Doctor or Healer?Dr Nicholas Martin 2016

The story of Kinjika - Darwin Hospital 1953

Kurdaitcha man

So what’s the point?

Voodoo is real?Magic happens?

Erich Menninger Von Lerchenthal

Flipside

Spontaneous remission project• 1000’s cancer survivors with a very poor prognosis.• 9 factors common to most of the patients

Dr Kelly Turner• Radically changed their diet• Took control of their health• Followed their intuition• Used herbs and supplements• Released suppressed emotions• Increased positive emotions• Embraced social support• Deepend their spiritual connection• Had strong reasons for living

What do these anecdotes and case reports suggest?

The body and the mind are connected

Activation Response

Neuro/hormonal response to a perceived threat

• Predominantly mediated through sympathetic pathways• Elevated HR / BP• Hypercoagulable – increased platelet function and blood viscosity• Endocrine changes mobilise glucose and fatty acids• Activation of Amygdala• Suppression of prefrontal cortex

Activation Response

What happens when the Activation Response is sustained?

Allostatic Load• Prolonged stress leads to wear and tear on the body• Allostatic load leads to:• Impaired immunity, atherosclerosis, metabolic syndrome, bone

demineralization• Atrophy of nerve cells in the brain

• Hyppocampal formation: Learning and memory• Prefrontal cortex: working memory, executive function

• Growth of Amygdala mediates fear response

• Many of these processes are seen in chronic depression and anxietyMcEwen BS. Ann N Y Acad Sci. 2004;1032:1-7.

Robert Sapolsky carries a tranquilized baboon.

Depression• Independent risk factor for CAD (Relative Risk 4.5 independent of

coronary RF)• 2 fold risk of all cause mortality in 8000 healthy volunteers over 6

years• Impaired recovery from stroke, hip fracture, MI• 40% higher all cause mortality in breast cancer patients

Work Stress and aging• Data from sample of 2911 of the Finnish working-age population aged

30-64• Individuals with prolonged work stress – Maslach’s Burnout Inventory

had leukocyte telomeres on average 0.042 relative units shorter than those with no exhaustion (p=0.009)

• High-Hostile men had significantly shorter leukocyte TL than their low-hostile counterparts• The relationship between hostility and disease is stronger in men than

in women, and men generally have a shorter life expectancy than women.

Hostility and telomere length

Relaxation Response

Studies on effects of Meditation (Pioneered Dr Herbert Benson)

• Decreased metabolism in body• Reduced HR• Reduced RR• Reduced BP• Reduced oxygen consumption

Relaxation Response

Relaxation response changes gene expressionRR practice comparing• Novice• Short term practitioners• Long term practitioners

Enhanced expression of genes associated with • energy metabolism, • mitochondrial function, • insulin secretion, • telomere maintenance

Reduced expression of genes associated with• Inflammatory response• Stress related pathways

Mindfulness and cellular aging• Meditation may slow genetic ageing and enhance genetic repair

• Increases Telomerase Activity

• Increases Telomerase Length

So what does that have to do with being a doctor?

That pesky placebo effect – getting in the way of studies and fooling patients!

Sham knee surgery

GERAC trial chronic back pain

Placebo Parkinsons• Improved motor scores 20-30%• Improvement and deterioration observed after introduction and

discontinuation of placebo• Placebo human fetal transplantation surgery 30% improvement

sustained for 18 months

• Increased Dopamine release in response to placebo

Placebo is a mind induced healing response

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262 IBS patients

EmpathyActive listening TouchThoughtful silence

Components of placebo

Therapeutic rituals

The right words…

Connecting, being.

Every interaction has the opportunity to be therapeutic

Take home messages• The body and the mind are inseparable

• The doctor patient relationship is a vehicle for harnessing the healing or destructive powers of the mind

• It begins with connection