Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

Evil weed or useful drug?

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The pros and cons of medical marijuana

Marcy Duda, a former home health aide with four children and two granddaughters, never dreamed she’d be publicly touting the medical benefits of “pot.”

But marijuana, says the 48-year-old Ware resident, is the only thing that even begins to control the migraine headaches that plague her nine days a month, which she describes as feeling like “hot, hot ice picks in the left side of my head.”Duda has always had migraines. But they got much worse 10 years ago after two operations to remove life-threatening aneurysms, weak areas in the blood vessels in her brain. None of the standard drugs her doctors prescribe help much with her post-surgical symptoms, which include nausea, vomiting, loss of appetite, and pain on her left side “as if my body were cut in half.”

With marijuana, however, “I can at least leave the dark room,” she says, “and it makes me eat a lot of food.”

The culture wars over marijuana, for recreational and medical use, have been simmering for decades, with marijuana (cannabis) still classified (like heroin) as a Schedule I controlled substance by the US government, meaning it has no approved medical use. (There is a government-approved synthetic form of marijuana called Marinol available as a prescription pill for treating nausea, vomiting, and loss of appetite, though advocates of the natural stuff say it is not as effective as smoked pot.)

Some, like David Evans, special adviser to the nonprofit Drug Free America Foundation of St. Petersburg, Fla., applaud the government’s view, saying marijuana has not gone through a rigorous US Food and Drug Administration approval process.

But that skepticism frustrates leading marijuana researchers like Dr. Donald Abrams, a cancer specialist at San Francisco General Hospital.

“Every day I see people with nausea secondary to chemotherapy, depression, trouble sleeping, pain,” he says. “I can recommend one drug [marijuana] for all those things, as opposed to writing five different prescriptions.”

The tide seems to be turning in favor of wider medical use of marijuana. The Obama administration announced in March that it will end the Bush administration’s practice of frequently raiding distributors of medical marijuana. Thirteen states, including Vermont, Rhode Island, and Maine, now allow medical use of marijuana, according to Bruce Mirken, spokesman for the Marijuana Policy Project, which advocates legalization of pot. Last week, however, New Hampshire Governor John Lynch vetoed legislation that would have legalized medical marijuana in that state.

Research on medical marijuana is hampered by federal regulations that tightly restrict supplies for studies. But there is a growing body of studies, much of it supportive of the drug’s medical usage, though some of it cautionary. Given the intense politics involved, it’s true, as Abrams puts it, that “you can find anything you want in the medical literature about what marijuana does and doesn’t do.”

With that in mind, here’s an overview of what the research says about the safety and effectiveness of using marijuana to treat various ailments.

Pain: Marijuana has been shown effective against various forms of severe, chronic pain. Some research suggests it helps with migraines, cluster headaches, and the pain from fibromyalgia and irritable bowel syndrome because these problems can be triggered by an underlying deficiency in the brain of naturally-occurring cannabinoids, ingredients in marijuana. Smoked pot also proved better than placebo cigarettes at relieving nerve pain in HIV patients, according to two recent studies by California researchers. Marijuana also seems to be effective against nerve pain that is resistant to opiates.

Cancer: The active ingredients in cannabis have been shown to combat pain, nausea, and loss of appetite in cancer patients, as well as block tumor growth in lab animals, according to a review article in the journal Nature in October 2003. But there’s vigorous debate about whether smoking marijuana increases cancer risk.

Some studies that have looked for a link between cancer risk and marijuana have failed to find one, including a key paper from the University of California-Los Angeles and the University of Southern California published in 2006. “We had hypothesized, based on prior laboratory evidence, including animal studies, that long-term heavy use of marijuana would increase the risk of lung and head and neck cancers,” said Hal Morgenstern, a coauthor and an epidemiologist at the University of Michigan School of Public Health. “But we didn’t get any evidence of that, once we controlled for confounding factors, especially cigarette smoking.”

Research published by a French group this year and by Kaiser Permanente, a California-based HMO, in 1997 came to a similar conclusion.

But a state health agency in California, the first state to legalize marijuana for medical use in 1996, recently declared pot smoke (though not the plant itself) a carcinogen because it has some of the same harmful substances as tobacco smoke. The active ingredient in marijuana can increase the risk for Kaposi’s sarcoma, a common cancer in HIV/AIDS patients, Harvard researchers reported in the journal Cancer Research in August 2007. And British researchers reported in May 2009 in Chemical Research in Toxicology that laboratory experiments showed that pot smoke can damage DNA, suggesting it might cause cancer.

The federal government’s National Institute on Drug Abuse says that it is “not yet determined” whether marijuana increases the risk for lung and other cancers.

Respiratory problems: Smoking one marijuana joint has similar adverse effects on lung function as 2.5 to 5 cigarettes, according to a New Zealand study published in Thorax in July 2007. A small Australian study published in Respirology in January 2008 showed that pot smoking can lead to one type of lung disease 20 years earlier than tobacco smoking.

Addictive potential: The National Institute on Drug Abuse says “repeated use could lead to addiction,” adding that some heavy users experience withdrawal symptoms such as irritability and sleep loss if they stop suddenly.

Mental effects: Cannabis may increase the risk of psychotic disorders, according to a 2002 study in the American Journal of Epidemiology. And the national drug abuse agency warns that “heavy or daily use of marijuana affects the parts of the brain that control memory, attention, and learning.” A study of 15 heavy pot smokers published in June 2008 in the Archives of General Psychiatry showed loss of tissue in two areas of the brain, the hippocampus and amygdala, regions that are rich in receptors for marijuana and that are important for memory and emotion, respectively.

Vaporizing vs. smoking: The push now among proponents of medical marijuana is toward inhaling the vapor, not smoking. Vaporizing is a safe and effective way of getting THC, the active ingredient, into the bloodstream and does not result in inhalation of toxic carbon monoxide, as smoking does, according to a study by Abrams published in 2007 in Clinical Pharmacology and Therapeutics.

Bottom line: From a purely medical, not political, point of view, my take is that if I had medical problems that other medications did not help and that marijuana might, I’d try it – in vaporized form.

Just as Marcy Duda does. “You use it as you need it. You can be normal. You can function,” she says. “I don’t get high. I get by.”

Cold comfort

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Think you know how to avoid the sniffles? Maybe not.

If there’s any good news about the common cold, it might be this: You don’t have to stop kissing your sniffling loved one’s lips just to avoid catching their colds. But you probably will want to stop holding hands.

That insight comes from research into the more than 100 viruses, called rhinoviruses, that cause the common cold. The more researchers learn about these viruses, the more it challenges our common assumptions about how colds spread – sneezing, for example, does not seem to be as important a route of transmission as touching. With time and luck, this knowledge could lead to better ways of preventing colds.

Rhinoviruses infect the lining of the nose. But surprisingly, these viruses don’t live in saliva, says Dr. J. Owen Hendley, a leading rhinovirus specialist and professor of pediatrics at the University of Virginia School of Medicine. The lining of the nose “is a different form of epithelial tissue from the lining of the mouth and throat,” he says. And the cold virus, having come from the nose, does not fare as well in the dissimilar environment of the mouth.

Colds typically spread when virus-laden mucus from a sick person’s nose gets onto the fingertips of a well person who then rubs his own nose or eyes. In short, says Hendley, that means that “kissing is okay, but hand holding is not.”

Viruses also go from the tear ducts down into the nose, says Dr. Diane E. Pappas, an associate professor of pediatrics also at the University of Virginia. And it’s almost impossible to refrain from touching your eyes and nose. “We touch our eyes and nose multiple times an hour,” she says – whether we know it or not.

Usually, the fingertips get contaminated from directly touching the sick person, but there’s growing evidence that cold viruses can live for at least a day on surfaces such as doorknobs, telephones, countertops.

Scientists disagree about how easily cold viruses are transmitted by coughing and sneezing, and they cite data to support their position. Dr. Kimon Zachary, an infectious disease specialist at Massachusetts General Hospital, contends that cold viruses “can be transmitted by sneezing on someone,” though touch is the more common route. Unlike viruses such as chicken pox that can be spread through the air across a room, the cold virus droplets in sneezes and coughs only travel 3 feet, he says.

Hendley, on the other hand, says, “I don’t think the rhinovirus spreads through the air” at all.

Whoever is right, there’s no harm in asking people with colds to cough or sneeze into their elbows (not their hands) and in your trying to stay out of the line of fire. If you’re sick, throw out your own used tissues.

And it’s best to “avoid contact with infected clothing – people still wipe their noses on their shirts,” says Dr. Martin Hirsch, an infectious disease specialist at MGH. [Parents: This means washing your hands after you handle your sick kid’s clothes.]

Besides endless hand washing, there is one way to kill viruses on your fingertips before you spread them to your nose and eyes. It’s iodine – but you probably don’t want to go there. Data show that iodine does block viral transmission from drippy-nosed kids to mothers’ hands. But it turns hands brown and dries out the skin, said Hendley.

As for those increasingly popular alcohol-based sanitizing gels, sorry, but they may not measure up to plain soap and water. “Rhinoviruses like alcohol. They think it’s tasty,” says Hendley. For whatever reason, adds Zachary of MGH, “cold viruses are not as susceptible to alcohol-based hand disinfectants as other viruses and bacteria.”

And what of the common assumption that the same nasty cold virus can get passed back and forth endlessly within a couple or family? Not true. Most of the time, the next round of colds is because of a new virus.

But if you find that you are recovering from a cold, only to feel sick again, it does not necessarily mean a new virus is at work. “Some cold viruses can be biphasic,” says Hirsch, which means that the sufferer can feel sick, then feel better, and then feel sick again – all with the same viral infection. In addition, other microbes, including bacteria, can cause secondary infections such as sinusitis and ear infections.

It may help to know that the time of greatest infectivity is when the sick person is producing the most nasal mucus. Typically, that period lasts three days. If you can manage superb hygiene for those three days, you may not get sick. But you can’t necessarily count on the three-day limit; sometimes people shed virus for up to three weeks, warns Hirsch.

The incubation period for rhinoviruses is a day and a half to two days – so if you’ve been exposed but don’t start getting symptoms within two days, you probably have escaped.

Sadly, there are no vaccines against the common cold – there are simply too many viruses that you’d have to be vaccinated against. But researchers’ greater understanding of how the virus spreads holds hope for more effective prevention. As consumers get more refined information on how the virus spreads, everyday habits – starting with when it’s most important to wash your hands, or the best way to disinfect surfaces – will adjust accordingly, with greater prevention the outcome.

For now, consumers are left with treatments of uncertain efficacy. Many people swear by zinc-based products, but doctors are unconvinced of their value. Gargling with salt water can make a sore throat feel better and nasal lavage with salt water can provide mild symptomatic relief.

Better antiviral drugs for the common cold are nowhere in sight. “Antiviral medications are more difficult to make than antibacterials,” says Zachary of MGH.

So back to the good news: Once you become immune to a particular strain of rhinovirus, you’re probably immune to that strain forever. But with more than 100 strains, if you get two colds a year, it takes 50 years to acquire immunity to all of them.

In the meantime, wash your hands a lot if your loved one has a cold, and don’t worry about the occasional kiss on the lips.

 

Comparing apples to organic apples

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We’d like to think pesticide-free food is better for us, but scientific proof remains elusive.

With the recession breathing down our necks, you may be looking for ways to cut the household budget without seriously compromising family well-being. So here’s a suggestion: If you buy organic fruits and veggies, consider going for the less pricey nonorganic produce instead.

I know, I know, abandoning an organic way of life seems unthinkable in this chemical age. But hold the e-mails and hear me out. There really is no proof that organic food, which costs about a third more, is better for us than the conventionally grown stuff.

Yes, it makes sense, intuitively, that crops grown without pesticides should be better for us. It’s appealing, politically, to think that food grown the old-fashioned way, by rotating crops and nurturing the soil naturally, would be superior to food that is mass-produced and chemically-saturated.

Many people feel that way. Sales of organic food and beverages have grown from $1 billion in 1990 to well over $20 billion this year, according to the Organic Trade Association, an industry group.

But the unfortunate truth is that, from a hard-nosed science point of view, it’s still unclear how much better, if at all, organic food is for human health.

“Organic,” for the record, means food grown without most conventional pesticides or fertilizers made with synthetic ingredients, according to the US Department of Agriculture’s website (usda.gov). To carry the “organic” seal, a product must be certified by a federally accredited agent as having been produced according federal regulations. Small farmers are exempt.

Prepared food made with organic ingredients also tends to be processed more gently, with fewer chemical additives, said Charles Benbrook, an agricultural economist who is chief scientist at the Organic Center. The nonprofit research group is based in Boulder, Colo., and supported by individuals and the organic food industry.

But the word organic has not been designated as an official “health claim” by the government. Such a designation is used only when there is evidence of significant health benefits – and so far, that evidence is lacking for organic food.

It’s clear, however, that conventionally grown food has remnants of pesticides on it. A 2002 study in the journal “Food Additives and Contaminants” showed there are more pesticide residues on conventional than organically grown food, even after the food is washed and prepared. There’s also clear evidence that pesticides can get into people, a major reason Environmental Protection Agency regulations exist to keep farm workers from entering recently sprayed fields.

A study by Emory University researchers and others published in 2006 in “Environmental Health Perspectives,” a peer-reviewed journal published by the National Institutes of Health, showed that when children are fed a conventional diet, their urine shows metabolic evidence of pesticide exposure, but that when they are switched to an organic diet, those signs of exposure disappear.

All of which raises the question: How much harm do the pesticides cause?

A number of studies suggest that, at high doses, organophosphate chemicals used in pesticides can cause acute poisoning, and even at somewhat lower doses may impair nervous system development in children and animals. But at the amounts allowed by the government in the American food supply? That’s where nutritionists and environmental scientists seem to part company.

“We don’t have any good proof that there is any harm from fruits and vegetables grown with the pesticides currently used,” said Dr. George Blackburn, a nutritionist at Beth Israel Deaconess Medical Center and associate director of the Division of Nutrition at Harvard Medical School. The real issue is to get people to eat more fruits and vegetables, whether they’re grown conventionally or organically, he added.

“Keeping herbicide and pesticide levels as low as possible does make sense, although there is no clear evidence that these increase health risks at the levels consumed currently in the US, ” said Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health.

What is of growing concern, he said, is the meat industry’s increasing use of growth hormones in animals. Those hormones may be linked to breast cancer in women, he said. (The “organic” label on beef means, among other things, that it was raised without antibiotics and hormones. Some nonorganic beef is also raised without hormones or antibiotics, as noted on its label.)

Even if we don’t yet have all the evidence that organic veggies and fruit might be desirable, Benbrook of the Organic Center said it’s time to change the old notion that “there’s nothing wrong with a little pesticide for breakfast.” Over the last two years, he said, “nearly every issue of Environmental Health Perspectives has had at least one new research report” on how pesticides can harm a child’s neurological growth, particularly on “brain architecture, learning ability and markers for ADHD, [attention deficit hyperactivity disorder].” While this falls short of incontrovertible “proof” that properly washed conventional produce can harm us, it does raise red flags, environmentalists say.

Weighing the value of organic foods also means looking at nutrition, not just the danger of pesticides – and there is also disagreement over whether organic food supplies more nutrients.

Researchers at the University of California, Davis, did a 10-year study in which a particular strain of tomatoes was grown with pesticides on conventional soil right next to the same strain grown on soil that was certified organic. All plants were subject to the same weather, irrigation, and harvesting conditions.

The conclusion? Organic tomatoes had more vitamin C and health-promoting antioxidants, specifically flavonoids called quercitin and kaemperfol – although researchers noted that year-to-year nutrient content can vary in both conventional and organic plants.

Other studies have also shown nutritional advantages for organic food, according to the Organic Center, which reviewed 97 studies on comparative nutrition. Benbrook, the center’s chief scientist, says that although conventionally grown food tends to have more protein, organic food is about 25 percent higher in vitamin C and other antioxidants.

Yet a recent Danish study published in the Journal of the Science of Food and Agriculture showed no vitamins and minerals advantage to organic food.

So, what to eat? I side with the nutritionists who urge us to eat more fruits and veggies, regardless of how they’re grown. If you can afford it, common sense, though not necessarily science, would seem to favor the organics. But if you want, split the difference – buy organic for fruits and veggies that are thin-skinned or hard to wash or peel, and go conventional for those, like bananas, that you can peel easily.

Time to cleanse? Think again

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To read the Internet ads, you’d think that our bodies were awash in “toxins” – usually unspecified – and that we should therefore go to dramatic lengths, like “colon cleansing” and chelation to get rid of all this bad stuff.

Don’t believe it. Or, to put it a bit more gently, don’t risk your health or your pocketbook on programs that promise to “detoxify” you, without at least doing lots of homework first. Like asking exactly what these supposed “toxins” are. And thinking twice – or 20 times – before undergoing chelation, a procedure that uses powerful drugs to rid your body of heavy metals such as mercury or lead.

Some alternative medicine practitioners, such as Dr. Glenn Rothfeld, medical director of WholeHealth New England in Arlington, believe – although research is skanty – that cleaning out the colon occasionally may help some people, particularly those with irritable bowel syndrome. “Though whether it helps by getting rid of toxins is not clear,” he said.

There’s evidence, Rothfeld said, that the digestive tracts of people who eat typical Western diets may move wastes along more slowly than those of people who eat more fiber. In theory, this longer “transit time” could mean that some substances, like nitrosamines, which are found in preserved meats and are carcinogenic in animals, have more time to cause trouble.

But generally, people don’t need to take dramatic steps to “detoxify” themselves because human bodies have multiple systems for getting rid of wastes, by sweating, exhaling, urinating, and defecating. If you really want a “clean” system, eat more fruits and vegetables and less junk food, all of which we’re supposed to do anyway.

One testimonial ad, next to a truly gross picture on drnatura.com, reads, “How would you feel if long pieces of old toxin-filled fecal matter were stuck to the inside of your colon for months or even years?” But it’s simply not true that waste material gets stuck indefinitely in the colon – though the cleansing products themselves can form the gels that look like huge stools.

“I’ve heard my kids say that there’s stuff in the GI [gastrointestinal] tract for seven years,” said Dr. Douglas Pleskow, a gastroenterologist at Beth Israel Deaconess Medical Center. “That is the urban legend. In reality, most people clear their GI tract within three days.”

The ads for colon cleansing are also remarkably vague about what toxins would be purged with enemas, laxatives, or special diets. Asked what toxins his colon cleansing dietary regimen called “Master Cleanse” gets rid of, author Peter Glick man, an advocate of a raw food diet, spoke of “metabolic toxins,” parasites, and “environmental toxins . . . whatever kinds of stuff we’re breathing in air.”

Wrong, said Dr. Bennett Roth, a gastroenterologist at UCLA: “There is absolutely no science to this whatsoever. There is no such thing as getting rid of ‘toxins.’ The colon was made to carry stool. This is total baloney.”

What’s actually in the intestinal tract is mostly bacteria, which can aid in digestion. “An enema or laxative does not get rid of more ‘bad’ versus ‘good’ bacteria,” said Dr. David Heber, director of the UCLA Center for Human Nutrition. It gets rid of both. “We don’t like the idea of carrying bacteria so lots of folks want to cleanse, but remember bacteria can be your friend.”

Moreover, colon cleansing would do no good at all for environmental pollutants such as PCBs and DDT, which are stored not in the gut but in fat, and can’t be eliminated by colon cleansing.

Perhaps most worrisome, colon cleansing can actually be dangerous because most techniques draw fluid from surrounding tissues into the colon. This disrupts the balance of electrolytes such as sodium, potassium, chloride, calcium, magnesium, and phosphorus, said Pleskow of Beth Israel. This shift in fluids can lead to dehydration and low blood pressure.

As for chelation, it can be useful for getting rid of heavy metals such as lead in people with very high blood levels. But chelation can also be dangerous – the chelating drugs themselves can be toxic to the liver and kidneys.

It is totally inappropriate for people who have near-normal levels of heavy metals to get chelation therapy, said Dr. Rose Goldman, an associate professor of environmental health at the Harvard School of Public Health.

Beware of practitioners who use hair sampling to detect multiple heavy metals and elements, said Goldman. “This type of hair sampling is highly inaccurate,” she said. Some practitioners push chelation on people who complain of vague symptoms like fatigue and difficulty concentrating, which could easily be due to problems other than heavy metal poisoning.

If you do decide on chelation, ask if the physician is board-certified by either the Accreditation Council for Graduate Medical Education or the American College of Occupational and Environmental Medicine. Be skeptical about practitioners who say they practice “clinical ecology,” which is not a recognized medical specialty.

And before you jump to chelation, said Dr. Alan Woolf, director of the pediatric environmental health center at Children’s Hospital Boston, make sure the environment is as free as possible of the contaminant in question, such as lead, so you don’t recontaminate yourself. And try conservative treatments first, like adding calcium, zinc, and iron to the diet because these minerals can block absorption of lead into the body.

Before you fall prey to the country’s rampant toxic phobia, ponder the whole notion of detoxification. And remember, your body has an extraordinary ability to cleanse itself.

The fading allure of vitamins

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My love affair with vitamins and supplements is over: With a few exceptions — stay tuned — I’m tossing them out.

Things started going south for this romance 13 years ago when a Finnish study of 29,000 male smokers showed a higher rate of lung cancer in men who took beta-carotene and vitamin E and, more shockingly, found that those who took beta-carotene had an 8 percent higher risk of death from all causes. Two years later, an American study reported similar findings for beta-carotene.

My love affair with vitamins and supplements is over: With a few exceptions — stay tuned — I’m tossing them out.

Things started going south for this romance 13 years ago when a Finnish study of 29,000 male smokers showed a higher rate of lung cancer in men who took beta-carotene and vitamin E and, more shockingly, found that those who took beta-carotene had an 8 percent higher risk of death from all causes. Two years later, an American study reported similar findings for beta-carotene.

I’ve never been a smoker, but a red flag is a red flag. Out went the beta-carotene.

Then came the bad news on vitamin E, for which I had had high hopes as a general disease-preventer. A 2004 analysis by Dr. Edgar R. Miller, of Johns Hopkins University, found an increase in deaths from all causes in people taking more than 400 International Units a day of vitamin E. In 2005, the Women’s Health Study of nearly 40,000 healthy women showed 600 international units of vitamin E taken every other day provided no overall benefit for heart disease or cancer.

Out went the vitamin E.

Along the way, I tossed my echinacea, which I once swore by for preventing or shortening the duration of colds. (Never underestimate the placebo effect!) Though proponents still contend the studies are flawed, I now believe the debunkers — among them the researchers who published a major study in 2005 in the New England Journal of Medicine showing that echinacea has no effect on colds.

Did I mention vitamin C? Oh, how I wanted to believe this famous antioxidant would keep me from getting cancer and all those colds! But despite numerous studies, “we haven’t been able to show a benefit,” Miller said.

The latest disillusionment came in February with a Danish study published in the Journal of the American Medical Association. When the researchers pooled the data from 47 reasonably unbiased studies involving 180,938 people, they found a 7 percent increased risk of death from all causes in those taking beta-carotene, a 16 percent increased risk of death in those taking vitamin A, and a 4 percent increased risk of death in those taking vitamin E.

Jeffrey Blumberg , a nutritionist and director of the antioxidants laboratory at Tufts University, among others, said that this study was based on flawed methodology, including the fact that the researchers left out of their analysis a number of studies that might have tipped the results in a different direction. But, to me, that’s clearly not a strong endorsement of vitamins.

(An important caveat here: If I were at risk of developing advanced age-related macular degeneration, a leading cause of vision loss, I would talk with my doctor about taking vitamin C, E, beta-carotene, and zinc. A National Eye Institute study published in 2001 showed that this combination can slow progression of the disease. On the other hand, a study in March in the Archives of Ophthalmology showed no benefit to beta carotene pills alone.)

Multivitamins? Somehow, I can’t part with mine yet, mostly because, try as I might, I still don’t eat enough fruits and veggies. But my faith is slipping. A state-of-the-science conference sponsored by the National Institutes of Health synthesized data from a number of randomized, controlled trials, the gold standard of clinical research. In a paper published in 2006 in the Annals of Internal Medicine, the scientists concluded, disappointingly, that the “evidence is insufficient to prove the presence or absence of benefits from use of multivitamin or mineral supplements to prevent cancer and chronic disease.” (For more, go to consensus.nih.gov.)

Adding to the speed at which the scales have been falling from my eyes is the latest news from ConsumerLab.com, a private company that tests vitamins, both for manufacturers and consumers.

ConsumerLab reported in January that 52 percent of the multivitamins it examined were contaminated with lead, didn’t disintegrate properly, or had more or less of certain ingredients than indicated on the label. While Centrum Silver passed, a multivitamin called AARP Maturity flunked because it failed to disintegrate properly. (An AARP spokesperson said it believes “the validity of the ConsumerLab study is in serious question” and is therefore still “evaluating whether or not to continue to make the product available.”)

A children’s product called Yummi Bears Multivitamin and Mineral flunked, too, because it contained too much vitamin A, which can be toxic. (A spokeswoman for the company said other, independent tests show Yummi Bears products meet all label claims and that there is no basis for concern about vitamin A levels in the product.) Vitamin Shoppe Multivitamins for Women flunked because it had too much lead; a company spokesman said last week that the company has removed the product from stores.

So, what’s left in my dietary supplement drawer?

Not much. Omega-3 fish oils, vitamin D, and calcium. Omega-3’s are still on my “good” list because considerable research suggests they lower the risk of cardiovascular disease and abnormal heart rhythms. In ConsumerLab testing, omega-3 fish oils, thankfully, were found to be free of mercury, PCBs, and other potential contaminants. Vitamin D is still on my list because it helps protect against certain cancers and with absorption of calcium. Calcium is still there because it seems to help protect against bone loss, although recent research has raised some questions, so this might be next to go.

For me, the most pressing question now is how to have the most fun with the handful of twenties I’m not spending on supplements! 

Favorite books on alternative medicine

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One of the many perks of writing about health is that you end up with a terrific collection of books. A decade ago, most of the tomes on my groaning shelves were the traditional sort  –  biology textbooks, medical dictionaries, pharmaceutical references and the like.

Lately, thanks to a deluge of new titles,  I’ve got an impressive library of books on alternative and complementary medicine as well. Some are so dense and soporific that I wouldn’t recommend them to any but the most determined reader.  Some are so light and fluffy as to be useless.

But many are quite good. So, without further ado, herewith my favorites.

The prettiest, and at $16.47, the least expensive, book in my collection is the “Mayo Clinic Book of Alternative Medicine” (2007), which is chock full of colorful images  –  thin women doing yoga, peaceful women smelling blossoms, huge garlic heads floating in space.

By contrast, the text explaining things like acupuncture or hypnosis seems a bit bland. But there is lots of good information in the  “sidebars” and I really like the book’s system of  green, yellow or red  traffic lights to signal approval, caution, or disapproval for various treatments. This is especially useful for herbs. Valerian, for instance, the herbal sleeping pill, gets a green light, while kava, the anti-anxiety herb that once appeared so promising, gets a red light because of potential liver toxicity.

Another graphically-pleasing, very solid reference is  ” The Duke Encyclopedia of New Medicine ” (more thin women doing yoga, more women running through meadows and getting massaged, more gigantic garlic heads). I like this 2006 book because it costs only $26.37 and has easy-to-use information about how the body works and about specific diseases, as well as a whole separate section on alternative and complementary therapies.

The latter section is excellent, though it includes some crazy stuff I would have left out. Like sophrology, supposedly the study of “harmonious consciousness”  (with a picture of a bare-chested guy rock climbing), and “neuocranial restructuring,”  manipulating the skull bones to treat medical problems. Like the Mayo book, Duke uses red and green color strips with check marks to indicate benefits and risks. To its credit, Duke rates sophrology as having minimal benefit (and minimal risk), and warns people in no uncertain terms to stay away from neurocranial restructuring.

Another general guide to the field is the “Fundamentals of Complementary and Integrative Medicine,” by  Dr. Marc Mizzoni [cq], who is also an anthropologist. At $56.03, this 2006 book is not cheap and, though it’s good for gaining general knowledge in the field, it doesn’t provide the nitty-gritty assessment of various techniques and individual herbs that many consumers may be looking for.

The American Botanical Council’s 2003 book, “The ABC Clinical Guide to Herbs,” has no color pictures, but, even at $69.56, is a must-have resource if you’re seriously into herbs. It has lots of footnotes on the 29 most commonly-used herbs and easy-to-read tables showing what different studies on the major herbs have shown. With chamomile, for example, used worldwide in teas, the ABC guide gives precise descriptions of chemical composition, details its uses for stomach upsets (and for some skin problems), lists dosages, contraindications,  regulatory status in 12 countries and common brand names.  

Another excellent source on herbs, for $59.95, is the third edition (2004) of the PDR for Herbal Medicines, put out by Thomson Healthcare. With write-ups on roughly 600 herbs, it’s more encyclopedic than the ABC guide, although the ABC guide is easier to use because it summarizes research studies in a more accessible way. Both books are helpful for serious herbalists, herbalist wannabes and physicians trying to figure out what’s in the stuff their patients are taking.

For those seeking a detailed understanding of the scientific basis of   “natural medicine,” there’s a very thorough 2,000-page, 2-volume set called the “Textbook of Natural Medicine” by Joseph E. Pizzorno, Jr. and  Michael T. Murray. But at $229, this 2006 reference is probably best perused in a library. Far more useful, in my view, and distinctly cheaper at $43.96, is The Clinician’s Handbook of Natural Medicine (2002), by the same authors, plus Herb Joiner-Bey. It’s especially useful for figuring out what dietary supplements may help for various illnesses.

For me, thumbing through the pages of these books is the quickest way to zero in on information I need. Granted, books are more expensive than the free information on the web, but I’m old fashioned enough to prefer turning pages. And if you don’t want to pay, you can always go to the library. In fairness, though, there are some great resources on the Internet as well, the first place many people turn to for medical information.

There are some great sources on alternative medicine there, too, among them www.nccam.nih.gov, the site of the National Center for Complementary and Alternative Medicine. I also like www.worstpills.org, run by Public Citizen’s Health Research Group; www.herbalgram.org, run by the previously-mentioned American Botanical Council; and a Consumer Reports site, www.consumerreports.org/mg/natural-medicine.

Happy reading and good health!

Benefits from aromatherapy tough to prove

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Aromatherapy — the use of plant oils to improve well-being — sounds lovely, doesn’t it? How wonderful if a whiff of lavender could make you feel drowsy, or a little dab of rosemary oil could relieve muscle pain.

There’s certainly a plausible biological basis for the idea that smells can have direct effects on the body. On the yucky side, for instance, nothing makes me nauseated more quickly than the odor of those pine tree-shaped “air fresheners” that taxi drivers hang in their cabs. On the positive side, for me, the scent of a fresh Christmas tree always evokes warm memories of childhood; or the smell of cookies baking in the oven can help sell a house.

But there’s little solid science behind many of the claims of medical benefit from aromatherapy, which usually means soothing the body through smells, but can also mean rubbing plant oils on the skin.

“There have been some pretty wild claims” about the effects of aromatherapy, said Dr. Charles J. Wysocki , a behavioral neuroscientist at the Monell Chemical Senses Center, a corporate-sponsored research institute in Philadelphia, who has spent more than 30 years studying smell.

It is precisely this lack of data that makes aromatherapy so important to study, said Ohio State University health psychologist Janice Kiecolt-Glaser. She is currently analyzing her results from a government-funded study in which she exposed one group to lavender, “which is supposed to be a relaxant,” she said, another to lemon, “which is supposed to be stimulating or uplifting,” and the third group to distilled water, which has no smell.

There is so little data supporting aromatherapy that the National Center for Complementary and Alternative Medicine, a branch of the government, does not even discuss aromatherapy on its website, though the agency is now funding one study: Kiecolt-Glaser’s.

Proponents of aromatherapy point to several studies that they claim show it works. Some data do suggest that pleasant odors such as rose, jasmine, and lavender might lower blood pressure, and a small study suggests that lemon oil might reduce the doses needed of antidepressants. But these studies were not rigorous.

Some better-designed studies, using placebo smells for comparison, showed no medical benefit from aromatherapy.

A 2001 study of 33 patients with postsurgical nausea found that oil of peppermint was no better than rubbing alcohol or saltwater in providing relief. A 2002 study of 17 hospice patients found that using a humidifier with plain old water was just as effective (and not very effective at that) as water with lavender oil in relieving anxiety and pain. A randomized, double-blind study in 2000 of 66 women awaiting abortions found that aromatherapy with essential oils (vetivert, bergamot, and geranium) was no more effective than a placebo smell (hair conditioner) at relieving anxiety. A 2003 randomized study of 313 cancer patients undergoing radiation similarly concluded that aromatherapy was psychologically “not beneficial.”

Worse yet, a study of 60 healthy men and women, published this year in Psychosomatic Medicine, showed that those exposed to either a pleasant odor (lemon) or an unpleasant odor (machine oil) actually had a greater response to experimentally induced pain than those exposed to no odor.

“It’s very difficult to demonstrate positive effects” from odors, said Wysocki. By contrast, “it’s very easy to demonstrate mood swings in the negative direction. If you expose people to nasty-smelling odors, they will get upset. If you expose them to vomit, some people will actually get sick and vomit.”

Perhaps that’s because the brain is hard-wired to detect “bad” smells — those like the smell of rotting food — that could signal danger.

Reactions to smells are also highly conditioned. “A child who experiences the smell of roses for the first time on a summer walk in the garden with his mother will have different memories of the smell of roses than a child who first experiences the smell of roses at his mother’s funeral,” said Wysocki.

Expectations also play a huge role in reaction to smells. In one of his own studies, Wysocki divided subjects into groups of 30 each and exposed them to the same, unknown smell. People in one group were told they were getting aromatherapy and they quickly got used to the smell and soon stopped smelling it at all, while a group that was told the smell could be dangerous in high concentrations was increasingly bothered by the odor as time went on, he said.

Because people expect a benefit from aromatherapy, it may help them feel better, said Cherie Perez , a research nurse supervisor at the University of Texas M.D. Anderson Cancer Center in Houston.

But it’s tough to pin down what’s going on when someone feels better after a massage with lavender oil, she said. Is it the massage? The oil being absorbed into the skin? The smell of the oil? The attention of the masseuse? All of the above?

My take on this? Enjoy a nice, warm bath if you want to relax. But don’t count on the expensive bath oil to help anyone but the company that sold it to you.

Physical therapy arrives, popularity surges for varied reasons

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So there I was, the quintessential battered athlete, standing in a silly, little “johnnie” so physical therapist Susan Lattanzi could put me through my paces.

I had arrived on her doorstep at Mount Auburn Physical Therapy Associates in Watertown because my right shoulder was killing me. I had just joined a swim team and suddenly increased my weekly yardage substantially. By the time I saw Lattanzi, I couldn’t swim 15 minutes without my shoulder screeching in protest.

She had me put my arm by my side, thumb facing forward, then lift it overhead alongside my ear. No problem. Then, another arm lift with my palm up and the arm raised to the side to shoulder level. Ouch!

My rotator cuff was damaged, but it felt better within weeks, after physical therapy with ultrasound to improve blood flow, deep friction massage to break up microscopic scarring, and home strengthening exercises.

No surgery! Back to swimming!

No one keeps good track of visits to physical therapists, but there is so much demand that there are now more than 200 training programs in the United States, up from 140 just 10 years ago. Physical therapists are also better trained than ever before, with the number getting doctorates soaring.

Despite the growing demand, in some ways, it’s easier than ever to see a physical therapist. Most states allows patients “direct access,”

without a referral from a doctor, though in some cases, insurance companies will not pay for physical therapy without a referral.

“Physical therapy is booming. We can’t get them out of school fast enough. Hospitals are crying out for physical therapists all over the country,” said Dr. Jeffrey B. Palmer, director of physical medicine and rehabilitation at Johns Hopkins Medical Institutions.

Part of the growing demand is because the population is getting older and creakier. But much of it, particularly for problems like back pain, he said, “is the desire for conservative management.”

Dr. Lyle Micheli, an orthopedic surgeon and director of sports medicine at Children’s Hospital Boston, said he now sends 90 percent of patients “to physical therapy instead of surgery.”

At the Spine Center at New England Baptist Hospital, Dr. Geno Martinez, who specializes in rehabilitation medicine, tells many patients that their back pain will improve if they get moving with the help of a physical therapist. Though some physicians still don’t believe it, he said, “in reality, back pain, in general, is not a surgical condition.”

Further driving the popularity of physical therapy is the fact that therapists can offer one-stop shopping, not just spinal manipulation or massaging muscles to get rid of tension. Physical therapists offer highly-individualized programs of specific exercises and therapy to heal injuries, said Diane Maeda, a physical therapist supervisor at the UCLA Medical Center. By contrast,  other physical therapists said, personal trainers in health clubs know how to build muscle, but often do not have the lengthy medical training that physical therapists do.

There is also growing evidence of the efficacy of physical therapy for specific problems.

In the old days, physical therapists often stuck to a one-size-fits-all approach, using the same techniques — massage, heat, stretching — for everybody. Now, they have a much better idea of which techniques work for which symptoms, especially with back pain.

Anthony Delitto, chairman of the department of physical therapy at the University of Pittsburgh, is one of the leaders in the emerging field of “evidence-based” physical therapy. Physical therapists, like others in medicine, are increasingly trying to base their treatments on research showing what works and what doesn’t.

Delitto, for instance, has developed “prediction rules” for which patients with back pain will respond to which exercises.

But it’s not just back pain that sends people to physical therapists. In addition to shoulder problems like mine, people go for help with neurological diseases such as multiple sclerosis, stroke, and even dizziness, among other things.

For those with multiple sclerosis, said Palmer of Hopkins, physical therapy doesn’t change the course of the disease, but it can help them move better within their limits.

For stroke patients, there is “very good evidence that movement therapy can produce changes in the brain, or reprogramming,” Palmer said. Brain scans show physical therapy can alter the brain so that a function, like moving an arm, that would normally be controlled by the damaged area of the brain can eventually be controlled by another area.

Anne Hartnett, 61, a Watertown health educator and artist, said physical therapy was tremendously helpful for her headaches and balance problems. Almost two years ago, Hartnett had a virus that attacked her inner ear — which sends signals that help the brain perceive motion and the body’s position in space.

She went to see Janet Callahan, a physical therapist at Massachusetts General Hospital, who taught her a series of exercises in which she keeps her eyes steady on a fixed target while moving her head. Over time, Callahan said, this teaches the brain to respond better to motion and orientation signals from what is remaining of Hartnett’s inner ear function.

In the early months of therapy, Hartnett still could not stand and carry on a conversation without getting dizzy. She “lurched” around, she said, and felt that she had to explain to strangers that “I am not a drunk.”

The physical therapy, Hartnett said, is slowing giving her back her life: “It is a godsend.”

For The Facts on ‘Natural’ Remedies, Go Online

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We Americans now spend an estimated $20 billion a year on dietary supplements and so-called “natural” remedies, many of us blissfully — even willfully — ignorant of the actual medicinal value, or utter lack thereof, in of these products.

It’s not entirely our fault that we buy this stuff so blindly. In 1994, Congress limited the power of the US Food and Drug Administration to regulate supplements and herbal medicines, which now are allowed to get — and stay — on the market unless clear evidence of harm is found.

We’ve been left largely to our own devices to figure out which alternative remedies actually work, and are safe, and which are pure snake oil.

Happily, a few reasonably trustworthy websites have sprung up allowing consumers to evaluate how much credible research there is (or isn’t) for a particular supplement,  how the “natural” remedy in question interacts with other such products or with prescription drugs, and what the major side effects are.

(I put “natural” in quotes, by the way, because the term is meaningless for health products. Pills from health food stores are not intrinsically safe, gentle or non-toxic just because they are called “natural.”  And they’re much less likely than prescription drugs to even contain the ingredients listed on the labels.)

To facilitate comparisons among my favorite sites, I’ve tracked how they rate three of the top-selling products: black cohosh, often used to treat hot flashes; Echinacea, used to treat and prevent colds; and the combination of glucosamine-chondroitin, used to ease the pain of osteoarthritis. In truth, it’s hard to tell how solid the science is for these, and many other, alternative remedies, but some sites do a better job than others at pointing out the products’ shortcomings. Some information on these sites is free, but for details, you often have to pay (typically $15 to $50) per year.

For starters, I recommend the site run by the National Center for Complementary and Alternative Medicine (part of the National Institutes of Health). It is quite helpful and easy to use. To check on echinacea, for instance, go to http://nccam.nih.gov/health/echinacea. The information is succinct, noting that studies show echinacea does not appear to prevent colds or other infections, nor does it shorten the lengths of colds or flu.

For black cohosh, the site says studies are mixed for menopausal relief and notes that it has been linked with liver problems, though the site cautions that it’s not clear if black cohosh is truly to blame. As for glucosamine-chondroitin, the site includes the GAIT study results showing the remedy did not provide significant relief for osteoarthritis patients, except for a small subset of people.

Another of my favorite sites, because it is the most aggressively critical, is www.worstpills.org the creation of Public Citizen’s Health Research Group in Washington, D.C., which takes no money from government or industry and relies on membership fees and product sales. The site is very thorough and put all three of my test supplements in the “Do Not Use” category.

Worstpills.org concludes, for instance, that “there is no significant evidence that black cohosh alleviates menopausal symptoms.” Among adverse effects, it cites two cases in the medical literature of liver transplants possibly linked  to the supplement.

As for echinacea, the site concludes that there is “no convincing evidence” that it reduces the frequency or severity of the common cold.

On glucosamine-chondroitin, www.worstpills.org  includes information from the most recent and most credible study (the so-called GAIT trial, published in February, 2006 in the New England Journal of Medicine) which found a non-commercial form of the combination ineffective except for a subgroup of people with moderate-to-severe pain.

Another good site is www.herbalgram.org  (click on “herbal information”), run by the Texas-based American Botanical Council and its chief guru, Mark Blumenthal. The council gets half its funding from the supplement/herbal industry, and the other half from health professionals and researchers. Despite its industry backing, I find the site thorough, accurate and fairly independent.

On black cohosh, herbalgram.org  put out a special article in March after an Australian government agency warned the substance was linked to liver toxicity. The site goes deep on black cohosh and notes that a leading black cohosh product, Remifemin, now carries a warning label about potential liver toxicity.

On echinacea, herbalgram.org has so much material it’s tough to find a bottom line. It acknowledges the lack of efficacy for treating or preventing colds, but points out that the most recent clinical trial was done with doses that were too low to be effective, Blumenthal said. The group did not evaluate glucosamine-chondroitin because it is not an herbal product.

Consumer Reports is another good site. A few weeks ago, the group added a rating system for “natural” remedies to its website — www.consumerreports.org/mg/natural-medicine/ratings.htm. The massive amount of information in these ratings of 14,000 herbs, vitamins and nutritional supplements comes directly from a respected source used by pharmacists and physicians, the Natural Medicines Comprehensive database, which gets no industry funding and is supported only by subscriptions from physicians and pharmacists.

The Consumer Reports site provides a huge amount of detail about each product and possible interactions with other medications. Despite its vastness, it’s easy to use. It goes easy on black cohosh, calling it “possibly effective” for hot flashes, though it does note possible interactions with drugs like cisplatin, the cancer drug. A “possibly effective” rating means there is some evidence of efficacy and possibly some negative evidence.

The site is also kind to Echinacea and glucosamine-chondroitin, calling them both “possibly effective.” Echinacea, said the database editor, Dr. Phil Gregory in an e-mail, is not effective at all in preventing colds, and is only possibly effective in treating an existing cold. On glucosamine-chondroitin, he said that although the GAIT trial looked at the combination, most research uses glucosamine sulfate alone and that does appear to be effective.

One other government site rates a mention. It’s run by the FDA, and lists dietary supplements the agency has issued safety alerts for (

http://www.cfsan.fda.gov/~dms/ds-warn.html) It has issued no such alerts for black cohosh, echinacea or glucosamine-chondroitin.

 My take on all this is that there are probably some useful, safe supplements out there.

But the whole field of dietary and herbal supplements is basically faith-based medicine, so I’m glad there are some websites to check with to make sure while I think I’m doing myself some good, I’m not accidentallly doing harm.

Meditation and the Brain ….?

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For decades, open-minded Westerners – patients and doctors alike – have been touting the medical benefits of meditation, an ancient Eastern practice that comes in hundreds if not thousands of different flavors but consists basically of quieting the mind through moment-to-moment nonjudgmental awareness.

Considerable research suggests that regular meditation, or even just 10-20 minutes a day practising the “relaxation response” long promoted by Dr. Herbert Benson, president of the Mind/Body Medical Institute and associate professor of medicine at Harvard Medical School, can reverse many of the ill effects of stress.

Meditation, or the relaxation response, has been shown to lower blood pressure, heart rate and respiration; to reduce anxiety, anger, hostility and mild to moderate depression; to help alleviate insomnia, premenstrual syndrome, hot flashes and infertility; and to relieve some types of pain, most notably tension headaches.  

What nobody, until now, has even come close to explaining is how meditation may work. That is, what mechanisms within the brain might explain why changing one’s mental focus can have such large effects on mood and metabolism. Nor has there been until now, much collaboration between experts in meditation such as Buddhist monks and neuroscientists.

All that is changing – fast.

A new study, accepted for publication soon in Psychosomatic Medicine, is a significant first step in understanding what goes on in the brain during meditation. The study was led by Richard Davidson, director of the laboratory for affective neuroscience at the University of Wisconsin, and Jon Kabat-Zinn, founding director of the Stress Reduction Clinic and Center for Mindfulness at the University of Massachusetts Medical School.

The underlying theory is that in people who are stressed, anxious or depressed, the right frontal cortex of the brain is overactive and the left frontal cortex, underactive. Such people also show heightened activation of the amygdala, a key center for processing fear.

By contrast, people who are habitually calm and happy typically show greater activity in the left frontal cortex relative to the right. These lucky folks pump out less of the stress hormone cortisol, recover faster from negative events and have higher levels of natural killer cells, a measure of immune system function.

Each person has a natural “set point,” a baseline frontal cortex activity level that is characteristically tipped left or right and around which daily fluctuations of mood swirl. What meditation may do is nudge this balance in the favorable direction.

To find out, they recruited stressed-out volunteers from the Promega Corp, a high tech firm in Madison, Wisc. At the outset, all volunteers were tested with EEGs (electro-encephalographs), in which electrodes were placed on the scalp to collect brain wave information. The volunteers were then randomized into one of two groups – 25 in the meditation group and 16 into the control group.

The meditators took an 8-week course developed by Kabat-Zinn. At the end of 8 weeks, both meditators and controls were again given EEG tests and a flu shot. They also got blood tests to check for antibody response to the flu shots. Four months later, all got EEG tests again.

By the end of the study, the meditators’ brains showed a pronounced shift toward the left frontal lobe, while the nonmeditators’ brains did not, suggesting that meditation may have shifted the “set point” to the left. (The nonmeditators actually got slightly worse, perhaps because they were cranky from making several trips to the lab without the payoff of learning to meditate.) The meditators also had more robust responses to the flu shots. Indeed, the bigger the mood effect, the bigger the immune response.

The Wisconsin study fits with a smaller study published in May, 2000 by Sara Lazar, a neurobiologist at Massachusetts General Hospital, Benson and others that looked at 5 Sikh meditators using a brain scanning technique called functional MRI. It found a shift in blood flow in the brain during meditation.

The new meditation work also fits with data suggesting that certain drugs produce meditation-like effects on the brain, says Dr. Solomon Snyder, director of the department of neuroscience at  Johns Hopkins Medical School. Synder. “It’s reasonable to assume,”: he says, that meditation may increase serotonin, a calming neurotransmitter, in the brain.

No one has been more fascinated by this kind of  research than the Dalai Lama himself,  the leader (in exile) of Tibetan Buddhism.

The Dalai Lama spent 5 days in March, 2000 meeting with other Buddhis monks, philosophers and Western neuroscientists at a retreat in Daramsala, India that is chronicled in a new book called “Destructive Emotions” by Daniel Goleman, author of  “Emotional Intelligence.”

In addition to lots of esoteric debate, the conference had a practice outcome. One participant, Paul Ekman, professor of psychology at the University of California, San Francisco, School of Medicine, went on to study several monks in his California lab.

Ekman had previously developed a way to measure the facial expression of emotions and found that most people don’t do well when asked to decipher rapid changes in facial expression. But the monks were near-perfect decoders of facial expression. And one meditator, a 60-year old French intellectual who has been a monk for nearly 30 years

Appeared able to suppress the startle reflex while meditating – a stunning display of control over a basic, biological response.

None of this, of course, means that meditation is a cure-all.  As Barrie Cassileth, chief of the integrative medical service at Memorial Sloan-Kettering Cancer Center in New York, puts it, meditation is a wonderful tool “but it’s not going to let you fly to Europe on your own without a plane.”

But it is, as Ekman says cautiously, “an exercise for the brain that could be of some benefit.”

So, what does it all mean? Obviously, a few studies on several dozen amateur meditators and a handful of pros is not the final answer on how meditation acts on the brain to produce changes in mood and basic, biological functions.

Though it’s “a wonderful tool,” no one should expect meditation to work miracles, cautions psychologist-medical sociologist Barrie Cassileth, chief of the integrative medicine service at Memorial Sloan-Kettering Cancer Center in New York. It  “cannot bring about levitation. It cannot control cellular activity in the sense of getting rid of disease. …It’s not going to let you fly to Europe on your own without a plane.” 

But what these very preliminary studies do suggest is that, at long last, the subtleties of mind long known subjectively to proficient meditators may prove capable of being understood objectively as well.