Sunday, August 23, 2009

An Interesting Case Study: Phantom Limb Pain

A few months ago I read an interesting article, Brain Games, in The New Yorker magazine. A few weeks ago, I saw the author, neuroscientist, VS Ramachandran, give a lecture, On Your Mind, on the fabulous website In both, a featured topic was phantom limb pain.

Phantom limb pain is the sensation of pain emanating from a missing limb that has been either lost in an accident or surgically amputated.
Specifically, Dr. Ramachandran was elaborating on the case of a man (James) whose amputated right forearm felt as if it was tightly and painfully knotted into a clenched fist.
Dr. Ramachandran had the man place his left arm into a mirror box, “visually resurrecting the phantom limb.” Even though James consciously knew it was his left arm in the mirror box, the image in the brain, seeing it as his right arm/hand, was very compelling and convincing. By unclenching the existing left fist in the mirror box, visually it appeared to the brain as though the right fist was unclenching. Using this “visual feedback to trick the brain,” upon unclenching his right fist, James’ pain immediately went away.
At the same time that I saw this, I had a 70 year old female patient enter my office complaining of low back pain. She also reported a 6 year history of ‘hemi-facial spasms.’ Her left eye appeared as though it was constantly, tightly winking. Over the years she had tried multiple medical approaches, including medications and even Botox injections, with no relief.
I excitedly told her about Dr. Ramachandran, James and the mirror box. I suggested that if the mirror could work for a phantom limb, it seemed very likely that it would work for her eye as well. I suggested that she go home and stand in front of a mirror, with her left eye out of the visual field, her good right eye in front of the mirror. Therefore, her brain would see the normal relaxed left eye looking back at her; again, using visual feedback to trick the brain.
She came in a few days later and reported: “as soon as I stood in front of the mirror, I felt my left eye relax.”
While she is by no means ‘cured,’ she now has a useful tool to use to relax her left eye. Now it is a matter of practice, like learning how to ride a bike or play violin, retraining neural networks to a normal relaxed left eye, to overcome 6 years of winking.
This is all small piece of a larger picture: reality, even the reality of your body, your body image, is constructed in your mind.
Note: Dr Ramachandran has a wonderful series on YouTube, Phantoms in the Brain. 3 min/ 13 seconds into Episode 1, Part 2 you can see James and the mirror box.

Sunday, August 9, 2009

Follow the Money

Things are getting seriously ugly as the health care reform debate moves forward. That’s because we have a President who is determined to actually DO something. What it is that he actually CAN do, remains to be seen.

Conservative and GOP-backed think-tanks along with the medical-pharmaceutical-insurance industrial complex’s media, advertising arms and hired guns/lobbyists have ratcheted up their spare-no-expense, no-holds barred, all-out-to-win, fear-mongering campaigns of misinformation and outright lies. Not to mention their wholesale buying of votes, as campaign contributions, from senators and congressmen.

In short, they have nothing positive to offer because they don’t see any problem. According to them, there is no health care crisis. Our health care and insurance systems are fine as they are. Any attempt at reform is a slippery slope to socialism (which, of course, leads to communism), that will lead to the rationing of care (as if we don’t already have it), the end of medical innovation, euthanasia of our elderly (I couldn’t make this up) and, God forbid (or, GOP forbid), higher taxes!

None of this is surprising or new. But sadly, these tactics work.

Fear is a great motivator. Throughout history, governments have used it and, more recently, multi-conglomerate global corporations use fear and lies to motivate the masses to act contrary to their own best interests. We just don’t want to believe that United States’ politicians or agencies (FDA, EPA, etc), or American corporations would knowingly do anything to hurt us.

They wouldn’t, right?

This is a betrayal of the public trust of the highest order, for profit over the public good. And, for that matter, profit over the viability of life on the planet.

We, the People, have the power to direct the national health care debate to achieve the outcome that benefits us most. First, we must learn and understand the facts of the issues and then get involved and take action.

We will be the victims of whatever level of ignorance, apathy and inaction we accept.

As the Nobel Laureate, Economist Paul Krugman, writes:

It’s not just that many Americans don’t understand what President Obama is proposing; many people don’t understand the way American health care works right now. They don’t understand, in particular, that getting the government involved in health care wouldn’t be a radical step: the government is already deeply involved (Medicare, Medicaid and the VA/Veteran's Administration), even in private insurance.

And that government involvement is the only reason our system works at all… the bottom line: if you currently have decent health insurance, thank the government

Indeed, surveys consistently show more patient satisfaction in the government run, single payer, systems of Medicare and the VA than with private sector or employer provided insurance.

And, don’t you find it more than ironic and cynical that the most outspoken critics against the public option for health care are Senators and Congressmen with government sponsored health care? Follow the money!

The role of government is to protect the basic rights of its' citizens from the government itself, and from businesses, corporate and other special interests.

In the case of the health care debate the case for the citizens is clear: access to affordable, ethical health care. Secretly negotiating and brokering deals with the medical, insurance and industrial special interests is clearly more about protecting their incomes than it is about protecting the welfare of Americans.

The 'single payer' sytems of Medicare and the VA, in particular, are excellent examples of government's success in protecting and providing for the basic right of health care to the elderly, the disabled and our veterans.

Perhaps, the area in which the government has proven the most incompetent and dysfunctional is in the Congress itself. That is where reform is needed most; campaign finance reform must happen to reclaim our political system and restore the government to the people.

Wednesday, August 5, 2009