Preventive medicine is the one ideal approach for combating disease. This is an entire spectrum of various approaches that we can categorize. To help remembering, we have created another acronym to define preventive medicine in a lighthearted way. CHEAPIES works because all of the elements are quite inexpensive. The concept of prevention can also include slowing down the progression of an already established disease. Anti-hypertensives, cholesterol lowering drugs, or stomach acid reducers, are a few examples where disastrous end stages can be avoided. We've seen how by 1920, holism was starting to be in vogue and was on center stage by 1970. This created a new paradigm in medicine, even though Hippocrates had alluded to this concept 2,000 years earlier. Thinking therapeutically, it is worth examining what therapies are actually holistic. This automatically leads us to the ideas of preventive medicine. All of the aspects of CHEAPIES are part of a holistic approach and can be managed largely by the patients themselves. One exception might be the use of antibiotics prophylactically. In general, there is no specific chemical or physical therapy that requires a therapist for a holistic approach. Psychological therapy is one realm that can sometimes require a therapist, but can also be exercised by an educated patient using the guidelines of cognitive behavioral therapy or even self-hypnosis. While new chemical therapies were being developed, there was a surgical experiment in the '50s that deserves mention. Doctors had determined that heart attacks were the result of poor coronary artery circulation with eventual blockage. In an effort to improve circulation, a procedure was theorized to help, by tying off an artery near the heart, but not actually supplying the heart. This was supposed to increase flow to the coronary arteries and collateral circulation was expected to supply the area that was cut off. Candidates for this procedure were patients with frequent or severe angina, the chest pain that occurs when the heart is starved for blood. Miraculously after surgery, 80 percent of the patients reported improvement or a lessening of their angina. This was very promising. But skeptics felt there needed to be some placebo control. Because the surgery was relatively simple, a sham surgery procedure was used when an incision was made, but there was no arteriole ligation. This would be questionably ethical today. But the results were valuable in showing that both categories of patients did equally well. The takeaway from this sham surgery shows just how much placebo can be enhanced by creating simultaneous duress. Just going under anesthesia requires a large measure of hope and faith, and the pain inconvenience and other costs add to the placebo effect. Pain is also the easiest symptom to control with placebo. It may be that surgery is the most powerful placebo of all. The next drug breakthroughs involve the treatment of psychiatric disorders. We have seen how psychotic patients commonly had to be locked up in order to prevent harm to themselves or others. The new drug, Thorazine could actually manage these psychotic patients in a way that would allow them for the first time to live relatively normal lives outside of institutions. In an accidental way came Valium, initially created in the '50s, but left sitting on the shelves for 10 years before being clinically researched. The effects were remarkable in controlling anxiety, and it was almost impossible to die from an overdose of Valium. The drug was also marketed as being non addictive because increasing doses were not required. Valium became the number 1 selling drug in the US by the '70s. A Rolling Stones song alludes to Valium as mama's little helper. Unfortunately, Valium did prove to be addictive and its use today has to be carefully monitored to prevent dependence. Despite this downside, Valium was an improvement, and there is still no better class of medication to control anxiety. Before the end of the Century came Prozac initially developed to control blood pressure or suppress appetite. The effects as an antidepressant, however, were truly remarkable for many, but not for all. Prozac was also safer than previous antidepressants and operated with a new mechanism by selectively inhibiting the re-uptake of serotonin, giving it the name SSRI. In the realm of heart disease came a newer class of drugs by the '80s to control blood levels of cholesterol. These were called statins and operated through the metabolic pathways of cholesterol production in the liver. Cholesterol is not all bad and is a necessary building block for growth and the production of steroids. The bad cholesterols are low density, contributing to the buildup of plaque in the arteries. High density cholesterol is actually beneficial. The problem with humans is basically genetic and diet can only have a limited effect. The statin drugs are particularly good at lowering low density cholesterol and the thickness of arterial plaques can actually be seen to shrink with objective imaging. When high blood cholesterol was finally proven to be a factor in heart disease by the '60s, one unintended effect involved children being put on low cholesterol diets by their parents and suffering because of limited growth and development. Diets low in saturated fats are still beneficial for adults and the best way to increase high density cholesterol is through exercise. There's a hypnosis story that's very apropos for this course. In order to create the first studies in medicine course at UCSC in 2016, I first had to go to the development department. The director of this department also had a perfect name to be involved with medicine, John Hopkins. I am truly indebted to him for finding Grant Hartzog the perfect faculty partner to team with and teach this class. John and I became good friends mainly because we liked each other. But we also had many things in common. We'd both gone to high school in Dallas, Texas, and had both been high jumpers. John was a true champion though, finally scaling seven feet. This was phenomenal and over a foot better than I could reach. He also eventually became the kicker for Stanford's football team. We both played golf and amazingly had exactly the same birthday, 9/11. We even celebrated our birthday once at a nice Santa Cruz restaurant, and John gave me a book as a present. This was very thoughtful of him and the book was titled Being Mortal, written by an Indian oncologist from New England. It was all about dying, which is difficult to write about. But the meat of the book focused on the art of medicine in that very difficult circumstance. I can highly recommend this book for anyone considering medicine as a profession. After this introduction, let's get back to the hypnosis part. Not long after we met, I asked John if when he was high jumping, he ever felt like he was in a trance. He thought for a few seconds and then said, "I think I was in a trance for the whole afternoon." This is just to emphasize that a trance is not just a drowsy, your eyelids are heavy now, state. The mind can be totally alert to the present and performance can be optimal.
