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Author of Worried Sick: A Prescription for Health in an Overtreated America Published June 2, 2008 $28.00 hardcover, ISBN 978-0-8078-3187-8

Q: You’re an eminent physician and scientist and a renowned clinician and clinical educator. In Worried Sick, you call for evidence-based medicine that demands that the care of the patient be tempered by the science that delimits clinical certainty. What compelled you to become a reformer? Do you think that your message will be controversial?

A: I never viewed myself as a reformer, only as a physician who feels compelled to bring the highest level of clinical scholarship to the bedside and to model such an approach for my students. I have taught medicine at the bedside for 40 years with the same rigor I bring to Worried Sick. Furthermore, the notion that medical practice should take advantage of whatever science has to contribute is not controversial. That notion is a tenet.

However, “evidence based medicine” has become a shibboleth rather than a process. All I am doing and all I am asking is that we closely examine the “evidence” as to its relevance to the well being of any particular patient. Worried Sick teaches how to do so, and how productive the exercise can be. The result demystifies much that is common practice, and informs the patient- physician dialogue. If the result flies in the face of common practice, it is common practice that needs reform.

Q: How do you hope Worried Sick will be used?

A: I have written Worried Sick to serve three audiences: I want to teach all how to interpret medical advice from any source and how to participate in a dialogue with anyone we choose to serve as our clinical resource. I want to establish a new standard for bedside teaching of all health care professionals. I want to inform the health care policy debate.

Overly ambitious? Certainly. Overdue? Also, certainly.

Q: Why did you decide to include a shadow chapter for each of the chapters?

A: Some of the lay readership will desire access to the details of the science that supports my assertions. In fact, I hope that all readers will feel such a need. However, all health professionals who read Worried Sick should demand ready access to such detail. After all, many of my assertions will seem counterintuitive at first blush. I would not serve the readership well without the shadow chapters and the extensive bibliography.

Q: How does this book differ from your previous work, The Last Well Person: How to Stay Well Despite the Health-Care System?

A: Worried Sick differs from The Last Well Person in many important aspects: First of all, Worried Sick picks up where The Last Well Person left off both chronologically (since the literature of the 4-year interval is emphasized) and substantively since much of the clinical science has matured. Secondly, several important issues that were barely touched upon in The Last Well Person are carefully dissected in Worried Sick. And I have gone to some length to cast the inferences in a light that is directly relevant to health policy considerations.

I have attempted to craft Worried Sick so that anyone who has read The Last Well Person will feel well served by reading Worried Sick as well. Many a medical journal club has used each of the shadow chapters in The Last Well Person as a focus and stimulus; the same journal clubs can productively return to the chapters in Worried Sick to good effect.

Q: Why is it so difficult for the average patient to advocate for himself or herself in the contemporary health-care delivery system?

A: It is not just the “average” patient who has such difficulty. We all do, even those of us with medical expertise. The role of the patient is one of inherent vulnerability. We must countenance the probing of another human being into aspects of our life story that we hold so very dear. We need to trust our “provider.” We reserve a special pedestal for our “provider.” We will feel a great deal of disquiet if that trust is lacking. “Health care” is a philosophy. It may be informed by science, but it is always a philosophy.

Today, trustworthiness is assaulted by a “health care delivery system” that places little value on these human interactions and great value on “efficiency” and profitability. Neither the patient nor the practitioner is a primary “stakeholder” any longer.

Worried Sick leaves no doubt as to this emperor’s clothing and tailor.
Q: What is “Type II medical malpractice”?

A: We all know about “medical malpractice.” It’s when appropriate medical care is administered inappropriately. I call this Type I medical malpractice. In Worried Sick I repeatedly illustrate another form of medical malpractice, the practice of doing the unnecessary very well. This Type II medical malpractice demands recognition and expunging as much as Type I medical malpractice. No one would argue. But you will learn in Worried Sick that some of the most technologically sophisticated and expensive interventions, interventions for which a great deal of training is required and about which there is exuberant institutional pride, interventions to which you and your neighbor are likely to submit are shining examples of Type II medical malpractice.

Q: What does it mean to be well, and what makes one’s sense of well-being so fragile?

A: To be well is to have a sense of invincibility, a sense that we can cope with much that life throws in our path. This sense of invincibility is repeatedly challenged; none of us lives long without such symptoms as backache, heartache, headache, heartburn and much else. Furthermore, often these challenges from within are confounded by challenges from without in our lives at home and at work.

To be well is never to be taken for granted. To feel well requires well tuned coping mechanisms.

Q: What keeps us from having a rational health-care delivery system? A: The simple answers: the profitability of the abomination we currently underwrite and the

marketing that fools us all.

Q: What is the relationship between socioeconomic status (ses) and longevity?

A: In the resource advantaged world, medicine has little to offer for the longevity of the population. Yes, we save lives. We save the lives of individuals with acute infectious diseases, some with trauma, some with acute illnesses such as appendicitis, and the like. But this saving of lives advantages a tiny, albeit crucial, percentage of the public. Furthermore, the classic “risk factors” such as some magnitude of BMI or of insulin resistance or of cholesterol are “risk factors” indeed, but the risk they represent is measurable in terms of months of longevity for the public. The majority of your risk for not living to a ripe old age is captured by 2 questions: Are you comfortable in your socioeconomic status? And are you comfortable in your employment? A negative answer puts years of longevity at risk.

We don’t understand the biological correlates of these real-world risk factors, though there are clues. But we do know they subsume all that is marketed as important including lowering you cholesterol or treating your adult onset diabetes.

Q: Why is “iatrogenicity” a word that we, as health consumers, should be more familiar with?

A: Iatrogenicity means diseases and illnesses caused by doctors. Much is made of iatrogenicity in the lay press, usually in terms of medical errors. I do not dismiss or excuse such errors. However, Worried Sick focuses on errors of commission that are not considered medical errors in the tradition of “Type I” medical malpractice. Worried Sick considers the personal price you pay if you learn that a PSA, or mammogram or cholesterol or bone mineral density is not up to snuff. You will learn whether this inference is a valid indicator of important consequences and whether the interventions based on this inference actually advantage you. If they don’t, you are left with an altered perception of your health and whatever toxicities you might derive from ineffective treatment. That is also iatrogenicity.

Q: You consider interventional cardiology and cardiovascular surgery the cash cows of the American health care delivery system. Why? Don’t many patients feel that they have benefited from cardiovascular surgery?

A: Interventional cardiology and cardiovascular are the leading “health care” expenses. The cash that flows on their watch underwrites medical centers and their administrators, many manufacturers, most insurance companies, and all the other purveyors including the medical “providers.” Furthermore, the cash that flows rewards the various purveyors obscenely generously. It would make sense if all this actually benefited the patients. It’s a scam.

However, no one can go before an American physician with anything approaching heart disease without finding themselves in the interventional vortex. No one can survive this vortex without assuming they survived as a result and not despite all that was done.

A read through Worried Sick might spare you, if you have the courage of your conviction and learn to ask the telling questions.

Q: You note that “normal body weight” is a social construction, as is osteopenia. How so? What’s harmful about this kind of thinking?

A: How about some reality testing? We will all die. The issue is not why, but when. We will all age. The issue is not why, but how elegantly.

A concomitant of aging is loss of bone mineral density. A risk factor for death is a body weight beyond “normal.”

In the first instance, we need to know if a diminished bone mineral density represents a meaningful hazard for our own quality of aging. In the second instance, we need to know if “obesity” is a meaningful risk for death before my time.

Read Worried Sick. Short of extremes, in both instances the hazard is not worth worry, let alone any potential for adverse effects of drugs or of being labeled abnormal.

Q: What fallacies surround the conclusions drawn from the Harvard Nurses’ Health study?

A: Let’s talk about hubris. Do you really think you can generate meaningful data about such lifestyle factors as nuances of dietary preferences over decades? Do you really think we can measure tiny differences in large data sets reliably, or meaningfully? Read Worried Sick before answering.

Q: In your opinion, did Katie Couric’s decision to have a televised colonoscopy do the general public more harm than good? Do the benefits of undergoing a colonoscopy outweigh the risks of the screening?

A: Katie Couric’s husband died long before his time and that is truly sad. Colonoscopy at a very early age might have saved his life.

However, death before your time from colon cancer is quite rare. We would do more harm performing colonoscopy on healthy young people from complications of the procedure than we would “do good” in sparing a rare individual (one without a family history of colon cancer) death before their time from colon cancer.

Likewise, finding colon cancer in the elderly is not likely to benefit the elderly. They are more likely to die with colon cancer but from something else.

Therein lays the debate.

A single colonoscopy sometime in your 50s probably has a tolerable risk/benefit ratio. Probably. I discuss the “probably” in detail in Worried Sick.

Q: How difficult do you think it will be to get patients to accept that it matters little what one dies of as long as it’s one’s time to die anyway? Why are we so resistant to the idea that we are mortal and likely to live only until about the age of 85?

A: Americans today are taught that there is a scientific solution to all problems. We have no sense of mortality. Furthermore, this sophism is highly profitable for many who promote it, and highly seductive to all who listen. I wrote Worried Sick to promote reality testing.

Q: Why do you think that many women would be better off if their breast cancer was never detected? Why do you think that mammography offers so little of value to women screened?

A: I fervently hope that some day we will have the ability to detect the breast cancer that is likely to kill a woman before her time. I would applaud such a screening modality and demand that we educate all women to be screened.

Mammography in all its current guises fails miserably in this regard. All it accomplishes is widespread anxiety, enormous numbers of biopsies that are irrelevant, and a great transfer of wealth.

Q: According to Worried Sick, most male physicians over the age of 50 have had Prostate Specific Antigen screening (PSA). You are one of the few who have not. Why won’t you submit to this test that’s considered almost a rite of passage?

A: PSA screening is a very flawed test. You never want to do screening unless the test detects a disease that should be treated. PSA screening is problematic. Firstly, by my age all men have prostate cancer though nearly all will die with prostate cancer and not from prostate cancer. PSA screening is very poor at distinguishing those who will die from prostate cancer from those who will die with it. As I say repeatedly, I will die but I am more concerned about when then how. PSA screening offers no solace.

So why not remove all aging prostates? Or, why not remove all aging prostates which happen to consistently secrete a lot of PSA? Very few would die with prostate cancer and almost none from prostate cancer. However, nearly all would die at the same time if they had not been subjected to the surgery. Furthermore, about 15% of these “saved” men would spend the rest of their life incontinent and 15% would be troubled by their impotence.

No thank you.

Q: You say that “To be well is not to be free of physical and emotional symptoms or to be spared physical and emotional challenges. . . . To be well is to be able to cope effectively with the challenges.” As a physician, how difficult is it for you to get patients and their families to accept this definition of wellness?

A: Medicine is a practice based on trust and trust grows out of many interactions over time. Mine is a subspecialty practice focusing on chronic illness. My patients know me. We can discuss issues such as these without discomfort. My patients are never “rheumatoids”; they are people who happen to be confronting rheumatoid arthritis. There should be no “survivors” or “diabetics” or “hypertensives” or the like—only people with an illness-colored narrative of life. Such individuals are comfortable discussing the role of coping in feeling well.

Q: It can be very stressful to resist a health practitioner’s advice. One can be afraid of displeasing one’s doctor by refusing to take a test or to fill a prescription. How would you advise such a patient? Should one find another doctor?

A: Yes, one should find another doctor. I wish that wasn’t easier said than done. It takes 20 seconds to write a prescription but 20 minutes not to. Physicians would like to have the 20 minutes. In our “health care delivery system”, they would be punished fiscally for doing so. That’s why Worried Sick is designed to inform the policy debate.

Q: Why do most patients resist simply coping on their own when symptoms arise? Why is it difficult to feel that one can be well without the supervision of a physician?

A: Some of us go through life feeling vulnerable. For some of these, this uncertainty is the product of the child rearing style of their parents. That’s not a condemnation. It’s an observation.

All of us are aggressively medicalized. Billions of dollars are spent in marketing vulnerability. Sleeplessness, leg twitching, fatigue, sadness, belching, being a brat, and so much more is medicalized so that taking a pill is sensible. Life in general is medicalized; it’s a minefield. Fish is good for you unless there’s too much mercury. This year if you feed your child margarine you’re a criminal; last year it was butter. The billions spent on neutraceuticals, biologics, and supplements advantage no consumer. It’s endless, unless you learn to ask the critical question. Is this evidence based health promotion or simply marketing?

Q: Why are alternative therapies so appealing?

A: I have two inter-related answers: Whenever medicine gets as outrageous as it is today, and was a century ago, “people” find safer ports in their storms. Furthermore, in our complex society, more and more we need a port in the storm. That doesn’t mean the alternative is salutary. As discussed in detail in Worried Sick, almost no “modality” purveyed as alternative withstands scientific testing. Alternative therapy buys you another friend with another mind set bolstered by another bundle of untested and often fatuous theories. Just because an alternative port is less likely to do you physical harm doesn’t mean the experience is trivial. It is guaranteed to change your sense of self, your idioms of distress, your mode of coping, and your narrative of illness forever. Caveat emptor.

Q: You state that you know of no higher calling that teaching medicine at bedside, and yet, you acknowledge that you feel like an anachronism in your own and other American hospitals. Do you think that other physicians feel the same way?

A: I know of many, and that many feel the same way. The national emphasis is on “throughput”. Patient care is “managed” with efficiency (profitability) the goal. There are few Socratic sessions, almost no references in charts, little argument between consulting groups, nor are

patients admitted for other than “reimbursable” goals. The vaunted clinical scholarship of mid- century is barely a ghost.

Q: What’s the difference between the Quality Movement in health care and the Effectiveness Movement?

A: There is a major emphasis on efficiency and “quality” as cures for the inadequacies of the American health care delivery system. There is no argument. However, efficiency and quality is the cart; effectiveness is the horse. If the treatment is ineffective, who cares how well or efficient it is delivered. That’s why CMS (Center for Medicare Services) studies of improved quality of care for in-patient interventional cardiology demonstrate no improvement in outcome. The “quality” of ineffective care was improved.

Q: Which groups have been most responsive to your message?

A: I’ve been asked to deliver this message to many groups: Congress, leaders of industry, “health” insurance and academic health center administrators, and many academics here and abroad. All are receptive to the message. However, any would pay a great personal and organizational price to act on it. After all some 17% of the GDP is invested in the status quo, an investment that captures many with its largesse. It would require a popular mandate for anyone to act. Worried Sick is written to incite such a mandate.

Q: How optimistic are you that reforms that you propose will be adopted?

A: I have no doubt they will be adopted. I have no doubt I will not live to see it. I have no doubt that between now and then we will have an ever more abusive “health care delivery system” until it implodes. Worried Sick is my attempt to circumvent the last.

### This interview may be reprinted in part or in its entirety with the following credit:
An interview with Nortin M. Hadler, M.D., author of Worried Sick: A Prescription for Health in an Overtreated America, University of North Carolina Press, June 2, 2008). The text of this interview is available at www.ibiblio.org/uncp/media/hadler.

PUBLISHING DETAILS

ISBN 978-0-8078-3187-8, $28.00 hardcover Approx. 392 pp., 12 tables, supplementary readings, bibl., index Publication date: June 2, 2008 The University of North Carolina Press 116 South Boundary Street, Chapel Hill, NC 27514-3808 1-800-848-6224 (orders), 919-966-3829 (fax)

CONTACTS Publicity: Gina Mahalek, 919-962-0581; gina_mahalek@unc.edu Sales: Michael Donatelli, 919-962-0475; michael_donatelli@unc.edu Rights: Vicky Wells, 919-962-0369; vicky_wells@unc.edu

A conversation with Nortin M. Hadler, M.D.

Author of Stabbed in the Back: Confronting Back Pain in an Overtreated Society Published November 15, 2009 $25.00 hardcover, ISBN 978-0-8078-3348-3

Q: How big, in round numbers, is the backache industry?
A: The question does not lend itself to “round numbers.” Everyone has backache occasionally, some 5% suffer persistently. Backache is one of the commonest reasons to seek medical care; the commonest reason to see an osteopath, chiropractor, physical therapist, or other provider; the most costly compensable injury; a common component of the disabling conditions for which the Social Security Administration provides pensions; and the “bread and butter” of spine surgery. In short, backache is an important part of the fabric of life and of society.

Q: Just what is “regional backache”?
A: This is a term I coined decades ago to denote the backache suffered by working-age adults who are otherwise well and that occurs in the course of customary activities without neurological damage.

Q: Do we know what causes it?
A: Every theory imaginable has been raised and tested. None has survived.

Q: Haven’t various backache treatments been subjected to scientific testing?
A: Thousands of randomized controlled trials have been done testing many inferences as to causation and many assertions as to treatment. Very, very little has survived this testing.

Q: You say that the idea of backache as an injury is a relatively new concept. How did this come to be and who is served by this idea?
A: A century ago, Workers’ Compensation Insurance came on the scene. The worker is insured for the consequences of any personal injury that arises out of and in the course of working. This is a scheme that provides all the medical/surgical care and compensates for lost wages. To this day, it is the closest the U.S. has to national health insurance, although each state and several other jurisdictions administer distinctive programs. Early on, the notion of “injury” was straightforward, the consequence of a violent, traumatic event.

Backache did not qualify until surgeons in the early 1930s developed the notion of a “ruptured disc.” If the worker has suffered a “rupture,” the judiciary found, then the backache is a compensable injury regardless of the activity that was first associated with the pain.

Q: What’s the link between Workers’ Compensation and the labeling of backache as an injury?
A: The notion of a “ruptured disc” found footing in Workers’ Compensation, but rapidly became part of the common sense. People could have a backache and exclaim “I injured my back.” Furthermore, the labeling as a ruptured disc ushered in the surgical era of disc surgery and the common sense that people have “bad backs” and suffer “wear and tear.”

Q: You mention that the prevalence of backache is much higher in Germany than in Great Britain. What accounts for the difference?
A: I doubt the prevalence of the experience of backache differs. The recall of and the likelihood of reporting back pain differs and has increased remarkably in both countries in the past decades. No doubt this reflects the social construction of back pain as a dire injury, a symptom of being worn out.

Q: Tell me about “Railway Spine.” Does it have twenty-first-century equivalents?
A: Whenever something new is introduced into our world, some new technology or new disease or the like, there is a period of discomfort. For some, the discomfort is easy to overcome, but not for all. The railroad was the engine of the Industrial Revolution, but it was a fright to behold. In Victorian Britain a new disease was described; people suffered pain in their backs and elsewhere, severe fatigue, mental fogginess, and fearfulness. The sufferers were all passengers who ascribed their severe, debilitating illness to the jostling and shaking experienced in passenger cars as trains moved. Queen Victoria herself would not allow her private train to travel at more than a snail’s pace. Her surgeon, Professor Erichsen, came up with theories about how the spinal cord had suffered a concussion. Law suits against the railroad companies for “Railway Spine” became commonplace. All this settled down in the early twentieth century as it became clear, even to Erichsen, that this was a psychosomatic illness, a form of mass hysteria.

There have been many examples since, such as the epidemic of carpal tunnel syndrome ascribed to keyboard usage (there is no hazard; nearly all who were labeled and operated on were mistreated.) The most dramatic examples are episodes of “sick building syndrome” when the rumor of some lurking hazard, some fume or toxin, makes all who are convinced feel ill. In Stabbed in the Back, I discuss “whiplash” and “fibromyalgia” as examples of potentially devastating illnesses that result from a noxious idea.

Q: When should someone suffering from regional backache seek medical attention?

A: When a person is concerned that the backache is not regional, that is, that there is a neurological symptom or the possibility of a more dire illness (metastatic cancer, etc). Or when the the need to cope with the backache and the need to cope with coincident challenges in life at home or work are competing to render the person more ill. Then a wise ear might be useful in helping the person sort this out.

Q: Are there any treatments that backache sufferers should be particularly wary of?
A: The specific treatments for regional backache are called “modalities.” Some are physical (manipulation, massage, acupuncture, etc), some pharmacological (all sorts of pills, poultices, and potions), and some surgical. Almost without exception, no modality is helpful. In choosing to seek care, the sufferer is engaging in a “treatment act” that teaches theories of pain and the language such theories support. The sufferer should be aware of this, be willing to learn their vocabulary.

Q: Should we simply consider backaches a part of life that we need to cope with?
A: Yes, but we should take to heart the lessons of the past century that the saga of regional back pain imparts. The symptoms are not trivial. Furthermore, the normal course of life offers up other challenges to our well being: heartache, sadness, heartburn, knee pain, and more. These, too, are not trivial. Furthermore, they are rendered even more disconcerting when they occur when other aspects of our life—our psychosocial milieu— are not in order. It is important to recognize the latter forest and not focus on the back pain or we will surely be engulfed in “treatment acts” to the detriment of our ability to cope with the confounding milieu—the psychosocial challenges of life at work and at home. If we can’t sort this out ourselves, we need helpful people trained to recognize these challenges.

Q: What would you say to a friend whose physician has recommended some sort of disc/spine surgery to “cure” his or her chronic regional back pain?
A: There is a wealth of scientific information that there is no benefit to be derived from any form of surgery for acute or chronic regional back pain. There is also a wealth of information that patients subjected to invasive procedures for chronic regional back pain do even more poorly.

Q: In what ways is Stabbed in the Back critical of orthopedics and the chiropractic?
A: Stabbed in the Back surveys the extraordinarily comprehensive science that informs therapeutic options for acute and chronic regional back pain. Neither orthopedics nor the chiropractic have “modalities,” that is, particular procedures, that can be shown to be helpful.

Q: Regarding back pain or injury, can you name some things that modern medicine does “right”—i.e., offers the consumer-patient a reasonable benefit-to-risk ratio?

A: In terms of evidence based alternatives, all that remains for the treatment of acute regional back pain is some acetaminophen and perhaps a single long-lever arm spinal manipulation if one is hurting for more than two weeks. For chronic regional back pain, there is no evidence based intervention to offer. However, there is a wealth of information that dissects the experience of these illnesses that could arm people with the insights and maybe the ability to cope until the natural history plays out in their favor.

Q: How would you describe the role that the insurance industry plays in the overmedicalization of American consumers? A: The American insurance industry is swimming in moral hazard. All Workers’ Compensation and nearly all health insurance provided by larger employers are contracted to “cost-plus providers.” The more people claiming and the more people who do not get well, the more cash flows through the coffers of the insurers from which a sizeable profit is taken. It is a system that is inherently conflictual.

Q: What would be the first thing that you would change about the American health- care system if given the chance?
A: We have an enormous international resource that has spent nearly two decades cataloguing interventions according to the degree of effectiveness. No rational reform is possible until effectiveness becomes the primary criteria for indemnification. If “it” doesn’t work, I don’t care how well, efficiently, or cheaply “it” is done, I don’t want “it,” and I don’t want to share the cost of your getting “it.”

Q: Both Worried Sick and Stabbed in the Back propose that the modern American medical industry is essentially, perhaps even hopelessly, flawed by a system that puts too much stock in procedures and drugs that do not actually benefit the patient in any significant way. Do you see a trend toward reform among the younger generation of physicians? Have any medical schools adopted your theories and begun to teach their students about the dangers of overmedicalization and advocate for evidence-based medicine?

A: Every medical school teaches the principals of evidence-based medicine. Some governments have attempted to institute reforms along the lines I am advocating. However, the push-back by the stakeholders is relentless. The only solution is to teach the people to ask “Does this really do anything important for me?” and then demand a substantive response. Once the people realize how they have been scammed, reform becomes possible. Until then, the people will confuse the rational with rationing.

This interview may be reprinted in its entirety with the following credit: A conversation with Nortin M. Hadler, M.D., author of Stabbed in the Back: Confronting Back Pain in an Overtreated Society (University of North Carolina Press, Fall 2009). The text of this interview is available at www.ibiblio.org/uncp/media/hadler/.

PUBLISHING DETAILS ISBN 978-0-8078-3348-3, $26.00 hardcover Publication date: November 15, 2009 224 pp., 5 illus., 4 figs., 12 tables, notes, index http://uncpress.unc.edu/books/T-9058.html The University of North Carolina Press, www.uncpress.unc.edu 116 South Boundary Street, Chapel Hill, NC 27514-3808 919-966-3561 (office) 1-800-848-6224 (orders) 919-966-3829 (fax)

CONTACTS Publicity: Gina Mahalek, 919-962-0581; gina_mahalek@unc.edu Sales: Michael Donatelli, 919-962-0475; michael_donatelli@unc.edu Rights: Vicky Wells, 919-962-0369; vicky_wells@unc.edu

From a very recent email exchange:

In a message dated 4/29/2010 12:42:47 P.M. Central Daylight Time drfmurphy@me.com writes:

Hey, Dad,

I was thinking yesterday about the sadness I have felt recently about you being in Viet Nam for a year when I was ten. I thought it was curious that it would come up 40 years later. And when I thought about you being a FAC pilot I often felt more tears come, which I didn't understand until yesterday. I took a deeper look at the sadness (or tears... maybe it was fear) that has or have come up when I tell people my father was a pilot in the Forward Air Control in Viet Nam for a year, or when I simply thought about that fact. Yesterday, I looked at it more closely and it came to me that it was simple. I was afraid you were going to die when I was 10; and I never embraced that fear. So the fear that you were going to die in Viet Nam waited patiently...

I am glad you didn't die. (To say the least.)

I love you.

I am proud of you.

You are a good man... and that is putting it mildly.

Thank you for your service to our country, too.

Love,

Your Grateful Son

On Tue, 4/27/10, hoodad1@aol.com wrote: 

Courage.

You're a 19 year old kid.

You're critically wounded and dying in the jungle somewhere in the Central Highlands of Viet Nam.

It's November 11, 1967.

LZ (landing zone) X-ray.

Your unit is outnumbered 8-1 and the enemy fire is so intense, from 100 yards away, that your CO (commanding officer) has ordered the MedEvac helicopters to stop coming in.

You're lying there, listening to the enemy machine guns and you know you're not getting out.

Your family is half way around the world, 12,000 miles away, and you'll never see them again.

As the world starts to fade in and out, you know this is the day.

Then - over the machine gun noise - you faintly hear that sound of a helicopter.

You look up to see a Huey coming in. But... It doesn't seem real because no MedEvac markings are on it.

Captain Ed Freeman is coming in for you.

He's not MedEvac so it's not his job, but he heard the radio call and decided he's flying his Huey down into the machine gun fire anyway.

Even after the MedEvacs were ordered not to come. He's coming anyway.

And he drops it in and sits there in the machine gun fire, as they load 3 of you at a time on board.

Then he flies you up and out through the gunfire to the doctors and nurses and safety.

And, he kept coming back!! 13 more times!!

Until all the wounded were out. No one knew until the mission was over that the Captain had been hit 4 times in the legs and left arm.

He took 29 of you and your buddies out that day. Some would not have made it without the Captain and his Huey.

Medal of Honor Recipient, Captain Ed Freeman, United States Air Force, died last Wednesday at the age of 70, in Boise, Idaho.

May God Bless and Rest His Soul.

I bet you didn't hear about this hero's passing, but we've sure seen a whole bunch about Michael Jackson and Tiger Woods.

Medal of Honor Winner, Captain Ed Freeman

Shame on the American media!!!

Now... YOU pass this along to YOUR mailing list.  Honor this real American.

Please.

I debated about whether or not to share this with my father. And I debated whether to share it here. But what better way to demonstrate what I'm talking about? This is walking the talk.

And it is also the perfect situation to share some Stephen Levine wisdom. My take on something powerful I'll always have from Stephen Levine from the moment I was exposed to it: Most people ask, "Why do I feel this way?" This is not a helpful question. It is not skillful means. This question is worth less than nothing. Understanding is the booby prize.

I recall first experiencing sadness about my father being in Vietnam about two years ago. I'd given a talk for a group of physicians the night before. I talked about Dr. Sarno and I had mentioned Col. Nathan Jessup, Commander of the U.S. Marine Ground Forces at Guantánamo Bay, Cuba. (I gave a copy of "A Few Good Men" to Dr. Sarno because oddly it is the story of the psychology of TMS!) I was thinking about Jessup and my thoughts went to my father who flew sorties in and around Vietnam. Suddenly I felt sadness. My intellect was intrigued. As a scientist and a psychiatrist I let the tears come. I thought it was interesting sadness should surface 38 years later. I subsequently used it as a teaching piece. But I found that when I told people that my father was a Forward Air Control (FAC) pilot in Nam and flew armed, low-level, photo-reconnaissance missions over enemy territory, tears would head for the surface. I found that confusing and embarrassing. (Confusion is not understanding plus thinking that you should understand.) But again, understanding is the booby prize. Maybe this understanding and insight into that confusing flow of emotion (that it was the 40-year-old, unfaced, unembraced, undigested fear that my father was going to die and I was never going to see him again) hits the nail on the head. Maybe not. Nevertheless, I have to feel it to heal it.

Which brings me to the other half of Stephen Levine's wisdom: a better question is, "What is this?" This question isn't asked to get an answer or arrive at an understanding. It is asked with genuine, innocent (unknowing) curiosity. And not to process some emotion and get rid of it (resistance gives persistence.) You are curiously and genuinely embracing it, simply because it is your present experience. What the soul can embrace, the soul can release. It is just energy that wants to move.

That's why Eckhart Tolle's saying "yes" to what is works. And that's why Forrest Gump's life worked. That's what was special about Forrest. He never said, "This shouldn't be." Even more accurately, Forrest never was "This shouldn't be." And perhaps the filmmakers made Forrest "special" because no normal person would accept everything that happens to them. 

And finally, in an attempt to weaken the goal of normal's grip on you...

Normal means approximately average. Not a powerful goal, I submit.

If you want clarification and elaboration on resolving inner emotional discomfort (as opposed to going for relief (The Road More Traveled)) I recommend you listen to the short show immediately below this blog or click this link:

I read somewhere an interesting and possibly important way to categorize people is into these three groups: 1) Those that are actively seeking expanding awareness; 2) Those that are indifferent to expanding awareness; 3) Those that are actively seeking to avoid expanding awareness. There is a fly in that ointment though... Your own unconscious mind is keeping stuff from you without your permission or awareness. It is like Jack Nicholson in A Few Good Men saying, "You can't handle the truth!" "No," you say to yourself. But listen to this... Dr. Ron Harrelson told me an interesting hypnosis story. He was teaching a college class and did a hypnosis demonstration. A girl volunteered to be the subject, he put her in trance, asked her if coming up on stage and standing on her head would be OK with her morally and ethically, etc. She said it would be. He then gave her the suggestion when he straightened his tie she would come up on stage and stand on her head. He woke her up and continued his lecture. A little while later he straightened his tie and she stood up, walked up on stage, and stood on her head. That's not the interesting part. He asked her, "Why did you do that?" She said, "Well... you know when you are sitting for a long time the blood leaves your head."

You and I have no idea how much of the time we are operating that way.

Here's another similar breakdown to the one above: accommodators and assimilators. I forget which is which. One adapts their personal worldview/model/map when new data shows up. The other modifies the data to fit what they already believe. One changes his/her map when the territory is seen to contradict the map. The other says basically, "The territory is wrong." I don't think it happens that often on the physical level ("There is no mountain there!") but modern "scientists" and physicians are notorious for ignoring, marginalizing, or repressing information that is inconsistent with the dominant mode of discourse as Foucault put it.

On my shows I have been referring to the Semmelweis Reflex. This is a term coined by Robert Anton Wilson for the rejecting out-of-hand of something without any investigation whatsoever. It is in honor of Dr. Ignaz Semmelweis who is the father of antisepsis along with Lister. Semmelweis was beaten to death in an insane asylum in Vienna where he lived. (The staff beat him when he tried to leave after discovering he had been tricked by friends and family.) Today he is known as the Savior of Mothers in Austria and his likeness appears on Austrian postage stamps. He showed that the washing of hands in chlorinated lime solution after morning autopsies and before touching a patient prevented the patient's death. The medical community began routinely washing their hands over fifty years after Semmelweis recommended it and demonstrated its marked tendency to cause patients to continue to live after seeing a doctor. He was beaten to death at the age of 47 in 1865. Fourteen years later in 1879 Louis Pasteur demonstrated Streptococcus in the bloodstream of women with childbed fever. Now it was a visible particle. The medical community refused to engage in routine hand washing for about two more decades. Dr. Thomas Errico, NYU neurosurgeon, told John Stossel on ABC News 20/20, "This is not a mainstream theory with regard to back pain," as a rebuke of Dr. Sarno's foolishness in curing people of back pain with logic, science, and critical thinking. He also implied that Sarno's theories were like swinging a cat around your head three times in a cemetery. If "This is not a mainstream theory" were a valid standard we would not have fire or the wheel and you wouldn't be reading this blog.

Ken Wilber tells this analogy to reduce the mind's tendency to fear and resist change and the unknown. Imagine you have lived your entire life in a dark basement. You have been terrified your entire life because of a snake coiled in an all-too-near corner of your dark room. One day someone flicks on the lights briefly and you see that the "snake" is a garden hose. You will never be afraid of that snake ever again because it isn't a snake anymore. It's a garden hose. And the darkness doesn't obscure what you have seen for yourself.

Wake up. While your body is mechanical, you are not a machine that breaks. Modern medicine is expensive, ineffective, and deadly because it is based on the unconscious assumption that the physical level of reality is the ultimate level of reality and gives rise to everything else. This is the disaster of the modern world... the disappearance of the Great Chain of Being and the resulting Flatland. (The dignity of modernity is that morals, science, and art... the Good, the True, and the Beautiful differentiated and science, freed of the old "hang by your neck until you are dead" warning of the Good, enjoyed impressive growth. Guess what scientific/technological breakthrough has saved far more lives than anything else... It isn't the glamorous Western Medicine. It is sanitation.)

The Flatland fundamental error in orientation toward reality and its consequent misperception makes modern medicine expensive, ineffective, and deadly analogous to taking your car to a mechanic who distinguishes "automobile" as "ox" and he starts stuffing hay in the radiator and smacking the fenders with a stick. He is not going to have a lot of power and mastery with regard to automobiles, the bill will be high, and he will have fantastic stories that attempt to make his explanations fit what is observed. The show attempts "to do violence whether to the claims of the everyday interpretation, or to its complacency and its tranquilized obviousness."1 "Of course we have the best healthcare system in the world." "Of course we are getting close to a cure." Really? Not if the prevailing paradigm is wrong. Not if you're not a machine. Have you ever heard, "Depression is caused by a chemical imbalance"? What caused the chemical imbalance? Prior to being awakened to the paradigm I was brought up and trained inside of by reading Dr. Sarno's books I told hundreds or thousands of patients, family members, and friends, "Depression is caused by a chemicl imbalance." Then when reading The Divided Mind by Dr. Sarno it occured to me for the very first time to ask a very logical question, "What caused the chemical imbalance?" That was pretty startling... not as startling as the next realization, "OMG! No one has ever asked me that!" "What caused the chemical imbalance?" is as logical a question as, "What do we do about it?" Everyone asked, "What do we do about it?" No one asked, "What caused the chemical imbalance?" In fact, I Googled, "What caused the chemical imbalance?" in 2006. I got five hits on the planet Earth and two of them were from my website. I challenge you to Google anything and get five hits. THIS REEKS OF A PARADIGM.

Distinguishing "automobile" as "ox"2 or "human being" as "machine" can lead to some very serious tap dancing to try and make it look like the territory fits the map. ("Because obviously my map is right. I'm a doctor. I'm a scientist." The practice of law uses far more critical thinking than the practice of medicine. Ouch. Can we please just start teaching critical thinking in medical school?)

To see examples of some serious yada yada to try and make one's theories fit what is observed watch the two doctors on John Stossel's ABC News 20/20 segment on Sarno that first aired in July 1999. (One of the doctors is John Stossel's brother.) The fancy footwork there is amazing. Seriously. Watch the video. The Earth is a sphere. No edge. No monsters. Never has been; never will be.

"It isn’t what you don’t know that hurts you. It’s what you know for sure . . . that just ain’t so." -- Will Rogers

1Martin Heidegger
2My thanks to Werner Erhard for the ox/auto analogy.