“Neither genius, fame, nor love show the greatness of the soul. Only kindness can do that.”
-Jean Baptiste Henri Lacordaire, preacher, journalist and activist (1802-1861)
I was trained to be a competent doctor. By the time we left medical school (26 years ago…), we could save lives, diagnose most diseases, prescribe for the most common of these, and complete basic surgery. A year of internship later (working an average of 100 hours a week), we could do still more.
When looking for a doctor, most of us patients focus on credentials. You look at the doctor’s “power wall” to see how many certificates are hanging there. You ask friends for recommendations. You want the best.
But a pleasant bedside manner? That’s well and good for the elderly, but how does it help ME to get better?
Most of us would rather have a clever doctor. We want competence first and foremost.
Researchers at Stanford University show that this view is wrong.
The goal of entering the healthcare system is to get healthy, right?
It turns out that kind doctors are better at reaching this goal.
Social psychologists Lauren Howe and Kari Leibowitz studied the effects of doctors’ bedside manner on patients. The studies were small in sample size, but the results are surprising nonetheless.
76 subjects took part in an allergy study. A doctor administered skin-prick allergy tests to these subjects, using histamine (a substance that causes allergic reactions in all people).
After this, the doctor examined the subjects’ arms. With some, he didn’t say much. With others, he said, “From this point forward, your allergic reaction will start to diminish. Your rash and irritation will go away.”
Nobody was given any medicine to relieve itchiness or irritation. But the ones who got the reassuring words reported less itchiness than the ones who hadn’t.
For the next study, the psychologists wanted to see if a doctor’s personal warmth made a difference.
Again, subjects were given a histamine skin prick. But this time they were split into three groups that saw three different doctors.
One doctor was kind and friendly. She smiled and addressed patients by name. She chatted with them and made eye contact.
The second doctor was cold. She stared at her computer screen. She didn’t introduce herself. She spoke to the subjects only to ask them for practical information.
A third doctor acted competent but was not warm.
All three doctors gave patients a cream saying it would help with the allergic reaction, the irritation, and itching. The cream was actually a placebo (unscented hand lotion). There was nothing active in it.
It turns out ONLY the group with the friendly and professional doctor had reduced allergy symptoms.
“Doctors who are warmer and more competent are able to set more powerful expectations about medical treatments,” said the research team. “Those positive expectations, in turn, have a measurable impact on health.”
The bottom line?
Good medical care requires more than just cold, hard facts. It requires caring. This is probably what Hippocrates called “the art of healing”. Science alone is not enough.
Find a doctor who treats you like a human being, not just a problem to be solved. You will get better faster.
As the Stanford researchers noted, doctor-patient rapport isn’t just a “feel-good bonus that boosts Yelp reviews.” It’s “a component of medical care that has important effects on a patient’s physical health.”
Note: This is not hocus-pocus stuff. The medical environment is a stressful one for patients, even at the best of times (and there aren’t many good times in a hospital). Stress leads to higher cortisol levels. Cortisol is the master brain behind everything that goes wrong in your body. It weakens the immune response, shuts down parts of the brain and pushes up blood glucose. All useful if you are running from a lion, but not good in the day-to-day setting. Reassurance and encouragement lower stress, thus lowering cortisol and increasing the rate at which the body heals itself.
|This has nothing to do with health. It is simply a reflection on the devastating forest fires here in the Garden Route. So, if you’re pressed for time, please delete this email. I’m sending my marketing email tomorrow (fingers crossed), with the month’s specials, etc in it.|
The past twelve days, all of us living in the Garden Route were affected by the forest fires raging out of control on our beloved mountains. At this time of writing, an area about one third as big as Cape Town has been devastated and fires are still burning in a dozen areas. Monday, a week ago, the smoke over our house was thick and heavy. Ash drifted down like snow, blanketing everything in a thin layer of grey-white soot.
In a crisis, communication systems break down – no landline, cell phones or wireless. No one knows how close the fire is. So, for the second time in as many years, we packed a bag and got ready to evacuate. In the end, the wind turned and nothing bad happened. The fire wasn’t even close. And so, like last year, we left our bag standing for a few days before unpacking it. Not because we were expecting the fire to return, but because unpacking this bag is an embarrassing and humiliating affair.
Let’s see what went into the bag…
Clothing. Of course. Who wants to wear stinky old clothing when everybody’s nose is blocked by smoke? You have to look presentable while sleeping on the floor of some church hall. We mostly wear clothing to hide and to fake. Hiding our shame, or hiding from weather or faking our true identity. Without clothing, we are vulnerable. So we pack clothes. What is confidence?
Medicines, toothbrushes and tooth paste. Who wants to get toothache while on evacuation? Not me. And if my medication runs out while I’m far away from a pharmacy, who will care for me? What is health?
ID, passports, birth certificates: Unpacking these, you realise that flimsy papers do not hold your identity. How strange that we become faceless when we lose these papers. Two hundred years ago, everyone in the village knew who you were. Today, even parents don’t recognise their teens. We need papers to prove that we are who we claim to be. What is identity?
Cell phone, lap top, data drives: You cannot go anywhere nowadays without telling people about it. I need my tech to earn income. But when the networks are down or overloaded, not even Mom knows where I am. Everyone phoning everyone to find out if everyone is safe. What is safety?
Money and credit cards: More flimsy paper. What separates me from a beggar, a homeless man or a tramp are a few sheets of paper. When I lie on the hard floor amid the unwashed masses, I will feel these papers in my purse and they will remind me that I’m not really homeless. That I’m able to buy my way out of this mess. Just give me some time. What is ambition?
Charger: What do you call a cellphone without a charger? A brick. Our devices need power. So you pack your charger to keep your devices powered. You forget that the city hall only has one socket, right in front, below the stage. Oh, and a hundred other people have the same idea as you. Even if someone brought a lead, the load will trip the circuit. That is, if folks remembered to pack adaptors, too. In the end, we’re all power-less in the midst of our personal, individualised crises, as the attention shifts from losing our shome to losing our connections. What is power?
Blanket: A night on a wooden floor can get really cold. One blanket has to cover a number of bodies . That means, pulling and shoving while all sorts of interesting bits get the chill. What is friendship?
Toilet paper: Toilets are at a premium during evacuations. Toilet paper is the new white gold. You either have it, or you are reduced to a smelly, second-class citizen. What is social status?
I finish unpacking the bag. My life just flashed before me. It was embarrassingly empty of substance. The things I valued so highly – the only items selected to survive my house burning down – are pitiful and meagre. Who am I? Really? Honestly?
I pack the suitcase back into the cupboard. If the fires return next year, I will walk out as I am. The clutter of things I call “important” is the real fire burning me up. I’ve allowed smoke and mirrors to rule my life.
“Naked I came from my mother’s womb, and naked I shall leave this life.”
When I was a medical student, “going viral” was something really bad. If a patient “went viral”, you’d feed them pancakes (because that was the only thing you could slide underneath the door). You didn’t open the door until you sent in the SWAT team in plastic coveralls.
It was that bad.
Nowadays,, “going viral” is regarded as something good. As in “the video clip went viral.” The SA restaurant rage videos currently doing the rounds are one such example of “going viral”. Although they are probably as bad for our minds as the old “going viral” was for our bodies. I truly hope they don’t spur on any further instances of restaurant rage.
As everyone is pointing fingers and moralising about what is happening in the clips, I’d like to step back and look at rage from a biological angle. Few people realise that rage is largely the result of two molecules in a kind of see-saw balance:
Glucose and insulin
If glucose goes up (courtesy of what we eat), insulin follows some time later (courtesy of the pancreas). This nudges glucose out of the blood into the cells. Glucose then drops again. Some time later, insulin drops in response to the lower glucose levels.
Fair enough. But how are food and mood linked?
The brain runs mainly on glucose. If blood glucose drops too fast, or too much, the brain gets anxious. A low blood glucose level is a threat to survival. Therefore, all the “fight or flight” responses are activated by low blood glucoe. Anything that gets in the way is pushed out of the way. No explanations. No niceties.
“Hand over that chocolate cake and no one will get hurt.”
If one person behaves rudely, all those around also start behaving rudely in defence. It’s a kind of chain reaction. Not long afterward and it looks like a fight scene from Asterix.
When does blood glucose drop very fast or too much? I’m glad you asked.
From my description above, you may have noticed that there is a lag in insulin response, both when glucose rises, as well as when it drops. It is that lag which causes the problem in a modern society eating modern foods.
But before we get there, a little fact that will change the way you understand sugar.
If I took ALL the glucose from the blood of an adult and purified it, how much glucose would I get? The answer is … one level teaspoon. About 5 g. That’s it. All the fuss about glucose levels fits into one teaspoon.
So… If I add a teaspoon of sugar to my tea or coffee, I basically double my blood sugar in a matter of minutes. This is not good news for the body’s balance.
In the olden days, when food technology was mostly limited to a wood fire, sugars came with plenty of fibre attached. True, you could suck out nectar from flowers, but you’d have to do this for an hour before getting to a teaspoon of sugar. And your fellow cave dwellers would probably give you some strange stares. Honey? Yes, but at a price that stings.
The pancreas liked that mellow life. Up the insulin a little, drop it a little. The range of blood glucose levels was pretty stable most of the time. On the low side (compared to our modern ‘normal’ levels), but stable. And the brain was happy.
Fast forward 150 years. Or a bit more.
Nowadays, it is possible to ingest 8 teaspoons of sugar in less than 10 minutes. By eating a medium sized pizza, nogal. Or by drinking one of the many carbonated drinks on store shelves. Without fibre, the sugar superdose is absorbed in minutes to supercharge the brain. It feels good. You feel like the Top Primate all over again.
It’s a bit like taking our cave dwelling ancestor for a spin in a Ferrari. You’re gonna need some serious soap to clean his seat afterwards.
The pancreas, likewise, is in a flat spin. It does not have the reserves to cope with such a load. It starts up the factory and pushes out all the insulin it can. The smell of burning pancreatic rubber goes mostly unnoticed as we bask in the happiness of a brain stuffed full of glucose. We’re on the nutritional highway to glory. Who cares what is happening below the hood?
But while the glucose rabbit falls asleep at the wheel, the insulin tortoise crawls past secretly. It takes about two hours, give or take a nose hair. At this point, the glucose rabbit gets pipped at the post and has to retreat into the cells. Order is restored. But that pancreatic factory isn’t so easy to stop. It just keeps running at full tilt for some time to come.
What happens next is nicely depicted in Greek mythology. The newly-freed Icarus flies too close to the sun, his waxen wings melt and he plummets to the ground. In our case, insulin does the melting. After that glucose overshoot, there’s an insulin overshoot, followed by a rapid glucose-drop that will make your head spin.
It is at that tipping point when even a tiny irritation can set off a firestorm. Road rage incidents often happen around meal times, when glucose levels are low. Drunkards get abusive when all the sugar has left the building but the alcohol keeps on shouting. But the true triggers happened some hours previously, when too much sugar started the ticking time bomb.
For decades, we’ve been conditioned that sugar gives “energy”. It’s an easy sell. Our cells burn sugar for energy, sugar makes us feel good, so why not boost sugar levels whenever we need a lift? Athletes swear by sugar. Students swear by
beer caffeine sugar. So it must be good, right? Wrong!
Moral of the story? Avoid refined sugar like the plague it is. That way, you are much less likely to end up “going viral”.
To your health!
You might have noticed that St Valentine’s Day is approaching. My wife and I don’t really “do the Valentine’s Day thing”. After Christmas, two wedding anniversaries (yes, we got married twice – double the fun, double the trouble) and one engagement anniversary early in the year, we’re kind of “uitgekuier” (worn out?) by the middle of February. At least, by that time, my wallet is thin enough to slide underneath the door without getting stuck.
Anyhow, I’d like to talk about the bugs of love. No, not the kind that hitch an unwelcome ride from partner to partner, although you’ll soon see that they are mere copycats of the true masters.
Where this is going: Over many years, I’ve come to understand that we humans judge other humans’ character chiefly by their fragrance. Visual appearance? Not even half as important. Clear judgement? Way, way down. Even stranger, when we make a “smell judgement”, we are not even aware of it (although, when you DO notice it, it normally evokes a very strong emotional response – either of revulsion or attraction).
You see, we all carry a smell. It becomes “our smell” within minutes of birth, and is as unique as our fingerprints (even if it is far less stable than a fingerprint). And yes, we have microbes to thank for this. Here’s a womb-to-womb view of how microbes and their smells influence our love lives.
Note: I may be accused of reducing love to “mere microbes”. Nothing could be further from the truth. I’m just showing how biology meets body, soul, spirit and society in ways we never imagined. I’m also not judging anyone’s microbial choices, but simply highlighting how things were meant to operate and how our best intentions can thwart that.
Like the inside of an egg, the pregnant womb is one of the few 100% sterile places on earth. Even a single microbe can cause havoc here. Sterility is essential for the unborn child, yet it is vital for baby’s survival to get colonised by microbes immediately after birth. And this is exactly how mammal bodies were designed.
While passing through the well-colonised birth canal, plenty of the most important microbes enter Baby’s mouth and nasal passages. At that point, Baby’s stomach is not yet producing acid and the microbes pass unhindered into the protein-filled guts. Bingo! At the same time, the shape of the pelvis is such that Baby’s head pushes out a small helping of … er … let’s call it “number two” (or what midwives euphemistically call “the first twin”). This coats Baby’s protein-covered head and skin with more important microbes. Presto!
But the bugs don’t stop here. The area around the breast nipple is wrinkled and dark. Why? It acts as a “mircorbe rain forest”, a treasure trove of microbes. Every time Baby sucks, it gets along a mouthful of microbes. Coincidentally (?), milk is alkaline, which neutralises the stomach acid and these microbes also pass alive through the dangerous stomach into the gut. Happiness!
A small step for a microbe, a giant leap for the microbiome.
In terms of microbes, the five minutes after birth are about as important as the next month.
And the first month is about as important as the first year.
And the first year is about as important as the next twenty years.
I made those figures up, but I hope you get the picture. I base those figures on years of clinical assessment and studying published research. They’re not just figments of my colonised imagination.
Every type of microbe breaks down its food in a different way. Many of these food fragments produce smells, and every food fragment produces a different smell. We are colonised by millions, of microbe subtypes, producing a huge variety of smells. The complex combination of all these smells becomes “your fragrance”. And all this happens within 5 minutes after birth.
Socially speaking, we differentiate between three kinds of fragrances (let’s call it the “social fragrance spectrum”):
* Smell of identity / peace
* Smell of attraction / curiosity
* Smell of opposition / fear
These are not hard categories, but fall along a spectrum. Each person experiences this spectrum differently, but we all have something like this Social Fragrance Spectrum inside of us. The bigger the overlap between an approaching stranger’s fragrance and ours, the more emotionally attracted we feel to that person. The less the overlap, the less the attraction and the greater the fear. Men and women differ markedly in this respect – most men need a greater fragrance overlap than women to feel a sense (“scents”?) of identity. At the same time, most men will still be in the sphere of attraction at a point when most women are already in the sphere of opposition.
In other words, when man and woman first meet, the man is much more likely to feel curious, while the woman is much more likely to feel fear. And you thought those were butterflies in your stomach?
Thus, when we’re talking romance, we’re hovering somewhere between Curiosity and Fear. At that point, we (hopefully) start using our other faculties to overcome (or otherwise) barriers to the approaching “mingling of microbes”.
If the mingling is successful, a neo-colonisation occurs as each partner’s microbes migrate to the other partner. This process needs to be repeated regularly (Yippee!), since either of the two “host” microbes doesn’t like invaders. It often takes years of a stable relationship before a “fragrance of identity” develops. Fortunately, the darkened, wrinkly (sometimes hairy) bits of skin in key contact areas act as “microbe rain forests” where invading microbes hide away. Eventually, the hosts and the invaders find a new truce, a kind of “two state solution” and a new Fragrance of Identity is established.
“And the two shall become one microbiome” (to paraphrase the Good Book)
You may remember how, as a child, you walked into your best friend’s parents’ house and it had a unique smell? And then, years later, you walked into your best friend’s apartment, now no longer living with his / her parents, and you got the same smell? That’s the power of microbes. That’s the Fragrance of Identity, passing on from one generation to the next.
After this cradle-to-cuddle look at microbes, let’s look at some of the ways in which we mess up (bug-ger up?) all of this.
First of all, in this post-Semmelweis era, healthcare professionals sterilise the birth canal and its neighbour directly before birth, to avoid “contamination” of the newborn. They conveniently forget that Semmelweis only advocated the washing of doctor’s contaminated hands. Over-eager sanitation weakens or destroys the inter-generational passage of microbes.
When Baby is born via Caesarean section (C/S for short), it is born in a completely sterile environment. By the time the first microbes enter, the stomach is already producing acid and colonisation of the gut has become incredibly difficult. By the time microbes manage to cross the stomach, the nutrient-dense meconium may have left the building, making it even harder for them to survive. Only a few colonies get established. Lack of microbe diversity leads to all sorts of health problems. A more diverse established microbiome leads to the best health and wellness outcomes.
By delivering sterile babies, we dramatically increase their chances of
* psychiatric illness,
* irritable bowel syndrome or ulcerative colitis
* heart attack
* and even cancer.
Yes, all of those diseases are linked to low microbe diversity. It’s that serious.
In the absence of breastfeeding, Baby also misses out on repeated paternal microbe re-culturing. Yes, dads, there’s a good reason why you must kiss mom regularly. And hug her often (preferably minus clothing). And another good reason why brea stfeeding is needed for at least a year.
Overall, dads contribute a lot less to the inter-generational microbe leap than moms do. Which helps explain why siblings from the same mother (but not the same father) will usually feel closer to each other than siblings from the same father (but not the same mother).
You may have noted how mammals lick their babies after birth. They don’t do it to look cute on Facebook, or to bath their offspring (animals don’t normally take baths). They do it to spread saliva and microbes all over the coat, thus passing on the Fragrance of Identity while preventing other microbes from taking over. Humans tend to bath newborns – with perfumed soap and shampoo – thus wreaking havoc on the newly establishing skin microbiome. Newborns are coated with a layer of nutrient-dense protein – perfect starter food for the new microbes. Remove that, and Baby’s chances of a life with skin allergies jumps significantly.
To top it all, society gently pressurises moms to put their children into the care of a crèche in order to return to “work”. At that level, Baby has more microbial exchange with other babies than with its own parents. The inter-generational Fragrance of Identity is weakened even further.
While I have not found any research in this area, it is very likely that all this lack of a coherent “Family Fragrance” leads to serious distrust between the generations. We’ve come up with social tricks to counter this – doing fun things together, e.g. – but this alone does not remove the underlying, deep-seated suspicion that arises when a “Fragrance of Opposition” exists within the modern household.
The modern child often feels more in common with those who use the same brand of soap and shampoo than with its own parents. “Kids of a lather like to gather.”
Once we get old enough to date, we add all sorts of smells to our natural smell. Like mosquito repellent, this confuses the potential partner (bloodsucker?), creating a loophole in his / her defences. It also helps explain why people drinking large amounts of the same matured beverage feel attracted to one another as the night wears on. The smell of alcohol in the breath overwhelms all others, leading to a feeling of attraction, even identity. It does not help that higher brain functions are impaired, either. By the next morning, the Fragrance of Opposition is, however, back in full force. As are (some of) the higher brain functions.
I sincerely hope I haven’t ruined St Valentine’s Day for you… Maybe try and make it more ‘natural’ and less contrived. Fewer added smells and more real life. Not so sensual, but more scent-ual.
And, ah yes, the fragrance of a bunch of roses is 100% natural.
To your love bugs!