The immobilising properties that make Botox sound potentially morbid are the same ones that make it an incredible drug. During the 1980s, researchers discovered that these properties were of tremendous benefit for patients suffering from involuntary muscle spasms associated with illnesses such as cerebral palsy. Compared to the other treatments available at the time, such as muscle relaxants, Botox was found to be the most effective since it worked quickly and had minimal side effects. In 1989 Botox was approved for the treatment of strabismus [commonly known as crossed eyes") and blepharospasm (involuntary winking]. The following year Botox was granted another approval, this time for cervical dystonia.The story of how Botox transformed from a medical drug to one with myriad beauty benefits is as fascinating as Botox itself. Anophthalmologist in Canada. Dr Jean Carruthers. noticed that the patients whom she was treating with Botox were not only seeing an improvement with their medical conditions, but the wrinkles in the surrounding areas were virtually disappearing Intrigued by this development, Dr Carruthers mentioned it to her husband, who happened to do a dermatologist. Just as intrigued, the dermatologist began to try out Botox on his patients, starting with his thirty-year-old, receptionist with deep creases between her eyebrows, and arrived at the same conclusion as his wife. A few years later, in 1990, the first medical paper was written on the potential of Botox as a significant aid in the field of cosmetic dermatology, bringing Botox greater recognition and acceptance among cosmetic dermatologists.*47\82\8*
You’d be surprised how many Americans don’t eat at their tables. They get really creative—eating in cars, in offices, in front of television sets, climbing into bed with a tray. Maybe they think variety is the spice of life. The fact is that if you are doing something else while you are eating, you are not concentrating on your food and therefore will not keep track of what or how much you are eating. When the Dodgers are losing, my husband is capable of eating everything we have in the house, and then asking what’s for dinner. If our son is eating while watching TV he will only want the foods he sees advertised—usually the sugar-coated variety. This is human nature and must be combated by limiting the places where you take your meals. Eat all three meals at the table. Never eat while you are working or doing something eke. Never eat standing up or lying down. If you take your lunch to work with you, get out of the office to eat it whenever possible.
Vaccines are simply a tweak that shifts the immune system response from the longer delay to the shorter delay. The tweaking of the immune system with vaccines has so strongly aided the immune system in this conflict that it has eradicated one scourge—smallpox—and virtually eradicated several others, such as polio, measles, and diphtheria, from large regions of the planet. We take pride in our vaccines, but really the vaccines are the simplest part of the defense. A vaccine is a mug shot of a criminal sent to a police station before the criminal is encountered. Sending the mug shot can be terribly important because it allows the police force to recognize and respond quickly to the real criminal. Merely sending the mug shot, though, is far less complex and difficult than tracking down, apprehending, and incarcerating the criminal.
Put bluntly, medicine’s successes at vaccination and antibiotic treatment are trivial accomplishments relative to natural selection’s success at generating the immune system. Recognizing this fact has important repercussions for the long-term control of infectious diseases. We will probably obtain much better disease control by figuring out how to further tweak the immune system and capitalize on its vastly superior abilities than by relying on some human invention such as new antimicrobials (antibiotics, antivirals, or antiprotozoal agents).
Antimicrobials are useful, but the problems they are good at solving differ from the problems vaccines are good at solving. Antimicrobials are not particularly suited to controlling or eradicating disease at the population level. Rather they are good at helping a patient who needs to control an infection now. Vaccines are effective at protecting individuals from becoming infected, at controlling the spread of disease through populations, and sometimes at eradicating a disease from a population. The blurring of this distinction between the roles of antimicrobials and vaccines has hampered the control of disease and exacerbated the dilemma of antibiotic resistance.
I am confident that we have only begun to capitalize on the immune system, though I doubt that we will soon be able to administer safely and effectively the chemical messengers used by the immune system to turn a particular response up or down. Some scientists hope that a more effective immune response could be generated by increasing or decreasing some of these chemical messengers, like turning the volume control on a radio up or down. I expect that the immune system is much too weblike to do that. Radios were engineered to be controlled by a listener. They therefore have controls for particular properties, such as volume, treble, and bass, controls that are well suited for adjustment by the fingers of the listener. The immune system, like the brain, was engineered by natural selection to be a self-controlling unit. It therefore does not have controls that allow an outside user to turn one attribute at a time up or down. If we increased a chemical messenger to try to improve immune function, we would probably cause many unforeseen effects as the immediate response affected other parts of the immunological web.
We can use the brain analogy to get a sense of what can be done with the immune system. If we start stimulating a neuron here and a neuron there, we are unlikely to improve the brain’s ability to function. Attempts to actually change the circuitry have ranged along the spectrum from very crude to moderately crude solutions; they may solve one problem but introduce others. One need only mention the gruesome failures of prefrontal lobotomy and electroshock therapy. A hands-on approach to the brain works best when some neuronal damage causes a shortage of a specific chemical, the effects of which can then be partially ameliorated by supplementing the shortage with the same chemical or a similar one. The use of L-dopa for Parkinson’s disease is this kind of solution; the L-dopa compensates for the shortage of the chemical transmitter dopamine. But even in this case the solution is generally only partially effective. We are headed for the same kinds of disappointments if we try to treat the immune system like a radio that can have its components adjusted, replaced, or removed.
We can effectively improve the brain’s functioning, however, by making use of the brain’s own already wired abilities to improve—we call it learning, or training. Vaccines similarly make use of the immune system’s already wired abilities to control microbes. Vaccines teach and train by providing information to the immune system, information that we humans know sooner than the immune system knows, information about what pathogens are out there ready to invade before they invade. That kind of tweaking has worked marvelously in the past, and it will undoubtedly do so in the near future. Vaccines teach the immune system, but good teachers know they cannot just present the information and leave it to the students to sort it out. Some students will be able to grasp an idea because of their background and inherent abilities, and others will not. A given student will grasp some ideas very well and other ideas poorly. The information that goes out will influence what is absorbed. If a teacher sends it out at too high an intensity, the student can be overwhelmed, and the entire subject can become frustrating and destroy the student’s interest, no matter how inherently interesting and manageable the subject. Medicine needs to figure out how to better teach the immune system, rather than trying to adjust and reconstruct it.
The immune system is an information-processing system that is analogous to the brain, but with different input and a different function. The brain deals with information from the outside world that comes in through sight, hearing, smell, taste, and touch and integrates it in the form of ideas and concepts; the brain’s goal is to interact more adeptly with relatively large organisms, those that we recognize as predators, competitors, and food sources. The immune system takes in information about small invading organisms, integrates it, and mobilizes it with the goal of interacting more adeptly with the microscopic environment. The goal tends to be more restricted, being largely the microscopic analog of avoiding predators and ectoparasites. But the task is more diffuse, more akin to controlling entire police forces or entire military operations than to altering the behavior of one person or one predator.
We rarely think of the immune system as an analog of the brain—as another decision-making system in our bodies—probably because the immune system does not generate sensations. We are therefore oblivious to its information processing and decision making. But it is there, and it integrates information and actions in very complex ways in each of us at every moment. We need not let our senses fool us into overestimating the importance and complexity of one system relative to another just because the one generates sensations and the other does not.
What options for tweaking are there besides vaccines? The brain function of my students can be overloaded with input. Immunological processing can be overloaded by pathogens if the dosage is too high, the harmfulness of the pathogen too great, or the route of entry too direct. One key to a truly preventive medicine will be to intervene in ways that keep the threat of pathogens well within the ability of the immune system to deal with them. We can keep the immune system from being overwhelmed, for example, by adjusting things so that pathogens
entering the body have a combination of low dosage and low inherent harmfulness, but this is a formidable task.
The good news, which will be developed in the remaining chapters of this article, is that evolutionary principles offer new directions that will probably allow .disease prevention programs to make better use of our immune systems by better controlling the evolution of their microbial adversaries. In short, there are ways to make vaccines, use antimicrobials, and improve hygiene so that control of pathogens by the immune system is much more manageable. Often these new methods capitalize on the immune system’s ability to mediate competition. If we intervene in ways that expose the immune system to milder organisms that are circulating in the population before they see the more harmful competitors, we can get the immune system to be better prepared for the more dangerous organisms, very much as if it had been vaccinated against the harmful strains.
Bhutani was suffering from bouts of depression for the last 3 years. Allopathic treatment had only dulled her sensitivity. Clinical tests had shown no abnormality. From outer appearance, there was no cause of mental depression. She had a loving husband with a reasonably good social and financial standing, good and healthy children.
But she was not happy. Her eldest daughter was married to a gentleman who had a very uncertain temperament. Sometimes he was of sweet temperament, at others hebecame violent. Sometimes he was glad to receive his inlaws in his house, at others he would detest their company and would not let his wife go to her parent’s home.
Mrs. Bhutani was much worried about the girl, although she had been assured from all reports that the girl was quite happy in her home and her husband was caring for her. No arguments or persuations could convince
Mrs. Bhutani that in our Indian society, the duty of the girl’s parents ceases when the girl is married and. joins her new home. Besides, when the girl was settled comfortably in her husband’s house, why should the parents bother? Mrs Bhutani was given a combination of (1) Chicory for her possessiveness towards her married daughter and (2) Red Chestnut for her fear & over-anxiety for others. She felt relief after 3 days and the medicine given T.D.S for 2 months changed her temperament and she no longer suffered from depression.
If you have been out of work for some time and have difficulty finding a job you can seek help from one of the Manpower Service Commission’s disablement resettlement officers (DROs). It may be that as a first step to helping you find a job, they will suggest that you apply (with their help) for a stay at one of the MSC’s rehabilitation centres, where you will be helped to establish a working routine and given advice about future employment. The next step may be to join a Training Opportunities course which will equip you with a special skill.
While you are doing these courses you will be given a tax-free living allowance, and your National Insurance record will be kept up to date by giving a credit of contributions.
REGISTERING AS DISABLED
Every handicapped person has to decide whether there is any advantage in being registered as a disabled person, or whether this might actually put off a prospective employer. There are advantages in being registered as disabled, and the more severely you are handicapped, the greater these advantages are likely to be. The registered disabled person can apply for sheltered employment and assistance with taxi fares to work if they are too severely handicapped to use public transport or drive themselves, for example. Employers of over 20 people are obliged by law to employ a quota of three per cent disabled people.
The DRO can help people who are too disabled to manage an ordinary job to find a job in sheltered employment. These jobs are available either through a government-sponsored company which provides work for nearly 8,000 people, or in a workshop run by a local authority or voluntary organization. Some local authorities employ people with epilepsy to work in parks and gardens; anyone doing such a job will be paid the full rate for it.
The Special Problem of “Hidden Diabetes”
Of the estimated 12 million Americans with Type II diabetes, at least half do not know that they are victims. If left untreated, life-threatening complications can result.
If you are over 40, overweight, or have relatives with diabetes, you should be checked by your doctor periodically. However, you should see your doctor immediately if you are thirsty and urinate excessively; tire easily; have blurred vision or cuts that are slow to heal; feel tingling, numbness, or cramps in your legs, feet, or fingers; or have frequent skin infections or itchy skin. These are all classic symptoms of diabetes.
Injecting Insulin-Making Cells
In September 1984, in one of the most promising advances, researchers at the University of Miami transplanted the insulin-making cells of the pancreas (called islets) into dogs with diabetes. Their disease was completely and permanently reversed. Human patients now are being prepared for these revolutionary experiments. If the scientists are successful, they will, in effect, have done a pancreas transplant without surgery – only an injection of cells into the patient. Experiments are being carried out at a dozen institutions. As of this writing, scientists are still struggling to make transplants work for a long time in humans.
Another promising method involves wrapping the insulin-making cells in plastic. The plastic has microscopic holes that allow small molecules to enter the space where the cells are. The small energy-containing molecules can seep in to feed the cells. But the tiny holes will not allow larger, cell-killing molecules to attack the insulin-producing cells.
It is clear that a number of crucial control elements called genes within the cell have to be altered before it becomes cancerous. What we have not yet said is how these alterations that produce the malfunctioning genes actually occur. A few of the processes that damage the genetic material are well understood, but most can only be described in very general terms. A small number of well-understood examples comes from the study of rare inherited cancers like retinoblastoma. Here it is easy to understand how the inheritance of an abnormal gene from parents can put the child at risk of developing a cancer. There are other examples of inherited cancer patterns. Perhaps the most closely studied is a condition (called familial polyposis coli) in which multiple growths occur in the bowel, many of them turning into cancers. Here again, the inheritance of an abnormal gene from parents puts the patient at risk of developing a cancer. However, we have already said that cancers that clearly run in families represent a small minority. Studying them has given important insights into how cancers develop but cannot tell us what happens for most common cancers where no clear family pattern exists. For these cancers it is likely that the oncogenes and tumour suppressor genes are damaged by factors present in the environment. There are very many chemicals which are known to damage DNA, our genetic material.
Such substances are usually referred to as mutagens (that is mutation-generating) and when they are capable of causing cancer they are called carcinogens (that is cancer-generating). We believe that exposure of normal cells to damaging substances in the environment produces the changes in oncogenes and tumour suppressor genes that lead on to the development of a cancer. We know that many of the environmental factors which appear to be associated with the development of cancers, each of which will be discussed in some detail in subsequent chapters, are capable of damaging DNA. We do not yet know which environmental factors cause consistent damage to particular oncogenes or whether the damage can (often) occur in many different oncogenes. Perhaps, when we do have this knowledge, the process of preventing cancer will become much simpler to plan and explain. For the time being, the new biology has provided us with an understanding of how cancers grow and what the essential targets for carcinogens are. It has not yet filled in all the gaps to explain step by step the link between cancer-causing substances in the environment and the development of the cancer in the patient.
When considering how RA affects the joints and why it produces some of the symptoms it does, it is important to recognize that no two people with RA are exactly alike. The severity of RA varies from person to person and joint to joint. Because of these differences it is often difficult to assess precisely how much joint damage is present.
What Is Inflammation?
Inflammation is a common but complicated process that our bodies experience as a response to injury or infection. Inflammation is actually part of the body’s immune system response to the injury or infection. Whenever we cut or burn ourselves, for example, inflammation occurs. Inflammation also occurs at the site of an infection (a person with bronchitis, for example, has inflamed bronchi, or airways). The symptoms and signs of inflammation are warmth, pain, redness, and swelling. The amount of inflammation involved is usually proportional to the severity of the injury or infection.
Under normal circumstances, unique white blood cells called lymphocytes, neutrophils, and macrophages strategically interact with one another to accomplish controlled inflammation. When the goal is fighting an infection, this team of cells works together to defend the body from the foreign invader causing the infection. They communicate with each other by messenger substances or signals called cytokines. In the process of fighting infection, cells produce noxious substances which cause the symptoms of inflammation. Again, under normal circumstances, after the infection is cleared, the cells retreat, and inflammation subsides. In these situations inflammatory cells are extremely useful in protecting the body. After an injury, the goal of these white blood cells is healing, and they work together to accomplish this goal.
Inflammation is usually self-limiting in that it goes away by itself after the infection is cleared from the body. As the infection goes away or the wound is healed and repaired, the signs of inflammation resolve as well.
It’s not always easy for an addict to find a doctor who will be helpful. Many doctors refuse to treat addicts who are using illegal drugs like heroin, cocaine and speed.
Luckily, many of these drugs don’t necessarily need medical help for withdrawals. As you will see in the next chapter, coming off heroin, methadone and many of the illegal drugs is surprisingly safe.
Barbiturates are quite another thing. These drugs can give dangerous withdrawal symptoms, and therefore coming off them should always be done with medical help.
Those who are taking tranquillisers and alcohol should have medical help on coming off – if it’s the right kind of help. The trouble is that the average family doctor doesn’t necessarily know very much about chemical dependence.
Besides, if you already have a doctor, he may be the one who is giving you the tranquillisers on which you are dependent. Good doctors are usually happy when their patients ask for help in coming off their prescribed pills, but occasionally an out-of-date doctor is reluctant to help. Some do not want to admit that the pills are doing harm, or they do not know how to manage a withdrawal schedule for their patient.
If you think your doctor comes into this category, a chat with long-standing NA or AA members may help you find a new doctor who understands drug dependence better. Treating addicts and alcoholics is still something of a speciality in medicine, rather than general knowledge.
Some addicts need treatment in hospitals and clinics. They just can’t seem to stop and stay stopped without this extra help.
Hence, if you give someone medication to change his mood from depression to elation, the depressed process may or may not disappear. If it is time for the person to change his mood and to combat these moods, then the medication will also correspond to a change in behavior. If, however, the person’s dreams and process of individuation want that depression for some particular reason, then medication will not work in a causal fashion because of the somatic-psychic coupling.
If you give medication to quiet down a highly aggressive patient, the medication will work only if the patient himself needs a pause from this aggression. But if the patient needs to learn how to use this aggression more consciously, he may not even take the medication in the first place.
Thus, the concept of channels and their couplings helps Us to understand why it is that medication sometimes works and sometimes does not. Working only in one channel, changing proprioception through pills, body work or jogging without considering the situation in other channels, like vision or relationship, could even be dangerous. I remember the case of one patient who had fits of negativity towards everyone. His medication helped him to get along better with others, but then, in a fit of anger, he threw himself through one of the windows of his mental hospital. That negativity needed expression and should have been worked with in relationships.
The existence of coupled effects has long been recognized in the physical sciences. We need only imagine a thermoelectric effect, for example. In physics, heat is one macroscopic process, while the flow of electricity is another. Heat up a certain material, and instead of it getting warmer, it may emit electricity and light up a bulb. Or think of another process in which you press a material and it gets warmer! Heating up a piece of material does not necessarily mean that it is going to get warmer! By the same token, giving someone psychopharmica does not necessarily mean that his mood is going to change, especially if there are coupled processes involved.