Dear PAAM Colleagues!

Welcome to a new edition of the PAAM Medical Letter! Thank you to all who subscribe or contribute to this letter! The summer seems to be out in full force. It seems appropriate, therefore, to start this issue with a meditation from Rudolf Steiner that speaks to the power of the sun and our inner connection to it.

Please note: This Letter is for your thoughtful consideration and personal research and is not to be taken as something dogmatic to believe in nor promote as something official from PAAM or the international anthroposophic medical movement.

In my heart
Sun-strength shines
In my soul
World-warmth works.
I will breathe
The strength of the sun
I will feel
The warmth of the world.
Sun-strength fills me
World-warmth penetrates me.

Rudolf Steiner, 1923
CW 268

Two other meditations seem to be apropos to our times, where earth-bound thinking towards physical life and matter predominates:

The human being requires inner loyalty;
Loyalty to the guidance of spiritual beings.
They can build on such loyalty
Their eternal existence and being,
And thereby perfuse and strengthen
Sensory existence
With eternal light.

Rudolf Steiner, 1922
in Truth-Wrought-Words, 1986, CW 40

Here is another quote from Steiner that elaborates on one aspect of what our loyalty and attention means:

The spiritual beings who, apart from ourselves, inhabit the spiritual world look with satisfaction and approval upon our thoughts about their world. They can help us only if we think about them; and although we may not have attained to clairvoyant vision into the spiritual world, if we know about these spiritual beings they can help us. In return for our study of spiritual science, help comes to us from the spiritual world. It is not merely the things we learn, the knowledge we acquire, it is the beings of the higher Hierarchies themselves who help us when we know about them.

[…] The spiritual world helps us. We have need of it, we must know about it, and unite ourselves with it through conscious understanding.

Source: Rudolf Steiner – CW 168 – How Can the Destitution of Soul in Modern Times Be Overcome? – Zurich, October 10th, 1916. The title of the lecture points to the degeneracy of modern times since the 20th century and how it deprives the human soul. There is a way out!  

The “Loyalty Verse”

Try to form a really heroic concept of loyalty. What people call loyalty is so evanescent. Try making this your loyalty:

You will find that there are fleeting moments in your experience with others when they seem suffused and illumined by the archetypes of their own spirits.

And then other periods come--perhaps quite long ones--when their beings are as though clouded over.

You can learn to say at such a time: 'The spirit makes me strong. I think of my friend's archetype, which I once glimpsed.

No deception, no outer appearance, can ever wrest this image from me.'

Struggle ceaselessly to keep this vision.

The struggle itself is loyalty.

In the effort to be loyal in this sense,

human beings come close to their fellow human beings with the strength and in the attitude of a guardian angel.

Reference not known.

One can see that loyalty and continued striving and remembering are keys to being fully human. This spiritual path is certainly counter-cultural to the dominant modern paradigm of materialism and its denial, dismissiveness and ignorance of the spirit. A really “heroic concept of loyalty “is required and it becomes obvious that this is no trivial task! Being loyal to the spiritual world around us and the vision that Steiner provides is a way to grow and become sensitive to the spirit. We can then begin to experience how sun-strength shines and world-warmth works.

ATTACHMENTS

Attachment 1 Branko Furst’s Radical Alternative: Is the Heart Moved by the Blood, Rather than Vice Versa? by Walter Alexander. This Perspective article in Pharmacology and Therapeutics, January 2017, nicely summarizes Branko Furst’s argument in his seminal monograph, The Heart and Circulation: An Integrative Model (2014) and in his 2015 article “The Heart: Pressure-Propulsion Pump or Organ of Impedance” in the Journal of Cardiothoracic and Vascular Anesthesia. Both works have been featured in the PAAM Medical Letter. This attached article by Walter Alexander, a professional medical and scientific writer as well as an anthroposophist, may be easier to approach and understand than the more technically difficult written sources by Branko. Although this subject has been featured here in the past, it is good to periodically review the topic from the same and different perspectives. It will be only with dint of effort for us and the medical profession to overcome our ingrained habits of thinking, despite recurrent evidence that our model of heart failure as a propulsion-pump failure and any attempted solutions tried don’t seem to work. Hence, inotropes in acute heart failure are de-emphasized and vasodilators are more commonly used. Also, very confounding to the dominant pressure-propulsion view of the heart pumping the blood, is the observation of increased cardiac output in the presence of an injured/compromised “heart pump”! This paradoxical observation, and other anomalies, are pointed out by Branko and Walter. Branko Furst’s view, in line with Rudolf Steiner’s, is that the blood itself is an active organ (a dynamic fluid) and produces its own kinetic energy (autonomous blood flow) from erythrocyte sensors of tissue metabolic demands, the release of ATP, its subsequent stimulation and release of NO, which then leads to vasodilatation and increase blood flow in the microcirculation. The summation of all the autoregulation at the microcirculation level leads to autonomous blood flow in the returning venous blood. [While not explicitly stated in a scientific context, the invisible astral body is likely to provide some of the impetus for the venous blood flow at the macro level.] The heart [via the astral body, and supervised by the “I” organization] then senses and impedes/restrains this blood flow within its chambers and converts the kinetic energy of the flowing blood into rhythmic, pulsatile pressure for the systemic and pulmonary circulations. Both circulations require hemodynamic coherence, that is, consistency between the monitored parameters we can measure in the macrocirculation (SV, BP, CO, SvO2, etc.) and the hemodynamics/autoregulation of the microcirculation, where tissue/organ demands must be met. Only a careful reading of this review article can bring insight into the few key concepts and principles so far mentioned. Further, more in depth, scientific information can be found in Branko Furst’s 2014 monograph. In figure 5 of the attached article, Walter has reprinted a helpful diagram comparing the three dominant paradigms in explaining circulation. Actually, all the figures in the article aid in the understanding of the key issues Branko brings up.

Attachment 2 and Attachment 3 These two attachments are letters to the editor about Walter Alexander’s article and his and Branko’s reply. Both attachments will help clarify the debate and the misconceptions readers can have. Further references are also provided for those wanting more information.

Attachment 4 is a copy of the Spring Edition 2017 of Holistic Primary Care. On page 14 is Walter Alexander’s book review of Peter Heusser’s Anthroposophy and Science: An Introduction. He starts by pointing out, as does Heusser, that holistic medicine or integrative medicine does have an epistemology problem because modern medicine is entrenched in western science’s belief and practice of materialism and reductionism. It certainly has been successful in many areas of the physical and biological worlds. However, the often cited refrain that homeopathy and AM have “no evidence” for them, doesn’t stand up to careful scrutiny. Much of the evidence is ignored, dismissed or criticized because it is believed to be impossible or incredible, based on the prevailing paradigm in science. However, modern physics’ quantum theory and results deeply challenge this materialist and reductionist notion. We have inherited this notion from Descartes, Newton and John Locke. Heusser goes on the explain that emergent properties of the whole do exist and can’t be explained or derived from a thorough knowledge of the parts. There are emergent properties in physical substances-from simple to complex- as well as the emergent properties of life, consciousness and spirit. Heusser goes into detail about this in his book. Lastly, the review points out Heusser’s view and demonstration that the qualitative aspects of reality are just as important and necessary as the quantitative aspects to have a full and legitimate understanding of reality. To have a science of qualities is necessary in integrative medicine and will need to be just as rigorous and disciplined as natural science. Goethean science and anthroposophy can provide this needed approach. This attachment gives you the whole HPC as a “bonus”.

Attachment 5 In AM we talk a lot about healthy rhythms and how important rhythms in our behavior (sleep, meals, etc.) help entrain our biological rhythms and promote our health. Rudolf Steiner once said in a response to the question, “what is life?”, that “rhythm carries life.”  If we want more vital life and more health, we must have more healthy rhythms. Our etheric body (and astral body) are time-dependent and specific rhythm generating bodies. We must recognize and work with these rhythms if we want to remain healthy and resilient, especially in our time when chaos and disorganization seems to rule. This attachment from JAMA discusses medical science’s recognition of chronobiology and how central rhythms (from the superchiasmatic nucleus), peripheral rhythms (from organs and tissues) and rhythmic behaviors can affect our health. Getting the behavioral rhythms of sleep-wake cycle and mealtimes are key to entraining the peripheral organ rhythms (the 4 cardinal organs and more) to be synchronized with the brain’s suprachiasmatic nucleus rhythm generator. This will lead to mental and metabolic health. In Fundamentals of Therapy Steiner and Wegman repeatedly point out that our physiology and metabolism change not only based on rhythms, the time of day or night, our eating behavior, etc., but also in what age and development we are in. The predominance and function of the 4 constituents of the human being change over time; a child’s ether body is quite predominant, while an old person’s astral body and “I” are more predominant.

Attachment 6 This JAMA Genomics and Precision Health article is a useful summary of where we are now clinically about “genomic medicine”. To date there has been a lot of hyperbole about the predictions genetics and genomic medicine will contribute to “individualized” or “precision medicine”. This article gives a balanced view of the state of affairs. By thinking “smaller”, genetics and genomics can provide help that is useful clinically, for example in BRCA1 and BRCA 2 mutations in breast cancer and mutations in Lynch syndrome. However, a broader reading of the literature strongly shows that genetic mutations in complex conditions like breast and ovarian cancer, are NOT fully determinative. There are a whole host of epigenetic influences with diet, lifestyle, physical activity, stress management, (and probably) environmental toxins exposure, as well as other factors that can influence someone’s overall risk of getting a feared disease.

Attachment 7 and Attachment 8 The last two attachments are interesting criticisms about using “whole genome” testing for finding genes that “cause” or contribute to a disease, and also for assessing potentially important genes in cancer patients. Despite the hyperbole, there are thoughtful researchers and scientists who question the legitimacy of this approach. See these brief articles for details. Much of genomic testing is hunting for genetic variants associated with a condition or disease, but we don’t know if the gene variants found are clinically important and how much they contribute to the illness. Furthermore, the whole notion of genomic testing seems to ignore the important field of epigenetics, where environmental and physiologic factors influence the expression of many genes and therefore the ultimate phenotype. Epigenetics is the scientific response and underpinning of the thought that your genes do not equal your destiny. In addition, in AM we are aware that behind the physical inheritance we receive, the etheric, astral and “I” organizations are determinative factors that aren’t accounted for in natural science. These suprasensible forces can be seen as working through the epigenetics that science is studying.

ANNOUNCEMENTS

Below are some brief announcements. The first listed conference (AIHM annual conference) is the first time AM in the US will be presented to a large audience of various clinicians. Consider attending the conference! 

For additional conference announcements and details, please look to the PAAM Training Educational Calendar coming in the next week.

Anthroposophic Medicine at the annual conference of the Academy of Integrative Health and Medicine (AIHM)October 22-25, 2017, in San Diego, California
Gunver Kienle, MD, Adam Blanning, MD, and Steven Johnson, DO, will offer presentations.
For more information, or to register go to: https://conference.aihm.org/annual/2017

True Botanica Webinar for PAAM Members
Fall 2017, date to be announced
To receive announcements and information from True Botanica, and to ask questions in advance of the free webinar, go to www.truebotanica.com and click on the "Join our mailing list" button.

Research Conference at the Medical Section, DornachPerspectives and Strategies for Research in Anthroposophic MedicineMarch 9-11, 2018 

International Postgraduate Medical Training (IPMT) 2018April 21-28, 2018, in Chestnut Ridge, New York
Special guest faculty: Georg Soldner, MD, Co-Head of the Medical Section at the Goetheanum. More details coming soon. Online registration opens autumn 2017.

NEW IPMT OFFERING: Advanced Practice Track - Mistletoe Use in Cancer TherapyThis marks the integration of an "advanced practice" track within the IPMT teaching program, which, this year, will focus on anthroposophic treatments in cancer therapy. This track is designed for participants who have completed at least three years of the IPMT, as well as more seasoned practitioners who have a foundation of clinical experience in mistletoe therapy. Afternoon workshops lead by Marion Debus, MD, oncologist, Klinik Arlesheim, Switzerland. Online registration opens autumn 2017.

AAMTA MeetingFirst weekend of August, 2018, in Hadley, MA
This conference for all AAMTA disciplines will carry the theme of Chronic Pain. We encourage submissions for workshops from the anthroposophic therapies in AAMTA.

An announcement from Walter Alexander. As you know, he has written two recent articles that help further the aim of PAAM to make AM and its ideas more available and accessible. Please consider funding his next big project.

This year I have published two breakthrough articles with strong relevance to anthroposophic medicine in conventional medical publications. The first, an overview of Branko Furst's work on the heart and circulation (The Heart and Circulation: An Integrative Model, Springer 2014) appeared in P&T, a peer-reviewed journal that goes to 65,000 pharmacists, and the second, a book review ("Anthroposophy, Quantum Physics & Holistic Medicine's Epistemology Crisis") of Peter Heusser's Anthroposophy and Science, (Peter Lang GmbH, 2016) appeared in Holistic Primary Care which goes to 100,000 holistic practitioners. The P&T article has already sparked a continuing lively "letters to the editor" debate.

The themes of these articles, I'm sure you know, have enormous relevance that extends way beyond physician audiences. My ongoing book project, Hearts and Minds: how we nearly lost them, takes on this task of presenting these themes in clear, non-technical terms to the interested, informed public. Please go to my website (www.wawrite.com) and click on the "Hearts and Minds book project" tab to learn more about the specific content, and to offer support for the project's completion. Please don't hesitate to contact me if you have any questions about the project. 

CONTRIBUTIONS

Thank you to PAAM members Branko Furst and Alicia Landman-Reiner for providing articles or material for this medical letter.

Please consider submitting questions, comments, articles or other material that you think may be relevant for the PAAM Medical Letter! Thank you! 

On behalf of the PAAM Board and to you, the PAAM Colleagues, 
Ricardo Bartelme, M.D.