itself notes that by far the largest gains in human health and longevity came about, not as a result of any medical interventions (including smallpox and polio vaccines, by the way), but as a result of improved nutrition and sanitation. That's right; the most powerful weapon mankind has ever had in its arsenal against bugs has not been drugs, but indoor plumbing.

Another major step forward occurred when medical doctors were finally willing to listen to fellow physician Ignaz Semmelweis and started washing their hands between patients. Interestingly, "Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands...Semmelweis's practice earned widespread acceptance only years after his death."

Today, this cycle of denial and rejection repeats itself. Unstated in all the dire warnings about the coming global bacterial apocalypse is the fact that it is modern medicine and agriculture that has made these bacteria possible. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, and drug-resistant Clostridium difficile exist today only because of our overuse of antibiotics and the pollution of our food chain with antibiotic-laden meats. Also as a result of antibiotic therapy, we have drug-resistant candida, gonorrhea, and pneumonia.

Had MDs not been handing out drugs like candy to any kid with an ouchy ear and any adult with a sore throat, drug-resistant bacteria would not exist.

Had agribusiness not been allowed to abuse livestock to the point of deathly illness and then stuff their food with antibiotics to keep the suffering animals alive long enough to reach the slaughterhouse, drug resistant bacteria would not exist.

Not to belabor the obvious, but I think it's fair to say that more of the same thinking that created the problem will not fix the problem. New drugs will only briefly plug the holes in the dyke created by the old drugs, while making new holes themselves.

The solutions to problems such as this require a paradigm shift. As doctors, we need to look at things, not in isolation, but as part of an integrated ecosystem. Instead of looking at the bugs and what kills them, we need to look at the cultural and environmental factors that allow them to proliferate. At the same time, we should examine, not the infectious agent, but the agent that it infects.

This is the exact opposite of the mainstream medical approach, which still chooses to derive its wisdom from research which mechanistically isolates components from their overall systems.

It is beyond the confines of this blog to describe a detailed analysis, but even a cursory examination from a more cybernetic perspective will yield some insight.

First of all, it is the overuse of antibiotics in medicine that is one of the primary causes of drug-resistant organisms, even medicine itself has acknowledged that. However, in doing so, medical apologists have consistently blamed the patient, not the doctor, for this failure. Even today, in conversation with my mainstream peers, I continue to hear the excuse that "my patient demanded an antibiotic," or "I had to give them something."

While the problem is being presented as a demanding patient, the actual problem is the doctor's failure to have the appropriate tool to address the patient's rightful request.

In my office, such a demand would not be a problem, because instead of handing out a useless antibiotic as an expensive and dangerous placebo, I instead utilize substances and procedures which oppose the offending organism by enhancing the patient's existing defense mechanisms. For example, instead of killing a fever, I encourage its appropriate control. A fever is one of your body's ways of destroying invaders, by overheating them to death. Like an overgrown forest can be thinned by a controlled fire, a bounded fever can restore a natural internal ecology.

Another way I help patients manage infection is by administration of herbs that are known to cause the proliferation or increased activity of immune cells. And I can couple that with the nutrients which support immune function, and which are in extremely high demand during infection. When these nutrients become scarce, they limit the effectiveness of the immune system; introducing greater amounts allows the immune system to attain peak activity.

These approaches do not suffer from the same problem as antibiotics, because my approach to restoring health is patient-centered, not disease-centered. This is an important distinction to make.

From the public health perspective, we need to adjust the cultural factors which allow for bacterial proliferation. That means reformation of how we produce and distribute our food, and the best way to do that is to change our consumption and purchase patterns; and that, of course, means farmers markets, CSAs and neighborhood (or individual) gardens. When you buy meat from a farmer who raises and butchers his livestock humanely, you are immediately reducing the likelihood of spreading food-borne diseases.

But there is an underlying cultural premise that inhibits these systemic changes from occurring. That premise being that bacteria are bad.

The trouble being, of course, that they aren't. We live, work, thrive, play and die in a organismic soup. The bacterial biome surrounds us, engulfs us, and, indeed, integrates us. Without bacteria, we would die. We have bacteria living in our gut, which helps us to digest our food, and bacteria living in our respiratory tract which aid our immune system. With all due apologies to Sting, every breath we take and every move we make is watched over by a billion bacteria, each with their own function. Some are detrimental, some are beneficial, but each is absolutely necessary for our life to exist.

Yet we have been taught that bacteria are bad, evil killers. To avoid confronting this misunderstanding, we even use euphemisms for the good bacteria. Instead of saying to a patient, "Here, take these bacteria for your intestinal problems," I have to say, "Here, let's use these probiotics to fix your intestines." If I actually reminded people that I was giving them bacteria to ingest, they would run screaming from my office.

(As an interesting side note, I have begun treating patients with chronic sinus infections as well as acute upper respiratory infections by giving them ENT "probiotics" in the same way I administer gastrointestinal "probiotics." It is a novel approach which has both support both experimentally and from clinical experience.)

I have even heard complaints from patients in my office that we use bar soap, rather than "antibacterial" liquid soap. The problem with that complaint being that all soap is sufficiently antibacterial for all but surgical purposes, and the so-called "antibacterial" soap is actually bad for your health.

The only thing we really need to do to avoid the predicted bacterial epidemic is to shed our irrational fear of bacteria. Like most other public relations wars  -- the War on Cancer, the War on Drugs, the War on Terrorism -- the War on Bacteria is a failure. We cannot exterminate, eliminate, or even control life forms that are so ubiquitous and so necessary to our survival.

Instead of looking at the problem like warriors, let's look at it like farmers, or like good managers of a profitable, long-term business enterprise. We need to create the conditions, in both our internal and external environments which cause the good bacteria to flourish, and the bad bacteria to shrink.

This, in turn, means we need adequate supplies of clean water and nutritious food. We need an economic system which encourages physical and mental health as core components of productivity. We need a cultural environment which admires health and intelligence over sloth and anti-intellectualism.

This will not eliminate death and disease due to bacteria, but on the other hand, nothing will. The advantages of an environmental approach like I am suggesting is that it utterly eliminates the arms race between us and bad bacteria, replacing it with a heterogeneous complex system which is adaptive to our health needs and maintains a healthy competitive advantage between us and the bad guys.

Approaching the post-antibiotic world from this perspective turns the apocalyptic predictions on their head. While not a utopia, a bacterially-healthy world based on good water, good food, and flexible stability is a far cry from the death and destruction the purveyors of drugs would have you believe.

*Fear, Uncertainty, and Doubt -- the marketing technique famously used by IBM, and more recently, mainstream medicine, to maintain a monopoly in the face of competing ideas and products.

5 Ways to Improve Your Health Immediately.

Almost as much as education, experience counts in health care. The more patients that I have seen, the more conditions I have treated, the more times I have treated the same condition in different people, the more I have learned. And the better I am able to help my patients become healthy. This month begins my 20th year as a doctor. As I look back over the past two decades, I can see certain commonalities emerge from the background of doctor-patient interchanges. The things that I have taught my patients not once, not twice, but hundreds of times. The mistakes that I have observed my patients make. The simple short-cuts which I have learned that, once applied, can make immediate and dramatic positive changes in someone's health.

Unlike most other health advice you're going to get from the internet, the information I'm about to give you will not cost you anything. As a matter of fact, most of my recommendations will save you money. And, with a few exceptions, none of them will be difficult or time-consuming. None of them require special equipment, special diets, or hard-to-get foodstuffs. As a special bonus, all of these recommendations are not only backed by a doctor with two decades of experience, but also by research and the collected wisdom of the doctors and healers that have preceded me by hundreds, and in some cases, thousands, of years. As Isaac Newton said in his letter to rival Robert Hook, "If I have seen a little further it is by standing on the shoulders of Giants."

Though there are a few more, I am giving you one work week's worth of ideas that you can use to improve your health. Everybody should implement all five of these recommendations, although the gains you will receive from each will vary wildly from person to person.

1. Turn off the TV and cut the cable.

I can think of no other piece of advice that will fundamentally change your life more than this one. Despite the recent flattening in the growth of cable companies, Americans still watch a tremendous amount of television -- 34 hours a week, according to a 2012 Nielsen study. In younger people, the amount is 10 hours less, and dropping, which is a good sign. Nonetheless, 24 hours a week turns television watching into a part-time job for most people.

So why is it bad for you? First of all, watching TV makes you fat. It makes you less fit. It makes you stupid. Do you need more reasons?

Interestingly, this recommendation, perhaps my most important one, is also the most ignored. Patients will nod their heads, dutifully agreeing with me, and proceed to completely forget every word that I said. The reason why is simple. Television is highly addictive. Like all addictions, it is difficult to break.

Also like all addictions, the best way to break this one is to go cold turkey. Call up the cable company, and terminate your cable channels. (Keep in mind that this step will save you anywhere from $75 to $200 per month.) The first thing that you will notice is that all of a sudden you have a bunch of spare time on your hands, time you once spent plugged into the television. Here's things that you can do with that time:

1. Learn another language.

2. Join a club or service organization.

3. Get a hobby! Knit, woodworking, model rocket building, fish, make pottery.

4. Spend time talking to your kids, spouse, husband. Walk the dog. Call your father.

You get the point. There's an infinite number of activities that you will not do today because you make the choice to sit in front of a 40-inch screen listening to retreaded jokes told over a laugh track. On your gravestone they can put the epitaph: "He Watched TV."

 2. Hide the car keys.

There's a reason that studies have shown city dwellers are thinner and more fit than rural residents. It's because city folk walk or ride bicycles more than people in suburbs or rural areas.

That doesn't have to be the case, though. Despite living in a small rural town, I rarely need to use my car. Trips to the grocery store, bank, and other daily chores are all done on my bicycle, most of the year. I usually ride to work, though more recently these days, I've been walking to my office a lot.

A lack of exercise is the number one cause of virtually every major health problem in this country, from heart disease to diabetes. Exercise also reduces the risk of breast cancer and other cancers as well.

My recommendation is to walk to any destination that is 1 mile away or less, and ride a bike if it is 3 miles or less. Don't think you have the time? Just remember Health Tip #1. You're already doing that, right? So you've got plenty of time. Use it to become healthier.

Interestingly, riding or walking will change your entire perception of time. For a variety of reasons neurological, travelling at speed tends to compress time; when we are driving our automobiles, we feel the constant pressure of needing to arrive at our destination. Our minds are focused on what's ahead of us, not what is immediately around us. After several months of low-speed transportation, you will find that pressure easing. You just notice things more as you walk and ride, putting your mind on the present rather than the always-unattainable future. Also, you will find yourself winnowing out the necessary tasks from the unnecessary, or better coordinating your daily journey to get more done with less. And you will soon realize that it is such a relief to not be constantly rushing about to get things done.

3. Look at the sky. Twice each day.

How someone carries themselves tells us much about them. A slouched posture is often associated with negative traits, from illness to depression to low self-esteem. The fact of the matter is that posture does indicate psychological health, relational status and physical well-being.

Most people, when trying to improve their posture, use the large muscles of the back to straighten the spine, creating a stiff, unnatural form that cannot be maintained longer than a minute or so. That's because the large muscles of the spine are intended to control movement, not posture. They need way too much energy to maintain contraction for any length of time. The postural muscles are much smaller, and positioned to use leverage to make the most out of minimal effort. These muscles, for the most part, are out of our conscious control.

To improve your posture, you must retrain your unconsciously controlled postural muscles. And how do you do that? Simple. Just keep your body relaxed, stand up, and tilt your head back as far as it can go to look at the sky directly above you. Your spine will naturally straighten when you do that. Bring your head back down, while remaining in that relaxed, straightened posture, and voila! You have straightened your spine without engaging the large movement muscles.

Of course, you'll forget about that in two minutes. Which is why you'll do the exercise later the same day. If you repeat that daily for 3-6 months, you will find that you will begin to retain a straight posture naturally, without conscious intervention. Now you can brush your teeth, comb your hair, and go get that job of your dreams.

4. Read 1 book every month.

Reading is to the mind what exercise is to the body. In ways large and small, reading is good for you. Reading improves mood and reduces stress. Reading reduces the impact of dementia. Reading reduces the risk of developing Alzheimer's disease.

I know I'm fighting an uphill battle on this one. Anti-intellectualism in America has deep roots. As a result, 25 percent of Americans haven't read a single book in the past year.

What you read tends to be less important than the act of reading itself. Whether you're reading Emerson or Evanovich, the result is the same; you're smarter, think better, and have more to talk about with others.

5. Laugh.

When there is nothing else I can do for a patient -- no way to relieve their pain or ameliorate their illness before they leave my office -- I do my best to make them laugh. And when I'm performing possibly painful procedures, I almost always crack wise. Patients will sometimes mistake my eager rush for laughter for sadism, but it's actually quite the opposite. Laughter is an effective painkiller; not only that, it improves immune function in cancer patients.

Laughter increases tissue oxygenation, exercises the trunk muscles, burns calories and provides cardiovascular benefits. As an all-around health stimulator, laughter ranks right up there with exercise. Heck, laughter reduces blood sugar in diabetics.

If I've done nothing else but make a patient laugh, I know I've improved their quality of life, perhaps for the rest of the day, as laughter's physiological benefits can linger.

Of course, laughter therapy can backfire as well. There was that time that I was explaining to a new patient how to get to my office. I said that my building was right across the street from the funeral home. "Yeah, it makes it really easy to take care of my mistakes," I said.

She never showed up.

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I have more of these, perhaps a dozen. But these are the nuggets of gold that have consistently worked for my patients, and not infrequently helped them to navigate difficult waters to a healthier life.

March Lecture: Managing Autoimmune Disease

 Autoimmune diseases cause chronic disability and are poorly managed using mainstream medicine techniques. At this lecture, you will learn the underlying problems that create or worsen autoimmune diseases, and how you can take control of your health problems.

Send me an email at alj@docaltmed.com to reserve your seat.

The Old Ways: A Review

The Old Ways: A Journey On Foot by Robert Macfarlane My rating: 5 of 5 stars

This book has taken its place in the top five of my pantheon of books. Macfarlane's lyrical prose allows us to see the mundane footpath placed in a greater cosmos, integrating the geographic passage of the path with its passage through time and community. For all paths are a statement of community, of the close passage of people to work, to home, to sea and to places unknown.

Read, from one of his closing paragraphs: "Images arise, gleaned from the miles on foot. White stones, white horses, flying islands, glowing eyes, mirages, drowned lands, dreams of flying, reversals and doubling, rights of way and rites of way, falcons and maps: the images move as brass spheres in an orrery, orbiting and converging in unlikely encounter. There is a flickering to order; gathered details are sealed by the stamp of the anterior. The land itself, filled with letters, words, texts, songs, signs and stories. And always, everywhere, the paths, spreading across counties and countries, recalled as pattern rather than as plot, bringing alignments and discrepancies elective affinities, shifts from familiar dispositions."

As excellent writing is wont to do, Mafarlane inspired in me a torrent of composition, some of which I have published and some of which remains to be seen.

I have been involved in trails, trail construction and hiking for most of my life, but Macfarlane's British perspective on paths and walking them was novel to me. Like most other things American, our trails are functional, utilitarian, planned. Starting with the name, they are "trails," not "paths." They have been designed for most efficient ascent, most pleasant passage with eye to overlook and flora and fauna, and engineered to handle literal parades of people (while working on the Appalachian Trail in the Franconia range, above treeline just past Greenleaf Hut, I once observed 145 people walk by me in a single day). Macfarlane's Old Ways are different entirely. These are paths that are organic to the land and the people living in them, winding, wandering and loosely arriving at a destination, or destinations that may or may not have been their original intent. One ambles along them, not to achieve a summit or capture an overlook in pictures, but to experience their passage through landscape and time.

I hope someday to walk a path like Macfarlane has. Reading this book has instilled in me a new way of thinking, a new way of experience the woods to which my life has been so closely tied.

View all my reviews

Fathers, Sons, Daughters, Paths and Patients

Nearly 17 years ago, my youngest daughter took her first steps at the airport on the way to attend my father's funeral. That moment, in the sterile hallway of an airway terminal, I experienced a strange crossing of emotions, as grief over the loss of the man who held my hand as I muddled my way through childhood collided into joy and pride as my daughter began her own long walk to independence. I didn't know what to do, really, so I did what my father had always done for me. I smiled at her and told her how very, very proud I was of her.

That's a memory I don't go to often, or willingly, but today it came unbidden and I suddenly realized how  much of my life has revolved around walking, and the paths on which we walk. I was no more than 14 or 15 when, enlisted by my mother and my best friend, I helped to create a woodland trail. Back in the late 1960s and early '70s, when land was less precious and government less war-crazed and more civic-minded, the Corps of Engineers bought up a huge tract of land -- an entire watershed, as a matter of fact -- so that they could build a dam and flood thousands of acres of what had been perfectly arable land. The ostensible reason was as a flood control measure for the downstream Ohio River, but everyone knew that the real reason was to create an outdoor recreation area in what had been a relatively backwater part of the state. I'm pretty sure the governor's  brother-in-law had a lot of real estate in the region, real estate whose value would  see a sharp increase as soon as the dam was completed and the farmland flooded.

But that wouldn't happen for a few years, yet. So in the meantime, I, and my friend Brian, and my mother, and his family, all chopped and cut and sweated and trampled and created many miles of trail to be used by both hikers and equestrians.

My first backpacking trip occurred on that trail, also with my friend. Out of plans found in a Boy Scout Fieldbook, I had built myself a wooden frame, wrapped it in canvas, and hooked onto it a packbag purchased at a local Army-Navy surplus store. Brian and I walked, and talked, and tried to make a no-match fire and cooked some undescribable and barely edible mess of freeze-dried food. It didn't rain, which was good, because our tents, such as they were, were simple tubes of plastic held up by a length of parachute cord. But I so clearly remember walking along the side of the soon-to-be-dammed creek, and seeing the muskrat holes in the banks of the stream, and poplar trees holding themselves violently upright with roots gripped tightly around the sedimentary rocks exposed by the meandering stream.

We knew nothing about trailbuilding, of course, simply cutting through what seemed to be the most reasonable and scenic route along the creek and the alongside the woodlands that lined it. We all knew that it wouldn't last long. The Corps of Engineers' creep to completion was as sure as it was slow. That path -- my first path -- is long gone, a sunken treasure of my adolescence.

I thought nothing of it at the time, for in that headlong rush with which the young meet the future, I had already found another berth. The day after graduating high school, I left my home in Ohio for New Hampshire, where I had secured a coveted spot on the professional Trail Crew of the Appalachian Mountain Club. At that time, it was the only professional trail crew in the country, and had a hallowed 75-year history in the most blue-blood of conservation organizations east of the Mississippi.

As a graduation gift, my parents had bought me a private berth on the Lakeshore Limited, an Amtrak route from Cleveland to Boston. From there I would find my own way to Pinkham Notch, New Hampshire, the place to which my compass would always point for the next several years. My father gave me a kiss, and a hug, and told me that no matter what I did, as long as I did the best I could, he would always be proud of me. As my train pulled out of the station, I waved to my parents. My dad had tears running  past the big smile on his face.

In the White Mountains of New Hampshire, I learned the craft of the trailbuilder. I learned how to drop a pine tree with a double-bit axe and skin the bark off it, sticky sap dripping from the naked wood, making it slippery to carry to its fate as a step or a footbridge or a waterbar. I learned how to quarry rock as large as bales of hay and roll its ungrateful mass to the trail, where I would dig a hole and expertly drop it in, leaving a flat, immutable surface to set foot on and another step in a long staircase up the side of one or another mountain. I remember one week counting in amazement after two of us, working together, had created 122 steps on a trail leading to Mizpah hut. Unlike the creek trail of my youth, these trails were made to last. Our goal was to create masterpieces that would last 100 years.

But building the Appalachian Trail was only part of my education. I also learned how to cook for six hungry men, how to motivate a ragged crew through their fifth straight  day of rain and mud with a little snow mixed in for variation. I learned what it meant to be part of a tribe. I learned to love and be loved. I learned how to absorb the beauty and majestic power of the mountains and make it my own. The trail I was building was to my own manhood.

I emerged four years later, stronger, hardier, and with an  unassailable sense of self. I knew who I was, and I knew the depths of my endurance.

Years passed, as they do, but the path never let me go. As I retooled from my first career to become a doctor, I also became a father. Thursdays, the traditional off day for chiropractors, became Daddy Day, and I soon found myself walking the wooded path holding the hand of Daughter #1, who contentedly ambled with me, stopping frequently to crouch down and intently examine a leaf. Or a bug. Or a pebble. Every week, we would walk along the same path, each trip filled with new discoveries.

One time we were walking along and she pointed to a log. "What's that, Daddy?" she said.

"That's a log, sweetie," I said.

"Where do logs come from?" she asked.

"A log is a tree that died and fell down," I told her.

Her eyes got wide. "It died? Why did it die?"

"Well, they have to make room for the other trees. See, when an old tree dies, it falls down to make room for a new, young tree to take it's place."

She chewed on that for a while. Then she took my hand and we began walking again. But she asked about it a few more times before she could really put her mind at ease about the whole subject.

Daughter #2 was the force behind my return to the mountains of my past. At the ripe age of 9, she decided she wanted to climb Mt. Washington with me. Of course, she thought the summit of Mt. Washington was a half-hour hike like the one to the summit of Mt. Tom here in Litchfield. She was a bit surprised on that June day when I pointed to that snow-capped summit half covered in clouds and told her that was where we were going.

No matter how you cut it, the trip up Washington is arduous. We went via Tuckerman Ravine, where we encountered our first snow, and then as soon as we hit the ridge, we entered the land of ice and clouds and wind. For hours we climbed, carefully moving from cairn to cairn so we wouldn't lose our way, as the path at that altitude was nothing but jumbled boulders and rock. By the time we reached the summit, visibility was down to about 30 feet, the wind was whipping us at 60 mph, and I don't even want to think about how cold it was. This was no simple hike for a nine-year-old. Daughter #2 was pushed hard by the trail, but she pushed right back.

After a short lunch break, we began picking our way down to Boot Spur. And as we reached the edge of the spur, a sudden gust of wind shredded the last of the clouds that had held us in blindness for so long.

"Look, honey, look!" I said, and pointed off the edge of the ravine. From 30 feet our visibility had gone to 30 miles, and you could see the whole majestic spread of the Presidential range and the valley from which we had climbed. My daughter's eyes grew as big as saucers. And I knew she would never look at the world the same again.

Today, I saw a new patient, someone who had been having back pain for several years, and the first thing I did, as I usually do with patients suffering from chronic back pain, was watch her walk. A biomechanically correct stride is important, and that's what I was analyzing, but as I did that, another part of my brain was thinking that how we walk says so much about who we are. And suddenly, I was taken back in time, to my daughter's first steps and my father's last. The friends who walked with me along parts of my path, and the miles I have walked alone. The bear I met in Maine, and the girl I met in Boston, who walks beside me still. And how even after all of these years, I can still skip surefootedly from root to rock and across the stream.

The skills of a trailbuilder are many. These days I no longer build anyone else's path but my own. But I'm putting the skills I learned walking the many paths of my life to good use, helping others walk along the paths they have created for themselves. There is little that could be more gratifying.

Of Reps, Wraps and Payola

I've never been one to hide my disdain for the tendency of mainstream medicine to allow financial incentives to color medical research and decision-making. In fact, what the record industry once called "payola" -- and which rocked that industry to its core in the 1950s -- is accepted practice in the medical industry.

As former Editor-in-Chief of the New England Journal of Medicine Marcia Angell has pointed out in her books and elsewhere, medical research has been virtually overrun by checkbook research -- with Big Pharma paying the Big Money to get the results they need.

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine,” Angell said.

She's not the only one to have seen first-hand the corruption of medical research. Take, for example, this quote from an abstract of a paper on vaccinations. This article was published by a group called the Cochrane Collaboration, an international collection of scientists who have volunteered to review medical research in the effort to develop evidence-based practice guidelines. And this is what the scientists had to say about the research on the influenza vaccine:

"Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products."

But the real problem of Pharmaceutical Payola occurs much further down the food chain, at the offices of individual doctors. Multiple studies have found that pharmaceutical marketing has dramatic impact on doctor's prescribing habits.  One of the most effective ways of influencing doctors is through providing continuing medical education credits for free through company-sponsored seminars.

I've seen this influence more directly through the eyes of others. I once knew a woman who worked for a specialist group practice; her sole job was to review drug company studies, and advise the practice as to which ones in which they should participate. Her decision algorithm, however, had nothing to do with scientific advancement or patient wellbeing. Rather, her recommendations were entirely based on which studies would prove most lucrative to the practice. Because what the doctor doesn't tell you, dear patient, when he offers you a chance to be cured by this new breakthrough drug that they are testing, is that he is getting paid anywhere from $6,000 to $18,000 for each patient he enrolls -- plus another $20,000 when he hits the 20-patient mark.

Not surprisingly, all of this kind of bothers me. It bothers me mostly because detractors of alternative medicine routinely claim that mainstream medicine is "based on science" and alternative medicine is not. Nothing could be further from the truth.

In fact, the opposite is likely to be more consistent with reality. According to one study, fewer than 20% of mainstream medical procedures are supported by research. Only one-half of medical interventions are therapeutic. And very, very few surgical procedures are subjected to double-blind trials before widespread acceptance.

In contrast, chiropractic care for a variety of musculoskeletal ailments is well documented in the scientific literature. Acupuncture has an exceedingly long trail of research, and nutritional interventions are "alternative" only in the minds of troglodytes.

Whether I am adjusting someone for their headache, using acupuncture to treat a child with Tourette's, or using diet and nutritional supplementation to help a patient eliminate their arthritis pain or control their autoimmune disease, I can in every case point to research supporting my use of those procedures. And, unlike in mainstream medicine, nobody -- but nobody -- makes money from research into nutritional therapy or chiropractic. So it is unlikely to be tainted by money, even if the players in the industry had the finances to do so.

Which, at long last, brings me to the point of this post. (In journalism, this is called "hiding the lead." When I was a newspaper editor, I regularly chastised my reporters for doing this.)

Coupled with my scorn for mainstream medicine for allowing itself to be bought by the highest bidder has always been my admittedly sanctimonious opinion of my own ability to stand above the fray. I have even bragged that the largest gift I have received from any nutritional company was a case of apples (It was from Douglas Laboratories, back in the 90s) and a bottle of honey.

All of that changed yesterday, however, when a rep from one of the nutritional vendors whom I use for patient's supplements stopped by. My relationship with this company is less than a year old, but not for lack of interest. I first encountered them several years ago at a nutritional conference I was attending. Impressed by their products at the time, I have intermittently contacted them for more information, but never received any response. I'm not surprised; in the larger scheme of things, my little practice in Podunk, Connecticut is not going to bring out the big marketing guns.

Purely by serendipity, however, that changed last year. One of their reps stopped by, unannounced, saying that she had seen my sign in passing, and wanted to introduce herself. I'm pretty sure that she was on the way for Someone Else's Office and just got lost, but it was a serendipitous visit nonetheless. In a short introductory meeting, I let it drop, without qualification, that what would sell me was science. And quality. And if their products did not stand up to either, #thankyouverymuchbutbutnothanks.

A few weeks later, she showed up again, armed and ready. She dropped journal after journal in my hands, explaining how it fit into her company's products and the benefits provided. I was impressed. She left, and I did some homework; she wasn't just blowing me smoke.

So I ordered a few products, and began using them. Patient feedback was good, but more importantly, patient improvement, documented objectively, was impressive. I know, there's always the problem of confirmation bias when a clinician reviews his own work, so I can't conclude from a truly objective standpoint that the products worked. But you have to go with what you've got, sometimes.

This company offers a number of conferences, and at her last visit, I asked the rep why they don't include CEU credits for doctors attending them. Her answer was simple, blunt, and honest.

"We won't," she said. "We talk about our products."

Compare that answer to that of the pharmaceutical companies, which routinely spend millions of dollars sponsoring CEUs for medical doctors, and consider it a routine cost of doing business. I have attended some of those lectures, all of which have been extended infomercials for one or another miracle drug. The fact that this nutritional supplement company specifically delineated a difference between education and marketing was impressive.

At this visit, she also plopped another inch of independent research on my desk, and we talked about the scientific backing for some of their new products.  I was so engrossed by the information, that I completely forgot about the wrap she had brought from some deli.

I shouldn't have; this was unique. During her previous visits, she had never provided me with a free sample of anything, except as a quick taste test when I had mentioned that other, similar products had been met with unhappy looks from my patients.

So engrossed was I with the data that I forgot about the sandwich. Sandwiches, by the way, fall well within the guidelines for proper behavior for representatives visiting doctors, so I did not feel any gross or subtle moral violation for accepting the food.

After the rep left, I got around to opening it up, and discovered, perhaps, the Best Wrap I Have Ever Had In My Entire Life. I immediately emailed the rep to get her source; she demurred, however. So I still don't know where The Wrap came from.

So I have to confess. In addition to having been courted by a case of Red Delicious apples, I have now been waylaid by a chicken wrap of unknown provenance but undisputed tasteworthiness. That is the full extent that any company has sought to influence my prescribing behavior.

So the next time I recommend a supplement to you, I want you to have full and transparent knowledge. I'm doing it for the wrap.

Chinese herbs prevent diabetes: As effective as drugs.

A recent study found that an herbal formula used in TCM can reduce the risk of people with prediabetes from developing Type 2 diabetes by 32 percent. In other words, simple, inexpensive and safe herbs are as effective in preventing Type 2 diabetes as the prescription drugs acarbose and metformin.

If you are concerned about your risk of diabetes, my suggestion is to start with the safe and proven methods that have been in use for centuries.

FDA approved drugs lack proof

Half of all new drug formulations in the US were approved without companies having to demonstrate a tangible benefit http://t.co/fBbLZuS804

— Dr. Avery Jenkins (@averyjenkinsdc) January 23, 2014

Are you tired of being tired?

Reflections from the shallow end of the pool of knowledge.

All creatures, simple to complex, have a limited level of understanding about this world. It is those limitations which make their life bearable, given the manifestation of their form. A dog cannot conceptualize much beyond his immediate environs; the hand of his master caressing his head, the full bowl of food, the warmth of the hearth upon which he lies. To have knowledge beyond that, of the atrocities which exist beyond his ken, would make his life one long terror. A dog is not equipped to cope with such knowings.

Conversely, this same limitation of understanding is a blessing to the dog afflicted by a cruel owner. To know of a better life, to be able to see and understand it and to know it exists, while daily experiencing the inhuman treatment of a heartless master --- that understanding, too, would make the poor mastiff's life even more of an unendurable hell. His ignorance protects him from even greater pain.

Man is no exception to this rule. The limitations of our insight befit our admittedly extraordinary ability to manipulate the world around us. From stone, sand and water, we create objects to extend our knowledge and presence to realms once unimaginable. Nonetheless, our understanding of the universe remains constrained by fetters we cannot see. They are so hidden that, like the dog, we don't even know that they are there.

To attempt to step over these boundaries is to dance toe-to-toe with madness. Those that can expand their horizons and absorb the chaos and heartbreak of fuller understanding yet retain their humanity are few and far between.

But from time to time, it does happen. And what then?

They return to us with their greater knowledge, and we immediately re-encumber them with the handcuffs of our own sad vision. We give them a name — Christ, Buddha, Moses — and anneal their message of dangerous freedom into a form which, by making it comprehensible, strips it of its meaning. The next thing you know, we are baptising, circumcising or prostrating in the pursuit of a reflection of the moon on a pool of water.

Knowledge becomes dogma, perception becomes ritual and teaching becomes liturgy, because we find no way to fit the larger picture into our smaller box.

However, if we discard the playthings of the ignorant worldlings that we are and look at the messages that these teachers have brought back, there are, as others have pointed out, universal truths that stand what we believe to be true on its head.

• Less is more.
• There is no I, only we.
• Belief is the fundamental act of our existence.

These spiritual truths are no less valuable from the perspective of health. How often have I suggested to a patient that they are partaking too much of a good thing, whether that thing is pizza or pantothenic acid? How many hours have I spent explaining that the very microbes that live inside of us are not only critical for our digestive health, but also our immune health and our mental health, and that without our microbial friends or each other, we would die? How often has a patient improved solely because they have confidence in the doctor treating them?

We truly create our health, and the health of the world around us, by our thoughts and our actions. Chronic diseases in particular are susceptible to the metaphysical, and it is here that the future of chronic disease treatment lies.

We have such good tools to create vibrant, healthy selves. But using them means dropping our attachments, and facing the veil of our unknowns without fear or desire. Though the path has been trod, it is a hard path to follow. And you don't have to win to succeed.

Just take a step. And breathe.

The secret of my success: Three principles of disease.

When it comes to understanding health and disease, there are three fundamental precepts which must be acknowledged. These principles fly against much of what passes for common wisdom in medicine, but understanding and utilizing these principles have been the secret to my ability to find solutions for my patients where others have failed.

The first tenet is that a disease cannot exist in isolation. The way we structure our language about disease has always bothered me, because it reflects the outdated  view that a disease is a thing, an entity that we must combat and control. When we are ill, we say that we "have" the disease; "I have a cold," or "I have arthritis," as if our ills were something that we pick up and plop into the shopping bag of self.

Nothing, of course, could be further from the truth. Diseases are not isolated entities, they are ongoing processes in which we play a part. Even with infectious diseases, illness cannot exist separate from our participation in the process. How can a fever exist without a body to become hyperthermic? Where is a headache without the head? Where is the bruise without the swelling? How can a cancer exist without the  cells to grow into a tumor?

There is no I, only We.

As I keep telling my patients (and anyone else who will listen), there is no "I", there is only "we". As I type this, millions of commensural bacteria are helping me to digest my last meal, eliminating the detritus on my skin, and challenging not-so-friendly bacteria that want to get into my lungs. Without them I would be dead. Extending the sphere of my existence outward, the air filling my lungs and the food filling my stomach are all part of my health environment, and exert profound influences for good and ill.

What it comes down to is that any disease is a dance between ourselves and our external and internal environment. For better or for worse, we are full participants in our disorders. Unfortunately, the culture and custom of medicine leads us to distance ourselves from our illnesses, thereby putting many of our tools for healing out of reach as well.

The second tenet is that, disease, as well as health, is not static. The fluctuation from healthy to ill, and back to healthy again, even within the limited range of a chronic illness, is a constantly changing process. But again, our language reflects a fundamental disconnect with this particular nature of illness. Labels that allegedly describe a disease, such as arthritis, or irritable bowel syndrome, attempt to tag and bag something which exists only as a process. Arthritis isn't a thing; it is the gradual erosion of joint surfaces as the body fails to create new joint material to replace what is worn away. Irritable bowel syndrome isn't a bucket full of symptom post-it notes, today presenting as diarrhea and fatigue, tomorrow as constipation and depression. IBS is the process of opportunistic bacteria overtaking the intestinal milieu, altering the environment to better suit their needs.

Again, by misrepresenting diseases as static entities rather than ongoing processes, we lose the ability to alter them. You can only change a "thing" by cutting away at it, or attaching things to it, or by removing it; a process, however, has multiple points of entry where  changes can be introduced, any one of which that can result in an altered process with an entirely new outcome.

A disease is only a disease because we make it so.

The third tenet is the most important, and perhaps the most difficult to grasp, because to understand it we have to step outside of our cultural predispositions. The essential fact is that any disease is primarily a social construct. That is, we have decided to connect disparate data points together, each point representing a symptom, or lab value, or observation, and give this conglomeration a name, not unlike the ancients would look at the night sky and create pictures from points of light connected only in the imagination of the astronomer. These constructs are created at the convenience of the tools we have on hand; in the case of a disease, it reflects the tools which we have to address it, whether that tool is a drug of unknown mechanism in the case of the modern MD, or the pantheon of gods and their consorts, in the case of the ancient astronomer. Were it not for the story of Orion, that constellation would not exist; similarly, were it not for the existence of the microscope, there would be no such thing as a Staph infection. Our tools of observation and correlation are what make diseases possible.

Which is why different cultures, with different analytical systems, have different diseases. The Western diagnosis of clinical depression does not exist in Chinese medicine. Multiple Eastern diagnoses partially overlap the clinical entity we call "depression," but none are an identical (or even close) match.

The same culture will also alter diseases with the progress of time. What we now call fibromyalgia has a long and storied history going back over 100 years. But back then it had a different name, and different aspects of it were emphasized according to the prevailing views of biology at the time. What you have today is certainly not your grandfather's fibromyalgia.

Interestingly, I think that this is one of the reasons that the chiropractic profession proved to be such a threat that the AMA has spent over 100 years and millions of dollars trying to quash it. For the first time in the history of Western medicine, the chiropractic paradigm of illness focused on the key intersystemic command and control system of the body -- the nervous system. To do this, early chiropractic researchers developed a new language and a new allegory to explain an individual's health status. This was during the time when medical doctors were still bloodletting their patients and dosing them with arsenic in the race to rid the body of "vile humors," and such an entirely different way of thinking posed an intolerable threat. It had to be stopped.

The man with the empty fire.

Politics aside, consider for a minute how applying these fundamental precepts of disease can dramatically alter our approach to health problems.

Let's take, for example, a possibly fictional patient sitting in my exam room. He has come to me with a history of uncontrollable high blood pressure. He has, per his MD's instructions, dropped excess weight and engaged in a regular exercise plan. For the most part, he is eating what the medical profession calls a "heart healthy" diet -- lots of vegetables and grains, and avoiding "unhealthy" fats and cholesterol-containing foods, like eggs.

Despite his efforts, his blood pressure remains high, and is only precariously controlled by an unhealthy brew of anti-hypertensive medications, providing a dose of fatigue and flat-lined libido on the side. This patient is not a happy man.

The process of figuring out what is wrong begins with a recombination of the data. For the most part, I am not availed of any secret information that wasn't also available to the physicians preceding me. But perhaps I look at it in different ways.

For example, I've noted over time that the majority of people with high blood pressure have a very distinctive feel to their pulse. So why is it that the patient in front of me presents with uncontrollable high blood pressure, yet his pulse lacks that unique signature? My further examination, while not necessarily uncovering anything new, will occur in the context of trying to answer that question. And slowly, the dots will connect in a constellation that hasn't been seen before. I note a ruddiness to his complexion. He complains of fatigue, yet speaks in a loud, emphatic voice and exercises regularly. He is a large man, and despite his controlled diet, demonstrates a rotund abdomen. He is firm, with a layer of cutaneous fat overlying muscle. In my midwest childhood, we called people like that "milk fed." Everything about this man speaks of paradox.

So what's going on here? Let's ignore the diagnosis that the man walked in with, and think about the person himself. The most obvious thing about this man is that he is on fire. He is active, engaged, refusing to sit still, and refusing to accept his condition. Yet underneath that, there is...not much. An empty stomach. Fatigue.

What else in the world is like this? My mind is immediately drawn to the image of a cup of alcohol burning. The flame is hot, but not long lasting, and the flame is difficult to see. Unlike a wood fire, long lasting, even tempered, creating coals and ashes as it burns, this fire is empty underneath. And that -- an "empty fire" -- is what describes the man in front of me.

So what would cause that sort of blaze in a human? Well, an empty fire depends upon ready fuel that is easily combusted and leaves nothing behind. Which is exactly the sort of fuel that this man has been using. His "heart healthy" diet is dependent on grains -- in other words, easy-to-access carbohydrates, which are burning and leaving nothing of value behind.

So I tell my patient that we are going to modify his diet. For him, a paleo diet makes more sense, with its slow-burning fats. We discuss the particulars of his plan, and send him off with instructions to monitor his blood pressure daily. And, sure enough, a month later, his blood pressure is out of the danger zone and stabilizing at a healthy level. He owned his involvement in his disease process, and danced with it, eventually leading it off the dance floor altogether.

Do not mistake this approach to finding solutions for an intuitive one, because it is actually highly analytical. As I go through my day, I am constantly reminded of the words of scientist/philosopher Alfred Korzybski.

"The map," Korzybski said, "is not the territory." And when it comes to human health, it is important to have a variety of maps on hand; where one shows impassible mountains, another might show a lowland path.