Sunday, April 18, 2021

How I cured my Stiff Neck: Holobionts and Health.

 

This is a reflection on epistemology in medicine. It deals with my personal case of a bad stiff neck that lasted for more than a year, until I found the trick to make it go away. Please understand that I am no doctor and I don't claim to be able to cure anyone. I am just pointing out that you should always remember that you are a holobiont. So, if you treat your biome well, your biome will treat you well.

 

About two years ago, I developed a bad case of stiff neck. Sometimes it meant so much pain that I had to stop whatever I was doing and clench my teeth to avoid screaming. And sometimes I really screamed aloud. Then, I had to trust God every time I crossed a street because I couldn't turn my head to see if a car was running in my direction. 

There are various medicines you can take to ease the pain of a stiff neck and I tried several of them. Aspirin, NSAIDs, creams, exercises, acupuncture, massages. But, apparently, my case was bad enough to be resistant to pills, creams, and manipulations. What the hell was happening to me?

I tried to reason it over and I thought I had found an explanation. More or less in coincidence with the start of my neck pain, I had relocated to a new home. It was partly underground, and the humidity inside was much higher than in my old home. On the right, you see one of the windows of my new home. No, not the big one. Look at where my wife, Grazia, is pointing. Yes, that one! The hygrometer in the new home consistently marked over 70% humidity, whereas in the old home the needle would normally stay between 40% and 50%.

I know that correlation doesn't mean causation, but the logical inference was that humidity was the reason for my stiff neck. I found that it is commonly written on the Web that indoor humidity should be between 40% and 60% for optimal comfort, and that seemed to confirm my suspicion: my home was too humid. Even my hygrometer said that there was something wrong when the needle went over 70%. It was made in Germany, and their boffins are said to know what they say. Humidity could have been the reason of my stiff neck. 

So, I bought a professional dehumidifier, It made a lot of noise and it considerably raised my electricity bill, but it did lower the humidity level at home. Not so much, but it could bring it below 70%. But the effect on my neck was nil. During that period, I also happened to visit Iran for a couple of weeks. Tehran is a very dry city, I had brought my hygrometer with me: humidity was around 20%. I thought that it would have some good effect on my stiff neck, but I noted no improvement at all. 

In the meantime, I searched the literature to try to understand why the "perfect" humidity is situated exactly in the middle of the scale. I found very little. Plenty of people say that if humidity goes above 80%, it is bad for your health. And they say that, above that level, you should see green mold appearing on the walls of your home. I saw that happening at home, but did it have anything to do with my stiff neck? I couldn't find a serious study on the effect of high humidity on human health and, in particular, on neck pain.

About one year and a half of pain had gone by when I had one of those serendipitous moments that change your life. Wait one moment..... something HAD changed about two years before: I had bought a new pair of glasses with bifocal lenses. As soon as I started thinking about that, I also noted that in moving to the new apartment I had set up my desk on a table that was a little higher than the one I was using before. And I noted that in order to focus my eyes on the screen, I had to strain my neck backward.

This noted, this done. I got rid of my glasses, discovering that I didn't really need them to read text on screen. And the improvement was rapid: I felt better after just a few days. Completely getting rid of the stiffness took at least 4-5 months, but I can report to you that now it is gone. Zero pain, it is wonderful! I can turn my neck as much as I like and I can cross the street in safety. 

So, what did I learn from this experience? That medicine is a complicated matter. I am trained as a scientist and I am a firm believer in the experimental method. But that's very difficult to apply to medicine. In my case, I found a trick that cured my neck, but does it have a general validity? Does it prove that humidity doesn't cause health damage? Does it prove that my stiff neck was caused by my new glasses? Would that apply to other people? How could I tell?

It is the general problem of "evidence based medicine." The golden standard in medicine is the "randomized controlled trial." That means a complex series of procedures to evaluate a significant number of patients while trying to control all the multiple parameters that might affect their health. 

Seen in this light, my experience with neck pain doesn't count anything. How can I prove that my neck improved because I stopped wearing my glasses? How can I exclude other factors, maybe a special astral conjunction? Or something else? 

The interesting point of this story is that it would be practically impossible to carry out a randomized controlled trial on whether excessive humidity causes a stiff neck. Think about that: how do you find a standardized set of patients? How do you standardize the humidity conditions? How do you define the intensity of one's stiff neck? In addition, who would pay for such a study? Since it doesn't involve pills, no pharmaceutical company would sponsor it. 

The result is that everybody says that medicine is a science, but it is a peculiar kind of science where the "scientific method" is often applied in a creative way (to say the least). That was seen very well with the recent Covid epidemics, where most of the actions that governments took were not based on hard data, but on haphazard evaluations taken on the spur of the moment. Just as an example, we saw everyone suddenly disinfecting everything, everywhere, all the time. Do we have proof that all that has any effect on the spread of the Covid epidemic? No, as you can read on "Nature" -- not normally so unreliable as a source.

Does that mean that randomized control studies are a bad idea? Not at all, and I invite you to follow the blog by Dr. Sebastian Rushworth, a true gold mine of ideas, suggestions, and data, all useful for your health. He is specialized in evaluating randomized control studies and he is very good at translating the dry and incomprehensible language of scientific papers into something that normal people can understand. 

It is, just, that medicine is a world that deals specifically with the most complex system we know: the human body. And complex systems, it is known, can't normally be described in terms of "causes" and "effects." No, complex systems only know forcings and feedbacks. And a small forcing applied on a complex system can generate a chain of feedbacks that sends the system to a completely different state. Just like when a pair of new glasses pushed me from a state of "healthy neck" to a state of "stiff neck."

In the end, I think that always asking for proof in medicine is a double-edged weapon. It may help in many cases, but in others it may lead you completely astray. If you ask me (and let me repeat, I am not a doctor) I would say, "try what looks reasonable and keep what works." And always remember that you are a holobiont. Treat your biome gently (don't try to kill it using disinfectants) and your biome will treat you gently. And onward we go, fellow holobionts!


(on a line completely opposite to that of trusting randomized control studies, you may be interested in the work of Dr. Natasha Campbell-McBride, who wrote the book “Gut and Psychology Syndrome." She never mentions the concept of holobiont in her book or in her talks, but her whole approach is very, very holobiontic!)

Wednesday, April 7, 2021

The Vaccine of Ancient Times: Sharing Water

 The "Old Normal" was an age that spanned from the end of the last Ice Age to the start of the Covid Age. One of the weird things that the people used to do during those remote times was to collectively dip their fingers into a horrible soup of bacteria and viruses called "holy water." Then, they engaged in a ritual gesture that involved touching one's own face with their fingers still wet with that water. How could they survive that remains a mystery. (image source)

 

Last week, I stopped to visit a church in my neighborhood. An eerie silence reigned among the benches where no one seemed to have been sitting for ages. The holy water bowls at the entrance of the deserted church were completely dry -- not even a trace of humidity! They had been replaced by disinfecting gel bottles. You see both the empty bowl and the gel bottle in the picture. Maybe the priest had blessed the gel?

The elimination of the holy water dispenser would seem to be an obvious thing to do. Think of the unhygienic condition of the water: with people dipping their fingers into it, it must have rapidly become a cocktail of viruses and bacteria, maybe holy, but surely unhealthy

But, amazingly, these "stoups" of holy water are a very ancient tradition. They go back to the very origins of Christianity. Were our ancestors so stupid to pass germs to each other in this way?

It is a diffuse hobby to think that our ancestors were ignorant and superstitious. But if they had been really so ignorant and superstitious, we wouldn't be here. If the holy water rituals were killing people, that would have been noted and people would have stopped using them

But all the variants of Christian religiosity include this kind of ablution rituals. Islam does, too, although in different forms. And many other religions include communal ablutions. These rituals go very deep into the very essence of religion. Whether it is water, wine, or bread, it doesn't matter: it is the sharing that counts. And if those habits were supposed to be purification rituals, they had to purify something.

There is a good reason why purification rituals were good for the health of the faithful. They were early forms of vaccination. 

Think about that: the idea of a vaccine is to put a person in contact with some forms of pathogens in order to stimulate one's natural resistance. An early form of vaccination was called "variolation" (from the Latin term "variola," "smallpox"). It goes back to several centuries ago and it consisted of actually infecting people with smallpox. The idea was to have them develop a mild infection that would then protect them from more dangerous forms. Later, variolation was replaced with vaccination using a live form of the smallpox virus, taken from cows. And, of course, our modern vaccines are small miracles of molecular biology, but they do basically the same thing. They put our bodies in direct contact with some forms of the pathogen we want to fight.

You see that our ancestors were doing the same with their ablution rituals. Of course, they knew nothing about bacteria and viruses but, again, they were not stupid. They tried many things and they kept what worked. The idea of communal ablutions was to put everyone in contact with the skin biome of the whole community, sharing the "good" germs and stimulating an immune reaction that would protect the person from worse infections. That was done also outside religious practices -- in Buddhist countries, for instance, there is no equivalent of the holy water basin of the West, but they do have a tradition of communal bathing.

These old traditions could also go beyond ablution. Look at the picture: it is the "Madonna del Parto" in the Church of St. Augustine in Rome. If you go there, you are supposed to kiss the foot of the statue for good luck. Imagine many people kissing it, one after the other. Can you imagine a better way to transfer bacteria and viruses to one another? Actually, the foot is in silver, known to have some bactericidal properties. The idea may have been that, yes, it is good to share germs in this way, but let's not exaggerate. But, surely, if you didn't want bacteria to spread, you'd better avoid that people would kiss the Madonna's foot, rather than making it in silver! They wanted some germs to be transferred!

So, the ancients had empirically understood the concept that today we call "holobiont."  Our bodies are not single organisms, we are colonies of microscopic creatures: our microbiome. These creatures are part of us and, among the many good things they do for us, one is to protect us from the external microbes that tend to invade our bodies. The microbes living on our skin are the first line of defense we have, but we are protected by multiple defensive layers. The active immune system, the "adaptive" one, is the final layer. It enters into action only after that the other lines have been breached. Your microbiome makes sure that it rarely happens. It is part of the good thing that is being a holobiont!

But there is more than sharing water in being holobionts. It is a deep and significant way to show that we belong to a community, which we can see as a higher-order holobiont. The basic idea of religion, any religion, is sharing. Sharing is the essence of the great planetary holobiont we call sometimes Gaia, from which we came and to which we return. Without sharing, there is no God/Goddess, no community, no life. 

Something of this attitude has filtered through the rather anodyne ritual of modern vaccination, with many people reporting a feeling of spiritual completeness after receiving their vaccine against the Covid pandemic. They felt they had done their duty in protecting not just themselves, but the whole community and they were proud of having shared the burden with everyone else. Which is the way any good holobiont should feel! 

Of course, this kind of feeling depends on trusting that you are doing the right thing. One thing is dipping one's finger in a bowl of holy water: you trust your local community. Another is to have synthetic RNA being delivered inside one's cells to operate the molecular mechanisms of protein creation: you trust science.  

Is science an entity worth our trust? Trust is not bestowed by definition, it must be earned. And we must say that the composite entity we call "science" has not been always up to the standards that would make it deserve everyone's trust. Especially in recent times, scientists have shown attitudes involving petty squabbles, greed, ignorance, subservience to power, arrogance, political partisanship, and more. That explains the diffuse resistance against the modern forms of vaccination, perceived as a violation of one's body. Scientists must do much better than they are doing now if they want to maintain the trust that the community still places on them.

In the end, we keep making the same mistake we have been doing for quite some time: contrasting religion with science, as if the former were superstition and the latter the truth. It is not like that. They are different forms of understanding ourselves and the world (and, eventually, understanding is sharing). 

Even in health care, we are creating a schizophrenic situation by creating an artificial contrast that doesn't need to exist. Are we sure that we did well in abolishing the basins of holy water? They were ways to "prime" our skin microbiome against infection. With our emphasis on molecular vaccines, we forgot that the human defense system is multilayered. And if this first line of defense works, we are not necessarily forced to recur to more invasive ones.

Worse, we are forgetting that being human means sharing with others. Saint Francis would kiss lepers when he met them. We don't need to go to such extremes, but we still need to remember that we are human. Masked, disinfected, and isolated, as we all are nowadays, we are declaring that we are not willing to share anything with anyone. Are we still human? And, if we are, why we treat each other as if we weren't?

Who

Ugo Bardi is a member of the Club of Rome, faculty member of the University of Florence, and the author of "Extracted" (Chelsea Green 2014), "The Seneca Effect" (Springer 2017), and Before the Collapse (Springer 2019)