PAAM Medical Letter Vol 8(1), January 20, 2021

Dear Colleagues!

Welcome to the first issue of the PAAM Medical Letter for 2021! Thank you for renewing your membership or your subscription. We hope you are able to thrive—not just survive—under the many current crises and challenges. May the New Year bring us an opportunity to deepen our knowledge of ourselves and the world; to feel a connection with others and with the spiritual world that anxiously awaits our opening up to it. Let us be worthy of the great tasks that lie before us and never lose heart, trusting with confidence that we can become worthy participants in the deep intentions of the spiritual powers that guide our troubled age. So much is required of us now that only when we freely join together can we give each other spirit certainty, speak our considered truth, and work towards healing of the world. Rudolf Steiner, Ita Wegman, Anthroposophia and the mighty Time Spirit, Michael, as the loyal spirit to the Cosmic “I”, ask nothing less than that from us.

Besides several relevant articles discussed, this issue also has a large section of contributions from various persons in the AM movement who have different points of view. They are offered for your consideration and reflection.

Meditation

Meditative Verse to Nurses (and Therapists) from Rudolf Steiner

In the heart there lives
In radiant light
The human will to help.
In the heart there works
In warmth-giving power
The human force of love.
So let us bear the soul’s whole will
In heart-warmth and heart-light.
Thus, we work to heal
Those in need of healing
Through God’s sense of Grace.

Rudolf Steiner’s Verse to an Italian Patient

I hear the Sun-Word
It speaks, saying:
May light shine into your heart

A Michaelic Meditation Steiner gave in 1922

The soul’s true home
is the spirit’s sphere,
and we shall surely reach it
if we go the way of true thinking,
choosing the heart’s powers of love
as our strong leader
and opening our inner soul senses
to the script
which we can always find,
and which everywhere
reveals itself in world existence,
heralding the spirit’s presence
in all that lives and, living, acts,
and in all that, lifeless,
extends itself in space,
and in all that passes
in time’s stream of becoming.

Rudolf Steiner, Verses and Meditations

Virtue of the Month—Capricorn (12/21 to 2/1)

Courage becomes the power of redemption, the power to transform.

Calendar of the Soul

Verse #42 (week of Jan 17-23, 2021)

It is in this winter gloom
The soul’s strong impulse to manifest
It’s innate strength,
To guide it into realms of darkness
And, feeling a premonition, anticipate
Through warmth of heart, the senses’ revelation.

Counter Verse #11

It is in this sun-hour for you
To recognize the wise tidings:
Surrendered to the world’s beauty,
Experience through life this:
The human “I” can lose itself
And find itself in the world’s cosmic “I”.

Medical and Relevant Literature

Attachment 1 [external link]: What are the principle factors that cause or lead to metabolic disease (diabetes mellitus, glucose intolerance, insulin resistance, metabolic syndrome, etc.)? This attachment is a summary and commentary on the recent 80th Scientific Session of the American Diabetes Association held in June, 2020. Three presenters presented their views and studies that help clarify the issue. The first speaker showed that there is good evidence that dietary saturated fat per se does not lead to elevated plasma saturated fat as measured by plasma palmitoleic acid, a biomarker for associated adverse metabolic and cardiovascular outcomes. In fact, increasing dietary carbohydrate (type not specified) does incrementally increase plasma palmitoleic acid levels, increase saturated fat storage, increase fatty acid synthesis leading to increased plasma saturated fat, increased insulin resistance and dyslipidemia. And the contrary is true; a low consumption of dietary carbohydrates, result in increased saturated fat oxidation and decreased saturated fat synthesis and leading to decreased plasma saturated fat and palmitoleic acid, increased insulin sensitivity and normolipidemia. As others have said, including Ursula Flatters, MD, an AM physician in Sweden, dietary saturated fat along with dietary refined carbohydrates is a bad combination that leads to metabolic disease and cardiovascular disease. The second speaker focused on the changed nature of our carbohydrates in modern society. Today, our carbohydrates are largely refined, processed and contain foreign synthetic chemicals such as preservatives, food colorings, biocides, xenoestrogens, and other ingredients. While carbohydrates don’t by themselves cause metabolic disease, they are essential for metabolic disease development. Removal of carbohydrates and following some type of ketogenic diet can improve metabolic disease and type 2 diabetes mellitus. However, we don’t have long-term data on ketogenic diets and extreme ones can lead to some nutritional deficiencies. The last speaker focused on ultra-processed diets and that they lead to more caloric intake (by about 500 calories per day). Eating an unprocessed diet is associated with weight loss (and presumably improved metabolic health).

These presenters point to much research that supports eating a clean, healthy, organic and largely unprocessed diet. Healthy fats, including saturated fats, can be eaten, but not in the context of sugar or refined carbohydrates. Desserts have both saturated fat and sugar in them and therefore should be enjoyed on a very limited basis.

Attachment 2: There have been RCTs and meta-analyses to show that vitamin D supplementation is helpful in improving cancer mortality, but less so in preventing cancer incidence. This article is a more detailed secondary analysis of the well-done VITAL RCT looking at vitamin D3 supplementation at 2000 IU/d and omega-3 fatty acids at 1 g/d on cancer and cardiovascular disease prevention. The results show that vitamin D3 supplementation decrease advanced cancer incidence (metastatic and fatal cancer) by 38% (HR 0.62, 95% CI, 0.45-0.86) in those with normal BMI, but not in overweight or obese individuals. It is unknown whether a higher dose of vitamin D3 is needed in obese and overweight individuals because of a volume dilution effect, because of the pro-inflammatory state with excess adipose tissue, and/or because of possible presence of an immune defect. The introduction in the article gives some of the research that supports vitamin D’s role in inhibiting carcinogenesis. The conclusion of the article seems valid, based on the evidence, and states that “even if vitamin D effects were modest, vitamin D supplementation at the studied levels are much less toxic and lower cost than many current cancer therapies.” Of course, an RCT with greater power and with cancer progression as a primary endpoint is needed.

Attachment 3: This next attachment is an invited commentary on the above secondary analysis. It points to another limitation of RCTs discovered in this secondary analysis and suggested by other data. That is, RCTs, as they are currently designed, cannot deal with the heterogeneity of treatment effects. In this case, supplementation with vitamin D3 only was effective in normal weight individuals. Randomization into two groups with the studied treatment given in one group and the other receiving only a placebo only works to give a valid result when you assume the treatment effect is largely the same in all individuals or that at least the variation in its treatment effect is random. If there is a subgroup that responds well to the treatment it won’t easily be detected in the larger treatment group, and you can get an overall null result that is actually a false negative result for the subgroup that does respond (in this case normal weight individuals who receive vitamin D3). The commentary goes on to cite research suggesting that there is substantial variation in the increase of serum 25-hydroxyvitamin D levels after supplementation with the same dose of vitamin D3. In addition, for many nutrients the association between nutrient status and health is nonlinear and more like a sigmoid curve. At low and high levels of nutrient status adding the nutrient shows little health improvement, whereas in the middle range of nutrient status there is a steep improvement in health outcome with increase dose of the nutrient. It now becomes imperative that RCTs are better designed and take into account the potential for heterogeneity of treatment effects.

Given the ongoing crisis with the current pandemic, it's impossible not to give at least some sense of the important recent literature on the coronavirus pandemic. Below are only 3 examples.

Attachment 4: This is a recent commentary by Peter Doshi, PhD, associate editor of the BMJ on the lack of complete and transparent data on the recently approved Pfizer-BioNTech and Moderna vaccines. The claim that they are about “95% effective” is premature to say the least. He pleads for more and complete details, and for the raw, individual data before making a more informed decision. It’s disturbing that the recent NEJM publications of the two RCTs on the mRNA vaccines leave out potentially important information that can only easily be found in the submitted report to the FDA. There are issues with the protocol for diagnosing Covid-19, for blinding the treatment groups and monitoring of adverse vaccine reactions, as well as for a lack of transparency and inability to get timely and vital data. So much for independent, transparent and objective science. From these published partial RCT data, how can we make informed decisions about the benefits and risks of these new vaccines? Many thinking scientists, physicians and educated public will remain skeptical, but the public health machine will press forward with their narrative and encourage widespread adoption of these vaccines. Only time will tell us of their true benefits and risks—if we are allowed to get true, accurate and complete monitoring data. The past history of significant adverse effects of the early polio vaccine, the DTP vaccine and from the first killed measles virus vaccine (with aluminum adjuvant) should remind us to be more thorough and more scientific in the development and testing of them.

Attachment 5: Many wonder about the knowledge and meaning of the various genetic variants of SARS-CoV-2. This JAMA Viewpoint gives succinct information about the known genetic variants and their likely significance. Figure B is a helpful graph showing the frequencies of circulating lineages (variants) of SARS-CoV-2 over time as of 12.28.2020. The newest SARs-CoV-2 variant that may be more virulent, but not more pathogenic, is the B.1.1.7 (also called 501Y.V1) variant.

Attachment 6: Finally, this article gives an estimation of US SARS-CoV-2 infections (including asymptomatic ones), symptomatic infections, hospitalizations and deaths using seroprevalence surveys and doing internal and external validity checks for the data, as well as the use of multipliers to give what appears to be accurate estimates of the above for the US as of November 15, 2020. Of course, this is aggregate data and doesn’t address the obvious differential susceptibility in different medical and social groups for infections, hospitalizations and deaths. In addition, all three of the authors have connections to either Pfizer or Merck. Nevertheless, based on the published article, we can say that the reported infections and deaths are underestimations because of underreporting and undertesting (hence, the need for multipliers for more accurate estimates). As of Nov. 15, 2020, ~14% of the US population has become infected with SARS-CoV-2 which corresponds to an estimation of ~47 million infected people in the US. The authors state that with an R0 (reproduction number) of 2.5 for SARS-CoV2 we would need a far larger number, ~60% of the population infected, to reach natural herd immunity and end the pandemic. However, others argue that with facial masking and social distancing measures, as well as possible cross-reactivity for other cold coronaviruses, the R0 is less and herd immunity threshold may be ~45%. Either way, we are still a long way away from reaching this threshold. At between 200-300K reported infected cases daily since November 15, and many others not detected or reported, we can conservatively say we are likely at or above 65 Million estimated infected people in the US now (300,000 reported cases x 60 days = 18 M, add 47 M = 65 M). This is ~20% of the US population.

Contributions

Many members, as well as another member of the larger AM movement, have shared essays or articles they have written or have shared talks they have given. They are here below.

PAAM Member, Kenneth McAlister, MD, has written an essay on consciousness (Attachment #7). This came out of a request from members of the First Class of the School for Spiritual Science after a conversation about the Twelfth Class Lesson. He describes, from a spiritual scientific point of view, what is happening to us in these times, what we are experiencing and what we could do to open and orient ourselves to the spiritual world. While the emphasis in the article is on consciousness, we must keep in mind that “consciousness” doesn’t stand alone, but that a spiritual being, or a community of spiritual beings, have a particular or multiple levels of consciousness.

PAAM member and past president of PAAM, Richard Fried, MD, has an essay on Anthroposophy and Trumpism, A Warning (Attachment # 8). This is basically a personal opinion piece that is troubling, and also polemical (with political overtones) and critical of some of the views expressed by some anthroposophists. It would be good to read this as a challenge to understand it, and perhaps respond with a different and cogent point of view. The further contributions below can provide readers with alternative points of view and with a wider base of evidence than is found in this essay. There can be much to say about the essay, but my basic feeling is that for many readers the essay will lack sufficient permeation with anthroposophic medical ideas to help inform, reformulate and critique the science and conventional points of view presented. Certainly, the essay points to weaknesses of some arguments of anthroposophic physicians and their willingness to dangerously associate themselves with fanatical groups or use “slogan thinking”. Rudolf Steiner never wanted to have any fanaticism associated with anthroposophy and AM. And yet, the essay uncritically accepts conventional science’s one-sided point of view regarding infections, the germ theory of disease and medicine’s largely consistent ignoring of the real importance of the host-- not just its immune system, but also the real, dynamic forces of the ether body, astral body and “I”-organization, as they live within a sociocultural and environmental context. Importantly, in the background of these dynamically weaving human members, lives and works the elusive, the invisible-spiritual, the real “I”. Previous PAAM Medical letters from last year have pointed to many important risk factors with respect to the pandemic and someone’s actual individual risk for getting Covid-19 disease.

PAAM member, Melissa Greer, DO, has written an essay on the pandemic effects on young children (Attachment #9). From a largely inner and anthroposophical point of view, she gives reasons for the damaging effects of masking and social distancing for young children. She also gives supporting links to expert summary statements that are useful. In addition there are important excerpts from Rudolf Steiner, Albert Einstein, Marcia Angell, and Jacques Lusseyran. When reading this essay, one can experience that here is a physician who deeply cares about young children and their world. There are several recent published articles that can provide external evidence for Melissa’s point of view. Two of them are:

1. Children’s (7-13 years) emotional inferences are markedly impaired by masked faces (including wearing sunglasses).

https://doi.org/10.1371/journal.pone.0243708, and

2. The preprint “Co-Ki” study, a Germany-wide registry on facial mask wearing by children documents many impairments such as irritability, headaches, difficulty concentrating, less happiness, reluctance to go to school, malaise, and others.

https://doi.org/10.21203/rs.3.rs-124394/v1.

Certainly, there are limitations to these studies, but they (and other ones) lend support to the anthroposophical view presented in the essay.

Daphné von Boch, MD, from Germany, and a serious, long-time student of the deceased teacher of AM, Otto Wolff, MD, has written an article on the meaning of the “rising coronavirus numbers” (Attachment #10). She brings in a number of good points to remember, especially about the meaning and significance of being “infected” and the need to focus on excess deaths. While she points to no significant excess deaths in many European countries, I’m not sure this still holds true since November 26 is when the date of the graphs end. For many countries now, including the USA, there have been increased excess deaths since December 2020. Also, she states that an infection with Covid-19 is not dangerous. I think this needs to be reworded to say that for most people, in actual good health and without obvious risk factors, including ones that conventional medicine ignores, then the infection isn’t likely to be dangerous and can be adequately treated with AM and some supplements. Most of the fear of contagion comes from an very unrealistic fear of one’s actual risk for severe disease or complications. Persons at increased risk of serious Covid-19 disease would need to take extra precautions. Exactly what the rest of the population should do to protect others is a hotly debated issue.

PAAM member, Branko Furst, MD, has provided his lecture notes on “Anthroposophic Perspective on Viral Illnesses” (Attachment #11). These are lecture notes and are not intended for publication. Please do not share beyond members of PAAM. Branko gives a comprehensive overview of the conventional science and spiritual science of viruses, viral illnesses, their primary causes, relevant neuroanatomy, threefold functional systems in humans and the relevant cosmic influences for influenza that Steiner indicates. His lecture notes complements the above contributions and also provide a good review of aspects of AM.

From me, PAAM member, Ricardo Bartelme, MD, comes my recently published monographic review on AM (Attachment #12). I have tried to be very scientific and anthroposophical to give a strong case for AM and the state of the art. I also tried to directly respond to many facile critiques of AM. The monograph has large parts devoted to infections, lifestyle, immunology and vaccinations that can complement the other contributions above. I apologize that there are minor typographical and grammatical errors still present in the monograph. I have submitted corrections to the publisher, but I was told a decision would need to be made and that it won’t necessarily be to correct them, since they consider this version to be the final version of record. Be assured that the content and references are correct despite the many minor errors. In any event, I’m grateful that the medical editors agreed to publish this unusual piece. As a student of Rudolf Steiner’s Anthroposophy, I take seriously Steiner’s recommendation to take a deeper, wider, more penetrating, more difficult and discerning plunge into the scientific literature, focusing on the methodology and results, and not the interpretations and conclusions of the researchers. Only along this path can one come to a truer, more objective assessment of the anthroposophical point of view. This article was the result of my modest attempt to do just this.

PAAM member, Ross Rentea, MD, and the Lili Kolisko Institute have provided two webinars on AM relevant to the coronavirus pandemic. In both of them Ross presents Steiner’s therapeutic eurythmy sequence to combat succumbing to the dreaded 1918-1920 influenza pandemic. He lectured and traveled throughout Europe during the pandemic (its contagion was certainly known by the medical and scientific community of the time) and when specifically asked on how one can protect oneself from “catching” the deadly influenza, he responded by giving a new and specific eurythmy sequence. See either one of the two links to the webinars below for the sequence and suggestions on how to do them. The specific sequence provided by Steiner is different from the one given by Girke and Soldner (see PAAM Medical Letter Vol 7, Issue 2), but there certainly is much overlap. Perhaps adding the “R” movement (that Girke and Soldner have as part of their recommended soul eurythmy gestures) would be good to add to the specific sequence Steiner gave. In these webinars there is also much other useful information and therapeutic suggestions from an anthroposophical point of view.

Kolisko Institute Webinars - Lili Kolisko Institute

Viral Illnesses and some ideas of what to do from an anthroposophical point to view (I)

Beyond the Masks in Viral Infections: anthroposophical viewpoints (II)

Given the pandemic crisis, the current public health statements, the approved “scientific” narrative and the censorship/condemnations of other points of view, it can require considerable courage to follow a path at variance with the conventional narrative and to take seriously what an anthroposophical, spiritual and scientific viewpoint would be. The “courage verse” spoken by Steiner in one of his lectures seems apropos in this month of Capricorn with its virtue of courage. The verse is both a call and a Michaelic challenge.

A Verse for Our Time:

We must eradicate from the soul
All fear and terror of what comes to meet the human being from out of the future.
We must acquire serenity
In all feelings and sensations about the future.
We must look forward with absolute equanimity
To everything that may come.
And we must think only that whatever comes
Is given to us by a world-direction, full of wisdom.
It is part of what we must learn in this age,
Namely, to live out of pure trust,
Without any security in outer existence.
Trust in the ever present help
Of the spiritual world.
Truly, nothing else will do
If our courage is not to fail us.
Let us seek the awakening from within ourselves
Every morning and every evening.

Please send any comments, responses or questions to us and we’ll try to get them to the appropriate person.

On Behalf of the PAAM Board and to You Our Valued Colleagues,

Ricardo R. Bartelme, M.D.

Emeritus Assistant Professor
Department of Family Medicine
University of Michigan Medical School
Ann Arbor, Michigan, USA 48109

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