In a prior posting from May 27, 2010 I described a non-Buddhist's attempt to come to terms with the concept of Non-Attachment.  Despite some difficulties I concurred with its general notion that we are, in general, too attached to the world of material objects, goals of "success" and wealth and even obsessively attempting to control those we love.

Perhaps another way of addressing the topic is to view non-attachment as a process rather than a goal.  We live in a goal-oriented culture.  Obtain this particular job, earn that amount of money, spend this amount on our homes, vacations, cars.  Marry a person with these specifications. 

It relates to the notion of someone's net worth as something that should be regarded as much more than their total financial picture.

By emphasizing the process of living to the fullest  in each moment  we find ourselves less distracted, less stressed, less obsessed with the future and any foreseen outcome.

This may seem somewhat contrary to the famed "Law of Attraction" in which the goal of any endeavor seen as the key to success.  But as I have written about previously, my issue with the "Law" is the potential for ignoring the process.  It is the process, I believe, which  ultimately allows us to reach any goal.

I am certainly not averse to planning and even visualizing a future state of being.  I do believe, however, that there is danger in forgetting the present moment, the only one that truly exists.

Understanding the reality of process also allows one to thoroughly enjoy doing what we are committed to do.  We can better accept what the results of our labors may bring.  Not every endeavor will bring success.  Perhaps the majority will not. But by emphasizing the process we can have no regrets, regardless of outcome.

And ironically, by not attaching our very sense of ourselves to outcomes, we will most likely do our best in the moment. The outcome will take care of itself.

I B S — A Syndrome By Any Other Name Would…. Feel the Same

While pondering he nature of this most common and uncomfortable condition, IBS, I thought of an alternative name–Internet Bowel Syndrome and another, Integrative Bowel Syndrome.

Why?  A few reasons.  To me the Internet represents a tremendous source of information on all areas of human inquiry.  The problem is in the discerning what is useful, what is erroneous, what is perhaps dangerous.

As a meta-physician in the 21st century I find it is my job/obligation to peruse what is "out there".  I need to know what is being written about IBS. Clearly my patients will and they will bring their questions to me–I hope.

A physician should be able and willing to address any questions and concerns.  They should not dismiss anything without examining it for possible validity.  At least they should discuss with their patient the risk/benefit ratio of any decision.

To me this is what is meant by integrative approach to health care.  Understand where medical science stands on any issue, including the areas of controversy.  Also be aware of the complementary and alternative world's perspective.

Help guide the patient through the morass of information.

And there's another aspect of the Internet which relates to IBS–the extra angst it brings to many who cannot wait for their "fix" of data.

The 24hr info /news which assaults our minds is something our ancestors never had to deal with. 

Stress offers another possibility to add to the name–Irritable Bowel Stress.



Speak the list upon awakening

Of all that's good and beautiful and healing in your life

Name those who love you

And those whom you love

Bless the light which illuminates your space

Rejoice in the breath which ebbs and flows

Touch the heart which beats within your chest

Honor the food which enlivens your being

Be thankful for your mind which embraces this awareness

Welcome the opportunity this day brings

To express kindness and compassion to the world

And to yourself

PROMOTING PALLIATIVE CARE — Wake Up My Fellow Physicians !

My congratulations to the New York State legislature for passing a recent bill promoting patient / family education regarding palliative care.  Shame on the NY State Medical Society for resisting it.

Today's article in the NY Times by Jane Brody  is worthy of further discussion.

Palliative care, end of life care, makes perfect sense.  The Resistance of fellow physicians is disturbing and deplorable.  We should be at the front lines in the debate on offering compassionate caring.  More than the public, we should be aware that much end of life treatments are not only ineffective, they produce more suffering.

This article references another from the New England Journal of Medicine which demonstrated that palliative care in addition to standard cancer therapy provided not only better quality of life at end of life but actually prolonged life by three months.  Presumably this was of a "higher quality" with less depression and pain.

I am not particularly a supporter of government mandated health care reform.  I fear the imposition of "standards" on my profession as much as the next physician.  But when my own profession continues to treat those who are in the final stages of life as if they will recover or life better, than perhaps we need outside intervention to bring back some sanity.

As I have written before, just because we CAN offer therapy does not mean we SHOULD be doing so.  The patient as a whole individual with not only physical but emotional and spiritual needs to be evaluated.

End of life issues need to be openly and actively discussed.  These are societal and ethical as well as medical issues.  They are clearly difficult to resolve and we must always be sensitive to the needs of particular patients and their families.  Government mandates should not replace guidelines.

Let's finally face the finality of death from a position of doing what is best for that individual.  And often what is best is comfort care.

DEATH — Returning The Carbon You Borrowed

Carbon–the "hot" topic.  Be aware of your carbon footprint we are told.  Carbon is the great polluter, the cause of global warming.

Yet there is another perspective on carbon worth considering.  It involves an understanding of who we are, where we came from and where we are going.

We are carbon-based life forms.  Every science fiction fan knows it.  So does every student of organic chemistry.  Carbon atoms form the structure upon which all life as we know it is built.  It is the scaffold.  Other atoms bind to it–oxygen, hydrogen, nitrogen etc. It is the basis of amino acids, nucleic acids, proteins, DNA, RNA etc.

 These carbon atoms are billions of years old.  And they are not making any new ones that I am aware of. They are not as old as the Big Bang which only produced hydrogen and helium, but of somewhat later, when these original stars went supernova and carbon was formed. Till ancient beyond comprehension. We are truly star dust.

So, do we own the carbon of which we are formed? Hardly.  Like the magician's alchemy, invisible CO2 became flesh.  Photosynthesis allowed chlorophyll containing plants to capture CO from the atmosphere and turn it into vegetable matter.  Carbon atoms entered life forms.  We ate the plants or other animals that ate plants.

Atoms don't age.  They never change.  They defy the process of decay.  Yet we can't contain them forever.  Living matter comes with an expiration date. Eventually it fails to hold its carbon atoms tight. 

Eventually the invoice comes.  Time is up.   You can't pay more to keep them in place.  The atoms of carbon you borrowed from the universe are restless.  They need to move on.  There are others who will need them.

Say goodbye.  Be grateful for the time you had together.  It is time to die.


IBS — It IS All In Your Head !!

As a gastroenterologist I have been treating patients with Irritable Bowel Syndrome (IBS) for over thirty years.  As  meta-physician I have been fascinated by the mind/body relationship as well.  IBS exemplifies this issue perfectly.

In the past physician's regarded IBS as a stress-related phenomenon which was mainly a neurotic, psychological disorder.  In other words, "its' all in your head".  This was a rather demeaning attitude by practitioners towards patients with IBS, as if to imply that they were not truly suffering but somehow "making it up" or seeking secondary gain/attention.

As someone who has treated IBS patients I can confirm the truth–they ARE suffering, they do not "make it up."

Fascinating neuroscientific research as reported in the L.A. Times article offers MRI brain scan evidence of structural changes in the brain.

This may add credibility to those skeptical physicians who failed to understand the true nature of IBS.

For me this is just further evidence for the mind/body interaction.  There is no distinction between our emotional and physical lives. The guts enteric nervous system  (brain in the gut) contains the same neuronal apparatus and serotonin production as our spinal cord.

 Science has clearly demonstrated how receptor sites on every cell of our body, in every organ of our bodies instantaneously react to neurotransmitters released by various organs of our body in response to our state of mind.

Hopefully, this will take some of the stigma away from patients with IBS who might even question their own feelings and suffering.


PS.  I will be lecturing on the Integrative Approach to IBS on September 9th at 7pm at the YMCA in Perth Amboy, NJ.



Christopher and Peter Hitchens are two well known English writers/intellectuals who apparently disagree on many things–and particularly on religion.

Christopher is the devout atheist, Peter the devout Christian.  Christopher is better known in the States for his books defending atheism and addressing the failings of organized religion.

Oh.  One more thing–Christopher is dealing with esophageal cancer.

Despite attempts from his brother and other well-wishers, he still refuses to convert to Christianity as prospects of dying loom near.

Discussions of religious belief remain highly charged, controversial and deeply emotional.  It is difficult for strong believers to debate such issues in anything close to dispassionate analysis. Religion is, after all, not a rational choice.  It is about faith and belief, not proof and logic.

My own perspective might lie somewhere between the two Hitchens.  I acknowledge the failings of organized religion and understand that they are all human constructs.  I am deeply aware of the historical consequences of fanatical belief–wars, genocides, holocausts, jihads.

Yet I do acknowledge the good that organized religion can do–providing structure for the challenges of life including the rites of passage–birth, marriage, death.  Religious people acting from the compassionate core of belief have done enormous good as well–charity, relief, caring.

I suppose my personal perspective favors a simplistic approach which recognizes the spiritual dimension to reality and an imperative to live a compassionate, caring, ethical existence NOT based on the desire to appease "god" or obediently follow he dictates of religion,  but simply because it is the right, humane thing to do.

My own spiritual perspective is based on the evidence obtained from reliable sources who have experienced near-death experiences (NDE), after death communications (ADC) or medium related information.

To some this might seem as a weak and flimsy basis for belief.  But the weight of accumulated "data" point me in that direction.

I have also gleaned various concepts from a variety of sources such as Buddhism and Kabbalah which appeal to me as well. Survival of consciousness and karma make sense to me.  The view that our lives are spiritual journeys played out in human form offers meaning in the face of obvious tragedy and suffering.  Reincarnation and the opportunity to learn and evolve also seem valid to me.

So perhaps I am the brother in between the Hitchens boys.  Someday we will all find out who is "right".  But for now we all need to live each day to the best of our abilities.


The practice of medicine is often described as an art as opposed to a science.  I could not agree more.

Clearly it is based upon sound scientific principles and is based on the latest scientific discoveries and perspectives.

The challenge to the practicing physician is how to integrate these findings into the day to day managemnt of real patients.

The patient who sits before me in the examination room with a series of complaints becomes the focus of all the knowledge and awareness of the latest scientific findings as applied to that particular individual.

A patient will rarely be impressed by my ability to quote from studies and articles regarding their disease IF I am unable to ease their suffering.  Wisdom is not an abstract notion in this setting.  It is simply the ability to make this patient, this one particular human being, better.

The practicing physician knows only too well the difficulty of such an undertaking.

Real people don't always follow the text books or the latest studies.  They don't respond to what "must" be the correct therapy.  They don't want to undergo anymore tests.  They are impatient to feel better.  "What are YOU going to do about this ?" is their implicit (or explicit) response.

The much talked about "evidence-based medicine' in which the results of scientific studies should be the basis of therapy, don't always work either.

Individuals are complex, intricate and confounding amalgams of the physical, emotional and spirtual selves. They seek help, relief from suffering from someone who cares about their problems.  The physician who seems unconcerned, distracted, annoyed will hardly win their trust nor will he/she be successful in healing.

An unhappy patient makes an unhappy doctor.

Perhaps other sources for the patient's failure to improve need to be explored.  Perhaps there is tremendous emotional / financial / personal stress underlying the patient's complaints.  Perhaps this psychosomatic components manifest their unhappiness in terms of physical symptoms.

The patients are not deliberately denying their stresses when it becomes clear that they exist, it is merely a desire not to admit to emotional weakness of any kind.  And even when stresses are acknowledged, there is often a denial that the patients physical complaints are in anyway related to it.

There is now the internet explorers who have already diagnosed and treated themselves as well.


KETAMINE & MAJOR DEPRESSION–Neurochemistry And Emotion

Recent articles in the psychiatry literature has reached the public at large demonstrating that iv ketamine can significantly improve the depressive symptoms of manic-depressive patients resistant to other treatment.

The significance of such research, I believe, is the demonstration that we live in an emotional bath of neurochemical transmitters. Our emotional equilibrium is directly connected to brain chemistry. We naively believe that we have control over our feelings/emotions.  In many ways we do not.

It is clear that personal events, thoughts, worries can lead to feelings of sadness and that we can often "think" our way out of these states by utilizing techniques of meditation and cognitive/behavior therapy (CBT).

But for those unfortunate enough to suffer from major depressions and/or manic-depression, more radical efforts are necessary.

Talk therapy, even self-talk will not due.

The patient is suffering from a powerful disturbance in an otherwise self-regulating  neurochemical state of being.  Standard pharmacological approaches have failed. The potential for self-injury or even suicide is great.

The treatment much be aggressive and directed towards altering disturbed neurochemical processes.  The powerful anesthetic ketamine seems to offer hope.

Let us hope that this observation will encourage even more research into the underlying neurochemical origin of emotions and potential life-saving treatments.