Scientists Who Said CRISPR Is Dangerous Can’t Even Replicate Their Own Results

An alarming study that claimed the gene-editing technique CRISPR could produce hundreds of unexpected mutations in edited genomes has now been followed up by its authors, who say they cannot replicate their controversial result.

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The acknowledgment – which comes in a report of new mice experiments that didn’t introduce such mutations – isn’t technically a retraction of their earlier findings, but it goes a long way to showing that the alarm bells should probably never have been sounded in the first place.

In the new research, the team conducted whole-genome sequencing on two mouse lines that had undergone a CRISPR-editing procedure.

In their original study, they performed the same analysis – and it was the first time whole-genome sequencing had ever been run on a living organism subjected to CRISPR gene-editing.

But unlike the original results, in the new experiments, no unintended gene variants showed up after the genetic alterations.

This contrasts starkly with the team’s first study, in which they found that the two CRISPR-edited mice had sustained over 1,500 single-nucleotide mutations, along with more than 100 larger deletions and insertions that weren’t intended.

These variations showed up in ‘off-target’ portions of the animals’ genomes, suggesting that while CRISPR editing could alter genetic code to fix certain abnormalities, it could also introduce unwanted mutations elsewhere in the genome.

“We feel it’s critical that the scientific community consider the potential hazards of all off-target mutations caused by CRISPR,” one of the team, cell biologist Stephen Tsang from Columbia University said at the time.

That’s a valid concern to have, and it’s something we certainly should be on the lookout for.

But the problems other scientists had with these alarming findings weren’t with the team’s ‘big picture’ approach, but with shortcomings in their method.

Soon after publication, a critique of the original paper by another team pointed out that the two gene-edited mice in the experiment were genetically more closely related to each other than to the third, ‘control’ mice.

The implication was that the ‘unexpected mutations’ Tsang’s team had detected weren’t the result of CRISPR, but simply due to the pre-existing genetics of the mice selected for the study.

And since their sample of animals in the experiment was so small, the results weren’t just unreliable, they were misleading – especially since the researchers were vocal about how this kind of analysis hadn’t been done before, implying it revealed dangerous shortcomings about CRISPR.

Due to the level of controversy and concern over the original study, the editors of Nature Methods – the journal in which the paper was published – formally stated they were concerned about the veracity of the findings, given an “alternative proposed interpretation is that the observed changes are due to normal genetic variation”.

While Tsang’s team did not share those concerns, they nonetheless cared enough to revisit the matter in their new research, and their Corrigendum (correction) analysis is a vindication for CRISPR, acknowledging the ‘unexpected mutations’ hypothesis was, as far as we call tell, a mistake and nothing more.

While defending their “reasonable concern” about such unintended mutations, the authors nonetheless conclude the new results “support the idea that in specific cases, CRISPR-Cas9 editing can precisely edit the genome at the organismal level and may not introduce numerous, unintended, off-target mutations”.

All this is a good thing. It’s the scientific method at work, revising our interpretation based on new information, and while some are arguing the original paper should finally be retracted, that hasn’t happened yet.

Many are probably still angry the original paper was published at all. But for now at least, new data have come to light, and there are still important things we have learned from this research.

Tetanus Shot: How Do We Know That It Works?

Tetanus Shot: How Do We Know That It Works?

Do we know how tetanus shots work? The medical establishment holds a view that a tetanus shot prevents tetanus, but how do we know this view is correct?

The cure for tetanus, a life-threatening and often deadly disease, has been sought from the very inception of the modern field of Immunology.  The original horse anti-serum treatment of tetanus was developed in the late 19th century and introduced into clinical practice at the time when a bio-statistical concept of a randomized placebo-controlled trial (RCT) did not yet exist.  The therapy was infamous for generating a serious adverse reaction called “serum sickness” attributed to the intolerance of humans to horse-derived serum.  To make this tetanus therapy usable, it was imperative to substitute the animal origin of anti-serum with the human origin.  But injecting a lethal toxin into human volunteers as substitutes for horses would have been unthinkable.

A practical solution was found in 1924: pre-treating the tetanus toxin with formaldehyde (a fixative chemical) made the toxin lose its ability to cause clinical tetanus symptoms.  The formaldehyde-treated tetanus toxin is called the toxoid.  The tetanus toxoid can be injected into human volunteers to produce a commercial human therapeutic product from their sera called tetanus immunoglobulin (TIG), a modern substitute of the original horse anti-serum.  The tetanus toxoid has also become the vaccine against clinical tetanus.

The tetanus toxin, called tetanospasmin, is produced by numerous C. tetani bacterial strains.  C. tetani normally live in animal intestines, notably in horses, without causing tetanus to their intestinal carriers.  These bacteria require anaerobic (no oxygen) conditions to be active, whereas in the presence of oxygen they turn into resilient but inactive spores, which do not produce the toxin.  It has been recognized that inactive tetanus spores are ubiquitous in the soil.  Tetanus can result from the exposure to C. tetani via poorly managed tetanus-prone wounds or cuts, but not from oral ingestion of tetanus spores.  Quite to the contrary, oral exposure to C. tetani has been found to build resistance to tetanus without carrying the risk of disease, as described in the section on “Natural Resistance to Tetanus.”

Once secreted by C. tetani germinating in a contaminated wound, tetanospasmin diffuses through the tissue’s interstitial fluids or bloodstream.  Upon reaching nerve endings, it is adsorbed by the cell membrane of neurons and transported through nerve trunks into the central nervous system, where it inhibits the release of a neurotransmitter gamma-aminobutyric acid (GABA).  This inhibition can result in various degrees of clinical tetanus symptoms: rigid muscular spasms, such as lockjaw, sardonic smile, and severe convulsions that frequently lead to bone fractures and death due to respiratory compromise.

Curative effects of the anti-serum therapy as well as the preventative effects of the tetanus vaccination are deemed to rely upon an antibody molecule called antitoxin.  But the assumption that such antitoxin was the sole “active” ingredient in the original horse anti-serum has not been borne out experimentally.  Since horses are natural carriers of tetanus spores, their bloodstream could have contained other unrecognized components, which got harnessed in the therapeutic anti-serum.  “Natural Resistance to Tetanus” discusses other serum entities detected in research animals carrying C. tetani, which better correlated with their protection from clinical tetanus than did serum antitoxin levels.  Nevertheless, the main research effort in the tetanus field remained narrowly focused on antitoxin.

Antitoxin molecules are thought to inactivate the corresponding toxin molecules by virtue of their toxin-binding capacity.  This implies that to accomplish its protective effect, antitoxin must come into close physical proximity with the toxin and combine with it in a way that would prevent or preempt the toxin from binding to nerve endings.  Early research on the properties of a newly discovered antitoxin was done in small-sized research animals, such as guinea pigs.  The tetanus toxin was pre-incubated in a test tube with the animal’s serum containing antitoxin before being injected into another (antitoxin-free) animal, susceptible to tetanus.  Such pre-incubation made the toxin lose its ability to cause tetanus in otherwise susceptible animals — i.e. the toxin was neutralized.

Nevertheless, researchers in the late 19th and early 20th centuries were baffled by a peculiar observation.  Research animals, whose serum contained enough antitoxin to inactivate a certain amount of the toxin in a test tube, would succumb to tetanus when they were injected with the same amount of the toxin.  Furthermore, it was noted that the mode of the toxin injection had a different effect on the ability of serum antitoxin to protect the animal.  The presence of antitoxin in the serum of animals afforded some degree of protection against the toxin injected directly into the bloodstream (intravenously).  However, when the toxin was injected into the skin it would be as lethal to animals containing substantial levels of serum antitoxin as to animals virtually free of serum antitoxin.[1]

The observed difference in serum antitoxin’s protective “behavior” was attributed to the toxin’s propensity to bind faster to nerve cells than to serum antitoxin.  The pre-incubation of the toxin with antitoxin in a test tube, or the injection of the toxin directly into the bloodstream, where serum antitoxin is found, gives antitoxin a head start in combining with and neutralizing the toxin.  However, a skin or muscle injection of the toxin does not give serum antitoxin such a head start.

Researchers in the 21st century have developed an advanced fluorescent labeling technique to track the uptake of the injected tetanus toxin into neurons.  Using this technique, researchers examined the effect of serum antitoxin, which was induced by vaccinating mice with the tetanus toxoid vaccine ahead of time (the same one currently used in humans), on blocking the neuronal uptake and transport of the tetanus toxin fragment C (TTC) to the brain from the site of intramuscular injection.  Vaccinated and non-vaccinated animals showed similar levels of TTC uptake into the brain.  The authors of the study concluded that the “uptake of TTC by nerve terminals from an intramuscular depot is an avid and rapid process and is not blocked by vaccination.”[2] They have further commented that their results appear to be surprising in view of protective effects of immunization with the tetanus toxoid.  Indeed, the medical establishment holds a view that a tetanus shot prevents tetanus, but how do we know this view is correct?

Neonatal Tetanus

Neonatal tetanus is common in tropical under-developed countries but is extremely rare in developed countries.  This form of tetanus results from unhygienic obstetric practices, when cutting the umbilical cord is performed with unsterilized devices, potentially contaminating it with tetanus spores.  Adhering to proper obstetric practices removes the risk of neonatal tetanus, but this has not been the standard of birth practices for some indigenous and rural people in the past or even present.

The authors of a neonatal tetanus study performed in the 1960s in New Guinea describe the typical conditions of childbirth among the locals:

“The mother cuts the cord 1 inch (2.5 cm) or less from the abdominal wall; it is never tied.  In the past she would always use a sliver of sago bark, but now she uses a steel trade-knife or an old razor blade.  These are not cleaned or sterilized in any way and no dressing is put of the cord.  The child lies after birth on a dirty piece of soft bark, and the cut cord can easily become contaminated by dust from the floor of the hut or my mother’s feces expressed during childbirth, as well as by the knife and her finger.”[3]

Not surprisingly, New Guinea had a high rate of neonatal tetanus.  Because improving birth practices seemed to be unachievable in places like New Guinea, subjecting pregnant women to tetanus vaccination was contemplated by public health authorities as a possible solution to neonatal tetanus.

A randomized controlled trial (RCT) assessing the effectiveness of the tetanus vaccine in preventing neonatal tetanus via maternal vaccination was conducted in the 1960s in rural Colombia in a community with high rates of neonatal tetanus.[4] The design of this trial has been recently reviewed by the Cochrane Collaboration for potential biases and limitations and, with minor comments, has been considered of good quality for the purposes of vaccine effectiveness (but not safety) determination.[5] The trial established that a single dose of the tetanus vaccine given before or during pregnancy had a partial effect on preventing neonatal tetanus in the offspring: 43% reduction was observed in the tetanus vaccine group compared to the control group, which instead of the tetanus shot received a flu shot.  A series of two or three tetanus booster shots, given six or more weeks apart before or during pregnancy, reduced neonatal tetanus by 98% in the tetanus vaccine group compared to the flu shot control group.  The duration of the follow up in this trial was less than five years.

In addition to testing the effects of vaccination, this study has also documented a clear relationship between the incidence of neonatal tetanus and the manner in which childbirth was conducted.  No babies delivered in a hospital, by a doctor or a nurse, contracted neonatal tetanus regardless of the mother’s vaccination status.  On the other hand, babies delivered at home by amateur midwives had the highest rate of neonatal tetanus.

Hygienic childbirth appears to be highly effective in preventing neonatal tetanus and makes tetanus vaccination regimen during pregnancy unnecessary for women who give birth under hygienic conditions.  Furthermore, it was estimated in 1989 in Tanzania that 40% of neonatal tetanus cases still occurred in infants born to mothers who were vaccinated during pregnancy,[6] stressing the importance of hygienic birth practices regardless of maternal vaccination status.

Tetanus In Adults

Based on the protective effect of maternal vaccination in neonatal tetanus, demonstrated by an RCT and discussed above, we might be tempted to infer that the same vaccine also protects from tetanus acquired by stepping on rusty nails or incurring other tetanus-prone injuries, when administered to children or adults, either routinely or as an emergency measure.  However, due to potential biologic differences in how tetanus is acquired by newborns versus by older children or adults, we should be cautious about reaching such conclusions without first having direct evidence for the vaccine effectiveness in preventing non-neonatal tetanus.

It is generally assumed that the tetanus toxin must first leach into the blood (where it would be intercepted by antitoxin, if it is already there due to timely vaccination) before it reaches nerve endings.  This scenario is plausible in neonatal tetanus, as it appears that the umbilical cord does not have its own nerves.[7] On the other hand, the secretion of the toxin by C. tetani germinating in untended skin cuts or in muscle injuries is more relevant to how children or adults might succumb to tetanus.  In such cases, there could be nerve endings near germinating C. tetani, and the toxin could potentially reach such nerve endings without first going through the blood to be intercepted by vaccine-induced serum antitoxin.  This scenario is consistent with the outcomes of the early experiments in mice, discussed in the beginning.

Although a major disease in tropical under-developed countries, tetanus in the USA has been very rare.  In the past, tetanus occurred primarily in poor segments of the population in southern states and in Mexican migrants in California.  It was swiftly diminishing with each decade prior to the 1950s (in the pre-vaccination era), as inferred from tetanus mortality records and similar case-fatality ratios (about 67-70%) in the early 20th century[8] versus the mid-20th century).[9] The tetanus vaccine was introduced in the USA in 1947 without performing any placebo-controlled clinical trials in the segment of the population (children or adults), where it is now routinely used.

The rationale for introducing the tetanus vaccine into the U.S. population, at low overall risk for tetanus anyway, was simply based on its use in the U.S. military personnel during World War II.  According to a post-war report:[10]

  1. the U.S. military personnel received a series of three injections of the tetanus toxoid, routine stimulating injection was administered one year after the initial series, and an emergency stimulating dose was given on the incurrence of wounds, severe burns, or other injuries that might result in tetanus;
  2. throughout the entire WWII period, 12 cases of tetanus have been documented in the U.S. Army;
  3. in World War I there were 70 cases of tetanus among approximately half a million admissions for wounds and injuries, an incidence of 13.4 per 100,000 wounds.  In World War II there were almost three million admissions for wounds and injuries, with a tetanus case rate of 0.44 per 100,000 wounds.

The report leads us to conclude that vaccination has played a role in tetanus reduction in wounded U.S. soldiers during WWII compared to WWI, and that this reduction vouches for the tetanus vaccine effectiveness.  However, there are other factors (e.g. differences in wound care protocols, including the use of antibiotics, higher likelihood of wound contamination with horse manure rich in already active C. tetani in earlier wars, when horses were used by the cavalry, etc.), which should preclude us from uncritically assigning tetanus reduction during WWII to the effects of vaccination.

Severe and even deadly tetanus is known to occur in recently vaccinated people with high levels of serum antitoxin.[11] Although the skeptic might say that no vaccine is effective 100% of the time, the situation with the tetanus vaccine is quite different.  In these cases of vaccine-unpreventable tetanus, vaccination was actually very effective in inducing serum antitoxin, but serum antitoxin did not appear to have helped preventing tetanus in these unfortunate individuals.

The occurrence of tetanus despite the presence of antitoxin in the serum should have raised a red flag regarding the rationale of the tetanus vaccination program.  But such reports were invariably interpreted as an indication that higher than previously thought levels of serum antitoxin must be maintained to protect from tetanus, hence the need for more frequent, if not incessant, boosters.  Then how much higher “than previously thought” do serum levels of antitoxin need to be to ensure protection from tetanus?

Crone & Reder (1992) have documented a curious case of severe tetanus in a 29-year old man with no pre-existing conditions and no history of drug abuse, typical among modern-day tetanus victims in the USA.  In addition to the regular series of tetanus immunization and boosters ten years earlier during his military service, this patient had been hyper-immunized (immunized with the tetanus toxoid to have extremely high serum antitoxin) as a volunteer for the purposes of the commercial TIG production.  He was monitored for the levels of antitoxin in his serum and, as expected, developed extremely high levels of antitoxin after the hyper-immunization procedure.  Nevertheless, he incurred severe tetanus 51 days after the procedure despite clearly documented presence of serum antitoxin prior to the disease.  In fact, upon hospital admission for tetanus treatment his serum antitoxin levels measured about 2,500 times higher than the level deemed protective.  His tetanus was severe and required more than five weeks of hospitalization with life-saving measures.  This case demonstrated that serum antitoxin has failed to prevent severe tetanus even in the amounts 2,500 times higher than what is considered sufficient for tetanus prevention in adults.

The medical establishment chooses to turn a blind eye to the lack of solid scientific evidence to substantiate our faith in the tetanus shot.  It also chooses to ignore the available experimental and clinical evidence that contradicts the assumed but unproven ability of vaccine-induced serum antitoxin to reduce the risk of tetanus in anyone other than maternally-vaccinated neonates, who do not even need this vaccination measure when their umbilical cords are dealt with using sterile techniques.

Ascorbic Acid In Tetanus Treatment

Anti-serum is not the only therapeutic measure tried in tetanus treatment.  Ascorbic acid (Vitamin C) has also been tried.  Early research on ascorbic acid has demonstrated that it too could neutralize the tetanus toxin.[12]

In a clinical study of tetanus treatment conducted in Bangladesh in 1984, the administration of conventional procedures, including the anti-tetanus serum, to patients who contracted tetanus left 74% of them dead in the 1-12 age group and 68% dead in the 13-30 age group.  In contrast, daily co-administration of one gram of ascorbic acid intravenously had cut down this high mortality to 0% in the 1-12 age group, and to 37% in the 13-30 age group.[13] The older patients were treated with the same amount of ascorbic acid without adjustments for their body weight.

Although this was a controlled clinical trial, it is not clear from the description of the trial in the publication by Jahan et al. whether or not the assignment of patients into the ascorbic acid treatment group versus the placebo-control group was randomized and blinded, which are crucial bio-statistical requirements for avoiding various biases.  A more definitive study is deemed necessary before intravenous ascorbic acid can be recommended as the standard of care in tetanus treatment.[14] It is odd that no properly documented RCT on ascorbic acid in tetanus treatment has been attempted since 1984 for the benefit of developing countries, where tetanus has been one of the major deadly diseases.  This is in stark contrast to the millions of philanthropic dollars being poured into sponsoring the tetanus vaccine implementation in the Third world.

Natural Resistance To Tetanus

In the early 20th century, investigators Drs. Carl Tenbroeck and Johannes Bauer pursued a line of laboratory research, which was much closer to addressing natural resistance to tetanus than the typical laboratory research on antitoxin in their days.  Omitted from immunologic textbooks and the history of immunologic research, their tetanus protection experiments in guinea pigs, together with relevant serological and bacteriological data in humans, nevertheless provide a good explanation for tetanus being a rather rare disease in many countries around the world, except under the conditions of past wars.

In the experience of these tetanus researchers, the injection of dormant tetanus spores could never by itself induce tetanus in research animals.  To induce tetanus experimentally by means of tetanus spores (as opposed to by injecting a ready-made toxin, which never happens under natural circumstances anyway), spores had to be premixed with irritating substances that could prevent rapid healing of the site of spore injection, thereby creating conditions conducive to spore germination.  In the past, researchers used wood splinters, saponin, calcium chloride, or aleuronat (flour made with aleurone) to accomplish this task.

In 1926, already being aware that oral exposure to tetanus spores does not lead to clinical tetanus, Drs. Tenbroeck and Bauer set out to determine whether feeding research animals with tetanus spores could provide protection from tetanus induced by an appropriate laboratory method of spore injection.  In their experiment, several groups of guinea pigs were given food containing distinct strains of C. tetani.  A separate group of animals were used as controls—their diet was free of any C. tetani.  After six months, all groups were injected under the skin with spores premixed with aleuronat.  The groups that were previously exposed to spores orally did not develop any symptoms of tetanus upon such tetanus-prone spore injection, whereas the control group did.  The observed protection was strain-specific, as animals still got tetanus if injected with spores from a mismatched strain—a strain they were not fed with.  But when fed multiple strains, they developed protection from all of them.

Quite striking, the protection from tetanus established via spore feeding did not have anything to do with the levels of antitoxin in the serum of these animals.  Instead, the protection correlated with the presence of another type of antibody called agglutinin—so named due to its ability to agglutinate (clump together) C. tetani spores in a test tube.  Just like the observed protection was strain-specific, agglutinins were also strain-specific.  These data are consistent with the role of strain-specific agglutinins, not of antitoxin, in natural protection from tetanus.  The mechanism thereby strain-specific agglutinins have caused, or correlated with, tetanus protection in these animals has remained unexplored.

In the spore-feeding experiment, it was still possible to induce tetanus by overwhelming this natural protection in research animals.  But to accomplish this task, a rather brute force procedure was required.  A large number of purified C. tetani spores were sealed in a glass capsule; the capsule was injected under the skin of research animals and then crushed.  Broken glass pieces were purposefully left under the skin of the poor creatures so that the gory mess was prevented from healing for a long time.  Researchers could succeed in overwhelming natural tetanus defenses with this excessively harsh method, perhaps mimicking a scenario of untended war-inflicted wounds.

How do these experimental data in research animals relate to humans?  In the early 20th century, not only animals but also humans were found to be intestinal carriers of C. tetani without developing tetanus.  About 33% of tested human subjects living around Beijing, China were found to be C. tetani carriers without any prior or current history of tetanus disease.[15] Bauer & Meyer (1926) cite other studies, which have reported around 25% of tested humans being healthy C. tetani carriers in other regions of China, 40% in Germany, 16% in England, and on average 25% in the USA, highest in central California and lowest on the southern coast.  Based on the California study, age, gender, or occupation denoting the proximity to horses did not appear to play a role in the distribution of human C. tetani carriers.

Another study was performed back in the 1920s in San Francisco, CA.[16] About 80% of the examined subjects had various levels of agglutinins to as many as five C. tetani strains at a time, although no antitoxin could be detected in the serum of these subjects.  C. tetani organisms could not be identified in the stool of these subjects either.  It is likely that tetanus spores were in their gut transiently in the past, leaving serological evidence of oral exposure, without germinating into toxin-producing organisms.  It would be important to know the extent of naturally acquired C. tetani spore agglutinins in humans in various parts of the world now, instead of relying on the old data, but similar studies are not likely to be performed anymore.

Regrettably, further research on naturally acquired agglutinins and on exactly how they are involved in the protection from clinical tetanus appears to have been abandoned in favor of more lucrative research on antitoxin and vaccines.  If such research continued, it would have given us clear understanding of natural tetanus defenses we may already have by virtue of our oral exposure to ubiquitous inactive C. tetani spores.

Since the extent of our natural resistance to clinical tetanus is unknown due to the lack of modern studies, all we can be certain of is that preventing dormant tetanus spores from germinating into toxin-producing microorganisms is an extremely important measure in the management of potentially contaminated skin cuts and wounds.  If this crucial stage of control—at the level of preventing spore germination—is missed and the toxin production ensues, the toxin must be neutralized before it manages to reach nerve endings.

Both antitoxin and ascorbic acid exhibit toxin-neutralizing properties in a test tube.  In the body, however, vaccine-induced antitoxin is located in the blood, whereas the toxin might be focally produced in the skin or muscle injury.  This creates an obvious physical impediment for toxin neutralization to happen effectively, if at all, by means of vaccine-induced serum antitoxin.  Furthermore, no placebo-controlled trials have ever been performed to rule out the concern about such an impediment by providing clear empirical evidence for the effectiveness of tetanus shots in children and adults.  Nevertheless, the medical establishment relies upon induction of serum antitoxin and withholds ascorbic acid in tetanus prevention and treatment.

When an old medical procedure of unknown effectiveness, such as the tetanus shot, has been the standard of medical care for a long time, finalizing its effectiveness via a modern rigorous placebo-controlled trial is deemed unethical in human research.  Therefore, our only hope for the advancement of tetanus care is that further investigation of the ascorbic acid therapy is performed and that this therapy becomes available to tetanus patients around the world, if confirmed effective by rigorous bio-statistical standards.

Until then, may the blind faith in the tetanus shot help us!

Learn more by reading Tetyana’s groundbreaking and lucid book Vaccine Illusion. 

About The Author

Tetyana Obukhanych earned her Ph.D. in Immunology at the Rockefeller University in New York, NY with her research dissertation focused on understanding immunologic memory, perceived by the mainstream biomedical establishment to be key to vaccination and immunity.  She was subsequently involved in laboratory research as a postdoctoral research fellow within leading biomedical institutions, such as Harvard Medical School and Stanford University School of Medicine.

Having had several childhood diseases despite being properly vaccinated against them, Dr. Obukhanych has undertaken a thorough investigation of scientific findings regarding vaccination and immunity.  Based on her analysis, Dr. Obukhanych has articulated a view that challenges mainstream assumptions and theories on vaccination in her e-book Vaccine Illusion.

Dr. Obukhanych continues her independent in-depth analysis of peer-reviewed scientific findings related to vaccination and natural requirements of the immune system function.  Her goal is to bring a scientifically-substantiated and dogma-free perspective on vaccination and natural immunity to parents and health care practitioners.  Visit for more information.

[1] Tenbroeck, C. & Bauer, J.H. The immunity produced by the growth of tetanus bacilli in the digestive tract. J Exp Med 43, 361-377 (1926).

[2] Fishman, P.S., Matthews, C.C., Parks, D.A., Box, M. & Fairweather, N.F. Immunization does not interfere with uptake and transport by motor neurons of the binding fragment of tetanus toxin. J Neurosci Res 83, 1540-1543 (2006).

[3] Schofield, F.D., Tucker, V.M. & Westbrook, G.R. Neonatal tetanus in New Guinea. Effect of active immunization in pregnancy. Br Med J 2, 785-789 (1961).

[4] Newell, K.W., Dueñas Lehmann, A., LeBlanc, D.R. & Garces Osorio, N. The use of toxoid for the prevention of tetanus neonatorum. Final report of a double-blind controlled field trial. Bull World Health Organ 35, 863-871 (1966).

[5] Demicheli, V., Barale, A. & Rivetti, A. Vaccines for women to prevent neonatal tetanus. Cochrane Database Syst Rev 5:CD002959 (2013).

[6] Maselle, S.Y., Matre, R., Mbise, R. & Hofstad, T. Neonatal tetanus despite protective serum antitoxin concentration. FEMS Microbiol Immunol 3, 171-175 (1991).

[7] Fox, S.B. & Khong, T.Y. Lack of innervation of human umbilical cord. An immunohistological and histochemical study. Placenta 11, 59-62 (1990).

[8] Bauer, J.H. & Meyer, K.F. Human intestinal carriers of tetanus spores in California. J Infect Dis 38, 295-305 (1926).

[9] LaForce, F.M., Young, L.S. & Bennett, J.V. Tetanus in the United States (1965-1966): epidemiologic and clinical features. N Engl J Med 280, 569-574 (1969).

[10] Editorial: Tetanus in the United States Army in World War II. N Engl J Med 237, 411-413 (1947).

[11] Abrahamian, F.M., Pollack, C.V., Jr., LoVecchio, F., Nanda, R. & Carlson, R.W. Fatal tetanus in a drug abuser with “protective” antitetanus antibodies. J Emerg Med 18, 189-193 (2000).

Beltran, A. et al. A case of clinical tetanus in a patient with protective antitetanus antibody level. South Med J 100, 83 (2007).

Berger, S.A., Cherubin, C.E., Nelson, S. & Levine, L. Tetanus despite preexisting antitetanus antibody. JAMA 240, 769-770 (1978).

Crone, N.E. & Reder, A.T. Severe tetanus in immunized patients with high anti-tetanus titers. Neurology 42, 761-764 (1992).

Passen, E.L. & Andersen, B.R. Clinical tetanus despite a protective level of toxin-neutralizing antibody. JAMA 255, 1171-1173 (1986).

Pryor, T., Onarecker, C. & Coniglione, T. Elevated antitoxin titers in a man with generalized tetanus. J Fam Pract 44, 299-303 (1997).

[12] Jungeblut, C.W. Inactivation of tetanus toxin by crystalline vitamin C (L-ascorbic acid). J Immunol 33, 203-214 (1937).

[13] Jahan, K., Ahmad, K. & Ali, M.A. Effect of ascorbic acid in the treatment of tetanus. Bangladesh Med Res Counc Bull 10, 24-28 (1984).

[14] Hemilä, H. & Koivula, T. Vitamin C for preventing and treating tetanus. Cochrane Database Syst Rev 2:CD006665 (2008).

[15] Tenbroeck, C. & Bauer, J.H. The tetanus bacillus as an intestinal saprophyte in man. J Exp Med 36, 261-271 (1922).

[16] Coleman, G.E. & Meyer, K.F. Study of tetanus agglutinins and antitoxin in human serums. J Infect Dis 39, 332-336 (1926).

We Are All Wounded Healers

One of the primary mythic patterns informing and giving shape to what is collectively playing out on the world stage—as well as within the human psyche—is the archetype of the “wounded healer.” The archetype of the wounded healer has to do with discovering the healing encoded within our wound, as if we are finding light that is hidden within the darkness. The wounded healer is the deeper pattern that is at the bottom of the process of healing itself. The figure of the healer who is wounded symbolically reveals to us that it is only by being willing to face, consciously experience and go through our wound do we receive its blessing. We have all been wounded, which is to say that we are all potentially wounded healers in training.

“The process of individuation,” of becoming whole, to quote C. G. Jung’s closest colleague Marie Louise von Franz, “generally begins with a wounding of the personality and the suffering that accompanies it. This initial shock amounts to a sort of ‘call,’ although it is not often recognized as such.” 1 Once we become wounded, we usually project the obstruction onto some external event or person. Upon closer investigation, however, our wound brings into bold relief the nature of our limited condition—it is not imposed on us from outside by external powers, but rather, the genesis of the forces obstructing us arises from within our own being. Paradoxically, it is only by experiencing our limitation to the utmost can we get in touch with the part of ourselves that is connected with the infinite.

As if following a deeper calling, the event of our wounding sends us on a journey in search of ourselves. It is a wounding experience when the ego (the smaller self) initially encounters something greater and more powerful than itself, which is to say that the event of our wounding is initiatory, potentially leading us to our true vocation and destiny in life.

Breakdown or breakthrough?

Being wounded can catalyze a breakdown or breakthrough, depending upon our ability to creatively express and give meaning to our overwhelming inner experience. The experience of becoming wounded can seemingly break us, while simultaneously breaking us open, thereby facilitating a connection to the world of the unconscious with its inexhaustible riches. In other words, our wound is potentially the doorway through which flows the revitalizing stream of the unconscious with its infinite creativity.

When our conscious ego encounters a “charged” unconscious, if the accompanying tension—experienced as an uncomfortable state of suffering—can be endured, something new and creative that the ego couldn’t have made by itself is the result. 2 As an added bonus, being in touch with our woundedness is a hedge against inflation, keeping us grounded and ensuring against any tendency we might have to become too self-important.

Songwriter Leonard Cohen sings, “There is a crack, a crack in everything, that’s where the light comes in.” 3 Though entering us through the cracks in our fragmented self, this power of light—the numinous dimension of the psyche with its mytho-poetic nutrients—is imbued with an intrinsic living intelligence that can deeply enrich our experience of being human. Similarly, the esteemed psychologist William James says, “If there are supernormal powers, it is through the cracked and fragmented self that they enter.” 4 The great 20 th century writer Ernest Hemingway said that the world breaks everyone, but afterwards, some of us become stronger in the broken places. 5

Challenge shows you your whole self

As if prompting our evolutionary growth, our wound can potentially reveal itself to be a sacred affliction that is mysteriously intertwined with our creative genius. The idea that difficulty, misfortune and wounding wakes up the genius 6 pervades classical literature. 7 Similarly, many spiritual traditions point out that the greatest realized beings have attained their enlightenment not because things were going smoothly, but because they encountered obstacles along their path which they were able to alchemically transform into catalysts for their realization.

The anguished realization of our wounded condition is actually the first step toward recovery of our lost wholeness. Wholeness doesn’t necessarily mean not having a wound; rather, it is to embrace the wound that we do have. The archetype of the wounded healer symbolizes a type of consciousness that can hold the seemingly mutually exclusive and contradictory opposites of being both wounded and whole at one and the same time.

As long as we feel victimized, bitter and resentful towards our wound, continually seeking to escape from suffering it, we remain inescapably bound to it. Paradoxically, we can only escape this seemingly endless suffering by accepting another kind of suffering that is purifying. It is important to distinguish these two kinds of suffering—on the one hand, there is the unnecessary, self-created suffering that is neurotic, meaningless and has no benefit (this is the type of chronic suffering for which the Buddha found the cure). Compared to this is another type of suffering that, seen through a spiritual/theological lens, can be envisioned as “coming from God.” 8 Accounts of the Christian mystics, including St. John of the Cross (author of The Dark Night of Soul)9 are replete with this second type of suffering—what Jung refers to as “genuine suffering”—which is a form of suffering they would not have missed for the world. 10 To quote Jung, “Real liberation comes not from glossing over or repressing painful states of feeling, but only from experiencing them to the full.” 11

Personal suffering, planetary suffering

There is a transformative and healing effect when we recognize how our individual suffering is a personalized reflection or instantiation of the collective suffering that pervades the entire field of consciousness. As if an iteration of a deeper fractal, our personal wound is, in condensed form, the localized signature of the impersonal collective wound in which we all partake. It is liberating and healing to step out of pathologizing ourselves and re-contextualize our personal conflicts, problems and wounds as part of a wider transpersonal pattern enfolded throughout the global field of human experience. As if potential shamans who have taken on (which has a double meaning: to confront, as well as to take into ourselves) the illness in the field, we are suffering from the spirit of the age.

Being a wounded healer doesn’t require us to be explicitly wounded through some specific life trauma; part of the nature of being human is to have been wounded in one way or another. Being interconnected with the whole of reality, we all carry a piece of the collective wound that is holographically encoded throughout the nonlocal field of consciousness. Our relationship to our wound—how we carry it—determines if the deeper, underlying archetype of the wounded healer enlists us to be one of its living instruments.

Recreated anew in each instant, our wound is not a static entity, but rather a continually unfolding dynamic process in which we are participating moment-by-moment. Our wound is not just happening to us in the role of a passive victim; we have a hand in its ongoing re-generation. Realizing our involvement in its genesis, we can relate to our wound as being an ephemeral yet dynamically changing artifact of the moment-to-moment dynamics of our creative process. In viewing our wound in this way, we do not make it “real” and grant it an undeserved solidity or invest it with an unwarranted substantial existence. When the wound comes up, instead of interpreting it as evidence to confirm our identity as someone who is wounded, we can recognize the wound’s momentary appearance as its own self-liberating revelation, a perspective which simultaneously frees us from being caught by it. The key is to consciously experience our wound without identifying ourselves with it.

In 1981, Paul Levy had a life-changing spiritual awakening, during the early stages of which he was repeatedly hospitalized, medicated and misdiagnosed as being mentally ill. Fortunately, he was able to extricate himself from the psychiatric establishment and continue his process of self-discovery. A pioneer in the field of spiritual emergence, Paul Levy is a wounded healer in private practice, assisting others who are also awakening to the dreamlike nature of reality. He is the author of the upcoming book The Quantum Revelation: A Radical Synthesis of Science and Spirituality (SelectBooks, May 2018), Awakened by Darkness: When Evil Becomes Your Father (Awaken in the Dream Publishing, 2015), Dispelling Wetiko: Breaking the Curse of Evil (North Atlantic Books, 2013) and The Madness of George W. Bush: A Reflection of Our Collective Psychosis (AuthorHouse, 2006). Paul is the founder of the “Awakening in the Dream Community” in Portland, Oregon. An artist, he is deeply steeped in the work of C. G. Jung, and has been a Tibetan Buddhist practitioner for over thirty years. Please visit Paul’s website You can contact Paul at; he looks forward to your reflections. References:

  • 1 C. G. Jung, Man and His Symbols (New York: Doubleday, 1964), 166.
  • 2 Jung refers  to this as the “transcendent function” or “reconciling symbol.”
  • 3 From his song “Anthem.”
  • 4 Quoted in Eugene Taylor, William James on Exceptional Mind States: The 1896 Lowell Lectures (Amherst, MA: The University of Massachusetts Press, 1984), 110.
  • 5 The opposite of post-traumatic stress disorder, this is called “post-traumatic growth.” See Jim Rendon, Upside: The New Science of Post-Traumatic Growth (New York: Touchstone, 2015).
  • 6 Etymologically, the genius is related to the inner voice and guiding spirit.
  • 7 To quote Ovid, “ingenium mala saepe movent” – misfortunes often stir up genius.
  • 8 This idea is expressed in the Bible, “Blessed are they that suffer for righteousness sake.”
  • 9 In this classic treatise, St. John talks about how the soul “suffers exceedingly when the divine light shines upon it.” He likens this divine-sponsored suffering to the process of purifying gold in a furnace.
  • 10 To quote Meister Eckhart, “Suffering is the fastest horse that can carry us to completion.”
  • 11 Jung, The Archetypes and the Collective Unconscious, CW 9i (New York: Pantheon Books, 1959), para. 587.

Relationships – The Four Golden Threads

“I no longer believed in the idea of soul mates, or love at first sight. But I was beginning to believe that a very few times in your life, if you were lucky, you might meet someone who was exactly right for you. Not because he was perfect, or because you were, but because your combined flaws were arranged in a way that allowed two separate beings to hinge together.” ~ Lisa Kleypas

In order for an intimate relationship to be healthy and sustainable, The Four Golden Threads — Physical, Emotional, Intellectual and Spiritual — need to be active and connected between two people. When entering into an intimate relationship, many people don’t pause long enough to make sure that all of these threads are lit up and in alignment with their partner. This simple misstep can lead to short-term pain or long-term misery, especially when two mismatched partners get married and have children together. Ultimately, what’s missing in the beginning will be the thing that derails the relationship in the end.

Relationships - The Four Golden Threads - Couple

Think about it. In the beginning of a relationship when everything is new and fresh, we often tell ourselves, “So what if everything’s not quite what we’re looking for?” However, over time, little bits of compromise creep in. We see what we want to see and ignore the rest. It’s usually months or years later, in retrospect that we see that the clues of what went wrong were always there; we just chose not to pay attention to them.

Grace and Hope

Not long ago, “Grace”, a client of mine, told me the story of her recent marriage and divorce. Grace’s husband was a lifelong friend that reappeared in her life after his marriage broke up. They got together and the relationship moved very quickly — too quickly for her — but as she put it, she got “swept along” by it. Then when he got down on his knee to propose in front of her family, she was too embarrassed to say no. Grace ignored her intuition, which told her to wait, and she ended up selling her much-loved Seattle condo, moving away from her family and setting up house in Kansas.

During the first few years of Grace’s marriage, the red flags she should have heeded began to reveal themselves, and she knew she’d made a terrible mistake. Ironically, one of her best sources of solace was her husband’s ex-wife. She understood what Grace was dealing with better than anyone, and the two became fast friends.

All the while, Grace knew she only had herself to blame. Well into her forties, this was her first marriage. Her fear of embarrassment and being judged by her family was so strong that she willingly ignored her inner voice and walked into a situation that she knew might not work.

There are thousands of similar stories out there. The point is to slow down, listen and observe. It can be so easy when we’re swept up in the excitement of a new relationship and the promise of companionship, to compromise and ultimately sacrifice our own needs and values in the false hope that things will change.

News flash: they usually don’t!

Let’s first examine each of The Four Golden Threads with special attention to the impact of their absence:


If we enter a relationship with a weak or absent physical connection, what might that look like?

  • No chemistry
  • No passion or excitement
  • No playful flirting and fun
  • No meaningful or close feelings of intimacy
  • No deep levels of affection


If we enter a relationship with a weak or absent emotional connection, what might that look like?

  • No shared vulnerability
  • No healing of emotional wounds
  • No understanding of your emotional states
  • No compassion or empathy for your experience
  • No real nurturing or heartfelt affection


If we enter a relationship with a weak or absent intellectual connection, what might that look like?

  • No one to share your big picture interests
  • No one to talk with for long hours into the night
  • No one to share your favorite movies, music, theater, books, etc.
  • No one to continually pique your interest and curiosity
  • No one to learn new things from


If we enter a relationship with a weak or absent spiritual connection, what might that look like?

  • No shared values or vision
  • No one to witness your experiences
  • No one to support you as you navigate the inner realms
  • No one to see and recognize your Higher Self
  • No spiritual companion

It’s much easier to see when spelled out this way. Once you recognize the warning signs, you might not want to get involved with someone you thought was a perfect partner after all. Far better to open your eyes, get some clarity before you make a long-term commitment and find yourself in the land of regret. In addition, when one of The Four Golden Threads is missing, you’ll always have that gnawing feeling in the core of your being telling you something’s wrong.

Examining The Four Golden Threads helps us to move this subject out of the closet, where it’s vague and hidden, into the light to be seen. Once illuminated, we can recognize our patterns of behavior.

Why then, are so many of us willing to compromise and leave one of these four threads out? More than likely it’s due to the following:

  • Fear of being alone
  • Wanting someone (anyone) to share life’s experiences with
  • Not believing that someone with all four areas of compatibility is out there
  • Impatience
  • A lack of trust in life
  • A desire to escape from one’s self
  • Pressure from friends and family to be in a relationship
  • A willingness to settle for less than you deserve

This list helps to clarify something that can be difficult to see and opens up the possibility of making different choices going forward.

Now that we’ve shed some light on what can happen when one of The Four Golden Threads is missing, let’s imagine what it would be like to partner with someone with whom all Four Golden Threads connect.

Your Partner…

  • … shares vulnerabilities with you
  • … is willing to help you heal your emotional wounds
  • … understands your emotional states
  • … is compassionate and has empathy for your experience
  • … shares your interests
  • … supports your creative expression
  • … enjoys talking with you for long hours into the night
  • … enjoys sharing your favorite movies, music, theater, books with you
  • … continually piques your interest and curiosity
  • … is attracted to you
  • … enjoys meaningful or close feelings of intimacy with you
  • … frequently expresses deep levels of affection with you
  • … has chemistry with you
  • … shares and supports your beliefs, values and life purpose
  • … wants to witness your experiences
  • … supports you as you navigate the inner realms
  • … loves you unconditionally, both your gifts and your wounds

This may sound idealistic and a bit too good to be true, however, when you look at the option of leaving one of those things out, it doesn’t seem even worth pursuing a relationship like that. Does this mean we need to seek the impossible in a partner? Do we need to look for the perfect match?

No, neither of those things.

It means we need to look for the perfect partner for us. We’re not looking for a pie-in-the-sky dream partner, we’re looking for someone whose gifts and wounds match well with our own. In other words, when you meet someone with whom all Four Golden Threads connect, you have the opportunity to get to know this person’s innate gifts and wounds, to love and accept the good with the bad and to work with all of it, because the blessings are so damn worth it.

The trick is to enter into the relationship fully cognizant of the fact that in order for a relationship to be healthy, fulfilling and sustainable for both parties, all four threads need attention and nurturing. Ignore one and the relationship will, without a doubt, fail or be severely handicapped.

Relationships - The Four Golden Threads

As humans we need to connect with all four threads to feel whole and truly express who we are.

To take this to an even higher level, ideally we want to be partnering with someone who is aligned with our life purpose, supporting us to authentically express our gifts and deepest passions so that our lives are rich and meaningful. This way of living is energizing and fuels us. That way, the relationship is not a source of energy, but rather a place to share ourselves. It becomes a shared journey rather than a place to get all of our needs met. It’s also a place where we can share our deepest fears and pain so they can be witnessed and healed. A good relationship will allow for a high level of trust, so that vulnerability comes naturally, hastening the healing process.

How sad that we were not taught how to use our most intimate relationships as a context for deep inner work and healing! Alas, many come to this place late in life and pay lots of money to do workshops, seminars and retreats to sort out the inner mess, not suspecting that when they return from those experiences, they’ll have to reconcile these issues in their relationships. This is a missed opportunity because while weekend workshops are great, the wisdom and insights don’t usually stick, which is why it’s better to work through issues in the ongoing “workshop” of our relationships.

All relationships are sacred — love combined with respect. All life is asking of us is to treat others and ourselves with love and respect. With The Four Golden Threads as our guide, we can partner with another in a way that nurtures and inspires us, and supports us to live the life of our highest joy.

Chocolate Trumps Fluoride in the Fight Against Tooth Decay

Imagine using chocolate to remineralize tooth enamel while discouraging cavities. Sound too good to be true? A researcher at Tulane University has come close with a non-toxic chocolate extract that outperforms fluoride. Taking into account the dangers associated with fluoride, and its presence in commercial toothpastes, a chocolate-based replacement offers a palatable solution.

Poison on the tip of your toothbrush

Fluoride has come under scrutiny over the years — and rightly so. Found in toothpaste, as well as our water supply, this industrial waste has been classified as “the most damaging environmental pollutant of the Cold War” by author Christopher Bryson, who wrote The Fluoride Deception. Linked with decreased thyroid and kidney function, endocrine disruption, infertility, lowered intelligence, cardiovascular disease, weak bones and increased cancer risk, fluoride is exceptionally harmful. (See: 15 Facts Most People Don’t Know About Fluoride.)

Moreover, the Fluoride Action Network calls attention to the fact that “just one… gram of fluoride toothpaste (a full strip of paste on a regular-sized brush) is sufficient to cause acute fluoride toxicity in [a] two-year old child (e.g., nausea, vomiting, headache, diarrhea).”

Fortunately, we have an alternative to such toxic madness — in the surprising form of chocolate.

Food of the gods, a boon for teeth

Arman Sadeghpour, a doctoral candidate at Tulane University, discovered an unlikely player in the fight against tooth decay — an extract derived from the cacao bean. Using leftover human molars, he applied either fluoride or cocoa extract. Next, the teeth were placed in a specialized machine which pressed an indentation into each tooth. The depth of the depression indicates the hardness of the enamel. Sadeghpour observed that the teeth treated with cocoa extract were more resilient than those where fluoride was used.

In a second test, each tooth was left overnight in a solution of either fluoride or cocoa extract. The following day, Sadeghpour subjected the tooth surface to strong acid for 10 minutes. When he measured the amount of calcium that had leached into the acid, he found that the teeth soaked in cocoa extract had lost 8 percent less calcium than their fluoride counterparts.

According to a press release by the university,

The extract, a white crystalline powder whose chemical makeup is similar to caffeine, helps harden teeth enamel, making users less susceptible to tooth decay. The cocoa extract could offer the first major innovation to commercial toothpaste since manufacturers began adding fluoride to toothpaste in 1914.

Understanding and Overcoming Food Addiction

It’s getting late. You’ve had a long stressful day at work and you are sitting flicking through the TV channels. You are bored. You go to the kitchen and grab the big bag of snacks you bought earlier. You figure you’ll just eat a few and save the rest. Pretty soon you are scrabbling around for crumbs at the bottom of the packet. You feel a bit sick. You go back through to the kitchen and grab some chocolate. You tell yourself you shouldn’t but you do it anyway. It makes you feel better. It makes you feel less stressed.

Understanding and Overcoming Food Addiction 6

Later you beat yourself up. Why didn’t you just grab something healthy? Why didn’t you stop when you’d had enough?

You tell yourself you are only eating because you are bored. You decide that tomorrow you will find something else to do so you don’t get bored.

Tomorrow comes. You haven’t found something else to do. You switch the TV on. You go and fetch a bag of snacks. You’ll find that thing tomorrow. Tonight you are too tired.

Night after night you repeat the same behaviour.

You try diets and they kind of work, for a while, but then it gets too much like hard work and you have a day off. Then a few days. And somehow you can’t motivate yourself to start again.

You feel like you have no willpower. What is wrong with you? All these other people seem to be able to eat whatever they want and they’re skinny. Life isn’t fair.

Subconscious action

Obesity has become such a problem all over the globe that it’s now referred to as an epidemic. Everyone is looking for the magic pill. Not a week goes by where someone doesn’t spout the latest research as evidence that some method or other is the answer to obesity: Weigh kids at school, refuse medical treatment for people with a high BMI, educate on healthy foods, etc.

Most research implies that people choose to be overweight; that they choose to have an unhealthy relationship with food. In my experience, over-eating or keeping weight on, is not a cognitive choice. The behaviours that lead to obesity are driven by the subconscious. We know the subconscious drives our actions for at least 90% of the day, so if it has a reason for doing something, then ultimately you will run out of conscious willpower and concede. The problem is that your ability to reason and exert self-control sits in the other 10% of your brain. The 90% is primitive, emotional, and quite frankly, stupid!

So what drives the subconscious if it isn’t logic and reason? How does it know the right way to react? What is the intent?

The purpose of the subconscious is to keep us safe and well. We are all familiar with how it keeps our heart pumping, fights off viruses etc. What most of us don’t realise is that it is also trying to keep us safe from stuff that is external to us; stuff in our environment that may cause us harm. Think about a tiger cub. It will learn from its mum and dad how to hunt, how to sleep safely and loads of other skills. Then, when it goes out on its own as an adult, it will be well prepared to survive.

We are the same, although for us it’s a bit more complex.

Understanding and Overcoming Food Addiction 5

All through childhood your subconscious is looking for lessons that it can learn to keep you safe as an adult; lessons that will go into a rulebook to be followed in that 90% of the time where it is in charge. The lessons for keeping you safe and well internally are pretty scientific, but the lessons for threats coming from your environment can be a little less clear. As far as the subconscious is concerned, it needs this rule book to truly give you the best chance of survival. The problem is that the brain is due a software upgrade. The rules are written based on the caveman principles of survival, where we needed to avoid sabre-toothed tigers and hunt to stay alive.


As a Cognitive Hypnotherapist, I guide clients to rewrite the rules that their subconscious is following. This frees them up from behaviours and thoughts that are holding them back in life. In my book “The Caveman Rules of survival” I explain in detail how the subconscious works and explore the three caveman rules of survival that our brains follow. Using case studies based on clients, I help you see how stuff in your life might be less about choice and conscious thought than you might believe.

Let’s go back to your behaviour at the end of a hard day at work.

Eating is not purely a physical act. You are not eating for fuel. You are eating to satisfy an emotional need. Maybe the food gives you comfort. That comfort is similar to a feeling that you first associated with being in your kitchen as a 6 year old child, eating dinner with your mother. You remember how your mother used to pile up your plate and tell you that you were a growing boy and needed to “eat up to be big and strong when you grow up”? Because of your caveman rule book it is important to notice those things; that  you associated pleasing your mother with finishing all the food on your plate. The rule says “If I eat all the food I will make my mum happy. If I make my mum happy she will love me more. If she loves me more she will look after me. I will not die”.

Now you are an adult, you are still following the rules in your rule book. When you eat, your subconscious time travels and pattern matches to that rule. The rule kicks in and you feel comforted and happy while you are eating. The survival imperative has been met.

By the time you reach fourteen years old 7,363,260 minutes have passed. Any one of those moments could end up as a rule in your rule book. You can never know because it is your subconscious that makes the choice.

It could be anything that drives the imperative to eat. One of the only things we can actually control when we are young is what we eat, and eating is not always about getting a good feeling. Sometimes we eat to escape a feeling or as an act of rebellion.

Let’s consider a different rule that might be behind your eating.

Maybe your parents split up when you were eight years old, and the only thing you felt you could control, when everything else was falling apart, was food.    By being picky about your food you got attention from your parents. A rule went in your rule book that says “when you make a fuss about food, your parents give you attention. Your parents giving you attention means they love you. If they love you they will look after you. You will not die.”  Now, as an adult, you can’t stop that behaviour, even though your parents are no longer around. It’s in the rule book so your subconscious follows it blindly.

In my experience, people who struggle with weight don’t do so due to lack of willpower. They struggle because their primitive subconscious has attached an emotional meaning to eating or to carrying weight. As the subconscious is in charge at least 90% of the day, there is a certain inevitability that your behaviours will default to what it drives. Conscious choice and self-control rarely get a look in.

Understanding and Overcoming Food Addiction 7

So is that it? Does that mean we are stuck with our behaviours? Not at all. The reality is that having a rule book actually makes it remarkably easy to change. The rules that our subconscious learns are miscalculations. They are formed by a primitive and stupid part of our brain, at an age where we have the limited understanding of a child, based on the rules of survival that come from the caveman days. You might have noticed that there are no sabre-toothed tigers, or in fact any predators, around these days. So those moments that were deemed as significant to survival, were simple miscalculations.

Let’s go back to the late night where you start snacking.  Imagine there was a way to travel back in time and have a conversation with the 6 year old version of you. As you look back on that moment from an adult perspective, what might you tell that child that would allow them to see that the food was merely incidental to that memory? How would you show them that their mother loved them irrespective of whether they ate all their food or not? Maybe you would imagine yourself saying “No thank you” when your mother offered you second helpings. Maybe you would then imagine her saying “Well done. I’m proud of you for knowing when you’ve had enough to eat”. If there was no connection between the food and your mother’s love then there would be no lesson for your subconscious to learn; there would be nothing entered in the rule book.

Now imagine travelling to the future. Imagine being offered food and, after some thought, you decline. After all, what’s the point of eating if you aren’t even hungry? It might feel a bit weird. It might feel too easy. It will be easy when you don’t have any resistance from your subconscious.

The thing it’s hard to understand sometimes is that all behaviour has a positive intention. Your subconscious is trying to protect you. Unfortunately, because it is stupid and primitive, the behaviours you end up with can be very negative and destructive. Moving on from those behaviours is simply a matter of tracking down the rule in the rule book and getting rid of it. This is something I do with almost every client in my Cognitive Hypnotherapy practice; we time travel. We use triggers from current thoughts and behaviours to travel back in time to when the subconscious first made the connection. Then we change it. We re-write time and lose the rules from the rule book, freeing you up to be whoever you want to be.

5 Amazing Properties of Sunlight You’ve Never Heard About

Sunlight is well-known to provide us vitamin D, but did you know that it kills pain, keeps us alert at night, burns fat and more…?

Our biological connection and dependence to the sun is so profound, that the very variation in human skin color from African, melanin-saturated dark skin, to the relatively melanin de-pigmented, Caucasian lighter-skin, is a byproduct of the offspring of our last common ancestor from Africa (as determined by mitochondrial DNA) migrating towards sunlight-impoverished higher latitudes, which began approximately 60,000 years ago. In order to compensate for the lower availability of sunlight, the body rapidly adjusted, essentially requiring the removal of the natural “sunscreen” melanin from the skin, which interferes with vitamin D production; vitamin D, of course, is involved in the regulation of over 2,000 genes, and therefore is more like a hormone, without which our entire genetic infrastructure becomes destabilized.

While the health benefits of vitamin D are well-documented (GreenMedInfo has identified over 200 health conditions that may benefit from optimizing vitamin D levels: Vitamin D Health Benefits page, and Henry Lahore’s Vitamin D Wiki has far more), the therapeutic properties of sunlight are only now being explored in greater depth by the research community.

Below are detailed five noteworthy properties of sunlight exposure:

1) Sunlight Has Pain-Killing (Analgesic) Properties

A 2005 study published in the journal Psychosomatic Medicine titled, “The effect of sunlight on postoperative analgesic medication use: a prospective study of patients undergoing spinal surgery,” analyzed patients staying on the bright side of the hospital unit who were exposed to 46% higher-intensity sunlight on average. The patients exposed to an increased intensity of sunlight experienced less perceived stress, marginally less, took 22% less analgesic medication per hour, and had 21% less pain medication costs.[i]

2) Sunlight Burns Fat

A 2011 study published in The Journal of Investigative Dermatology revealed a remarkable fact of metabolism: The exposure of human skin to UV light results in increased subcutaneous fat metabolism. While subcutaneous fat, unlike visceral fat, is not considered a risk factor for cardiovascular disease, it is known that a deficiency of one of sunlight’s best known beneficial byproducts, vitamin D, is associated with greater visceral fat.[ii] Also, there is a solid body of research showing that vitamin D deficiency is linked to obesity, with 9 such studies on GreenMedInfo’s obesity research page.

One of them, titled “Association of plasma vitamin D levels with adiposity in Hispanic and African Americans,” and which was published in the journal Anticancer Research in 2005, found that vitamin D levels were inversely associated with adiposity in Hispanics and African-Americans, including abdominal obesity.[iii] The point? Exposure to UVB radiation, which is most abundant two hours on either side of solar noon and responsible for producing vitamin D, may be an essential strategy in burning fat, the natural way.

3) Sunlight via Solar Cycles May Directly Regulate Human Lifespan

In a study published in 2010 in the journal Medical Hypotheses, titled “The effect of solar cycles on human lifespan in the 50 United states: variation in light affects the human genome,” researchers review the possibility that solar cycles directly affect the human genome. According to the researchers:

In the current study we report that those persons conceived and likely born during the peaks (MAX approximately 3 years) of approximately 11-year solar cycles lived an average 1.7 years less than those conceived and likely born during non-peaks (MIN approximately 8 years). Increased energy at solar MAX, albeit relatively a small 0.1% increase from MIN, apparently modifies the human genome/epigenome and engenders changes that predispose to various diseases, thereby shortening lifespan. It is likely that same energy increases beneficial variety in the genome which may enhance adaptability in a changing environment.

Sunlight exposure, therefore, may directly affect the length of our life, and may even accelerate genetic changes that may confer a survival advantage.[iv]

4) Daytime Sunlight Exposure Improves Evening Alertness

A 2012 study published in the journal Behavioral Neuroscience, titled “Effects of prior light exposure on early evening performance, subjective sleepiness, and hormonal secretion,” found that subjects felt significantly more alert at the beginning of the evening after being exposed to 6 hours of mainly daylight exposure, whereas they became sleepier at the end of the evening after artificial light exposure.[v]

5) Sunlight May Convert to Metabolic Energy

If a novel hypothesis published in 2008 in the Journal of Alternative and Complementary Medicine is correct,[vi] a longstanding assumption that animals are incapable of utilizing light energy directly is now called into question. In other words, our skin may contain the equivalent of melanin “solar-panels,” and it may be possible to “ingest” energy, as plants do, directly from the Sun.

Melanin has a diverse set of roles in various organisms. From the ink of the octopus, to the melanin-based protective colorings of bacteria and fungi, melanin offers protection against a variety of threats: from predators and similar biochemical threats (host defenses against invading organisms), UV light, and other chemical stresses (i.e. heavy metals and oxidizing agents). Commonly overlooked, however, is melanin’s ability to convert gamma and ultraviolet radiation into metabolic energy within living systems.

Single-celled fungi, for instance, have been observed thriving within the collapsed nuclear reactor at Chernobyl, Ukraine, using gamma radiation as a source of energy. Albino fungi, without melanin, were studied to be incapable of using gamma radiation in this way, proving that gamma rays initiate a yet-unknown process of energy production within exposed melanin.

Vertebrate animals may also convert light directly into metabolic energy through the help of melanin. In a review, titled “Melanin directly converts light for vertebrate metabolic use: heuristic thoughts on birds, Icarus and dark human skin,” Geoffrey Goodman and Dani Bercovich offer a thought-provoking reflection on the topic, the abstract of which is well worth reading in its entirety:

Pigments serve many visually obvious animal functions (e.g. hair, skin, eyes, feathers, scales). One is ‘melanin’, unusual in an absorption across the UV-visual spectrum which is controversial. Any polymer or macro-structure of melanin monomers is ‘melanin’. Its roles derive from complex structural and physical-chemical properties e.g. semiconductor, stable radical, conductor, free radical scavenger, charge-transfer.

Clinicians and researchers are well acquainted with melanin in skin and ocular pathologies and now increasingly are with internal, melanized, pathology-associated sites not obviously subject to light radiation (e.g. brain, cochlea). At both types of sites some findings puzzle: positive and negative neuromelanin effects in Parkinsons; unexpected melanocyte action in the cochlea, in deafness; melanin reduces DNA damage, but can promote melanoma; in melanotic cells, mitochondrial number was 83% less, respiration down 30%, but development similar to normal amelanotic cells.

A little known, avian anatomical conundrum may help resolve melanin paradoxes. One of many unique adaptations to flight, the pecten, strange intra-ocular organ with unresolved function(s), is much enlarged and heavily melanized in birds fighting gravity, hypoxia, thirst and hunger during long-distance, frequently sub-zero, non-stop migration. The pecten may help cope with energy and nutrient needs under extreme conditions, by a marginal but critical, melanin-initiated conversion of light to metabolic energy, coupled to local metabolite recycling.

Similarly in Central Africa, reduction in body hair and melanin increase may also have lead to ‘photomelanometabolism’ which, though small scale/ unit body area, in total may have enabled a sharply increased development of the energy-hungry cortex and enhanced human survival generally. Animal inability to utilize light energy directly has been traditionally assumed. Melanin and the pecten may have unexpected lessons also for human physiology and medicine.

Article sources:

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  • [ii] Association Between Visceral Obesity and Sarcopenia and Vitamin D Deficiency in Older Koreans: The Ansan Geriatric Study. J Am Geriatr Soc. 2012 Feb 8. Epub 2012 Feb 8. PMID: 22316299
  • [iii] Association of plasma vitamin D levels with adiposity in Hispanic and African Americans. Anticancer Res. 2005 Mar-Apr;25(2A):971-9. PMID: 19549738
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  • [v] Mirjam Mà¼nch, Friedrich Linhart, Apiparn Borisuit, Susanne M Jaeggi, Jean-Louis Scartezzini. Effects of prior light exposure on early evening performance, subjective sleepiness, and hormonal secretion. Behav Neurosci. 2012 Feb ;126(1):196-203. Epub 2011 Dec 26. PMID: 22201280
  • [vi] Geoffrey Goodman, Dani Bercovich. Melanin directly converts light for vertebrate metabolic use: heuristic thoughts on birds, Icarus and dark human skin. J Altern Complement Med. 2008 Jan-Feb;14(1):17-25. PMID: 18479839

People Aren’t as Safe From Lead as Thought: Study

Long-term, low-level lead exposure may be linked with more than 256,000 premature deaths from heart disease in middle-aged and older Americans each year, according to a new study.

The researchers analyzed data from 14,300 people in the United States, covering nearly 20 years. All participants had a medical exam and a blood test for lead at the start of the study.

The findings revealed a link between low-level exposure and increased risk of premature death. Lead exposure has been associated with hardened arteries, high blood pressure and coronary heart disease, according to the researchers.

“Our study estimates the impact of historical lead exposure on adults currently aged 44 years old or over in the USA, whose exposure to lead occurred in the years before the study began,” said study lead author Dr. Bruce Lanphear. He’s a professor at Simon Fraser University in British Columbia, Canada.

Historical exposure occurs from lead present in the environment because of past use in fuel, paint and plumbing. There’s also ongoing exposure from foods, emissions from industrial sources and contamination from lead smelting sites and lead batteries, the researchers explained.

“Today, lead exposure is much lower because of regulations banning the use of lead in petrol, paints and other consumer products so the number of deaths from lead exposure will be lower in younger generations,” Lanphear said.

But efforts to reduce environmental lead exposure is still vital, he said.

“Our study calls into question the assumption that specific toxicants, like lead, have ‘safe levels,'” Lanphear said. Rather, he said, it “suggests that low-level environmental lead exposure is a leading risk factor for premature death in the USA, particularly from cardiovascular disease.”

The findings were published online March 12 in The Lancet Public Health journal.

Stemming the risk requires a range of public health measures, Lanphear said in a journal news release, such as “abating older housing, phasing out lead-containing jet fuels, replacing lead-plumbing lines and reducing emissions from smelters and lead battery facilities.”

Dr. Philip Landrigan, a professor at the Icahn School of Medicine at Mount Sinai in New York City, wrote an editorial published with the study.

“A recurrent theme in lead poisoning research has been the realization that lead has toxic effects on multiple organ systems at relatively low levels of exposure previously thought to be safe,” Landrigan wrote. “A key conclusion to be drawn from this analysis is that lead has a much greater impact on cardiovascular mortality than previously recognized.”

Study Confirms Lifesaving Value of Colonoscopy

A large study has confirmed what many public health experts have long believed: Colonoscopy saves lives.

The study looked at roughly 25,000 patients in the Veterans Affairs (VA) health system, where colonoscopy is widely used. The VA views it as the main screening test for patients aged 50 and older who have average odds for developing colon or rectal cancer.

Of that group, close to 20,000 patients were cancer-free between 2002 and 2008. About 5,000 were diagnosed with colorectal cancer during that time and died of the disease by 2010.

Those who died were significantly less likely to have had a colonoscopy, the study found.

A comparison of screening histories over about two decades found that “colonoscopy was associated with a 61 percent reduction in colorectal cancer mortality,” said study author Dr. Charles Kahi.

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Kahi is gastroenterology section chief with the Roudebush VA Medical Center in Indianapolis.

The U.S. Centers for Disease Control and Prevention recommends everyone between the ages of 50 and 75 get screened for colon cancer. Those at high risk — including those with a family history of the disease — should be tested even earlier, the CDC advises.

Screening can take several forms, including stool tests; a lower colon exam called flexible sigmoidoscopy; and even a “virtual” colonoscopy that relies on X-rays to scan the entire colon.

But many public health advocates favor a full colon exam, or colonoscopy. For the test, a patient is typically sedated and a doctor inserts a flexible, lighted tube to examine the entire colon. If found, growths called polyps can be removed during the procedure.

Between 11.5 million and 14 million Americans have a colonoscopy each year, according to the study team.

The new study focused on patients aged 50 and older who were treated at VA facilities between 1997 and 2010.

The investigators found that a colonoscopy reduced the risk of death from right-sided colorectal cancer by 46 percent and left-sided cancer by 72 percent, equaling a combined drop of 61 percent.

“These findings are important at several levels,” Kahi said.

For one, the study shows that the quality of care within the VA system — the nation’s largest — “is at least as good as other health care settings,” despite recent concerns, he suggested.

But more broadly, Kahi noted, the finding removes any doubt as to whether a colonoscopy can effectively reduce cancer deaths.

The answer, he said, “is an unequivocal ‘yes.'”

Both points were seconded by Dr. Andrew Chan, an associate professor of medicine at Harvard Medical School who reviewed the findings.

“I am not surprised,” Chan said. “The results confirm an already substantial body of data supporting that colonoscopy is associated with a substantial reduction in risk of colorectal cancer.”

The results provide reassurance that colonoscopy is an effective screening tool for patients in the massive VA health care system, he explained.

Chan added that doctors need to make colorectal cancer screening a routine part of their patients’ preventive care.

“And it is clear that we need to improve the performance of colonoscopy in the prevention of cancers that arise in the right side of the colon,” he concluded.

“This will likely require a focus on ensuring that patients undergo an optimal bowel preparation for the procedure and the physician performing the procedure does a high-quality exam with a focus on careful inspection of the entire colon,” Chan said.

Kahi and his colleagues published their findings online March 13 in the Annals of Internal Medicine.

Opioids: A Crisis Decades In the Making

In 1980, Jane Porter and Hershel Jick published in a prominent medical journal the results of their study of pain among hospital patients.

These simple words about patients who took opioids would be used — and misused – for decades:

“We conclude,” the doctors wrote in a letter to the editor, “that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.”

Nearly four decades later, Jick said he regrets that he and Porter ever published their work. But they are hardly to blame for what would come.

Pain, Pills, and Death

An estimated 100 million Americans live with long-term pain. For decades, medicine’s overwhelming response has been prescription opioids like hydrocodone and fentanyl. Retail pharmacies dispensed more than 214 million opioid prescriptions in 2016. That’s more than 66 prescriptions for every 100 people and more prescriptions than any other country in the world.

In 2015, a reported 2 million Americans ages 12 and older were addicted to prescription pain relievers. In 2015 and 2016, nearly 117,000 Americans died from opioid overdoses. That’s more than the number of U.S. soldiers killed in the Korean, Vietnam, Iraq, and Afghanistan wars combined.

The numbers are so massive, they’re hard to comprehend. They have led dozens of cities and states, joined by the U.S. Justice Department, to sue opioid manufacturers and distributors as the federal government tightens regulations on opioid prescribing and calls the epidemic a public health emergency.

And it started with the mistaken idea that opioids were not addictive.

There’s plenty of blame to go around, from companies that used questionable marketing to make opioids the go-to for pain treatment, to the doctors who failed to change their habits even as patients’ bodies piled up, to the insurance companies that may not cover alternatives to opioids.

Because the drugs are so addictive, some patients, too, played a role in the crisis. Lax regulation and tracking allowed some to “doctor shop”: If one doctor refused to prescribe opioids, there’s another just down the street who might.

War on Pain

In their 1980 study, Jick and Porter wanted to find out whether hospital patients who received narcotics for acute pain for a short time became addicted to them. They reviewed the medical records of about 39,000 hospital patients. Nearly 12,000 of them received opioids while they were in the hospital. Four developed addiction to them. They reported their findings in a letter to the editor in the New England Journal of Medicine.

The patients that Porter and Jick observed “weren’t being treated with chronic opioid therapy for chronic pain, so the observation had no bearing at all on the risk of developing addiction” with chronic use, says Daniel Tobin, MD, medical director of Adult Primary Care at Yale-New Haven Hospital in New Haven, CT. He focuses on long-term pain management and opioid safety. “But this letter to the editor became doctrine.”

A study found that Porter and Jick’s five-sentence letter was cited 608 times in support of opioids. In 80% of those citations, the authors did not note that the patients received the drugs in the hospital.

A 1986 study in the journal Pain, which observed 38 patients, concluded again that opioid addiction was extremely rare.

“If we were talking about (blood pressure) medication, doctors would want rigorous evidence from long-term trials. We were ready to use opioids more freely before we had that data. I’d say physicians should take some of the responsibility,” says William Becker, MD, a core investigator in the Pain Research, Informatics, Multimorbidities & Education (PRIME) Center of Innovation at the VA Connecticut Healthcare System in West Haven, CT.

The ‘Fifth Vital Sign’

Around the same time, the medical community started paying more attention to the treatment of pain.

In the 1980s, the HIV epidemic called the medical profession’s attention to the under treatment of pain. “It triggered a worldwide outcry about the underutilization of opioids in the treatment of pain and how doctors needed to do a better job of treating chronic pain,” says Walter Ling, MD, a psychiatrist and founding director of the Integrated Substance Abuse Programs at the University of California-Los Angeles.

In 1996, increasing concern about untreated pain led the American Pain Society, a group of health care professionals and scientists that promote changes in public policy and medical practice to reduce pain-related suffering, to declare pain the “fifth vital sign.” That suggests it’s just as important for health care professionals to evaluate and address pain in every patient visit as it is to address the four common vital signs: temperature, pulse, breathing rate, and blood pressure.

While patients’ perception about their own pain is important, there is no test or instrument to verify it.

“Of course, pain is not a vital sign. There’s no objective test for it,” Tobin says. “We only have patients’ self-reports.”

That same year, Purdue Pharma released a new opioid prescription medication called OxyContin. In the 1998 OxyContin promotional video “I Got My Life Back,” targeted at doctors, a doctor explains that opioid painkillers are the best pain medicine available, they have few if any side effects, and fewer than 1% of people who use them get addicted.

OxyContin, originally sold in 80 milligram tablets, was appropriate, its label said, “for the management of moderate to severe pain where use of an opioid analgesic is appropriate for more than a few days.”

“The drug companies were ‘educating’ the doctors,” Ling says. “But there’s a very thin line between educating doctors and promoting your product.”

At the same time, drug reps were everywhere. They traveled from clinic to clinic, promoting their drugs while offering doctors gifts such as travel and lodging at expensive medical conferences in exchange for a visit to their booth. “They were literally throwing money at us,” says Joji Suzuki, MD, a psychiatrist who specializes in substance abuse at Brigham and Women’s Hospital in Boston. “These were the Wild West days when drug reps had free rein.”

Other Options Cheaper, Safer

Opioid painkillers aren’t the only pain medications available. They were just more aggressively marketed. Studies have shown that over-the-counter ibuprofen or a combination of ibuprofen and acetaminophen may treat pain better than opioids. Topical creams, certain antidepressants called SNRIs, and nerve pain medications such as gabapentin can ease chronic pain in some people, too. Other therapies, like yoga, acupuncture, physical therapy, and exercise, have also shown benefit for some.

While opioid manufacturers were “educating” doctors, American medical schools offered little or no training in the management of long-term pain. In 2010, only 1 in 5 American medical schools had any formal instruction on the topic. Among those, some schools required fewer than 5 hours of instruction. “In the absence of adequate education, pharmaceutical manufacturers stepped into the void with the message that long-term opioids were unquestionably safe and effective,” Becker says.

In 2003, the FDA warned the company its advertisements and promotional materials, which claimed OxyContin was less addictive than other opioids, were breaking federal law.

“The combination in these advertisements of suggesting such a broad use of this drug to treat pain without disclosing the potential for abuse with the drug and the serious, potentially fatal risks associated with its use, is especially egregious and alarming in its potential impact on the public health,” the agency wrote.

In 2007, the company agreed to pay $634 million to settle criminal and civil charges over its “long-term illegal scheme to promote, market and sell OxyContin,” according to an FDA press release issued at the time.

Today, Purdue Pharma publicly supports state and federal programs to fight the opioid epidemic, including encouraging prescribers to consult prescription-drug-monitoring program databases and repeating the CDC’s call to shorten the duration of first opioid prescriptions. The drug company distributed the CDC’s guidelines to prescribers and pharmacists when they were first released.

“Our industry and our company have and will continue to take meaningful action to reduce opioid abuse,” the company says in a statement. The company says it supports efforts to limit the length of first prescriptions of opioids and vows to continue research into new, non-opioid pain medications.

But the horse was already out of the barn before the FDA’s warning to Purdue Pharma in 2003.

Both the Veterans Administration and the Joint Commission, the independent organization that accredits American hospitals, had also declared pain the fifth vital sign. Health care professionals took notice when, soon after, a doctor was fined $1.5 million for under treatment of pain in an 85-year-old patient who died of lung cancer. “Under treatment of pain became a form of malpractice, of medical abuse,” Ling says.

By 2006, the Centers for Medicare and Medicaid Services launched a patient-satisfaction survey that would affect how much reimbursement hospitals got. Among other questions, the survey asked patients whether their pain was well managed.

“It behoved hospitals to push opioids as much as they could to keep patients happy,” Becker says.

A Way Forward?

Though opioid prescribing is still high, it peaked in 2010 and has continued to fall. In 2014, there was a steeper decline in opioid prescriptions after new laws took effect that required patients to see their doctor every time they wanted a refill of certain painkillers, Jones says.

The requirement made it a little harder for people to get opioids, and it may have raised doctors’ awareness of how much of the medication their patients were taking.

As of October 2017, in response to comments from doctors, the U.S. Department of Health and Human Services no longer considers hospitals’ pain management scores on patient satisfaction surveys in its reimbursement decisions for Medicare and Medicaid patients. The agency also plans to take another look at pain management survey questions and may revise them, says Jones.

These policy changes are intended to cut prescribing but not end access to the drugs altogether. “There are patients who do benefit from opioids,” says Daniel Tobin, MD, medical director of adult primary care at Yale-New Haven Hospital in New Haven, CT. He focuses on long-term pain management and opioid safety. “For those patients who benefit without evidence of harm, you don’t need to just take it all away. I would hate to see the pendulum swing too far.”

But there is some evidence that the proverbial pendulum has already begun to swing too far, according to a recent article in The New England Journal of Medicine. “The increase in opioid-related mortality fueled by injudicious prescribing and increasing illicit use of both prescription and illegal opioids has led some clinicians to simplify their lives by discontinuing prescribing of opioid analgesics,” the authors of the article write.

The authors say that halting opioid prescribing altogether would cause patients to suffer and could push some to seek out illegal opioids, like heroin, on the street.

“We need to find a middle ground,” says Tobin, “where we’re being deliberate and careful about prescribing.”

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