From Medication to Meditation

Change Just One Letter and Change Your Life

I met a young patient last week who reminded me of why I had become a doctor. This 9 year old with shoulder-length curly brown hair immediately captured my attention with her sparkly smile and the intensity in her sky-blue eyes. I had met thousands of patients over my 20 years of medical practice, and had gotten quite good at assessing individuals in a very short time; this little lady was inquisitive, bright, and engaged; she was quiet, but only because she was intently observing me and learning about her new environment as I began to talk to her. I gleaned from her mother that she had been brought to see me for an eye exam because her teachers were concerned that she had a learning disability. After a delightful few minutes of joking around with this young lady (I often start in with humor to establish rapport with a child, but I think it's a great gauge of intelligence as well!), I opened up her medical chart to read that she was on SIX psychiatric drugs: three attention deficit drugs, two anti-depressants, and one to improve her appetite. I took a deep breath to compose myself and then turned to the mom and said, "Hmmm... six medications, huh?" The mom said, without a blink, "Seven, actually: we've just added another to help her sleep."

Drugged Out

Renowned molecular biologist Bruce Lipton lectures that among the top three causes of death in the developed world, the top is "iatrogenic death." "Iatrogenic" means arising from medical intervention. Lipton says that, once all the causes of iatrogenic death are tallied, they account for 784000 deaths per year, making medically-caused death the leader over heart disease and cancer. An astounding statistic by itself, but even more striking when we factor in that the medical field is supposed to save lives?! Now, Lipton is considered by some to be on the fringe; but so was Galileo. These 784,000 deaths are caused by so called "side-effects." Sounds like they are actually main effects?

If 784,000 seems like a crazy number, consider this well-documented statistic: prescribed drugs used according to FDA specifications are responsible for 80-100,000 deaths annually in the US. So the pharmaceutical industry, which supposedly exists to cure illness, instead is killing 80-100,000 a year with properly prescribed medication. The counter argument to such statistics is that drugs save many more lives than the relative few who experience sometimes lethal side effects. But my home state of Tennessee, whose residents are regularly among the highest consumers of prescription drugs, continues to have off-the-charts rates of obesity, diabetes, high blood pressure, and premature death.

[As an aside: a parallel is the food industry, which should have as its core mission to provide nutritional well-being, but is instead the hidden culprit of untold numbers of deaths and illness from obesity, diabetes, heart disease, to name a few. But that's another story...]

Why do medications have such an unintended toll on our health? Simply put, it's because we are applying a torque wrench to an intricate Swiss timepiece. Prozac has as much in common with the naturally-produced serotonin as an apple-flavored Jolly Rancher has with an organic apple. And placing an 9 year old on 7 psychiatric drugs is like trying to tune a Ferrari engine with a sledgehammer. Her in-born hormone and neurotransmitter system doesn't stand a chance of balanced function with 7 drugs tooling around in her brain! "Learning disability"? I was surprised that any semblance of her beautiful personality could shine through the drug-induced fog.

I've never seen a more striking example of medical mismanagement as in this little girl. But less obvious examples are commonplace in my experience: 85 year olds on lipid-lowering drugs, Coke-guzzling diabetics wearing insulin pumps, frail elderly on dangerous blood-thinning medications, on and on. What we doctors are up against is a type of medical inertia: we start a medication, then when it doesn't work fully or has side effects we either increase the dose or add another medication. While Dr. Lipton makes clear in his talk that doctors are not to blame, I don't agree. Doctors (most of us) set out to do good; I know that to be true based on what I saw in medical school. But somewhere along the way we lose our direction. After all, I see patients like this little girl everyday: patients who are clearly mismanaged with prescription drugs, unnecessary tests, and aggressive surgery by us well-meaning doctors. If we are not to blame, we are at least complicit; very few of us speak up like Dr. Lipton (who, by the way, has been fired from two major universities for his views).

Selling an Eskimo Bottled Water

The above diagram is a flowchart of just one type of hormone production in our bodies. The point I want to make here is this: each of us is sitting inside a profoundly powerful pharmaceutical factory called the human body. So the pharmaceutical industry's business is the equivalent of selling an Eskimo bottled water. In fact, EVERY drug is just a cheap and oversimplified copy of some substance that our bodies already produce.The reason that "side"effects exist is that scientists can't create a drug that produces good "main" effects but doesn't cause unwanted effects. Billions are spent on trying to create drugs with "specific"actions and no side effects. You may remember the Vioxx mess? This drug was supposed to be special: it was designed to treat arthritis pain but not destroy our stomach lining like other drugs in its class. Unfortunately, Vioxx caused heart attacks, and it also turned out not to protect the stomach lining all that well anyway?! Our system is incomprehensibly complex, but at the same time beautifully balanced and simple. Drugs can't approach the elegance and power of our mind and body.

So the question to ask is not "How do we produce better drugs?", but "How do we harness our natural drug factory?"

Meditation, not Medication

Several years ago, good friend reminded me that "our cells are eavesdropping on our thoughts" after catching me on an angry rant about something or another. The point she was making is that our mental state directly and powerfully affects our physiology. In other words, our state of mind can make or break our health.

Why is our mental state so strongly linked to our health? Because through our pituitary gland and our hormone systems, our brain literally turns thoughts into matter. For example, a stressful thought almost instantly causes the production of the adrenal gland stress hormones adrenaline and cortisol, which produce the stress response we have all felt: our muscles tense, our pulse races, our palms get sweaty: our mind and body are preparing for a survival battle. These physiologic changes occur based on our mind's perception of a threat - whether the threat is real or not does not seem to matter. The stress response is one obvious example of our mind affecting our body, but there are countless more subtle examples. For instance, immune function seems to be regulated by our mental state: a recent controlled UCLA study on HIV patients showed slowed reduction of CD-4 cell counts from daily mindfulness meditation.

While I am a fervent believer in sound nutrition and exercise, and preach about them to my patients incessantly, I feel the most important core skill we need to stay healthy is how to control one's mental state. The drug I use for this purpose is cheap, plentiful, and relatively painless: Meditation. Becoming skilled at meditation is the most effective way I know to harness your personal in-house pharmaceutical factory!

How to Meditate

What: When I teach meditation to beginners, we always start with a simple goal: to observe the breath. I don't emphasize rules or create a tightly structured meditation practice. I simply ask my students to close their eyes, and become aware of their breathing, without any attempt to control the breath. The next step is to gently return attention to the breath when the mind wanders to the next random thought. This process, called "Focus and Return" is the basis upon which every meditation technique is built.

When: I suggest that my students start meditating early in the morning, before the rush of our daily routine kicks in. Timing meditation in this way sets the tone for the entire day.

Where: Though the eventual goal is to be able to meditate in the middle of a traffic jam, initially I recommend a quiet place with a comfortable seat where you will be undisturbed for at least 15 minutes

How Much: The simple answer is "as much as you can." In most of us, our mind is used to being constantly populated with a string of random, habitual thoughts from the moment we awaken to when we drop into sleep. Just like a drug addiction, this habit can be difficult, and sometimes even painful, to break. After a few minutes of silence, sitting and observing your breath, you may feel the strong urge to jump up and resume your To-Do list items or check your smart phone. Here's the moment that counts... just notice your urge, and push through it. Give yourself at least 15 minutes of freedom!!

The Goal: To develop the skill such that you can drop into a meditative state quickly, and maintain it as long as you like.