Abstract
Dr. Kenneth R. Pelletier received his PhD, MD from the University of California and the Ministry of Medicine, Sri Lanka. In 1974, he became an Associate Clinical Professor in the Department of Medicine and Department of Psychiatry at the UCSF School of Medicine. In 1990, he transferred to the Stanford University School of Medicine as a Clinical Professor of Medicine. At the present time, he is a Clinical Professor of Medicine, Family and Community Medicine, and Psychiatry at UCSF, serves as Director of the Corporate Health Improvement Program (CHIP) at the UCSF School of Medicine, is a Vice President with American Specialty Health (ASH) in San Diego, and is also Chairman of the American Health Association.
One day, I was on the beach living under a fig tree when all of these people descended on the island. I watched them for about four or five days, and I did not see limbs regenerate. I did not see the blind have their sight restored. However, I did see people who were clearly in pain emerge walking briskly from the chapel. People who had gnarled limbs were flexible and moving. People in intractable pain found relief. People who had lost their voice were speaking. So there were some radical changes that occurred out of their acts of faith.
When I returned to UCSF, I became preoccupied with the nature of mind–body interaction that might have made this possible. At that time, all textbooks distinguished the voluntary and involuntary nervous system, and that they were inviolately separate. They ran in parallel tracks, but they were seldom if ever interactive. What I saw in Greece made me think that maybe this was not accurate. One instance remains in my mind to this day that breathing is both voluntary and involuntary. We can hold our breath, but as our blood oxygen levels drop, we reflexively or involuntarily start to breathe again. That is true also for blinking our eyes. So, clearly the two systems are interconnected.
Through colleagues, I discovered some early research by Dr. Elmer E. Green, PhD, at the Menninger Foundation. He had studied a couple of adept meditators who were capable of self-inflicting pain and not responding in the normal involuntary response to pain. However, he had not conducted his research under rigorous laboratory conditions, so it was suspect, and it was really dismissed.
So, I decided to pick up on his work and do that same research under very controlled laboratory conditions. This involved a series of studies of what we ended up calling “adept meditators”—people who were able to inflict very painful, puncture wounds on their bodies. We had one man from Holland who would push a sharpened, unsterilized bicycle spoke completely through his left bicep and completely out the other side. When he was in meditation, he looked as though he was on vacation on a beach, completely relaxed. His electroencephalogram (EEG) indicated that he was in alpha rhythm or a resting state. His electromyogram (EMG) for his muscle activity was normal. His electrocardiogram (ECG) was regular and not accelerated. His peripheral pulse was normal. His respiration was slow, abdominal, and regular. It just looked as though he was sitting quietly on a beach, and yet he had just pushed this bicycle spoke through his arm. We monitored him for a week or two afterwards. There was no spontaneous bleeding from this wound and no subsequent infection. He repeated this several times under laboratory conditions, and we documented it. Later, we filmed this same experiment for a Canadian Broadcasting Company (CBC) documentary.
At the time that this research was being done, in the early 1970s, to have multichannel monitoring fed into a single computer was radical. It took a lot of engineering. We did not have the kind of biotechnology we have now to look at immunological response, but we could see that there was no localized bleeding or bruising.
Playboy magazine somehow got wind of this research and did an interview with me. I was amazed to see how many people in prison or in the military read Playboy magazine, as I got flooded with letters. It turned out that one of the people who wrote to us was a prisoner at San Quentin, just outside of San Francisco. He said that he could control bleeding and pain. As a drug smuggler, he had been shot and stabbed. In order to prevent crying out and being discovered, he had to control bleeding and pain.
We worked with the California Department of Corrections to bring him to the medical school. One morning, the highway patrol showed up. Here was this man with a complete orange jumpsuit, and shackles on his wrists and feet, shuffling into our laboratory. He took three sharpened bicycle spokes, pushed them through the cheeks of his face, in one side, through his open mouth, and out the other side of this cheek. When he was finished, he looked like a cat with six steel whiskers. We published a photograph of him in the International Journal of Clinical and Experimental Hypnosis. 1 He is with his mouth open, and you can see the bicycle spokes crossing inside of his mouth. Again, he did not bleed and he did not register pain when he was in meditation.
Interestingly, all of these individuals we studied responded normally to pain when they were not meditating. They had normal clotting time for bleeding. Their respiration changed. Their muscle tension increased. Their EEG showed high stress. So they were not abnormal. It was simply that they had this ability during meditation to bridge between the autonomic and the voluntary nervous system and create this state of quiet.
This is a bit of a longwinded answer to your question. But it was the beginning of my interest in what creates states of health. These individuals were doing something that all of our patients could really benefit from. It was also a state from which anyone with any condition could exert an extraordinary degree of control if they had the right training and if they had the right understanding of their mind–body connection.
It was the same thing with the San Quentin prisoner. He had not studied formally. He just learned how to do it in order to survive and not be discovered by the border patrol when he was smuggling drugs. There were other people who we studied who had karate discipline, and so they had studied in a more traditional manner.
For the 48 Hours program, I was filmed viewing this documentary and making a commentary. They asked me what I thought the significance was. I said that my advice was never to do this at home! This is clearly not a good example of how to take care of your health. But the point is that we make choices all the time unconsciously between mind and body. Now we then can turn that around and make those choices consciously.
People who were the participants in the pain studies in our lab said that they were aware of the pain—that the pain does not disappear. What changes is their perception and how they respond. So, rather than a sharp, shooting, distracting, traditionally painful sensation, they said it is more like pressing on their own arm with their own finger.
So, the question that came to me is what kind of choices are we making day in and day out through stress, through diet, through exercise, through pharmacology, using supplements, and through physical and psychosocial environmental exposures that lead us down the road of ill health, when in fact we could be moving toward optimal health? We are making the choices literally second by second with profound consequences.
Until we are aware of the choice, until we know that we do not have to be a victim of stress, or we know that we can improve our diet, we know what physical activity can do to forestall the aging process, we know the positive influences in our environment both psychosocially and physically that create health, only then can we begin to make more informed choices.
This book is still doing well, and I still get royalties. It led to my very first interview of any kind on a book on the Today show. It was with Tom Brokaw and Jane Pauley. It was her first day on the Today show. After it was over, Tom Brokaw told me that I did a great job and that I would have a successful career. But he reminded me that “after my 15 minutes of fame, there would be the dog food commercial.” That has stayed with me ever since. I was scared to death, even though it didn't show. I was just in my 20s. In the early 1980s, that book became even more popular. It was a global bestseller in 16 or 17 languages.
In about 1987, Bob Beck left IBM and came to San Francisco. He became head of human resources at Bank of America. He asked me about data related to prevention and health programs for keeping employees healthy for cost-effectiveness. At that time, there was almost nothing. But a lightbulb went off for me. The sector of our society that has an interest in health is the corporate sector. These companies are self-insured. They pay the medical costs. They are global. IBM has offices all over the world, and the program needs to be modified, depending on the country in which the program occurs. However, human biology is fairly universal. So, we created a program called the Corporate Health Improvement Program or CHIP. That program still exists. Companies that Bob Beck thought might be interested, such as Levi Strauss, American Airlines, Bank of America, Shaklee, Wells Fargo Bank, and AT&T, were invited to come to this program. I invited faculty members who I thought had an interest, and we met twice a year and developed research projects.
In 1990, I took the program to the Stanford Medical School, and then more of the Silicon Valley companies joined. So, Oracle, Hewlett Packard, Apple, and IBM became participating members. Then, in 2002, we took the program back to UCSF where it still exists. Some of the companies are still the same. They now consist of Oracle, Prudential, IBM, Cummins, Ford, Dow, and Lockheed Martin. We meet twice a year and develop programs and interventions for their own employees that emphasize early detection, prevention, and optimizing of health, and evaluate them for both clinical and cost outcomes.
At Stanford, my main focus was preventive cardiology, and I learned about the dietary, physical fitness, stress, psychosocial, and depression impacts on heart disease. From there came the impact of physical activity and its mediating influence on our health status. From there, it went to the environment and the relationship of the absence of friends with a high risk for disease. Looking at the interaction between depression and heart disease, we find that depressed individuals tend to manifest more heart disease. It is also harder to treat in depressed individuals. Furthermore, people who undergo cardiothoracic surgery and/or pharmacology do not do as well if they have a comorbidity of depression.
So, the whole picture, if you will, began to just pull together into this multifactorial approach. That approach within the corporate sector was very acceptable. The corporate sector does not have the usual restrictions in terms of how research models are designed. For them, the idea of a multifactorial involvement with positive outcomes, both clinical outcomes and cost outcomes, was all they wanted. They wanted to see it have an impact. So, my research was focused on demonstrating an impact. Once we found that this multifactorial model for heart disease, pain, AIDS, hypertension, elevated cholesterol, irritable bowel syndrome, or stress management worked, that it made a difference, then we could let other people worry about which part made a difference and what was the significance level of factor x versus factor y.
Those basic questions were not the kind of research that interested me. I was interested in whether we could make a difference in people's lives or for their organizations. This is still what drives my interest to this date.
This multifactorial, integrative medicine model has evolved. Interacting and thinking with my very long-time friend and colleague Dr. Andy Weil, MD, at the University of Arizona and in other settings has influenced my thinking immensely. While I was a faculty member at the University of Arizona, Dr. Weil and Dr. Victoria Maizes, MD, created an Integrative Medicine program, which has since graduated almost 1,600 physicians with knowledge in acupuncture, Ayurveda, chiropractic, herbal medicine, nutrition and supplements, Traditional Chinese Medicine, meditation, and mind–body work. This is a very optimistic direction for the future. That program is now quite large, with about 80 physicians a year, because it is all electronic distance learning. People no longer have to give up their practice or move from their geographic location. This kind of program and thinking and colleagues has had a big impact on me.
What I prefer to do is to invest time and energy into what is positive. What are the alternatives? What are the options? How do we integrate conventional and alternative medicine into a model of integrative, personalized medicine and health? Those options and practices cross these boundaries completely naturally.
For instance, we conducted a back pain program at Ford Motor Company. Now, if you look at back pain, you think about surgery and diagnostics and MRIs and physical therapy, opioids, steroids, et cetera—the whole Western medical Pharmageddon. We did a study working with the Ford medical director looking at both the clinical and the cost side.
These boundaries do not bother me. We don't have time to worry if we are crossing over from conventional to alternative, from health to disease. If we are looking at a problem and deciding what is the best empirical, documentable, and scientific way to solve it, there is no one right science. That is scientism. It is a belief system that dictates certain protocols and standards, but that is not the purpose of genuine scientific inquiry.
In one of the CHIP meetings, the medical director at Ford said that total medical costs add about $2,300 to the cost of a Ford automobile—about $500 for back pain alone. Back pain is the single biggest contributor. However, he told us that at Honda, the total medical costs are about $500. In other words, Ford is spending as much on back pain as Honda is spending on total medical costs. So, guess which product is going to be priced excessively in the world market?
Our study was conducted with employees at one Ford assembly plant. 3 There are three Ford engine assembly plants around Louisville, Kentucky, with virtually identical employee populations and onsite medical services. These employees were perfectly matched with respect to the kind of job, socioeconomic status, and geographic location. We then randomly selected workers who reported first-time back pain to come into the clinic. We randomized them into usual care or usual care plus integrative medicine, consisting of three additional interventions: chiropractic, meditation, and acupuncture.
At the end of one year, there was a 58% reduction in the use of opioid medications. That meant that 58% of the workers could return to active work engagement on the assembly line earlier. We also found a difference in the conversion from short-term to long-term disability. Ford employees are required to be in treatment for six months. After that, they cycle out of long-term disability, and they usually do not return to full employment. They become very, very costly to the company. We found that very few, if any, converted from short-term to long-term disability in the intervention group. So, this integrative model is now one that is used. We also looked back at the data and asked which of the integrative medicine options—chiropractic, acupuncture, or meditation—predicted the best outcomes? Much to my surprise, the presence or absence of regular practice of meditation, mainly mindfulness meditation, was what predicted the most successful outcome from back pain.
Actually, the title of the book is a teaser. “Change your genes” is in fact not a reality. You do not ever change your genes. Genes are impenetrable and unchangeable, unless they are damaged in some way such as by radiation. But the expression of a gene is what changes. And the analogy I use in the book is the Shakespearean play Hamlet. Hamlet has been played by Richard Burton, Kenneth Branagh, Benedict Cumberbatch, and a number of other individuals. Each actor gives a totally different performance. The play does not change. The play is the gene. However, its expression, through those different people, through those different times and circumstances, that is what changes.
Epigenesis means above or beyond the gene. 5 So, the epigenesis is the environment, the behavioral, mental, nutritional, physical, and psychosocial environment in which the gene operates. This is what determines what is expressed and what is suppressed. This means that someone may have a genetic predisposition to a certain disease. That disease may or may not ever become manifest. If certain things are done right, that gene may never express itself. It will remain dormant. On the other hand, if you have a gene that is predisposed to a disease and you do everything wrong, that gene would then express itself as that particular disease.
My new book basically looks at the biochemical pathways of the body that are governed by a finite set of genes. We have about 24,000 genes in the human body. Of those, there are only about 40 or 50 that govern what we would call chronic disease. We can test for most of those. We can test how it is manifesting in a state of health or illness. This is what is exciting to me. Just like in meditation, once you have a choice, once you understand what these influences are, you can make choices about your diet, physical activity, environment, your mind, exposure to radiation, et cetera. We can make choices that optimize the expression as opposed to suppress or deny a healthy expression of a gene.
There was a story very recently on the NBC News about a reporter that took four or five of these tests and evaluated one versus the other. Initially, two of them did not respond at all to her submitting her sample. Of the ones that responded, four or five gave contradictory results or ambiguous statistical predictions, which have no real meaning. That is the biggest problem.
Our approach that we are taking involves three components: the genetic, the blood, and the biome, or intestinal tract. The analogy I use is the gene is like the blueprint of the house. The blood is the building of the house. The genes create the structure of the house and how you live in it by expressing themselves.
Our biome or gastrointestinal activity is the result of living in the house. It tells you what has gone on in your body, given the fact that you have certain genes creating a certain biochemistry in your blood. What is the result after all of your organs and all of your systems have been manifested in terms of your intestinal tract?
Once we have those three, then we have a set of healthy biomarkers. Healthy biomarkers are simple. It is like cholesterol. You have got a range of normal cholesterol. If it is too low, it may be indicative of cancer or other kinds of diseases. If it is too high, it may be predisposing to heart disease. But what you want to know is whether you are in that middle range.
You can do that for virtually every biomarker in the body. And ideally what comes out of this is information that is very useful to you. This information tells you whether the biomarker is too low, too high, or normal. It also tells the individual what they can do if it is too low or too high. That gives us an objective biochemical model of personalized medicine. Then, the individual will know the best diet, exercise, and/or pharmacology for them. It is no longer a guessing game. As an example, it is not one diet versus another—high-carb, low-carb, high-fat, low-fat, paleo, or ketogenic. It is what fits you, your own individual biochemistry. To me, that is what is exciting. It is integrative, individualized, personalized care.
What if you knew that information? What would you do? You would have to be more circumspect about diet and exercise. You would know you have a gene that is predisposing you to a larger waist circumference as the maternal grandchild of this lineage.
So, getting back to the mother who smoked. If you had a mother who smoked, you may have activated or expressed a cluster of genes that would influence nicotinic acid to bind more readily to your receptor sites. Knowing your mother was a smoker, and knowing that you might have a predisposition, would be the extra bit of caution telling you that you really cannot even start. You cannot even try a cigarette because you are probably going to be hooked more rapidly than someone that does not have this predisposition. It becomes an informed choice. If we know what the push and pulls are, we can optimize them or minimize them, depending on steps that we can take.
Some of the better genetic assays that are available through companies that are doing a good job will get down to the specifics of telling someone to avoid certain foods because they do not digest them well. They will provide alternatives. For example, if someone does not digest almonds very well but does digest walnuts, the information will suggest a shift to walnuts. Personalized care or precision medicine tells us how we can match specific interventions to specific body biochemistries.
We have the genetic code—the blueprint. This is the plan for the structure of the house. But when you go from a blueprint to actually building the house, you have to make changes or modifications. It does not match the blueprint. Then when you are living in the house, you make further changes. You modify things. You take out a door, change a window. We need to look at this connection. When does the genetic predisposition lead to something in the blood, lead to something in the biome, in the intestinal tract? When does it not? When is there something that is a strong genetic push, but does not show up in the blood, and does not show up in the biome?
These are the fascinating patterns that we need to look at. Actually, the biggest caveat I have right now is that we do not know what these patterns mean. We have an idea. There are some data relatively easy to interpret, and there are genetic counselors who can do that.
Let me use another analogy. If you walk into a supermarket, all of the barcodes are there. They are on every product. We do not know what the barcode means because we can't read it. If we could, we would know exactly what the price of the product is and many other factors about it. With the human genome, we are looking at something infinitely more complex. We do not know how to read or fully understand it yet. We are reading hieroglyphics at this stage, and we need to get a lot better. That is the challenge for the future.
James Watson of Watson and Crick, the first person to have his human genome completely mapped about five years ago, suggested that if he took his completely mapped human genome to his family doctor, he would know 1–3% more about his general health than just having a thorough physical exam. In other words, it is hardly worth doing. We have certain patterns now that genetic experts—people who are sophisticated at reading these three levels of biochemistry—are good at doing, but we have got a long way to go.
Having said that, there are some things we can do generally. In the book, I say that despite the absence of these evolving precision measures, there are some things we know from basic research that have a positive effect on inflammation, detoxification, and the other major biochemical pathways in the body. So, if you want to evoke positive pathways and hedge your bets and optimize your health, there are things you can do now, even while these tests are evolving.
The other thing about open-ocean sailing is the isolation and intense, peaceful quiet. There is no gas station. No supermarket. No illustrated weather on the evening news. No rush-hour traffic. There is no readily available help. You have to know about electricity and plumbing, the wind and the weather, the tides and the currents, underwater obstructions and reefs, how to use GPS and/or celestial navigation and to plot a course. You need to be in tune with your environment. You become very, very aware of the impact of ecology. You know that if you are moored in a lagoon and you are flushing waste overboard, it is going to be there the next morning, and you are going to suffer the consequences. So, everything is in microcosm.
My experience of going sailing has done more than any meditation, diet, guru, any book, or anything else, for me. That, to me, is my centering, the place where everything clears away. There is a time or a point of equanimity or balance in the meditation sense when you are in a boat, with the wind and the pressure from the current on the hull, and the balance of the boat is absolutely perfect. You can steer it with one finger. Everything is in harmony. Then, a few seconds or a few minutes later, it breaks up, and it is out of harmony, and you are back, having to sail, and correct, and make course changes. But that half a minute or minute of time is when things are perfect, and it gives you a sense of alignment, of equanimity internally that is reflected in the outside world. And to me, that is it. That does it.
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