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Taking Charge of Your Health


Hello. What a wonderful turnout. I’d like to welcome you
to the third Longwood Seminar of 2018, Bridging
East and West, New Frontiers in Medicine. I’m Gina Vild. I’m the Associate Dean for
Communications and External Relations for Harvard
Medical School. And in addition to welcoming
those of you who are here in the auditorium
with us tonight, I’d like to welcome
our livestream viewers. As you know if you’ve
attended seminars, we invite viewers from
around the world to join us. And our first two
seminars of 2018 were viewed by 46,000
people around the world, including countries Brazil,
Japan, Turkey, Australia, South Korea, Morocco, and
Ireland, just to name a few. And we will be taking questions
from our livestream viewers, as well as questions
from our audience. If you happen to miss these– have missed these
first two seminars, we invite you to go to the
Harvard Medical School website and look up the
Longwood Seminars. And there, you will find
this year’s seminars and many seminars
from past years. And many of the
topics are evergreen. So I think you’ll
really enjoy it. I invite you also to join us
for our final seminar of 2018. It’s on May 9, Weighing
the Facts of Obesity. So by dint of the fact that
you’re here with us tonight, we know you have an interest
in the varied approaches to medicine in healing. So I invite you to access even
more of our Harvard Medical School resources by visiting
www.health.harvard.edu, that’s www.health.harvard.edu,
where you will find a wealth of interesting
health information on a host of topics,
ranging from pain relief to stretching to tai chi. In fact, on this site, you’ll
find a special health report edited by Dr. Peter Wayne, who
is one of tonight’s speakers. So as we always do a few brief
announcements, on the screen, you will see information
on receiving certificates of completion for those who
have attended three or more of the year seminars. And also if you’re a teacher
and have attended all four, you will receive professional
development points. Our speakers will be
taking your questions at the end of
their presentation. So we invite you
to jot them down on the index cards you were
given when you registered. And our members of our team
will be walking up and down the aisle. You can pass your
questions to them. And if you are watching
through the livestream, we ask you to please
write your question into the Comment section of our
Facebook page or our YouTube page. And we will get to as many
of the questions as possible. We also invite you to join
our Twitter conversation using #hmsminimed, #hmsminimed. Now, for this evening’s
program, Bridging East and West, New
Frontiers in Medicine, there’s a burgeoning
interest in Eastern medicine. You are not alone. In fact, a search on Amazon– I did this today– reveals
30,000 search results on complementary medicine
and 100,000 search results on alternative medicine. According to recent studies
from the National Institutes of Health– and I’ve seen
varied statistics– but most would agree
that at least a third of American adults are opting
for health care methods that are outside of what we consider
Western or conventional medicine. But what do we really know
about the effectiveness of these therapies used
either alone or in conjunction with Western medicine? Can Eastern medicine influence
our treatment outcomes? Can natural products, such as
herbs or techniques, including acupuncture and tai
chi, work together with medications to help us
manage pain or other chronic conditions? And can we use insights
from all that we know from all healing traditions
to better treat our ailments? These questions will
be addressed tonight by some of Harvard Medical
School’s leading researchers. And we’re really delighted
to have them with us. So I’m pleased to welcome
our panel of experts, who are looking
forward to sharing their knowledge about health
and wellness with all of you. Dr. Timothy Mitchison is
the Hasib Sabbagh Professor of Systems Biology at
Harvard Medical School. Dr. Peter Wayne is an
Associate Professor of Medicine at Harvard
Medical School and Research Director of the Osher Center
for Integrative Medicine and Founder and Director of the
Tree of Life Tai Chi Center. And one of his special reports
was on the table in the lobby. Our moderator, Helene Langevin
is the Bernard Osher Professor in Residence of Complementary
and Integrative Medical Therapies at Harvard
Medical School and the Director
of the Osher Center for Integrative Medicine
for Harvard Medical School and Brigham
and Women’s Hospital. Please join me in welcoming
our special guests tonight. Thank you. [APPLAUSE] Good evening. Is my microphone on? Yes. Thank you so much, Gina. This is really such a
pleasure to be here. And we’re going to be
talking about some very sort of interesting topics. At the Osher Center, we fall
under the umbrella of what we call integrative medicine. Is this going to advance? No? I need the slides, please. Have a little bit
of an issue here. So when we think about
integrative medicine, we– thank you– we usually
think about bringing conventional medicine and what
we call alternative medicine together. And alternative
medicine, we usually think about as these are
the types of treatments that don’t usually get
taught in medical school, although that’s
starting to change. There’s more and
more integration of these different other
types of traditional healing practices in medical schools. But we think that
it actually goes beyond that, in that
integrative medicine is really at arriving at a deeper
understanding of the human body that underlies both
complementary and conventional medicine. So we also pay a
lot of attention to not only understanding
the treatments, but understanding the
underlying pathology and even the normal
physiology that without a real understanding
of how the body works it’s difficult to do research
on how a treatment might work. And what we believe is that
traditional healing practices, such as traditional
Chinese medicine and other oriental
healing practices, can really inform
our understanding– a fundamental
understanding of the body and that can help us derive new
and more effective treatments. So the three talks
today, the first one I’m going to be talking
about acupuncture and how the insights
derived from acupuncture can help us understanding
a very sort of– a part of the body that we don’t
usually pay much attention to, which is the connective tissue. After that, Dr. Tim
Mitchison is going to be talking
about how the study of traditional Chinese
herbs can be used as a way to deepen our understanding
of pharmacology. And finally, Dr.
Peter Wayne is going to be talking about how
the study of Tai Chi can inform our understanding
of the connections between the mind and the body. So talking about
acupuncture, I’ve entitled my talk Reconnecting
the Body, Insights from Acupuncture, because
in conventional medicine, one of the things that I think– one of the strengths,
as well as one of the weaknesses of our
conventional medicine is that the body is
sort of broken down into different segments. For example, we
think of the body as different
physiological systems. And this dates back
to the very beginning of what we think of modern
medicine in the 19th century. There was the cardiovascular
system, the respiratory system, the digestive system. And this separation of the body
into these different systems has carried over into
our medical specialties– cardiology,
pulmonary, et cetera– but also into our
academic departments. We do research very much
one system at a time. But this is something that
patients complain about. A lot of times you go to the
doctor and people complain, it’s like I’m
treated like I’m just a bunch of disconnected
body parts. Now, traditional
Chinese medicine takes a different
view of the body. It thinks of the body as
an interconnected whole. And an example of how the
traditional Chinese medicine thinks that way is that
there is a set of– oops, I’m sorry,
this is the one– of meridians that they call. These are sort of– there are these sort
of longitudinal lines that sort of go around
the body and up and down and connect everything
with everything else. That’s how acupuncture
practitioners think of these meridians. Now earlier on when I used to
be at the University of Vermont, we did a study where we looked
at these acupuncture meridians using ultrasound. And what we found is that
acupuncture meridians, when you look at the body using
ultrasound– so here’s an example here. When we do
ultrasound, you first, you see the surface of the skin. Then you see the
subcutaneous tissue here. And then we see here muscles. And this white stuff is
the connective tissue that separates the muscles. And what we noticed is that a
lot of the acupuncture points were located in-between
muscles, where you can see planes of connective tissue. And when you look at a series
of different cadaver slices and you map these
acupuncture points, you can see that
over 80% of them is located in-between
two muscles. So this made us
wonder whether there might be a connection
between acupuncture meridians and connective tissue. It turns out that a
serendipitous observation was that when you insert
an acupuncture needle, you don’t just
insert it, you also rotate it and manipulate it. And what acupuncturists
feel is that there is a kind of a sensation
that the acupuncture feels like the tissues are
grabbing the needle. And there was no
physiological explanation for that when I went to
acupuncture school many, many years ago. And the common belief
was that this was due to a muscle contracting. But when we did a little bit
of experiments in the lab, we found that, in
fact, this grabbing is due to connective
tissue, collagen fibers underneath the skin
in the subcutaneous tissue that wind around the needle,
a little bit like spaghetti around a fork, and tighten. And that’s what
causes this sensation. One of the earliest
experiments that we did is we designed a robotic
machine, like this, that actually inserted the
acupuncture needle mechanically, rotated
the needle, either all in one direction– what we
called unidirectional– or back and forth, bidirectional,
or no rotation. And we measured how much force
it took to pull the needle out, because we figured this
might be an interesting way to quantify this phenomenon that
you can feel with your hands. And what we found is, indeed,
as you rotate the needle, you get more– it takes more force
to put the needle. So in fact, this
corroborated the fact that there is a change in the
interaction between the needle and the tissue. The other thing we did is we
compared acupuncture points compared with
non-acupuncture points and found that there
was a difference. It was statistically
significant, even though it was only
a small difference, 20%. But on average, you had
more of this pulling force at acupuncture points. So we also looked
using ultrasound directly down at– this is
a high frequency ultrasound. Now, we’re looking
down on the tissue. And here is the
needle in the center. And you can see that when
the needle is rotated, the tissue winds around
the needle like a whirl. Now, this is
interesting, because we started wondering,
well, what happens to the tissues in
response to this? And very recently in the news– I don’t know if– some of you,
probably some of you have heard of this
new organ paper that made the sensation
about three weeks ago or so in the news. Well, they were claiming that
they said– it turned out it was not a new organ
that they discovered, but they did make an
interesting new observation about what they called
the interstitium, which is the tissue right
underneath the skin. And what they found
using a special camera is that this interstitium
is structured very much like a sponge, where there’s
these kind of little honeycomb structure filled with fluid. And every time you
move or you twist or you turn, say
your wrist, this distributes the fluid
underneath the skin. Well, guess what? The same thing happens
during acupuncture. And this is very similar. You can see that the
pictures that they took are very similar to
our ultrasound pictures that we took quite a while ago. But this is interesting,
because it really draws a parallel
between what they describe at this interstitium
and the phenomenon of acupuncture. So why is this important? Well, this is because
every time you move, the connective tissue
slips and slides and moves. So I’m going to
play you a movie. This is somebody who is
lying down on a table. And this is a chiropractic
table that bend like this. So essentially, the
person is lying, and their body is being
bent back and forth. And here is an example– [VIDEO PLAYBACK] –of how– you can see
here this white line is what we call the
thoracolumbar fascia. This is a thick layer of
connective tissue in the back. And you can see that– hopefully, you can appreciate
that these layers are slipping and sliding past one another. And they’re also stretching. So every time you move,
your connective tissue is being sort of
massaged from the inside. And you can imagine– [END PLAYBACK] –if this connective tissue
is actually like a sponge, the liquid is being squished and
squeezed and pulled and moved around. So this is an
interesting, I think, kind of way to think about
connective tissue and the role that it might play. So the important thing
to think about also is that connective
tissue literally goes everywhere in the body. You could draw a line from
any point of your body to any other point of
your body via a path of connective tissue. And so it surrounds every
muscle, every nerve, every blood vessel. And it goes inside
the organs as well. And that’s what acupuncture–
when they describe acupuncture meridians, that’s how they
describe them exactly– connecting the organs
with the periphery, connecting the superficial with
the deep, connecting the inside with the outside. And so what we think
is that there are– we’re not saying
it’s the same thing, that meridians are the same
thing as connective tissue. But one could be kind of like
a representation of the other. In my lab, we’re really
interested in a connection between the musculoskeletal
system and the immune system, because, interestingly
enough, connective tissue is part of both. It’s part of the
musculoskeletal system, because just as
I was explaining, connective tissue goes
around the muscle. And a lot of the force that
the muscle exerts actually goes to the connective
tissue and gets transmitted to the other
tissues next to it. The connective tissue
is also a place where a lot of immune
responses take place. When immune cells circulate
throughout the body, they go around sort of
looking for trouble. And what they do is
they go from the blood out into what we call
the extracellular space, or the interstitium. Well, guess what, that’s
the connective tissue. That’s where they go. So a lot of responses, like
inflammation, for example, happen right in
connective tissue. So what we wonder is,
can the mechanical forces within the connective tissues,
when you move around every day, does that influence
the immune responses that are going on in
the connective tissue, such as inflammation
and even cancer? So the effect of stretching
on acute inflammation, we studied that using
an animal model, where we induce the animal to stretch
by simply lifting it gently by the tail. And I had a student in my
lab who did a lot of yoga. And she was interested
to see whether we could do a little bit of
sort of like rat yoga. And so it turns out you can. If you lift the mouse
very gently by the tail and you let it grab on to
something, what it does is it stretches its
front feet and back feet. And it can hold this
position for several minutes. And then you can look and see
whether there is an effect. And we induce a small
amount of inflammation on the back of the animal on
the thoracolumbar fascia, which is that same fascia
I was showing you that moves back and forth. And you can see that stretching
reduces the inflammation by quite a bit. And so stretching has an
anti-inflammatory effect. Now, how could that be? Well, we are very interested
in the mechanisms by which inflammation turns itself off. Inflammation is a very
important response of the body. If you didn’t have
inflammation, you would never be able to heal a wound. But once the wound is healed,
inflammation has to stop, because ongoing
inflammation is not good. And one of the mechanisms that
was discovered– this is by Dr. Charlie Serhan here
at the Brigham– some time ago was that
there is a resolution. These are phase of
information that is governed by
some molecules that are actually derived from
dietary omega 3 fatty acids. These are what is
in the fish oil that we are recommended
to eat, to take on as a dietary supplement
or simply in fish, if that’s part of our diet. And so these fatty acids turn– our body makes
these, what we call, pro-resolving mediators that
helps turn off inflammation. If, on the other hand, this does
not happen and pro-inflammatory mediators dominate,
then you become– this turns into chronic
inflammation, which can then result in fibrosis. Now, what we found is that
stretching actually activists the pro-resolution mechanisms
within connective tissue. So we found that
stretching the animal does the same effect as
injecting the resolvin, which is the pro-resolving mediator. If you compare the
effect of stretching without the injection to no
stretching with the mediator, they both reduce inflammation
compared to the no stretching. And we also looked
at the production of this pro-resolving mediator
in the tissues in response to stretch. So you can see that
the connective tissue is making its own resolvin
in response to stretching. So that really suggests
that this is really a natural mechanism
that happens. So in summary, I think
that what I was suggesting is that we can take hints from
traditional Chinese medicine from this concept of
acupuncture meridians, which really seems very
sort of foreign and difficult to understand. But when we start thinking about
the relationship of meridians to connective tissue, it
starts to make more sense. When we further look at
the mechanical effect of acupuncture needles,
when the tissue is rotated, and, in fact, when
you– it’s almost like stretching the
tissue from the inside. And what we think
about in our lab is acupuncture
needles as being sort of little micro manipulators. And it’s used to
insert the needle and then do a very, very
targeted little mini stretching around the needle. But we also know that
there are other ways of stretching tissues. You can stretch tissues using
your hands, like in massage, for example. You can stretch your tissues
doing yoga or Tai Chi. And so these various ways of
stretching tissues we think have common mechanisms
of action at the level of connective tissue. So I think what we’re going
to see in the next two talks is more examples of how
observations and insights derived from other
healing practices and other healing
traditions can really influence enrich our basic
fundamental understanding of the body. Thank you very much. [APPLAUSE] So our next is
Dr. Tim Mitchison. And I’m going to– [SIDE CONVERSATION] Now, why is it not switching
over, I don’t know. So this is yours, right? Why does it say thank you? Yeah, we need some help. I’m having difficulty
switching the presentations. Maybe they needed to do it. OK, I’m going to– Save, save. OK, so now, where is yours? Mitchison. There we go. And now, we’re going
to go slideshow. [INAUDIBLE] You put your logos on it. I forgot about the logos. Thank you. All right. Good evening. It’s very nice to be here. This is a wonderfully
diverse audience compared to audiences
I’m usually talking to. So I see lots of different
kinds of people and a lot more young people than
perhaps I was expecting. I guess that a lot of the
young people in the audience are here because they
want to become doctors. And that’s a great
ambition in life. But let me recommend to you
guys being a scientist instead. It’s much more fun. [LAUGHTER] And it’s also you’re pretty
much guaranteed a job if you’re becoming a scientist. So it’s quite
economically fine as well. And if anyone doesn’t know
about being a scientist and would like to learn what
you could do with a PhD, for example, please email me. I’d be happy to talk about it. So I want to talk a bit
about herbal medicines– more a Western herbal medicine,
actually, than Eastern, but I think the philosophy is similar. I’d like to make a couple
of disclaimers first. One is I don’t have any
financial conflict of interest or anything. We’re supposed do
that at Harvard. The other is if you’re
interested in herbal medicines and are considering
taking a herbal medicine or are taking one, I’d like
to make a couple of points. Some people think
because something is sort of natural or from the
wild environment it’s safe. And that simply isn’t the case. Some of the most potent
poisons we know of are made by plants
and microorganisms. So you have to be
really careful. And the medicines I’m
going to talk about are actually deadly poisons. They’re only safe if taken
in very limited quantities as medicines. And secondarily, if you are
taking herbal medicines, you should definitely tell
your Western doctor about it. There are some
herbal medicines that are quite safe on their own. But they can interact
with Western medicines, affect their metabolism. And you can get
drug-drug interactions. So it’s really important that
your Western practitioner know about it as well. And I’m not a doctor. I’m not a healer. I am a biochemist, actually. I’ve sort of been a
biochemist my whole life. I conceived that
enthusiasm in college. And to me, a human
being is a sort of ultimate
biochemical black box. When I look at you
guys, I see systems of molecules interacting. That’s just the– [LAUGHTER] –the way I grew up. And so I think you’ll see
through this talk out, although I’m really
interested in healing for my own body, my family, et
cetera, I do sort of approach these problems sort of
thinking about it as a chemist very much. And as a biochemist, I’m
very interested in drugs– medicines that you eat
or that are injected, molecules that we take
into our body hoping for therapeutic effect. And broadly speaking,
if we take a drug, we hope to go from sick to wow. And the sorts of questions that
interest me that we research in my group and that I teach
as well is questions like, how can we develop drugs for
diseases we cannot treat at all at the moment? For example, there’s
enormous interest in developing drugs in your
degenerative diseases, diseases like Alzheimer’s and ALS. We really don’t have any
treatments at the moment. How can we improve
drugs we already have for treatable diseases
or partly treatable diseases? And then I think a
really crucial problem in modern pharmacology is, how
can we personalize treatment? How can we treat
individual patients, not treat people as
statistics, but figure out what really works for individuals? And so these are
kind of the themes in modern Western
medicine, I would say. And because I am very
interested in drug discovery– and I don’t know how many
of you guys know this– but Boston has become– or
the Boston Cambridge area has actually become essentially the
world mecca for drug discovery these days– used to be in New Jersey and
the Bay Area in California. But half of the drug
discovery in the world has moved to Boston
in the last few years, in Cambridge particularly,
to take advantage of all the great universities
and medical schools around here. And so I have more
and more colleagues who are scientists
like me, but they work in Biogen or Novartis
or some place trying to develop new treatments. And if you look at modern drug
discovery going on in Boston in a very Western manner– so we’re trying to
develop new drugs– the modern emphasis is to
figure out the molecular basis of disease– and human genetics has been
particular important, new set of insights into that– to identify what
we call targets, which are molecules that
are naturally in our body that there’s too
much or too little of or they’re defective in
some way that we figured out molecularly, and then to
use these targets, which are very often proteins, and to
develop drugs that bind to them and improve their
properties in some ways. And this sort of modern
version of drug discovery, if I was asked to
name some examples, I think, for example, antiviral
drugs for HIV in the 1990s. I lived in San
Francisco in the 1990s. And I watched as AIDS/HIV came
and killed a lot of people. And then these amazing
drugs were developed. And now, it’s become a
manageable chronic disease. And then more recently, some
beautiful new antivirals, so hepatitis– so people
figured out the viral proteins that the viruses
needed to replicate. And they developed
small molecules that stuck to those
proteins and poisoned them. And then those were treatments. And this is by far the main– all these drug
discovery companies, such as there’s
one, Merck, is just a stone’s throw from here, one
of those nice glass buildings and over in Cambridge. This is the main approach. But there is a– I called it here a
neoclassical approach. But it’s sort of combining– starting from a more traditional
treatment and sort of reverse engineering it. And I would say until the
genetic revolution, which started in the 1980s, this is
the main way Western medicines were discovered. Now, after the
genetic revolution, this is much less
used in the West. But I think it still
has a lot of potential. So if you know of some
traditional treatment– I’m talking now about a drug,
so a herb or a plant material or something that
people have eaten or otherwise being administered
to treat the disease– you could try and figure out
the molecular and physiological basis of the treatment
now– reverse engineer the treatment– and
then from there, try to develop a new treatment. And this has a
distinguished history. For example– and I think you
heard a seminar in the series about opioids– but modern surgical anesthetics
derived from morphine, which is one of the most ancient
drugs, the natural product of poppies, was well
known in the ancient world as a treatment of pain. Actually, plant-derived
natural product is still used. It’s a very important pain
medicine still particularly in terminally ill patients. But we’ve developed
a lot of molecules based on this that are
tuned for, for example, surgical applications. And I actually don’t
know exactly when morphine was isolated. But that was an important
molecular step forward there. And whether you’re
taught whatever the root that a molecule
was discovered, I’m actually a professor
of systems biology, and I sort of view the human
body as the ultimate system to study. But in drugs, we’re looking
to make a perturbation. At the molecular level,
these are crystal structures of proteins. These are G
protein-coupled receptors with a drug bound to it. And we’re looking from a
molecular level perturbation at the molecular level
to do something good at the whole body level. And I think if
you’re not trained as a molecular
biologist, you might look at a protein
molecule and think, oh, that’s very complicated,
and the human body sort of being sick or being well
seems, perhaps, simpler. But nothing could be
further from the truth. Actually, molecules in their
own way are really quite simple. You can describe them precisely,
whereas the human body is immensely complex, as
Helene was telling you about some parts that
people don’t usually think about as much. And I think when
we eat a medicine and it gets into our body
and binds to a protein, I sort of think of this
in a way like dropping a pebble into a still pond. So the pebble hits, and
then these ripples move outwards, as every
part of our body responds to that
perturbation, which might be quite specific
on the molecular level, but it’s going to ripple
out through our body. And understanding
that, I consider is sort of one of the
most difficult challenges and would further say that
traditional healers didn’t know about molecules, and they also
had a very limited toolbox of treatments, mostly
coming from herbs or other natural materials. But they did very much consider
the whole body and mind of their patients. And I think for this
reason if no other, we need to be respectful of
traditional treatments and try to learn from them. And with that spirit
in mind, this seminar you’re hearing today is
a little bit in some ways a reprise of a seminar
we had in 2017, which Helene and I
organized with a colleague from Hong Kong, which was
mostly focused on drugs, but where we really had
talks on Western pharmacology and Eastern
pharmacology and efforts to bring those two together. And it was a really
fascinating seminar. I think it was our
collaborators on this was a school of traditional
Chinese medicine in Hong Kong, which I think is a rather
modern school of that kind. And they had quite an
emphasis on understanding that traditional medicines from
a fairly a Western perspective. But I certainly gained
a lot of respect and was convinced– there was
some interesting– like, how do you do a clinical trial, a
double-blinded clinical trial, like we do in the West on
a traditional medicine that was fascinating to
learn about that. But some of these
things really work. So in my lab, we study two
plant-derived natural products. They both happen to be from the
Western rather than the East, although that’s a
kind of coincidence. I’m going to talk today a
little bit about colchicine, this molecule here, which is
the poison of the autumn crocus. And this is very much a
traditional Western medicine. It has an ancient history. It was in use clearly
by the Ancient Greeks. And there’s one medical
papyrus from the Middle Kingdom in Egypt, which is
interpreted as this flower. And then we also– I won’t talk about today– we
also spend quite a lot of time on a poison derived from the
Pacific yew tree, paclitaxel, rather a famous
molecule that’s a very important treatment for breast
cancer and other solid tumors. This one is used to treat
inflammatory disease. So why those
particular medicines? The answer is they both
impinge on a molecule I’ve been studying
ever since my PhD, the microtubule, which is a
long, thread-like polymer that runs through our
cells and provides structural organization
and transport. And in my PhD, I studied how
these microtubules are built by tubule and adding at the
end, and the microtubule gets longer, or
they can come off and the microtubule
gets shorter. And I could give you a whole
lecture on microtubules, and I won’t. But let me just
tell you, they’re very important
when cells divide. The chromosomes are
separated by microtubules. And the neurons, which are the
longest cells in our bodies– so they have very
long processes. For example, motor
neurons, the cell bodies that are in your spinal
cord, that the synapses are in muscles that could be,
for example, in your toes and it’s an
electrical signal that triggers muscle contraction. But the axon has
microtubules in it. And they are the railroad tracks
to supply new material using motors down to it. Today, I want to talk about,
well, really only one poison, but colchicine inhibits
microtubules from being built. Paclitaxel inhibits
them from breaking down. These are both poisons. They were evolved
by these plants to become poisonous to
herbivores, basically. And microtubules–
probably one reason that plants evolved microtubule
poisons is microtubules are pretty similar in
really all animals. And so if you’re
poisonous to humans, you’re also going to be
poisonous to insects. Their microtubules
are pretty similar. And the actual biochemistry
here is fairly easy to block with small molecules. So these molecules
evolved to be poisonous. And then it was found that in
lower doses, in nontoxic doses, they can be useful medicines. For colchicine, that knowledge
was discovered long, long ago. And there’s a wonderful
and colorful history. Paclitaxel was
discovered in the 1970s by the National Cancer Institute
as part of a screening program. And I’ve heard some
hints that there was– this is from
the Pacific yew– that the native peoples might
have used it as a medicine. I tried to track that
down multiple times and not found any
written literature. But if anybody knows any
traditional uses of the Pacific yew, I’d be delighted
to hear from them. So he here’s me in a field
of colchicine flowers outside Vienna. It grows wild all
around the Mediterranean as far north as Vienna. This is the molecule
that’s extracted for it. In ancient times,
it was the bulb of the colchicine plant
that was ground up and used very cautiously as a medicine. It was probably also
used as a poison in ancient times as well. Nowadays, colchicine
is produced, commercially extracted. And you take it in a pill form. The pills are about
half a milligram. And there’s a– they cost
far too much in America. They should cost a penny a pill. They actually cost
$10 for a legal snafu that I won’t spend
time talking about. But in this seminar, I shouldn’t
be showing a picture of myself, I should be showing a picture
of Jui-Hsia Weng a postdoc, who I actually noticed
in the audience. Jui-Hsia is a very brave– she’s an absolute
fearless experimentalist. And she was willing to
tackle a really wacky theory I’m going to tell you about. And she’s become the expert
on inflammation and colchicine in my group. She’s the only person
working on this. So what I’m telling you is
several years of her life. And I really appreciate
her dedication. And we need it to
be a big splash. Sorry, I’m rattling on too much. My time is timing out. So colchicine is mostly
used to treat gout. So if you eat rich food, it’s
broken down into uric acid. That’s supposed to be excreted. As we get older in some
people, the excess uric acid precipitates in the joints. The crystals don’t
cause any problem. The problem is when white
blood cells eat them. And that damages the
white blood cells. And they secrete a damaged
signal, particularly IL-1 beta that causes the
pain and swelling. And Helene mentioned
inflammation already. And it’s this process
where white blood cells sense tissue damage. They leave the blood. And then they start
making more of these tissue-damaged signals. So there tends to be
positive feedback. And colchicine in
some way blocks that. But the question
is, how does that relate to its molecular action? The textbook model– and if any
of you are in medical school, this is the right
answer on board, so you should
remember this or not, I’m going to tell you is
a different answer– is that the colchicine gets
directly into the white blood cells, damages
their microtubules, and stops them sticking. It’s the obvious model,
but it has a number of problems I won’t elaborate. Jui-Hsia and I don’t
believe this model. But what are the alternatives? And I can ask you guys a
very quick question here. Colchicine is a plant-derived
toxin that gets into our blood. It’s absorbed from eating
it and gets into the blood. Do you guys know which
organ in our blood is most responsible for
detoxifying a foreign chemical in our blood, anyone? Liver. Liver, very good,
you guys, exactly. Much faster than my
PhD class, may I say. [LAUGHTER] Yeah, so the liver. So is it possible that
colchicine actually acts on the liver? This is an outrageous
suggestion, because it doesn’t
affect the liver. There are no liver side
effects of colchicine. It affects white blood cells
and possibly the endothelium and blocks inflammation. But Jui-Hsia and I– these are all her experiments. She started doing some
experiments of feeding colchicine to mice– actually,
we inject it into mice; it’s more reliable– dissect tissues. And I’m going to show you an
experiment where we measure a marker of cellular stress. And it doesn’t really matter. We’re looking at an SDS shell. This is actually a Western blot. This here is a marker
of cellular stress. This is a marker that the
she loaded the right amount of protein each gel. But just looking at that, here
are four tissues labeled here. Can you guys see which tissue
the colchicine is acting on? Liver, yes. Well, that was a ringer, right? But we really see no action
anywhere in the mouse except in the liver. Now, this mark of the
relationship to this to the medicine is not clear. But basically, our model is that
colchicine gets into the liver, and really only the
liver, causes the liver to secrete some factor,
I’ll call factor X, that acts on white blood cells. And that’s not a totally
outrageous suggestion, because the liver makes almost
all the proteins in our blood. And so that it makes
one more protein that affects white blood cells,
I think is not unreasonable. And Jui-Hsia has identified
a candidate for this, that since she hasn’t
published and I’m not going to talk about today, but
we have a specific molecule here in mind. And I’ll just end by saying,
if this is true for one traditional medicine– and this
is a fairly wild assertion that we haven’t published yet– I think it could
be true for others. In general, the liver exists– I mean, it evolved in
part, the biochemistry, to detoxify plant-derived
toxins so we could survive in the wild. And when people are
developing Western drugs, one of the main things
they have to fight is the tendency of the liver
to inactivate those drugs. So I think it’s an
interesting speculation that some of these wonderful
traditional Chinese medicine that are always
given as mixtures actually also act, not
directly on the whole body, but indirectly
through the liver. And this may seem a little
Galenist or something. Galen was an ancient
Roman doctor, who believed in the
humors and things. But the liver is really– it’s
the largest organ in our body. It makes most of the
proteins in blood. And it picks up, essentially,
any small molecule, toxin, and acts on it. So I think this outrageous
model here should be considered more widely. And just thank my
group, particularly Jui-Hsia, who’s there,
hiking in New Hampshire. Thank you. [APPLAUSE] I think I went into
orange, but not red. So Peter, the podium is yours. Thank you for dealing
with the computer, Helene. I bet escape first. Well, thank you. Thank you all for being here. It’s exciting. So building on this theme
of reaching into the East to look for new
therapies for medicine, I think one of the more
promising and popular therapies that we’re looking to the East
for is what we call tai chi and mind-body practices. And this is also one
of the main areas of focus in my laboratory. So what I wanted to do
today in the next 15, 20 minutes is show how this
traditional exercise, that’s designed as a mind-body
exercise to touch both the mind and the body to sort
of connect these systems, is promising for a
lot of issues that are facing our society
today, especially our aging population,
namely related to balance and cognition. I think you talked about
neurodegenerative diseases. But more broadly, not
only looking at these, but how this mind-body
ecological approach to health is starting to shift how we
think of the body as a more holistic system-oriented
perspective, like Dr. Langevin and
Dr. Mitchison has already introduced. I need to disclose
that in addition to being a researcher
of tai chi, I teach tai chi
in the community, but that the Brigham and
I keep a strong firewall between keeping my science
away from my practice and my practice away
from my science. So I think everyone here
knows that falls in dementia are really a huge part and a
pressing issue in our aging society. When you look at
the statistics, it’s really alarming and staggering. I think many of you know
that about one third of older adults over the
age of 65 fall each year. And those falls have huge
impacts on their health and the health of
the whole community as a society as a whole. One out of five people who
fall and have a fracture die that year, not because
of the fracture itself, but because of what we call the
sequelae, the side effects– the changes in
lifestyle, the inability to go out and socialize,
and things like that. And obviously, this
has huge impacts on the individuals,
their families, but also societal costs. It’s estimated
that by 2020, falls will cost society
close to $55 billion. And there’s no pill to take
to stop you from falling. The statistics for dementia
are even more alarming. And you hear a lot
of this on the news. About 5 and 1/2
million people have what’s called mild
cognitive impairment, an early stage of dementia
before Alzheimer’s and other degenerative diseases. And another 3 and 1/2 million
have full-blown dementia. And these costs are staggering. They’re about $150
billion in 2010. And because our society
is aging rapidly, the numbers are escalating. And the traditional approaches
to dealing with both balance and cognition, as Helene
showed in her model, there are different departments, and
they focus on different things. And they’re not
highly integrated. So if you have balance
issues, traditionally, you go to a gerontologist
or a physical therapist. They’ll say, let’s work
on your physical strength. Let’s strengthen
your legs, create a little bit of flexibility,
a little bit of agility, maybe some aerobics, so
you have more stamina. And at the other end, if
you have mental problems and beginning of some
cognitive things, let’s do some
cognitive training, maybe start doing
Sudoku puzzles, crosswords, learn
a new language, a lot of social
activities, maybe even some behavioral therapy. And again, there’s not
many good medicines available for
arresting dementia. But what we’re learning
in systems thinking is that things even as simple
as walking and balancing require things from the
bottom-up and the top-down. And I’m just going to say
a few things about that. There’s a really
rich literature, has nothing to do with tai chi. But people are really starting
to know that how you move predicts whether
or not you’re going to have dementia in the future. So for example, there are
studies that show when you come in to a study, a big
epidemiological study, if you walk slowly or your
gait is slightly impaired, even if you control for your
current cognitive function or your diet, whether you
smoke or not, it predicts– how you move– whether or not you’re more
or less likely to have dementia in the future. What’s also true
is the converse, which is that how you think
affects whether or not you’re going to fall. And that makes
sense in some ways. And I’ll show you lots of data
that we use in our laboratory. But if I asked you all
to stand on one leg, you could do pretty good. But if I asked you
to stand on one leg and count backwards by 6 and
a 1/2’s, all of a sudden, because your attention is
not focused on your balance and it’s distracted,
that impacts things. And we know that these
top-down processes– what we call executive
function and other higher order functions– impact how we move. So this more
ecological approach, where the mind affects the body
and the body affects the mind, is making us wonder. How do we prescribe
exercise and activities for our aging population? Maybe if we’re interested in
these sorts of interactions, we should be teaching people
how to do Sudoku puzzles while they’re on a treadmill. And actually, there’s
quite a bit of research. Some research what’s called
dual-tasking interventions, where you do practice
balance while you’re doing some cognitive skills,
mathematical things, memory games. And there’s even
high tech approaches, where they use virtual reality. So you can practice
walking on a treadmill, but while you’re
wearing glasses, there may be obstacles
that you have to come. So you have to start
to plan and react. And you’re using the
top-down and the bottom-up at the same time. So that’s a very
modern approach. And there’s a lot
of promise there. But there’s also some, what
we would call, old school approaches. And that’s where
some of the things– one of the topics in my lab. And one of the interventions
we focus a lot on is called tai chi. So just a quick definition–
just by show of hands, how many here have experienced something
like tai chi or qigong? Oh good, good, good. We’re actually going to do
a little exercise together, so you’ll all have
left have learning just a little bit of tai chi. But just to create some
context, as you all know, tai chi is what we call
a mind-body exercise. It has roots in Asian
medicine, as well as philosophy and martial arts. And it integrates slow,
intentional movements– maybe you’ve seen people
do this in the park– with breathing and, importantly
for this mind-body work, multiple cognitive skills. You’re focusing intently on
your body, heightened body awareness, where your limbs are. And you also use mental
skills, like imagination, like flow like river, or
be rooted like a tree– those thoughts affect
our physical body. And we’re going to experience
some of that in a few moments. And the goals of tai chi
are to strengthen, relax, and integrate– to
make more whole– the physical body, the
mind and, through that, improve health, personal
awareness, and development. And on some levels, tai
chi is a martial art. So you get to protect yourself. So are you all willing
to do a little bit of what we call hand tai chi? I think the purpose here is we
could talk about this stuff, but if you have just even
a two-minute experience, then I think you’ll appreciate
this research and its potential a little bit more. So what you need to do is
just put some things down so you have your hands free,
and in particular one hand. But it’s nice to just start
and compare your hands. So we’re going to do what’s
called an N-of-1 experiment. You’re the subject,
and we’re going to do an experiment together. And just rest your hands
comfortably and just notice them. It’s not something people
ask you to do, but just notice the sensations. And then put one
of them to rest. And with the other hand,
maybe its your index finger, I want you to just
wiggle it around and just play with your finger. One of the things
you’ll notice is the second you start
moving something, you can feel it more. So it brings your
attention there. Now, I want you to just
slow it down a little bit and just begin to stretch all
the tissues in your fingers, all the way out to
the end knuckle, and then relax it deeply. And if you can remember some
of that Dr. Langevin’s slides, every knuckle and
muscle is wrapped in this elastic
connective tissue. So you’re just drawing on
these little bungee cords and stretching them all the
way– not to the point where you feel strain or fear, but
just to tune in a little bit, and then you relax that. And each time we do this for
about three or six more times, I want you to see
if you can notice another part of your
knuckle you haven’t noticed, maybe a top part
or a bottom part or a distal part near fingernail
or near the base of the finger. But you’re moving to
start to notice more, to bring a little bit more
awareness of your own body. Remember, Dr. Langevin said
that all of these tissues are in this big soup that’s
floating around with really nourishing chemicals that
rehydrate your tissues and wash out inflammation. So maybe you can notice
how juicy your finger is as you stretch
and release it, and see if you can just spread
this juice a little bit more freely into every
nook and cranny. And there’s no rush. You don’t get more points
for doing a lot of these. So rest in between,
and then when you feel like doing another
stretch, you can do it. Now, what if you coordinated
this with your breathing? So now, you just sort of breathe
in a little bit as you stretch, and you breathe
out as you relax. And you do that a few times. Then you add all
your other fingers. And you’ve got all five
of these working together. And I know that everyone
at the medical school and the communities are really
interested in eliminating health disparities. So you can ask,
which of your fingers is a little underserved
right now, and can you stretch that just a little
bit and include every knuckle that you care about? So it’s a little bit of kindness
of giving back to your hand. And then here’s the
last piece, because this is a big part of the research
here at the med school– placebo or imagination. So imagine in the
heart of your palm you can just put a couple
drops of the fountain of youth, and all your ailments, all
your aches and pains go away. And you just sort of stretch,
and magically your hand starts to feel a
little bit more tingly, more relaxed, more juicy. Now, I just want you
to rest that hand and compare it to
your other hand. Any differences you can notice? I see some nodding– some people more tingly, a
little warmer, more sensation, more life there. What you can imagine
that tai chi is doing is just the same thing
with the whole body. You’re stretching
all the tissues. It’s like a dynamic yoga. And what just happened
there, and what happens in a typical tai
chi class, is quite complex. You could think of tai chi
as a multi-drug intervention. We moved our physical body– they’re stretching,
they’re strengthening. When we’re doing it standing
up, it’s weight-bearing. So here– let me get this– we’ve got this thing that
looks like typical exercise– aerobics and strengthening. But we’re not just
interested in the pieces, but how they all fit together–
the coordination of things, so structural integration
and dynamic integration. We’re doing a lot
of mind-body work. It’s like dynamic meditation,
focus attention, mindfulness. And imagery– I asked you
to imagine this juicy ocean and imagine something. And we know from
very good research that what we believe greatly
affects our physiology, whether it’s in placebo
or in meditation. Breathing– typically,
tai chi is done in groups. And we know that being part of
a group is quite therapeutic. And I’m seeing sometimes in the
teachings, do a little less. There’s a philosophy to
it– go with the flow. And so all of these together
are components that we’ve studied separately in medicine. But when we put the
package together, it’s a much more
ecological approach. And we bring that into
this complex system that affects the mind and the body. And this is just an example. It’s a little busy. I’ll just say a few
things about it. But we know that tai chi is
one of the better exercises. The Cochrane
Collaborative reports on what’s the state of
knowledge in different fields. And in terms of
balance, tai chi is one of the best
exercises out there. And on average for older people,
it reduces the risks of falls by about 30%. And that’s pretty good. And the question
is, why and how? And it’s not the
same as a single drug hitting a certain molecule. But it’s a little bit more
like Dr. Mitchison was saying, it’s this ripple
effect, but you’re hitting with lots of stones
that are rippling altogether at the same time. The whole system is moving. And here is some of the
things that change– prevent falls. We get stronger muscles. The sensation in your fingers
and the soles of your feet that help you
balance get better. There’s better reaction time,
because the neuromuscular system is working better. And I’m going to say some more
things about these mind-body pieces– the fear of falling
and what that does to the body and
the paying attention. Very good research
done in the Boston area on pain for osteoarthritis
of the knee, some neck pain and back pain studies as well. So you get the idea? This is a very different
approach to the first model that Dr. Langevin talked about,
where we separate everything and we treat pieces. Here, we have a
complex intervention going into the whole
system and shifting it. So one of the areas where
mind and body come together is in fear of falling. And anyone who has an
elder friend or a colleague or if, God forbid,
you’ve fallen yourself, you know there’s a, what
we call a phenotype, a shape to falling. You literally get scared stiff. You start walking
in a more stiff way. You hold your breath,
you’re anxious. And ironically, that
braced distracted behavior makes it
much less likely that you’re going to go
out to do exercise, which makes it much more likely
for you to be deconditioned, which makes it much more
likely you’re going to fall. And it’s this vicious cycle. And it’s hard to
break this cycle. And one of the areas
that tai chi has been shown to be
really helpful for is to alleviate this fear
or anxiety of falling. And we know, ironically, one
of the biggest predictors of falling is fear of falling. So we’ve got to
break that cycle. So there’s very good research to
show from multiple large scale clinical trials that tai
chi reduces this anxiety and that that change in
anxiety is contributing to the reduction in fall rate. And then more generally, because
it’s this gradual approach of feeling your body
and not giving it 120%, but just going to the place
where you feel comfortable, we’re starting– it makes people who
are deconditioned with health issues more
comfortable, easing back into exercise. So we’re starting to call
it a gateway exercise. It’s a nice transition. Another area that we’re
very interested in is this idea I mentioned
before about paying attention and affecting your balance. And we know that
there is what we call a cost to thinking or
arguing with your spouse or friend while you’re walking. So this is just
showing different types of distractions. So there’s no distraction here. This is asking
someone to tell me all the vegetables that
begin with the letter P. It’s called phenoms. This is someone counting
backwards by threes and by sevens. And you can see, as the
task gets more complicated, they walk slower. So there’s a cost to
thinking while you’re moving. This is the same tasks,
but it’s not just speed, it’s what we call variability. So someone who walks very
regularly has a nice rhythm. Someone who walks irregularly
has high variability in the timing of steps. An extreme version
of that would be what we call freezing of gait in
Parkinson’s, where people just get stuck, and they need
to break out of that cycle. So thinking can affect
the speed and rate. And the question
that we ask is this– this is a woman walking in
our laboratory, same person. You can see that at the top
she is without a dual task. She’s counting
backwards by sevens. And on the bottom,
she has a dual test. She’s counting– at the
top, she’s not counting. At the bottom, she is. You can see, without the
task, she walks both faster, but also look at the
placement of the steps and the regularity in
the top and the bottom. And what we want to know in
our research is, if she studies tai chi for three or
six months or a year, while she’s counting, can her
steps look more like this? So you get that? And the short answer is yes. This is walking speed
improvements following tai chi after just 12 weeks. These are not spring chickens. This is a group of
people whose average age is 85 years old when they’re
starting to learn tai chi. And more than 20 of the
participants are over 90 years old. And what we see is
that short term tai chi training improves speed. And these are the
people who were not doing tai chi When we shift
them to the other group, they catch up. And we see a similar thing with
respect to the variability. And this is an important
marker, because this is now in very healthy adults that
are slightly younger, 50 to 80. And this is highly
predictive of falls. And what we can see
is that the tai chi people who have been
practicing for a while have lower variability, which
as I mentioned, is better. We can also bring them
into the laboratory. And all of this
stuff, what’s nice is we’re using these
objective measures of science to look at these
traditional measures. So we can bring them
into the laboratory and say, what does
their balance look like with very precise measurements. There’s cameras all around. Each of those dots as
an infrared sensor. So we can create a robot. And this is someone just doing
a simple tai chi movement. But this arrow here shows you
where their center of pressure is– how much they wobble,
basically, over the base of support in their feet. And what we can
do is we can say, OK, here’s a person who
we asked to stand still, and this is how much
they wobble front to back and left to right. This is how much they wobble
while they’re counting. So you can see that they
wobble a lot more when they’re distracted. And the difference
between those areas– the blue and the red area– is what we call the cost
of being distracted. And we want to know
if tai chi reduces that costs, improves the
cognitive-motor interactions. And yes, the short answer is. This is some work
done in our group. And for many measures
of these wobbles, whether it’s the speed of
wobbling or the overall area, tai chi reduces the cost. The last thing I
want to say is we’ve been very interested in
looking at cognition itself. And we’re doing
some empirical work. But we’ve also reviewed
the literature. And we know that
exercise is very good for preserving
and sometimes reversing loss of mental function. And we were interested in
whether the slow tai chi movement and the multi-component
attention and breathing and relaxation would do it. And the short answer
is there seems to be promising
evidence in that area. And people are starting to do
brain imaging to show that not only do the behavioral changes
that we see look robust, but there’s actually
literally plastic changes in the function of
the brain that we can measure in MRI scanners. So just to conclude
and pull this together, I think it’s fair to
say that tai chi is a promising intervention
to continue looking at for preserving and enhancing
a number of domains of health, especially in the
aging population. And cognition and
balance are two of them. The multi-component nature
of mind-body training and how it’s been designed to
sort of get into the system and connect the pieces in
a more holistic way I think makes it very different
than unimodel drug therapies or even unimodel
physical therapies that work on individual
parts of the body. And I think this ecological
approach makes it a useful tool, much like Dr.
Mitchison’s and Langevin’s approaches to reach
out to the East and to use these not
just as therapies, but as tools to probe
the fundamental nature of the human body and
its health and balance. So my lab is very collaborative,
and I’m a small part of a lot of my research. So lots of people to thank
that they don’t have time for, including the
National Institutes of Health for their support,
but especially to you guys for listening. [APPLAUSE] Good. I reckon, you should be
in the middle, Helene. You’re the boss. I think they [INAUDIBLE]
sit here [INAUDIBLE].. OK, well. Whatever. Yeah. Was it something I said? Huh? [LAUGHS] [INAUDIBLE] Oh, OK. See how many people
stay for questions. OK, so we’re going to be
now taking some questions. And you’ve been kind
enough to put them down on these index cards. So I’m going to be directing
the first question to Dr. Wayne. How are the benefits of tai chi
similar or different to yoga? That’s a great question. If you remember the
diagram that shows all the multiple
components, many of those ingredients or
components are common to yoga. There’s stretching, there’s
mindfulness, there’s breathing, there’s relaxation,
there’s imagery. So I think there are more
parallels and commonalities than differences. There have been almost
no studies, actually, that I’m aware of– maybe one
small one that have literally put them back to back. It’s a tough question. Because even within
yoga and tai chi, you have a lot of variability. You’ve got vinyasa flow yoga
and kundalini yoga and pranayama yoga. And then you have different
styles of tai chi. I think at the core
they share many more similarities than differences. And I think the main
difference to me is that tai chi evolved
as a martial art. And so you’re up on your feet,
and it’s very functional. And I think it translates
to pushing car doors open and lifting boxes. And there are no Downward
Dog poses, for example. So I think there’s
some advantage to both. But I think the tai chi
translates a little bit more closely to me to
activities of daily living. Thank you. For Dr. Mitchison,
by targets, do you refer to the general
areas that are affected by the disease or the components
of the disease that are causing problems in the first place? And this is by a high
school sophomore. That’s a very good question. So I was talking about
targets mostly in the context of drug discovery. I think when professional
drug discoverers use the word target, they’re usually
referring to a molecule. For example, right now
for cancer treatment, we’re very excited about
turning on the immune system. And we’ve learned how
to turn on T cells by targeting a
couple of molecules. One’s called PD1
and PD1 ligands. So PD1 is just the
name of a molecule on the outside of a cell. So the word target
is usually used to mean a specific molecule. And a huge thrust
in academic research has been how you take something
as complex as a human disease that affects many parts of
your body and boil it down to one target, which if
you hit that target– and that’s literally the word
people use– it will help. And that’s the art and the
challenge of drug discovery. But it’s usually used to mean
a particular molecule that has some causal
relationships to the disease. This one is for me. Does reduced inflammation
occur in all parts of the body or the area local
to the stretched connective tissue? That’s a great question. I agree. And we don’t know the answer. [LAUGHTER] But we are actually designing
some experiments right now to test that. And one of the reasons we
think this is really important, say you have a part
of your body that has some inflammation in it. So you have tendinitis
or something like that. That part of the body
maybe painful to stretch. What if you could
improve that area by stretching the other side? Wouldn’t that be nice? We think its actually important
to stretch the area that’s actually inflamed for
a variety of reasons, but needs to be
done very gently. And gentle is key. And pain should be a signal to
not stretch beyond the point where it hurts. But this is a very,
very good question. What is the difference between
alternative and complementary medicine? You want to take a stab at that? Yeah. You know, the terminology in
this field has really evolved. It used to be alternative
medicine at the NIH. And then the National
Institutes of Health, that is, then formed the
Center for Complementary and Alternative Medicine. And then in the
last year or two, they’ve changed it to
Complementary and Integrative Medicine. And really, it means
generally that it offers an alternate approach
or a complementary approach to whatever is mainstream. And what has been mainstream
changes over time. Back in the days
of Galen and Roman, there were people
saying, well, if you’re going to go over to the temples
where they do dream yoga, don’t come to me, because
my work with the four humors is the real medicine and
that’s the alternative one. And what’s mainstreaming
and what’s alternative keeps changing. And over time, as Helene
showed at the bottom of that set of
icebergs, we’re starting to realize that there’s
fundamental things that are common to everything. And I think this is the idea
of integrative medicine, that it really is we’re
taking the best of everything, and we’re understanding
the basic biology, and we’re putting them
together with a more system’s view of health. But it’s a really
challenging question. And everyone uses these
words very differently. Nice. What led you to your
interest in this field? Who’s that for? I think it’s for you. Yes, the work I
was talking about. It’s been a long journey for me. When I was younger,
I was interested just in how life worked, how
proteins and DNA got together to build cells. So I wasn’t interested
in medicine. I was just interested
in how cells work. And that’s an interest I had
kindled in childhood, actually, looking, peering at
living processes. It’s really in the
last 10 years or so that I’ve gotten much more
interested in medicine. Part of the reason
for that, actually, is our knowledge of how cells
work, the sort of basics of life processes, has
gotten much more complete. So there are many things
that were totally mysterious when I was a kid
that now we have some sense of how they work. And so like a lot of basic
scientists, which is still what I am, now
feels like the time to start applying
that knowledge. So that’s part of my evolution. And I think of a lot
of basics, I think– at Harvard Medical
School, I work on the quad that’s just
across the street here, you may see on
your way in or out. I think the quad has long
been a hotbed of what people call fundamental research. But more and more
of us are realizing, you know, we’ve actually
made some progress on those problems. Hey, it’s time to look up and
feed people in real medicine. I think we should all
answer this question. Yes. You go next. I’m next? Well, I already gave
you part of my answer in what I was talking
about this grabbing thing. I used to be an internist. I used to practice
internal medicine. And a lot of my patients
had chronic pain. Even though I was an internist,
I was not a pain specialist, but still, you will ask any
doctor in any specialty, they will say treating
chronic pain is the most frustrating
and difficult thing. And at the time– this
was back in the 1980s– there was really very little
in terms of alternatives to pharmacological treatments. And so there happened to be
an acupuncture school in town next to where I was practicing. And so I went,
and they taught me how to manipulate the needles. And then I realized I
was feeling something as I was manipulating them, and
there was no good explanation for that. And I told you the rest. [LAUGHS] Sp Like Dr. Mitchison, I
grew up being a science geek. I love science. And I was also very interested
in environmental issues. So I pursued a degree
in evolutionary biology. I actually did my
PhD here at Harvard. And I was very interested in
ecosystems and climate change and plants. But at the same
time, starting when I was 15 years old
in high school, I started doing tai
chi and martial arts. And I was teaching
in the Boston area. And somehow, these
worlds started to interact with each other. I was very interested in this
ecological view of health. And I was looking at what
conventional medicine was offering and thinking,
there are some views here that are missing. And I was still
interested in my science. So I took my
perspectives of nature and how things are
all interconnected and how to design
experiments and how to quantify
interactions and just left the world of
plants and forests and applied it to animals– to humans and medicine– well, animals I guess. And that’s been about 20 years
since I’ve made that shift. But I think they
go well together. Yeah. Lovely. Do you feel that integrative
medicine is being more accepted in the West? Or do you find people
may be reluctant? Maybe I should take that. Yes. You’re the expert. [LAUGHS] So I would say,
definitely, there is a lot of progress in the
understanding and the curiosity and the willingness to embrace
healing traditions that, number one, are not conventional,
and number two, where we may not
know all the answers. Dr. Wayne talk about
the placebo effect. And this is something that
is a very important part of all types of treatment. It doesn’t matter if
you give somebody a pill or if you do massage to them or
if you do any type of a surgery even. There is a component
of that treatment that has to do with the what we
call nonspecific effects that happen. Regardless of the fact that
person is put in a healing environment, somebody is
doing something to them, somebody is being kind to them,
somebody is listening to them, somebody is– And so all of these
things, it turns out that once we started studying
like alternative medicine and then we would
compare that to like, for example, to acupuncture,
real acupuncture, compared with
placebo acupuncture, and there was not a
whole lot of difference between what we would do fake
acupuncture by pretending to insert the needles and
really insert the needles. And people would say,
oh, it’s just placebo. Well, turns out that the
placebo response is really an important healing response. Imagine if you are able to
incorporate something that happens to you during some kind
of therapy and heal yourself, that’s really important. So we’re starting
to understand how the healing aspect of
some of these treatments may or may not be– we don’t understand all
the mechanisms behind it. But it really has
enlarged our understanding of what a therapy is. So I think that there
is a long way to go. But we’ve certainly
expanded our understanding of the variety of
different options that are available to
patients, especially for pain, because right now, we’re
stuck with pain, with pain treatments. We really have this problem
now with addictive drugs, especially the opiates. And people are really looking
at nonpharmacological or less addictive drugs. So this is an
opportunity, I think. And a lot of
medicine is starting to embrace that as a great
opportunity to learn more and to offer different
options to patients. And can I add to that? Yeah. We’ve really come a long way,
and we have a long way to go, not just for what we call
alternative or integrative medicine, but cancer biology
is still, in many ways, at its infancy. It’s interesting– I
think at this point, there’s probably
about 16 hospitals associated with Harvard. I think about more than
12 or 13 or 14 of them offer acupuncture. They offer it in
the cancer wards, because there’s good
scientific evidence to show that it’s a nice
adjunct to chemotherapy to manage nausea and side
effects of treatment– and also in pain clinics. And there’s good research– far from comprehensive research. And we don’t exactly know
why it works in some cases. But there’s good research,
especially for pain and cancer. In the case of tai
chi, my colleagues here are often surprised
to know that there’s close to 2,000 peer-review
articles on tai chi. And I think it’s this research
and research done carefully and research done in settings
like the Harvard Medical School that’s just opening up
these conversations. And I think that’s
really important. And I think, as
scientists, we want to be very careful about not
overstating what we know, but at the same time saying
there’s something here that’s worth looking at. And so I think that’s
creating a big shift. Yeah. And I want to just add,
if like, say, for example, we end up finding
that– remember, I was talking these
acupuncture points and meridians–
if there really is no difference between putting
a needle at an acupuncture point or a not
acupuncture point, we need to understand that. And we need to say, well,
maybe that’s not important. But there are other things
about the acupuncture treatment that may be important. And we need to really
start pulling this apart, so that we can
refine and understand what is the ingredient of
these treatments that actually is what matters. And so the more science
we do, the more we can answer these
questions, I think the more accepted it is going to be. Do you have anything
you wanted– It’s very interesting
visiting China and talking to people who have a
foot in both worlds about their attitude
to– for example, traditional Chinese
medicine in China is a whole parallel
health system. They have hospitals,
they have universities. But they’re also very
accepting of Western medicines. For example, no one tries
to treat infectious disease with traditional
Chinese medicine. They go straight to
Western antibiotics. So there’s– I know traditional,
sort of a high level from a good university, traditional
Chinese practitioner in China has to learn a lot
of Western medicine. Essentially, all of them
use both in parallel. And the people I
talk to you know, they were very honest with me. There’s some things we feel
we can treat better other ways and other things we absolutely
go for Western medicine. Infectious disease was just one. And so I think it is very
interesting seeing that system. China has become quite
a modern country. But traditional Chinese medicine
is an academic discipline. And as a medical practice,
it isn’t going anywhere. It’s still very popular. And so maybe– I don’t quite see
America going there. But it’s interesting
to see that side of it. How can one find out
if their doctor is open to integrative medicine? What should they ask? I can say something about that,
because at the Osher clinic, one of the studies
I’ve led is to ask 1,700 consecutive patients
about their attitudes about integrative medicine. And one of the questions
is, do you disclose this– your use of integrative
medicine– with your doctor? And I think Dr. Mitchison
said, it’s important if you’re doing these
things to disclose them, because it’s important to
combine it in a very safe way. One of the reasons the
Osher Center exists is because, in the early
1990s, Dr. Eisenberg wrote the first article in the
New England Journal of Medicine saying that many, many millions
of people are using this. They’re spending lots of money. And they’re not telling
their doctors about it. And they were afraid about that. I think that
attitude is changing. I think people are more
comfortable talking about it. I think physicians are
being trained in med school to ask proactively and
maybe with less judgment. And also, as the Osher
Center here Brigham and Women’s Hospital,
these clinics are embedded within conventional
care hospital, where the acupuncturist writes notes
so that the neurologist can read them. So I think we’re starting to
break down those barriers. But I think it’s
important to share that. And I think the question
of finding the right doctor is a complicated one. You have to find one that
you feel comfortable with, that you trust, but that
you can be honest with. I do want to reiterate,
with herbal medicine, if it’s something
you’re eating, I do think it’s important
to share with your doctor, because of the risk of
drug-drug interactions. And if your doctor may not
be trained to deal with that, hopefully he can refer
you to someone who can. Part of the training
now of medical students is, when we say we’re taking
the history from the patient is to ask about these things. And this is the new
generation of doctors who are growing up
with from the time that they were in
medical school. It’s going to become
second nature. When that study that
Dr. Wayne mentioned– So just a few years
ago, there was a survey that really
demonstrated that doctors generally do not ask. That’s one of the main reasons
patients don’t talk about it. But that’s starting to change. A related question– what
regulatory hurdles do doctors– but I think it goes
beyond doctors– face when wanting to
incorporate these types into their practice? And I know from a
pharmacology point of view, the regulations are
quite important, right? Yes. I mean, Western medicines
are regulated by the FDA. And there is quite an
industry in America of rather active
substances being sold on the internet
that probably should be. But if they’re sold as a
nutraceutical or something, they may escape FDA regulation. I think people really
should be careful with that in my opinion. There’s also– we learned
at a conference last year– there’s a fascinating
issue of how do you really test if a
traditional medicine actually works by a Western criteria
or of a double-blind clinical trial? And rather little of
that has been done, but is happening
much more in China. But I’m not an expert
on regulatory science. But I mean, I am a huge
believer in the FDA regulation of medicine. I personally have
seen a lot of evidence that the FDA tries to
walk a line of allowing as many new treatments as
possible, while protecting patients. But they have that
double mandate. And I think it’s very
difficult. They’re under huge pressure from
pharmaceutical companies to approve things. I mean, something that
hasn’t been mentioned today is the money aspect of medicine. I mean, in teaching
pharmacology, one of the things I
find most troubling is the cost of
medicine and what’s going on there, which
has become a huge issue. And that’s related
to regulation. I mean, these are
complicated issues that I– I’m just a biochemist. With my students, when they
ask about regulation on money, I usually say, well, I could
take off my professor hat and answer as a citizen, but
as a professor, I my expertise is restricted to the molecular. Well, I think we’ve come
to the end of our session. So thank you all for
your good questions. [APPLAUSE] I have still one
question from Michelle we didn’t want to read out. I don’t know if
she’s still around, but I will be happy
to talk to her.

4 thoughts on “Bridging East and West: New Frontiers in Medicine

  1. Using the expression “Western Medicine” when you actually mean something else seems problematic to me.

    Western medicine is leaches and bleeding. Western medicine is based on faulty principles with no evidential backing such as humor theory (which present parallels to similar principles in Ayurveda & TCM). Western medicine is a random hodgepodge of poorly validated remedies of herbs (and other miscellaneous substances such as mummy powder) sometimes chosen on the basis of sympathetic magic based reasoning. Western medicine is a strange fascination with the consumption of heavy metals (which can also be found in Ayurveda & TCM)

    An effect of this misuse of the term is that it gives the impression of a comparison two sets of things that are comparable (implicit in this is the possibility that diminished acceptance of Eastern medicine may be nothing more than the result of cultural prejudice). Whether intentional or not, this becomes a sort of sleight of hand since, despite the fact that Western medicine and Eastern medicine are comparable (as I point out), any references to integrative medicine are references to the incorporation of medicine that is not evidence based with medicine that is evidence based.

    Evidence based medicine is not Western or Eastern.

  2. seminar#3
    name":Catherine Chimilio
    nyc/ Central America
    How does tai chi differ from meditation?

    viewing via: Youtube

  3. Catherine Chimilio ..Nyc
    ideas & thoughts
    Does harvard have a media center?
    Harvard Broadcast Channel/ HarvardRadio

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