Power to the Reader

A website can be many things for many people. For me it’s a way to explain myself; to help my patients and their families; and to share with a broader readership things that are creative, new, or inspiring. There is a quote thought to be from the 12th century physician, Moses Maimonides, which has animated me for some time. He is said to have seen all of the forces of good in the world in perfect balance with all of the forces of evil, and that each day brings us a chance to shift the balance. I have never met anyone who claimed to do this every day. But the person who doesn’t want to try is suffering from what Maimonides called the evil against the self. In the 20th century we called this evil mental illness. But if we have learned anything, it’s that illness is not only something we bring on ourselves, but something our environment and genes bring on us willy-nilly. No one wishes for cancer, but millions of people have fallen into the environmental trap of smoking, for example, and died nonetheless. More...

eBook Just Released! The No Nonsense Guide to Drugs & Alcohol

February 22nd, 2013 No comments

Everyone knows that drugs can kill you. Yet half the kids in America will try some drug before they leave high school. Too often kids don’t believe what they hear because they only get part of the story. They need more. For some kids, drugs are simply fun. For others they’re liquid courage at a party, or a way to take the edge off the blues. This eBook is for the kids who ask “What’s wrong with that, Doc?” Plenty, of course. Few kids die from drugs, but many are hurt, and some are hurt for a life time. This eBook sorts out the risks with the click of a mouse or the touch of a finger.

It’s the first eBook ever that deals with kids sixteen years and older and the drugs they choose. It’s designed to enable the reader to search a topic of interest, and jump to the main points quickly. Whether they have the focus of a genius or the attention span of a gnat, this eBook helps kids make smarter choices about drugs. As an eBook it harnesses the power of the Internet to provide the reader with the latest science for and against many drug claims.  It’s a book, it’s a myth buster, and it’s a doorway to the whole world of drug information. But it’s also a way to save a kid’s life.

  • Clear and compelling graphics.
  • Clinical stories, humor, and pop icons.
  • The hands-down greatest killer, and how Big Tobacco plots to keep it that way.
  • Marijuana as medicine, and marijuana as an assault to the growing brain.
  • The hidden benefits of caffeine.
  • The hidden dangers in the medicine cabinet.
  • The drugs in chemicals, plants, and toads.
  • The surprising winners and losers in our Drug War.
  • And a way to empower young people to change things for the better.

Categories: Home

Medical Marijuana

January 20th, 2015 No comments

Henry David Abraham, MD

Two thirds of the voters of Massachusetts have joined those in 17 other states to declare that marijuana is now a medicine. This is the not the usual way a medication gets approved for use. But marijuana is no usual medication. No modern medicine is smoked. Voters have danced democratically around the Federal government’s regulations, laws, and threats of punishment over the medical use of weed. Medical science took a back seat to all this, as if the laws of chemistry, physics and biology could be repealed by a show of hands.

To the majority the vote was all about compassion. On Valentine’s Day the Department of Public Health held a “listening session” on medical marijuana. Sufferers of many ailments for whom the weed is a godsend made moving testimonials. To others the vote appears to be the camel’s nose in the tent. If medicalized weed is here, can recreational weed be far behind? To many of my medical colleagues, the vote felt like we were being hijacked into offering a “medication” which has more proven risks than benefits. New evidence, for example, shows that weed is found more often in stroke victims than controls.

For parents the vote opened up a box of tough new potential questions from their kids. Is weed safer than we thought? If sick people can use it for medicine, why can’t other people use it for fun? And if they can use it, why can’t kids? These questions are likely to multiply as “treatment” centers blossom like poppies in the morn.

But hold on, Moms and Dads! Let’s stick to the evidence. Marijuana is still a risky drug to mess with, especially for kids. And the younger a kid starts, the worse it is. A recent study of more than 1,000 kids from New Zealand, for example, showed that if kids smoked heavily as teens, by age 38 their IQs were lower than those in kids who didn’t smoke. Now this is scary. Worse, mental declines persisted long after kids stopped the drug. This doesn’t prove that using weed caused the mental drop. Maybe weed users drank more alcohol, had more head injuries, or had more drug overdoses than controls. This kind of comparison usually has more than one explanation. But it’s consistent with many other brain and cognitive studies of the same question. Now let’s have a new vote. All you kids who want to be dumber please raise your hands. Not too many, eh? Good. This little vote is nothing I just made up, by the way. That’s what the data show.

Contrary to what you would fear, large scale surveys of high school students in the U.S. show that 80% “disapprove” of frequent marijuana use, and have done so for the last twenty years. By that measure, the average high school student gets higher marks than the average Massachusetts voter. But the kids don’t get straight A’s, since the same national survey found that the percentage of kids who saw smoking weed every day as a “great risk” fell steadily from 80 to 40% in the same twenty year period. Clearly, our kids are getting a bit too comfortable with weed in their lives. It’s important to note that the trend began before the first state approved of medical marijuana. But the medical marijuana movement is only likely to make the trend worse. In Danvers, for example, Jason Verhoosky, who works with kids messed up on drugs, reports weed use went up when we decriminalized it.

There is another concern. More weed in the community means more weed in the hands of our little darlings. John Carmichael Jr., the deputy police chief in Walpole, raised this point at the Public Health meeting. ‘‘It would be naive to think there is not going to be diversion,’’ he said. His fear is well founded. A recent study from the University of Colorado, where medical weed was legalized in 2000, found that the diversion of medical marijuana to the young can happen. Among 164 teens in treatment for drug abuse, 74% of them admitted using someone else’s medical marijuana.

Much of the discussion at the public meeting focused on who would be eligible for medical weed. Medical treatment is built on a hierarchy based on the types of evidence that support it. Does it work, and is it safe? A man who claims that marijuana reduces his chronic pain, for example, is worth listening to. He may be telling us something that medical scientists can work with to help lots of other people. But personal testimonials are seldom controlled experiments. I remember a nearly 100 year old man telling me the secret to his long life: “A glass of warm water every day.”

For stuff to become a proven medicine we need a higher level of validity than voting, personal or otherwise. We need studies that use powerful words in their titles like “controlled,” “placebo,” and “randomized.” While the body of evidence supporting medical marijuana is growing, it’s no credit to the Federal government for having stood in the way of legitimate research for decades in the name of the War on Drugs. Controlled studies are appearing for the use of weed in cancer chemotherapy, AIDS, and MS. Wider claims are being made for the treatment of pain and PTSD. Pain appears to be the commonest reason given for using medical marijuana.

In the end, will we smoking our way to health? I doubt it. But as Chou en Lai allegedly said when  asked about the future of democracy given the success of the American revolution, “It’s too soon to tell.”

Categories: Opinion Editorials

A Blueprint for Happiness, Really!

January 20th, 2015 No comments

Henry David Abraham MD

And now for a really old question, Mom and Dad: Can money buy happiness? Before I give you the answer, let me say that exponents of positive psychology like Martin Seligman have actually figured out a blueprint of happiness. Seligman and other exponents of positive psychology say that happiness is made up of pleasure, engagement, and meaning. Colleague Daniel Kahneman, who is also a Nobelist in economics, splits it up pleasure into two parts:  how you feel right now (“experienced wellbeing”), and the overall report card you give for your life (“life satisfaction”). Both psychologists believe they can measure this stuff.

Thinking about happiness in two parts is useful. You can feel quite accomplished if you earn a gazillion dollars a year, but you can still have a bad day at the office. Both types of happiness can be measured, though what you are experiencing in the here and now is more valid.  As in the board game, Life, higher education can lead to a higher evaluation of your life, but not necessarily greater experienced well-being. Studies show that more educated Americans report higher stress.

Psychologists even have an index for feeling bummed out, weighted for how much time you’re in that state. For example, in a study of 1,000 American women, 19% spent of their time in unpleasant states, compared to 16% of French women and 14% of Danish women. Researchers have measured which activities bum out American women the most. For 29% it’s the morning commute, for 27% it’s work, and surprisingly, for 24% it’s child care. Living with kids results in more reports of stress and anger. But on a cheery note it has less adverse effects on the global feel of one’s life. Religion has opposite effects that kids have on our lives. It has greater favorable impact on emotions and stress reduction in the present, but less of an effect on the big picture. The bummer index is higher on weekdays and lower on the weekends. Does this begin to sound familiar, parental units?

What you’re doing at the time obviously affects your happiness at the moment. But different cultures derive different degrees of pleasure from the same activities. The French, for example, spend the same amount of time eating as Americans, but report twice the pleasure. This may have something to do with the fact that Americans often eat while doing something else, lose track of the food, and so diminish its pleasure.  This brings me back to the question: can money buy happiness?

The quick answer is yes, but only up to an annual income of $75,000, at least in a Gallup survey of 1,000 people. Beyond that income level the data show that “experienced wellbeing” fails to increase an iota. In the jargon of researchers, a “satiation level” is reached. That is, you can buy many more things after you bring in the first 75 thou, but you don’t buy more day to day happiness! Why? One idea is that the highest income actually reduces your ability to enjoy the smaller pleasures of life. An experiment makes the point nicely. A group of students were given chocolate bars, and asked to rate the pleasure in eating them. At another time they were first primed with ideas of wealth, and then given the same chocolate bars. And lo and behold! They reported less pleasure. Ah, yes, Mr. Smarty Pants, you might be thinking. Can I send my kid to Harvard on $75,000 a year? Not without help. But the family who can write the big checks for private colleges reaps a benefit in life satisfaction, not day to day happiness.

Clearly we all could use a bit more of both. But there is a danger in letting economic decisions rule the roost. Long hours at work mean short hours with your kids. A good goal for parents is to reduce stress in themselves and their kids. One way is to get off the gerbil wheel. More than one mom I’ve worked with over the years lived as a chauffeur, shuttling kids each week between soccer, ballet, gymnastics, skating, t-ball, and the math tutor (there’s always room in that college essay that your little darling solved Fermat’s Last Theorem, right?). And then CCD, Hebrew School, SAT-prep, and the parent’s reluctant role of designated driver from teenage parties. The gerbil wheel starts spinning long before the teenage years. One family with kids in an elite college said “college begins at two.” Any family who believes that is consigning themselves to 16 years of anxiety and depression. Don’t like doing that for one kid? Try three. Something has to give.

OK, doc, so what’s the prescription? The easiest path to happiness is to control your use of time. Less driving could help, and shared driving. Think carpools. Switching from passive to active forms of leisure, including socializing and exercise, has also been shown to help. When the Gallup World Poll was taken in 150 countries, a common cause of feeling miserable during the day was a headache. But the second best predictor of how you’d feel that day was whether you spent time with a friend or relative.

Categories: Opinion Editorials

Talking with Aunt Toby

January 20th, 2015 No comments

Henry David Abraham MD

I had a talk with my Aunt Toby recently. She’s 79, thrice married, and started life as an Orthodox Jew. I hadn’t known much else about her, and I thought it was time I did. She lives on the other side of the country. Our paths never seemed to cross. But we live in the greatest age information in history. It took a few strokes at the computer, a call here, a call there, and Aunt Toby came back into my life. Though she’s on Facebook and corresponds by email quite nicely, there is nothing better than two human beings talking in real time. So no emails, selfies, tweets, or posts on FB. We were just two people in a family who wanted to catch up.

Why is this important? Because talking like this helps answer where we and our families came from. Of all the data in our lives, thinking about our own families of origin is pushed on the back burner by the thousand claims of daily life. Don’t believe me? Test this idea out with a little quiz to your kids. Ask them where their grandparents were born, where they grew up, and what they did for a living. How did they score? 100%? Great! It means your family takes special pains to know itself. Less than 100%? Not unusual. The first generation often doesn’t talk, and the second generation doesn’t ask. But what better way for kids to get a sense of their own history than getting it straight from the source? Stories count. Old jokes count. Shared troubles count. These are some of the ties that bind a family together.

But there’s a hitch. What’s more fun for a kid, Gramps’ story about life before the cellphone, or playing Mortal Kombat (the Komplete Edition)? Get real, Gramps, you’ve just been upstaged by an Xbox. So getting a kid to buy into this family history thing is not easy. But don’t blame the Xbox. There’s good neuroscience to explain why a kid will lapse into semi-stupor, cross her eyes and start drooling at the sound of any sentence that starts “Did I ever tell you about the time…?” This talking stuff between generations is hard to do. There are more non-starters than starters. What makes things even harder is that kids’ brains are wired for coding the here and now, not for planning the future or viewing the past. That’s why it’s perfectly healthy if your child never turns in a term paper early.

The trouble the young brain has wrapping itself around the big picture is an especial challenge to history teachers. It’s also why the easy road is for a teacher to hammer on the names and dates of history, and the higher road is to help the student connect the dots with a sweeping perspective that is, well, History. The easy lesson teaches that the Battle of Zama was in 202 B.C., but the greater one gets you thinking that if the Romans had lost the Battle, we might be speaking Punic today.

So that’s your assignment, Mom and Dad: Become the inspired teacher of your family’s history. You can start by asking your parents the questions you always wanted to. Don’t be timid. They’ve probably wanted to tell you for years. And once you know, don’t be shy about telling the children. The stories make the family stronger. They strengthen your religious, artistic, and intellectual values. You and your parents are an unspoken text waiting to be given new life. Who came from China? Grew up in the North End? Went to Vietnam? Korea? World War Two? Who were the family athletes? Writers? Carpenters? Cooks? The geniuses behind the great family dishes?

Let me give technology its due in this regard. There has sprung up an internet industry to help. Ancestry.com and Genealogy.com enable you to actually construct a family tree from documents that they help you find. Sites like JewishGen.org help with uncovering Jewish family ties in Europe and elsewhere. But some of the most valuable treasures waiting for you to find may be in your attic or basement- the photo albums and letters of loved ones from the past. Who are these people? What were they doing in their lives when the picture was taken? And old letters? A family’s treasure.

Kids have no sense of history unless you give them one. The family history need not be filled with big stories or a clatter of skeletons tumbling from an old closet. And of course, parents have to use common sense and make them appropriate to a child’s age. The story of an aunt who was the first girl to run the 440 in her high school is forgotten until it’s retold. And once it is she becomes a star in the family for the moment, and over time, perhaps, an inspiration to her nieces and nephews.

My Aunt Toby didn’t run the 440 in high school. She told me, “I was famous for being a shopper. When I went on vacation all the sales people would call my house to make sure I was OK.” Then in passing she told me how she named two of her daughters for family members she lost in the Holocaust.

Categories: Opinion Editorials

The Heroes among Us

January 20th, 2015 No comments

Henry David Abraham MD

Any baseball fan knows that at Fenway Park there is a brief ceremony at every game recognizing the Heroes among Us- veterans, firefighters, police workers, and community activists who stand and take a well-earned bow. Added to that list I’d like to see vaccination workers, especially those who put their lives on the line around the world to prevent polio, diphtheria, whooping cough, tetanus, measles, and smallpox. Vaccine workers have been abused by Afghan tribes. They’ve been killed by the Taliban. And yet they persist in trying to reduce illness, suffering, and death afflicting millions.

It’s hard for people to be afraid of things they haven’t experienced. Polio is a case in point. As a kid growing up in Philadelphia I had a wonderful community resource in the summer – the public swimming pool. But in the sumer of 1954 polio was loose in American cities. The city fathers shut down the pools, and the police looked the other way as folks turned on the fire hydrants to cool us down in the city heat. I escaped polio in 1954. My friend John was less lucky. Polio paralyzed his face and throat. The following year the March of Times, founded by FDR, our famously paralyzed President, funded one of the largest field trials of vaccination in history. The results were staggering. In 1953 35,000 people had polio. By 1961 there were only 161 cases recorded in the United States. Ask someone today born after 1960 what polio is. Thanks to the vaccine, the answers you get are likely to be spotty. Gone are the images of wards filled with children in iron lungs and leg braces. The last case of polio in all of the Americas was in 1991.

The last known case of polio in the Americas. Luis Fermin Tenorio, 1991.

Like any drug, a vaccine is not perfectly safe or 100% effective. But the numbers speak for themselves. A complication from vaccination occurs once in 2.5 million doses. But becoming paralyzed from a natural infection by the virus occurs in one in 100 cases. The polio vaccines are not perfect, but they reduce the chance of getting sick by 80%.

So why has the epidemic disappeared? One answer is “herd immunity.” If only one or two kids in a classroom get sick, the chance of an epidemic spreading to the other kids is much less the more the rest of the class is immunized. This source of protection begins to fall apart the greater the number of kids who are not immunized. Hence, the alphabet soup of DPT and MMR shots our kids get poked with before they even show up in school.

There have always been folks who are suspicious or downright antagonistic toward vaccination. The great caricaturist, James Gillray, attacked the vaccine against smallpox made from cows by drawing miniature cows growing out of the bodies of the haplessly vaccinated. Today’s anti-vaxers don’t draw like Gillray, but they exercise their First Amendment rights. They also represent a lamentable assault on the common good.

Who are the anti-vaxers? Some are Libertarians who believe that government should not mess with their children. Some are celebrities with an ill child looking for a simple answer to a complex problem. Some are members of a religious sect. Others are health nuts nursing personal theories of sickness and health. And some are salesmen of products to health nuts, talking down vaccination while talking up coconut oil. And God bless the Internet- the flames of all of these ideas are fanned on the Web. A common theme is that the rights of the individual are more important than the safety of the group, and that government and corporations can’t be trusted. Sadly, not all anti-vaxers can be, either.

One of the more notorious cases of anti-vaxing came to light after a paper was published in 1998 in the scientific journal Lancet, claiming that autism was associated with the MMR vaccine. But the “data” in the paper were falsified, and the lead author had been paid to testify by a litigant in an anti-vaccine law suit. It took over a decade for this misdeed to be corrected. In the meanwhile, thousands of children were needlessly left unprotected from ancient scourges of childhood, and honest autism researchers were thrown off the scent for autism’s actual causes and treatments.

An equally dangerous activity comes from feckless legislators who permit parents to take “philosophical exemptions” to their state’s vaccination requirements. When we’re talking philosophical in statehouses, we’re not talking Edmund Burke here, but the Gospel according to Granola. On Vashon Island, Washington, for example, across the Puget Sound from Seattle, 18% of the kids were not immunized against polio, measles, mumps, rubella, diphtheria, whooping cough, tetanus, hepatitis B and chicken pox at one point. You can wipe that smile off your face, East Coasters. 11 states reported increases in such exemptions in 1999, including Massachusetts, despite a measles outbreak in California a decade before that sickened 43,000 unimmunized children and killed 101. And in 2012 seven percent of Massachusetts kindergartners were not immunized against polio (compared to ½ % of those in Nebraska).

Clusters of unvaccinated children are not only in danger themselves. They but are also a threat to the ‘herd immunity’ that walls out viruses, since a weakened “herd” reduces protection for the unborn fetus, the infant too young to be immunized, and the older person with a weakened immune system. And since no vaccine is perfect, even vaccinated kids are at increased risk. And a virus can travel from one side of the world to the other in a day. The worldwide rise of whooping cough in the last decade makes the point. Vaccination protects your children, and the rest of us.

Categories: Opinion Editorials

Smarter Kids in Just Twelve Weeks!

January 20th, 2015 No comments

Henry David Abraham MD

This is a joke, right? Like six minute abs? No, it is not a joke, but the conclusion of a scientific study on the value of teaching kids music. Psychologist Hossein Kaviani and others in England randomly assigned five and six year olds to one of two groups for twelve weeks: one group received music training, and one didn’t. At the end of the study the first group had higher IQs, especially in verbal reasoning and short term memory.  To anyone who’s studied music, this is no big surprise. A raft of researchers has confirmed psychological benefits from music. Neurologist Robert Ellis and colleagues at the Beth Israel Deaconess Medical Center in Boston have even found where in the brain these benefits occur. And the Journal of Neuroscience reports that brain changes from learning music can persist for at least a decade after the lessons stop.

What about babies? Music gives infants a boost, too, in language and social development. Lullabies sung to premature infants in the hospital affect their heart and lungs, improve feeding, and increase alertness. And as any pregnant mother will tell you, fetuses too, got rhythm. One mother told me she has fond memories of a pregnancy in which one of her kids in utero responded to different songs from Fats Waller’s Ain’t Misbehavin’- “The Joint Is Jumpin’,” (bladder kicking), and “Two Sleepy People,” (party over, night-night). Maestro Joel Smirnoff of the Cleveland Institute of Music speculates that such early connections to music are tied to the first rhythms a fetus hears in the womb- the sound of its mother’s heartbeat. This is likely the foundation rhythm in lullabies, chants, and even the likes of Bach and Beethoven. It’s also the unconscious basis for the near universal appeal of rock and roll. And if your copy of the medical journal, Noise Health, was lost in the mail, you missed the report that even cells in a Petri dish can respond to music by changing their size and contents.

Then there are the benefits that music brings to a kid’s personality and character. Kids see cultural doors open onto different times and places. They learn discipline and perseverance. As musical skills increase, they see themselves go from nowhere to somewhere, which gives self-esteem a shot in the arm. They learn to play together. They feel the pride of doing something really hard, perhaps something that even their parents can’t do. Music is about doing, and doing is the heart and soul of both school and the workplace.

Music needs a place in every home, and I don’t mean the radio. Humans at home need to make music. Parents with infants and toddlers should sing and dance with them, and play rhythmic games. Patty cake is still at the top of the baby charts. Newborns need music, too, though this one can be tricky. A music teacher said she only played Bach and Mozart to her babies, not Beethoven. I didn’t know why until I made that mistake with my grandson. A little of Beethoven’s Ninth to get him to sleep, right? Ah, the 3rd movement, a dream, it’s working, he’s drifting off. Then comes the 4th, the ever popular Ode to Joy. You know the piece: trumpets, sopranos, high octane pleading about joy and brotherhood best heard in an open field. A few blasts of “Freude!” and the grandson slept no more.

With all this power packed into music lessons, it only baffles why music education has been a casualty in more than half of the states’ cutbacks this the last year. Happily, Lexington is an exception. The 2013 school budget eliminated the regressive fees for music lessons in elementary schools. Bravo, School Committee! In the last six years the number of kids in this program has grown from 314 to 501. And bravo, parents, who know a good thing when they see it! But winning the battle is not winning the war. Parents are in a great position to put cognitive science in practice.

Music lessons come in many flavors. The Suzuki systems for violin and piano are admirable for fostering a stronger bond between parent and child, because both parent and child are students of the instrument. This is no time to be shy. We are not looking for the next Joshua Bell here, but a stronger, more resourceful child. You need nerves of steel, however, when the violin slips from the fingers of a five year old and crashes to the floor. Fear not. Student violins are built to take a hit. And you don’t have to do this alone. Schools are behind you, public and music, and an army of gifted public and private teachers. Music changes the child. And the child changes society.

One pioneering example of music as social change is the after school program, Neighborhood Strings. Two string players, Peter Sulski and Ariana Falk, formed it two years ago in the “Mean South” section of Worcester. They teach violin, viola and cello to twenty kids of Hispanic, Vietnamese and Albanian origins. The students learn how to sing, read music and count rhythms. They play pieces like Boil Them Cabbage Down and March of the First Finger. The kid Oscar is known for his enthusiasm. The kid Anderson has a flawless grip on the bow. Their last concert drew 800 people. Sulski and Falk have a dream. They hope to see these twenty kids go to college. Why not?

Categories: Opinion Editorials