Drop Dead Healthy

My shoulder injury has prompted me to devote this month to researching—and ridding myself of—pain. The first lesson: Thank God I was born in the age of painkillers. The majority of Americans are accustomed to living relatively pain-free lives most of the time. This situation hasn’t been the case for most of human history. Pain has long been our constant, horrible companion.

Just contemplate the awful spectacle of surgery without anesthesia. If you read the absorbing book The Pain Chronicles by Melanie Thernstrom, you learn that doctors refused to tell their patients what day surgery was scheduled for. They simply showed up at the patient’s house on a random Tuesday or Thursday for a surprise operation. Otherwise, the patients would commit suicide the night before. It was that bad.

Thernstrom quotes Fanny Burney, a British novelist who had a mastectomy in 1810 (performed, incidentally, by Napoleon’s chief surgeon). Burney gave us the most vivid surviving description of predrug surgery. You might need anesthesia to read it:

[It was] a terror that surpasses all description . . . when the dreadful steel was plunged into the breast—cutting through veins, arteries, flesh, nerves . . . I began a scream that lasted unintermittingly during the whole time of the incision, and I almost marvel that it rings not in my ears still! . . . When the wound was made and the instrument withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp poniards . . . when again I felt the instrument, describing a curve, cutting against the grain, while the flesh resisted in a manner so forcible as to oppose and tire the hand, then, indeed, I thought I must have expired.

Even after anesthesia was invented, it wasn’t always used. Suffering, you see, was natural. When I wrote my book on the Bible, I read about the bizarre nineteenth-century controversy over women giving birth under anesthesia. Some felt it violated God’s commandment “Women will give birth in pain.”

Nowadays, pain has receded from our lives a bit. But we have a long way to go. Chronic pain—meaning pain that lasts several months—afflicts 70 million Americans at a cost of $100 billion to the economy, according to a study by the National Institutes of Health Pain Research Consortium. We haven’t yet found a suitable treatment for chronic pain. Pills sometimes work—but they tend to be addictive.

Reading about pain, I’m reminded, once again, that I want a refund on my body. Everybody should get one. Send this fleshy bag of bones and muscles back to the factory!

I’m not saying the body isn’t amazing in many ways. It is. I could marvel for days at the design of the ear, and how it converts puffs of air into a Haydn concerto.

But at the same time, the body has many deeply embedded bugs. We’re the result of ad hoc evolution and outdated hardware. And pain is one of the cruelest, most primal systems.

Pain is so unsubtle. Couldn’t evolution have found a better way to alert us that we stubbed our toe? Rather than this sensation that makes us curse the day our mom and dad met at the college cafeteria? What about just having the toe throb gently? Or turn green? Or play a little ragtime number? I’d pay attention. I swear.

Pain is annoying and unnecessary, like getting an e-mail in all caps. It’s like a six-year-old who alerts you every fifteen seconds that he wants Hungry Hungry Hippos for his birthday. Yes, I understand. Message received.

Maybe when we were slugs, we needed pain’s brutish alarm system to pay attention. But now that we have cerebral cortices, pain should have been phased out.

Not to mention that pain is ridiculously unreliable. Thernstrom describes this problem with a wonderful metaphor. Think of pain as a guard in a watchtower. He rings the bell when he sees enemies. Problem is, the guard is “erratic, lazy, easily confused, fearful, a poor multitasker, and sometimes just deluded.” Sometimes he’ll ring the bell for no reason. Sometimes he keeps ringing the bell long after the enemies have been killed.

Pain can erupt with no cause, linger for years, even appear in a phantom limb. And here’s one of pain’s most sadistic qualities: If you suffer from chronic pain, it often doesn’t ebb as the body heals. It often gets worse. Pain begets pain. The neural pathways become smoother, the message stronger. It’s a positive feedback loop that serves only to increase our misery.

Sharp Relief

My shoulder pain has gotten bad enough that I’ll try anything to cure it. My general practitioner taught me some physical therapy exercises, which I do at home, using a pole as a very light barbell. No improvement so far. Julie gives me a massage every night as she reads her historical novels, which is somewhat helpful.

I’ve tried a makeshift Buddhist approach—instead of fleeing from the pain, I concentrate on it with a Zen, nonpartisan mind-set. I say to myself, “Now that’s an interesting sensation. The burning. The throbbing.” I overthink the pain. But this strategy works better with short-term pain—a thumb jammed in a drawer, for instance—than it does with my lingering shoulder ache.

So today, I’m trying out new strategy: acupuncture. I find a place a block away—in New York, an acupuncturist is never more than a five-minute walk from your house.

And now I’m in the waiting room in the basement of a building. The door to the waiting room is propped open with a watermelon-size Buddha. I’m getting a whiff of that unmistakable Alterna Health scent. I can’t pinpoint it—jasmine? frankincense? spilled kale juice?—but I always smell it at non-Western medical practices.

I fill out my forms and browse the pamphlets, which are clearly targeted at another gender. Example: a gluten-free tonic called Zenopause.

The acupuncturist calls me into her office. She introduces herself as Galina. She’s a solid Russian woman in her sixties with bangs, a thick accent, and a white robe covered with words such as “Calm” and “Relax” in both English and Chinese.

“What brings you here?” she asks.

I explain the pain in my shoulder. She nods, jots down a note. Then she asks me questions for ten minutes straight, scribbling more notes.

“Do you sweat?”

“Yes.”

“Which places?”

“Armpits and face.”

I look around the office. It’s dark, more like a Viennese café than an eye-squintingly fluorescent Western doctor’s office. Asian fans and anatomy posters cover the walls.

After quizzing me on my sleep, bathroom, and eating habits, Galina gets up from her chair.

“You ready?”

“I’m ready. Except for the head. I don’t want it on the head.”

“Well, I’m doing the head.”

Apparently, the customer-is-always-right philosophy wasn’t taught in Galina’s native Russia.

I groan. I have some long-standing neuroses about anything touching my head, much less piercing my skull. I’m irrationally afraid of brain damage. When I was a kid, it was even worse: The skull was off-limits. No friendly pats on the head. No soccer, with its insane practice of bonking the ball on your pate. And if Grandma came in for a kiss on the forehead, I would dart my head like Manny Pacquiao. Nowadays, I let Julie tousle my hair, but I’m still careful.

“The head actually has the least nerve endings,” Galina assures me. “So it’ll be the least painful.”

I give a weak smile.

“One in a hundred people pass out. Maybe not even that. Usually it’s the big guys.” She laughs. She leads me to another chair in the center of the room.

“Which is more sensitive, one, two, three, or four?” She presses her fingers down hard on different areas near my bald spot.

“Three,” I say.

“You know, acupuncture probably started in Russia,” she says as she rubs alcohol-soaked cotton on my head. “The first corpse that had markings of acupuncture was found in Siberia. It was mummified.”

I’m not going to argue with a woman who is about to insert sharp objects into my exposed skull. She takes out a matchstick-size needle and pulls off its blue plastic cap. Then I feel a prick. Then a slide. There’s a faint but distinct sound of the needle gliding through the various layers of skin. It’s not too painful—about twice as bad as a mosquito bite—but the sound makes my stomach turn.

“You can look in the mirror if you want,” she says.

I get up and walk carefully across the room. There it is, sticking out of my head like a tiny antenna.

As she presses on my skull again, Galina gives me a crash course in acupuncture theory. “It’s about energy pathways. They are like roads in the body. And the energy can build up behind one part and cause the other parts not to have enough energy.”

The acupuncture is like a tow truck that clears up the traffic jam. The chi (energy) can flow smoothly through the body’s channels or meridians.

The channels are linked to different body parts. Today, she’s working on the lung channel, which is linked to my sore shoulder.

Galina slides another needle into my head, and one into my left leg. She flicks the needle in my leg. It boings like a cartoon arrow going into a target.

After my acupuncture session, I head straight to the gym for a workout with Tony. “How many needles did she put in?” Tony asks.

“Three,” I say.

“Three?” He laughs. “You got ripped off, my friend. On a per-needle basis, you got ripped off big-time.”

Tony tells me his acupuncturist puts in forty needles, minimum. Even when he does acupuncture on dogs, which is his sideline business.

That’s annoying. I didn’t even get as many needles as your average Scottish terrier. Did Galina not think I was virile enough to take more than three needles? I could have at least hit double digits.

But here’s the weird thing. Even though I was poked only three times, I notice something: My shoulder feels better. Not totally better. But a lot better.

For the first time in months, I can raise my arms in the air without a twinge. For the first time in months, I do shoulder presses with dumbbells bigger than hot dogs.

“This is amazing,” I say. “The voodoo worked. It really worked.”

So what happened?

To figure this out, here’s a quick summary of science’s view of acupuncture.

Studies are a frustrating mix. Some show it works, while just as many show it doesn’t. The studies display cultural bias as well: Chinese studies generally come out more pro-acupuncture than American ones.

A couple of recent studies show that acupuncture works better than doing nothing. But so does “sham acupuncture,” which consists of inserting needles in random places around the body.

So here are four possibilities of what happened today:

1. Chinese medicine is correct, and the needles restored my energy balance along my meridians. I’m too entrenched in Western thought to agree with number one.

2. The body does have pressure points that respond to needles, but science hasn’t found the mechanism that makes them reduce pain.

3. Sticking needles into almost any part of the body (not including the eyes) relieves pain. Perhaps by causing a surge in opioids.

4. It’s all a placebo effect.

My guess? And it’s only a guess: a combination of three and four. And by number four, I don’t mean to be dismissive.

Placebo Nation

The more I learn about placebos, the more I’m in awe. Humans are masters of self-delusion. It’s one of our greatest gifts, right up there with speech, math and the ability to make soft-serve ice cream.

Placebo—which comes from “I shall please” in Latin—is any fake treatment that gives patients real or imagined results. The placebo has probably been history’s single most effective medical tool so far. It’s cured more pain than aspirin, opium, and ice packs combined.

Placebos work on dozens of diseases and conditions. Pain, of course. But also coughs, depression, ulcers, and many others. They’re effective about 30 percent of the time.

Though in the case of my children, the rate is much higher. It’s amazing how a strip of sticky plastic will make my kids’ pain vanish. Lucas will be howling about a stepped-on finger, but as soon as the SpongeBob Band-Aid touches his pinkie, he’s all smiles. My sons are so convinced of the magical healing powers of Band-Aids, they think they can solve almost any problem. A couple of years ago, when our Sony TV blew a fuse, Jasper stuck a Band-Aid on the screen hoping to revive it.

If you looked inside my sons’ skulls, you’d see that the placebo makes deep changes to their brains, the same changes that would occur if they ingested real painkillers. Here’s how Thernstrom describes it in The Pain Chronicles: “In a 2005 study led by Dr. Jon-Kar Zubieta at the University of Michigan Medical School, the brains of men were imaged after a stinging saltwater solution was injected into their jaws. The men were then each given a placebo and told that it would relieve their pain. The men immediately felt better, and the screen showed how: in the image, the parts of the brain that release their own opioid-like substances (endorphins, enkephalins, and dynorphins) lit up. In a sense, fake painkillers caused the brain to dispense real ones.”

You could view placebos as depressing, I suppose. So much of medicine is a sham. Your brain is a three-card monte dealer running cons on the rest of your body. But I don’t see it that way. I find placebos uplifting and exhilarating. It means that taking action—no matter what that action is—might help you feel better. The key is just to get your aching butt off the couch.

I’m such a big placebo fan that I asked my general practitioner—a no-nonsense woman—to prescribe me some.

“Half the time I want real medicine, and half the time I want sugar pills,” I told her. “Just don’t tell me which is which.”

“I can’t do that,” she said.

“Why not?”

“For ethical reasons,” she said.

A shame. I blame the woman who successfully sued her doctor in 1890 for injecting her with water instead of morphine, even though the placebo worked.

It should be noted that not all placebos are created equal. Studies show the mere shape and size of the dummy pill can make a difference in how people react. Capsules are more effective than tablets. Blue pills are better at mimicking soothing tranquilizers, apparently because blue is associated with nighttime. Pink pills are better fake stimulants. (Except among Italian men, where it’s the opposite. The researchers’ theory? Blue is the color of the Italian soccer team, and the color gets pill takers excited.) Syringes dull pain more than pills.

In short, the more elaborate the fake treatment, the better it works. Which is, I think, the secret to a lot of alternative medicine. Consider cupping. This is the practice of using a candle to heat the air inside an empty cup, then placing the cup facedown on the body. The lack of oxygen creates pressure that sucks the skin into the cups, causing flesh mounds to pop up all over your body. This supposedly draws out the toxins. With all that rigmarole, cupping has to do something, right?

The same logic could apply to acupuncture, explaining at least part of its efficacy. Turning yourself into a human pincushion is an extreme measure; the brain expects it to work.

Which brings up a question: Does the brain have to believe in the placebo for it to work? Do you need faith? Most studies have said yes. I still remember the sad day when I read that my favorite cold remedy, Airborne—those orange pills that dissolve in water—has little scientific data behind it. I believed in Airborne, and because of that, I’m convinced it stopped many runny noses. My faith evaporated after reading that wet blanket of an article. Airborne became useless.

On the other hand, one 2010 Harvard Medical School study purports to show that placebos work . . . even when patients know they’re fake. Patients with irritable bowel syndrome improved when given pills they were told were dummies. Taking pills twice a day creates a “self-healing ritual,” said the study’s author.

I’ve experienced this so-called honest placebo effect as well. Though not with irritable bowel syndrome, thankfully. A few months ago, my glasses frames snapped during a wrestling match with my four-year-old. The lenses popped out. Lazy and stubborn, I wore the empty frames for a few days before getting them fixed. And here’s the thing: I swear my vision was sharper when wearing my empty frames than without them.

If the “honest placebo” effect turns out to be true, I’m going to start a pharmaceutical company and market my new blockbuster drug, Plazibo.

The Cursing Cure

Today, I ran across the park again to visit my grandfather. He was napping in his trusty recliner when I got there, and it took him a minute to emerge from the sleepy haze.

“What are you working on these days?” he asks.

I tell him about the health project, as I’ve told him a dozen times before. He nods his head. It’s unclear if he remembers or not.

I update him about my pain research.

“My favorite study shows you can alleviate pain by cursing,” I say.

He laughs.

The study, which appeared in the journal NeuroReport, showed that volunteers could hold their hands in freezing water forty seconds longer if they uttered expletives—it’s possible the cursing activates the amygdala, a part of the brain associated with fight-or-flight response, which makes us less sensitive to pain.

My aunt Jane—who is visiting again from Maryland—says there’s a lecture on the Internet about the psychology of cursing by Harvard professor Steven Pinker.

“Let’s watch it,” my grandfather says.

Jane finds it on YouTube, and presses play. Pinker starts with a quote from Bono—“This is really, really fucking brilliant”—which led to a Supreme Court case on obscenity. Pinker went on to utter the F-word with Mamet-esque frequency, as well as the C-word, the S-word, and every other offensive word you can think of, in noun, verb, adjectival, and adverbial form.

If ever I was going to listen to a string of swearwords sitting next to a ninety-four-year-old, I’m glad that ninety-four-year-old was my grandfather. Not that he swears a lot. It’s just that he can take it. And, he is currently laughing so hard his eyes are watery.

He was—and still is—young at mind. He watches Colbert and South Park. He’s fascinated by new things. He was an early adopter before there was such a phrase. I remember when he bought a video camera when they were still shoulder-mounted behemoths that looked like they could launch missiles. He loves the computer, the Internet, and cell phones.

And his friends? They are all younger than he—partly by default, since there aren’t a lot of ninety-four-year-olds around. But also by choice. He’s always preferred young friends. I’m not sure he ever accepted being an old man. At his eighty-sixth birthday party, he switched the numbers on his cake so they read “68.” “Much better,” he said.

My grandmother was even more of an age denialist. She rarely associated with people from her own vintage. “All they ever talk about is where it hurts and what’s wrong with their bodies.” She preferred my generation. She came to my friend Douglas’s thirtieth birthday at a club downtown, the only guest born before the Korean War, much less Vietnam. She said one of the highest compliments I ever paid her was to call her an honorary member of Generation X.

I can’t cite a study, but I wonder if there’s a correlation between age denialism and longevity.

Checkup: Month 8

Weight: 160

Miles walked on treadmill while writing: 302

Meals eaten in front of mirror this month: 18

Miles run per day: 2

Biggest health sin: 27 candy corns in a single sitting

It’s a mixed month. Some good, some bad.

Dietwise, I discovered purees, which I love. Carrot purees, broccoli purees, squash purees. I steam the vegetables, toss them in the food processor, and there they are, my brightly colored pastes. I find this adult baby food comforting, which I don’t want to overanalyze. I’d rather point out that there’s strong evidence that purees help you lose weight. They take up a lot of room in your stomach, making you feel full on fewer calories.

But my mental state isn’t so good. I’m mildly depressed, and I’m not sure why. Perhaps it’s been the rash of health problems in my family. Julie’s stepdad had to have leg surgery, and her dad is having trouble balancing after his stroke a couple of years ago.

Maybe my mood’s cause is more superficial. Thanks to my bum shoulder and my inability to lift big weights, my chest muscles have shrunk again, so I still look like a recovering heroin addict.

I decide I need something to lift me from my funk. Which is why I chose to try out a fitness class called “intenSati.”

I’d been hearing about this eccentrically capitalized class for months. Friends of friends would not so much recommend intenSati as command it. “You have to do intenSati.”

So on a Tuesday, I convince Julie to join me. She’s agreed to come on one health adventure per week. She reminds me I should choose carefully.

“This is going to be worth it,” I tell her.

The class is held at Equinox—a fancy gym where an attractive spokesmodel is giving out free samples of a new blueberry-flavored energy drink.

The hundred or so students gather in the heavily mirrored aerobics room. We grab our mats, and wait for our leader, Patricia Moreno. Patricia is the inventor of intenSati, and one of the most cultishly adored trainers in New York.

She appears. She’s a beautiful, caramel-skinned woman wearing a head mike, a pink stretch top, and carrying a notepad. She’s also seven months pregnant, a fact that won’t stop her from deep squats or high kicks.

She flicks the lights to red, giving the room a soothing feel, or a developing-old-photographs feel, depending on your point of view.

“We’re going to have a great new program today!” says Patricia.

Whoops and applause from the crowd.

Patricia glances down at her notepad. She gives a five-minute speech about how you have to sacrifice to achieve your goals.

I glance over at Julie. Her arms are crossed. Bad sign. Julie doesn’t come to the gym for sermons. She just wants to expend energy and fatigue her muscles.

And we do. After the speech, we give every part of our bodies a workout—and that includes the vocal cords.

IntenSati, it turns out, isn’t just aerobics. It’s aerobics mixed with a Tony Robbins workshop and a Pentecostal service. It’s fifty minutes of thrusting, pumping, jumping—all overlaid with shouted affirmations.

“I am never giving up!” yells Patricia as she squats and jumps.

“I AM NEVER GIVING UP!” we yell back, squatting and jumping.

“Are you in it to win it?!”

“I AM IN IT TO WIN IT!” We bend down, touch the floor, punch the air in front of us.

“I want it, I want it, I really really want it!” shouts Patricia.

“I WANT IT, I WANT IT, I REALLY REALLY WANT IT!” we holler back as we step to the side and kick.

The crowd—mostly women, mostly well toned, mostly glistening by now—are really into it, shouting loudly enough to raise the veins in their necks. I look at Julie. She’s saying the words with all the enthusiasm of a third-grader reciting the Pledge of Allegiance.

“Warrior pose!” shouts Patricia.

We jump and spread our legs out like ninjas.

“Every day, in every way, I co-create my reality!” she shouts.

“EVERY DAY, IN EVERY WAY, I CO-CREATE MY REALITY!” we shout.

I’m trying to balance Julie’s lack of intenSati spirit with my own zealousness, which is part earnest, part manufactured. I’m doing this somewhat out of guilt. I made Julie come, and I want to convince her—and myself—that it’s a worthwhile hour.

I have nothing against affirmations, even overly complicated ones. Co-creating my reality? I can go with that. We do see the world the way we want to.

It’s not a bad catchphrase. And I’ve been on the hunt for some good inspirational slogans ever since I had to stop using Nike’s beautifully succinct “Just do it!” (I discovered that the advertising copywriter got the idea for the phrase from the last words of executed murderer Gary Gilmore. So I can’t say it without thinking of a firing squad.)

Anyway, I’m committing myself to these affirmations. And I swear, over the course of forty minutes, I start to get more confident. My posture improves. My endorphins flow.

Yell this stuff in a room for long enough, and you start to believe it. I can do anything! I can write an epic poem! I can design a hydrogen fuel cell! Unfortunately, one thing I cannot do is convince Julie the class was worth her time.

“I feel like I was just at a Hare Krishna meeting,” she says as we’re packing up to leave.

Julie won’t be coming back. Though for the next two weeks, she did incorporate intenSati into our lives.

“Can you hand me the business section?” she said the next morning. “I want it. I want it. I really, really want it!”

In the end, I probably won’t be a regular intenSati-goer either. But I see its charms. Some level of delusional optimism is healthy. As long as that delusional optimism is balanced with a sensible understanding that we have pathetically little control over our fates. It’s a tricky mix, but a crucial one.

You need both. Without some delusional optimism, you’ll suffer from Depressive Realism. This psychological theory holds that the people with the most accurate view of the world aren’t happier—they’re clinically depressed. Studies show they have a correct perception of how much they control the outcome of events—namely, very little—and it crushes them. (Not all scientists buy this theory, but the ones who don’t are probably, you know, deluded.)

If your worldview is too real, you might spend all your time in bed eating Bugles corn chips feeling overwhelmed and listless. You’ll be too aware of all the thousands of factors toying with your destiny—from the weather to your genes to a misplaced pair of socks.

On the other hand, if you’re too delusionally optimistic, you’ll be unbearable. You’ll refuse to save money or make backup plans. You’ll invade foreign countries and expect to be greeted as liberators. Like everything else in health, you need balance.