Archive for November 20, 2012

Mind-Pops

Brilliantly timed Shot

Why do odd images suddenly pop into your head for no reason?

You’re walking down the street, just like any other day, when suddenly a memory pops into your head from years ago. It’s about a person you haven’t thought of for years. Just for a moment you’re transported back to a time and place you thought was long forgotten. In a flash, though, the memory has vanished as quickly as it appeared. This experience has been dubbed a ‘mind-pop’ and sometimes it is prompted by nothing your conscious mind is aware of. There is, perhaps, an even weirder type of ‘mind-pop’. This is when all you get is a word or an image which seems to have no connection to anything at all. Like suddenly thinking of the word ‘orange’ or getting the image of a cheese grater. They seem weirder because they feel unconnected to any past experience, place or person—a thought without any autobiographical context.

Not everyone has these experiences, but many do. When psychologists have recorded these involuntary memories, they find that, on average, people have about one a day. They are most likely to occur during routine, habitual activities, like walking down the street, brushing your teeth or getting dressed. They are also more likely to come when your attention is roaming and diffused. Some of these mind-pops can even be traced back to their causes. Here is one psychologist describing some mental detective work "…while throwing a used bag in a dust bin the word “Acapulco” popped up and since she had no idea what it was and where she might have come across the word, she turned to a member of family for help. To her surprise, it was pointed out to her that Acapulco was mentioned on the TV news some 45 minutes ago. This ability to trace a mind-pop back to its source wasn’t an isolated case. When they surveyed people, Kvavilashvili and Mandler found that the words and images that seemed to pop up randomly didn’t actually come from nowhere.

Sometimes it was an associative mind-pop, like being reminded about Christmas and later having the words ‘Jingle Bells’ pop into your head. It could be a sound-a-like, for example having the image of a sandy beach appear after you see a banana (Bahamas sounds like bananas). The fact that many mind-pops could not be traced back to their source is probably the result of how much of our processing is carried out unconsciously. The fascinating thing was that many of these mind-pops occurred weeks or months after exposure to the original trigger. This suggests that these words, images and ideas can lie in wait for a considerable period. Some even think that experiencing mind-pops could be associated with creativity as these apparently random associations can help to solve creative problems.

Mind-pops are another hint that we are recording more information than we know. Fortunately, our minds mostly do a good job of suppressing random thoughts and images, as they can be extremely distracting. So next time you have a mind-pop, remember that, however weird, it has probably been triggered by something you’ve seen, heard or thought about recently, even if you can’t remember what. Of course, why we get these particular ones and not others is still a mystery.

End of Medicine As We Know It

I’m trying to zoom in on critical aspects of how the digital world will create better healthcare. George Orwell once said that the hospital is the antechamber to the tomb. That was written decades ago, and unfortunately there’s still truth to that today. It’s really sad to think that 1 in 4 hospital patients in America have a problem with medical errors or that they have problems like nosocomial, or hospital-acquired, infections and medication errors.

There’s a book that was recently published called Unaccountable, by Marty Makary, MD, a surgeon at Johns Hopkins Hospital, and it’s quite an alarmist view of this problem with lack of accountability in hospitals and in the medical profession in general. The digital world could potentially help this; we’ve seen some disappointing aspects with respect to electronic medical records, which haven’t really been shown to markedly reduce medical errors. They certainly haven’t done anything to reduce hospital-acquired infections.

What will be interesting to see in the future are things like scorecards of hospitals. You saw, in recent months, Consumer Reports’ cover article about rating hospitals. This is just the beginning of where we can go to give direct information, transparency, accountability, and data to consumers and that Consumer Reports story is just going to be amplified over time, and not just through one particular magazine.

When we give a window to the consumer using real data, they can select a physician. Consumers can go to Google Scholar and figure out who the experts are in a particular field, just as we in the medical community can when we’re trying to find a physician to refer to and we can pick anywhere in the world. This is the sort of thing that can be digitally available for consumers. We as peers can put together the information that’s necessary for the proper transparency, selection of physicians, and selection of hospitals. Hopefully, that’s one way to make improvements in the future.

One of the interesting things why trustees volunteer to serve on hospital boards is that when you talk to them, they say they volunteer to be trustees so they can get access to information on which doctor is the right doctor to go to when they have a problem and, of course, there are very few people who can serve as hospital trustees, but that’s the equivalent of where we need to go with transparency, accountably, and scorecards in the future.

Consumer-Driven healthcare is a concept that a lot of physicians are very uncomfortable with. If you go back to the Gutenberg printing press, it was only then in the Middle Ages when the Bible and all the printed information could be read by others besides the high priest. In fact, that’s an analogy of what is going to happen in medicine, because until now there has been this tremendous information asymmetry.

Essentially, all the data, information, and knowledge were in the domain of doctors and healthcare professionals, and the consumer, patient, and individual was out there without that information, not even their own data. But that’s changing very quickly.

Patients will have the capability of accessing notes from an office visit and hospital records, as well as laboratory data and DNA sequencing — and on one’s smartphone, for example, blood pressure and glucose and all the key physiologic metrics.

When each individual has access to all this critical data, there will be a real shakeup to the old way that medicine was practiced. In the past, the Internet was supposed to be empowering for consumers, but that really didn’t matter because what the consumer could get through the Internet was data about a population. Now, one can get data about oneself, and, of course, a center hub for that data-sharing will be the smartphone.

Even critical information based on one’s genomic sequencing, such as drug interactions, will have a whole different look. We’ve already learned so much about the direct-to-consumer movement from the pharmaceutical industry in which patients were directed to go to their doctors and ask them for a prescription drug. That had a very powerful impact.

But in the future, with each person potentially armed with so much data and information, the role of the doctor is a very different one: It is to provide guidance, wisdom, knowledge, and judgment and, of course, the critical aspects of compassion, empathy, and communication. That is a whole different look for the consumer-driven healthcare world of the future.

We can get rid of the randomized trial and here is a better way. How we can Schumpeter or reboot the future of healthcare by leveraging the big innovations that are occurring in the digital world, including digital medicine. But one of the things that have been missed along the way is that how we do clinical research will be radically affected as well. We have this big thing about evidence-based medicine and, of course, the sanctimonious randomized, placebo-controlled clinical trial. Well, that’s great if one can do that, but often we’re talking about needing thousands, if not tens of thousands, of patients for these types of clinical trials, and things are changing so fast with respect to medicine and, for example, genomically guided interventions that it’s going to become increasingly difficult to justify these very large clinical trials.

For example, there was a drug trial for melanoma and the mutation of BRAF, which is the gene that is found in about 60% of people with malignant melanoma. When that trial was done, there was a placebo control, and there was a big ethical charge asking whether it is justifiable to have a body count. This was a matched drug for the biology underpinning metastatic melanoma, which is essentially a fatal condition within 1 year, and researchers were giving some individuals a placebo.

Would we even do that kind of trial in the future when we now have such elegant matching of the biological defect and the specific drug intervention? A remarkable example of a trial of the future was announced in May. For this trial, the National Institutes of Health is working with Banner Alzheimer’s Institute in Arizona, the University of Antioquia in Colombia, and Genentech to have a specific mutation studied in a large extended family living in the country of Colombia in South America. There is a family of 8000 individuals who have the so-called Paisa mutation, a presenilin gene mutation, which results in every member of this family developing dementia in their 40s.

Researchers will be testing a drug that binds amyloid, a monoclonal antibody, in just [300] [1] family members. They’re not following these patients out to the point of where they get dementia. Instead, they are using surrogate markers to see whether or not the process of developing Alzheimer’s can be blocked using this drug. This is an exciting way in which we can study treatments that can potentially prevent Alzheimer’s in a very well-demarcated, very restricted population with a genetic defect, and then branch out to a much broader population of people who are at risk for Alzheimer’s. These are the types of trials of the future and, in fact, it would be great if we could get rid of the randomization and the placebo-controlled era going forward.

One of things that I’ve been trying to push is that we need a different position at the FDA. Now, we can find great efficacy, but the problem is that establishing safety often also requires thousands, or tens of thousands, of patients. That is not going to happen in the contrived clinical trial world. We need to get to the real world and into this digital world where we would have electronic surveillance of every single patient who is admitted and enrolled in a trial. Why can’t we do that? Why can’t we have conditional approval for a new drug or device or even a diagnostic test, and then monitor that very carefully. Then we can grant, if the data are supported, final approval.

I hope that we can finally get an innovative spirit, a whole new way of a conditional and then final approval in phases in the real world, rather than continuing in this contrived clinical trial environment. These are some things that can change in the rebooting or in the creative destruction, or reconstruction, of medicine going forward.

Social networking is having big impact on medicine. Social networking is changing the practice of medicine. Everybody is familiar with Facebook, which soon will have 1 billion registrants and be second only to China and India as far as a community or population. What isn’t so much appreciated by the medical community is that our patients are turning to online health social networking. These are such Websites as PatientsLikeMe, CureTogether, and many others.

Interestingly, patients with like conditions — often chronic conditions, such as multiple sclerosis, diabetes, or amyotrophic lateral sclerosis — will find patients with the same condition on these networking sites, and these virtual peers will become very much a key guidance source. This is so different from the past, when all information emanated from physicians. In fact, now many of these individuals who use social networks trust their virtual peers more than their physicians, so this is a real change that’s taken place. In addition to this, the social networking platforms, which are free, offer an opportunity we haven’t seen before.

If you combine the capability of monitoring such things as blood pressure or glucose with social networking, then you can have managed competitions with your friends, your family, or your social networking cohort, and you can start to compete for such things as who has the best blood pressure or who has the best glucose level. This, of course, is beyond competitions as simple as who has the best weight or does the most activity in terms of number of steps.

What we’re going to see going forward is the leveraging of social networking for improving healthcare. This is really taking advantage of a preexisting platform of digital infrastructure, and something that we did not anticipate would be so popular in the medical sphere. This is superimposed on Facebook, for example, which has already had individuals who at least claim that their lives were saved on the basis of pictures of themselves and their condition.

In fact, there was a young boy who was desperately ill and undiagnosed, but a Facebook friend of the mother of this boy made the diagnosis of Kawasaki disease. Historically, this is the first case in which social networking supposedly led to saving one’s life. There have been many other cases like this one that have been subsequently documented.

This is really an interesting trend, social networking. I’m really big on Twitter. My handle is @ nishanil1, and I get my most useful information in the whole biomedical research digital health arena through that mechanism. I’d encourage you to try it out or get active on it if you haven’t. Social networking is having a big impact on medicine at multiple levels.

Five devices physicians need to know about in digital revolution occurring in the practice of medicine and how this revolution can radically improve the healthcare of the future. I’d like to show you many of the devices that I think are transforming medicine today. These devices represent an exciting opportunity as we move forward in the practice of medicine.

This is 2012, obviously, and this is something that we’re going to build upon. You’re used to wireless devices that can be used for fitness and health, but these are now breaking the medical sphere. One device you may have already noticed turns your smartphone into an electrocardiogram (ECG). The ECG adaptor comes in the form of a case that fits on the back of a smartphone or in a credit card-size version. Both contain 2 sensors. With the first model, you put the smartphone into the case and then pull up the app — in this case I’m using the AliveCor app — and put 2 fingers on each of the sensors to set up a circuit for the heart rhythm. Soon you’ll see an ECG. What’s great about this is you don’t just get a cardiogram, which would be like a lead II equivalent; using the "credit card" version, you get all the V-leads across the chest as well. I have found this to be really helpful. It even helped me diagnose an anterior wall myocardial infarction in a passenger on a flight.

The second device I will enumerate is another adaptation of the smartphone, but this one is for measuring blood glucose. Obviously we do that now with finger-sticks, but the whole idea is to get away from finger-sticks. I’m wearing a sensor right now that can be worn on the arm. It also can be worn on the abdomen. What’s nice about this is that I can just turn on my phone, and every minute I get an update of my blood glucose right on the opening screen of the phone. It’s a really nice tool, because then I can look at the trends over the course of 3, 6, 12, or even 24 hours. It plays a big behavioral modification type of a role, because when you’re looking at your phone, as you would be for checking email or surfing the Web, you also are integrating what you eat and your activity with how your glucose responds. This is going to be very helpful for patients — not only those with diabetes, but also those who are at risk for diabetes, have metabolic syndrome, or are considered to be in the pre-diabetic state.

The third device I’d like to talk about is another device from the cardiovascular arena that comes in the form of an adhesive patch. It’s called the iRhythm, and I tried this out on myself. It’s really a neat device, because the results are sent by mail to the patient. You put it on your chest for 2 weeks, and then you mail it back. It’s the Netflix equivalent of a cardiovascular exam. The company then sends the patient 2 weeks’ worth of heart rhythm detection. I think it’s a far better, practical way, as compared to the Holter monitor wireless device. It’s not as time-continuous as the ECG or glucose device, but it’s in that spectrum.

I want to now explain a fourth device, which I use on my iPad. This device allows physicians the ability to monitor patients in the intensive care unit on their iPads. I use it to monitor patients at the ICU. You can use it for any ICU that allows for the electronic transmission of data. Right now, I’m monitoring 4 patients simultaneously. You can change the field to monitor up to 8 patients simultaneously. This is a great way to monitor patients in the ICU because you can do it remotely and from anywhere in the world where you have access to the Web. This is just to give you a sense of what this innovative software sensor can do to change the face of medicine.

Finally, I wanted to describe is something that I’ve become reliant upon, and that’s this high-resolution ultrasound device known as the Vscan. I use this in every patient to listen to their heart. In fact, I haven’t used a stethoscope for over 2 years to listen to a patient’s heart. What’s really striking about this is that it’s a real stethoscope. "Scope" means look into. "Steth" is the chest. And so now I carry this in my pocket, and it’s just great. I still need a stethoscope for the lungs, but for the heart this is terrific. You just pop it open, put a little gel on the tip of the probe, and get a quick, complete readout with the patient looking on as well. I’m sharing their image on the Vscan while I’m acquiring it and it only takes about a minute. It is validated of its usefulness in an Annals of Internal Medicine paper, in July 2011, [1] describing how it compares favorably to the in-hospital ultrasound echo lab-type image. This could be another very useful device in emergency departments, where the wireless loops could be sent to a cardiologist. Another application it could be used for is detecting an abdominal aortic aneurysm. Paramedics who are out in the field, or at a trauma case, could use this to wirelessly send these video loops to get input from a radiologist or expertise from any physician for interpretation.

These are just a few of the gadgets that give you a feel for the innovative, transformative, and really radical changes that will be seen going forward in medicine.

Live Forever

Given the chance, would you want to live forever? In the Epic of Gilgamesh, written over 4,000 years ago, a Sumerian king seeks eternal life. And 500 years ago, Spanish explorer Ponce de Leon came to the Americas searching for the fountain of youth. Every generation, a new ploy for outsmarting the reaper emerges–always futile, always in vain. But is the key to immortality within reach? Some people think that technology will help us cure diseases, build new organs, and essentially reprogram our bodies’ faulty software. Futurist Ray Kurzweil calculates that 20 years is all it’ll take for this exponential boom in computing power to help us live forever. But other scientists are more skeptical. They say that to understand immortality, we must understand our own DNA.

Have you heard of the Turritopsis nutricula? It’s a type of jellyfish, said to be biologically immortal. Now, this doesn’t mean that it’s immune to disease or injury, but it is immune to the leading cause of death: aging. That’s because it can revert back to the polyp stage even after it reaches sexual maturity. In essence, it can stay alive forever, since every time it grows up, its cells undergo trans-differentiation to become young and sexually immature again. That’s one way to live forever. So if this special jellyfish can do it, why can’t we?

It’s a complicated question, and scientists think the answers may be deep within the nuclei of our cells, where the building blocks of life are stored. See, every time one cell replicates to become two, its DNA also has to replicate, and when it does that, little bits at the end break off. These areas are called telomeres, and they’re there for that very reason: to buffer against breakage when DNA replicates, so the important bits don’t get lost. But eventually, after enough replication, the telomeres get broken off too. It’s called the Hayflick limit, named for Leonard Hayflick, the first dude to notice that there is finite number of times a cell can divide. But if we can use special enzymes, like telomerase, to increase the life of the telomere, we may also be able to prolong the life of the cell.

If we can get a handle on how to prevent cellular aging, in theory, we can extend life, potentially indefinitely. We may also be able to fight cancer, since the cellular mechanism involved in this deadly disease is closely related to that in aging. In fact, cancer is a type of cell that simply doesn’t die. That’s why it’s so hard to treat. This wouldn’t be a problem, except that cancer cells also divide uncontrollably and invade the healthy cells around them. In fact, biomedical researchers routinely use HeLa cells in their studies. They’re named for Henrietta Lacks, a woman dying of cervical cancer in 1951. Her cells were harvested without her permission, and grown in culture. Since they are so hearty and easily divide; this exact same cell line is used today in labs all around the world and if that doesn’t blow your mind, think about this.

In a way, we’re all already immortal. Think about it: there’s a line of cells, traceable to the earliest human being–in all of us. See, before I became me, with ten fingers and toes, brown hair and eyes, and a funny birthmark on my arm, I was a single cell. That cell eventually divided over and over to make the person you see today. But that single cell was nothing more than a combination of my father’s sperm (with half the chromosomes necessary to make me) and my mother’s egg (also with half of my chromosomes). Together, they made a single cell, and that single cell divided to become all the cells in my entire body, including my own eggs. One day, one of those eggs may combine with sperm to make another human being and so it goes, down the line, until those branches of the family tree end. But if you trace the branches backward, earlier and earlier in time, you’ll find a common ancestor to us all. Really think about it. The cells in your body, in my body, are traceable to the earliest cells of the very first humans and not just figuratively. We are literally made of the same DNA, the same cytoplasm, the same molecular ingredients as those who harnessed the energy of fire, invented tools, developed language, and first stepped out of Africa, the seat of all humanity. They are physically within us. We are made of them and in that way, we are all immortal.

So you tell me. Would you want to live forever? Or do you feel that you already are, being part of the great lineage of humankind, a lineage that will never die?

Safe Haven of the Soul

On this day, I see clearly that we must explore and develop those ways to engender the passion for the possible in our human development while discovering what that "possible" is. In so doing we will discover ways of transcending and transforming the local self so that extraordinary life can arise. There is no question but that a larger life is latent in the human species and that we live only a small part of the life that is given. Thus it will require from those of you who are really serious about making a difference something that astronauts, sportspeople, great artists and inventors, mystics, social artists, and co-creators are always open and available to–the acquiring of a greater nature. This means however that one agrees to relinquish those limited and limiting patterns of body, that is sensory and motor patterns, of emotions, of volition, of intelligence and understanding, and of spirit that have been keeping you from becoming all that you can be. Stop it. You are boring God.

One also must agree to allow yourself to instead become available to the extraordinary dimensions that each of you contains for much larger life in body, mind, and spirit. This, I absolutely believe is what is required of us if you who will continue to live are going to help our era survive and grow. Now what is going on in our era that is unique in human history? Get beneath the patterns of chaos and this is what I think you can detect. We are in jump time, also called whole system transition. This means that we have a rare choice point both for the world and for ourselves. As you all know, the current movements of change are accelerating radically, with new happenings in structural and social development, complexity, behavioral variety, and awareness. There is a multileveled transformation of our entire nature in the works as well as in the very nature and function of society. This includes the democratization of our human potential, as well as the wide scale experience of aspects of ourselves that we never thought to have.

I believe that the very evolution of life is asking us to co-partner with it and to make choices that will serve the greater story. We must come to realize that grace, or, if you will, the larger reality structure, the Field of Being within which you are embedded, the Divine Reality is always and everywhere present, ever near, utterly available, and totally responsive to our desire for it. We are at the stage where the real work of humanity begins. This is the time and place where we partner Creation in the re-creation of ourselves, in the restoration of the biosphere, and in the assuming of a new kind of culture–what we might term a culture of kindness wherein we live daily life in such a way as to be connected and charged by the Source of our reality and become liberated in our inventiveness as well as deeply engaged in our world and our tasks.

Now there is a quickening, a tremendous sense of need for this possible human in all of us to help create the possible world if we are to survive our own personal and planetary odyssey and come safely home – to the sanctuary of the soul.

Human Pheromones—Fact-or-Fiction

Pheromones are naturally occurring odorless substances the fertile body excretes externally, conveying an airborne signal that provides information to, and triggers responses from, the opposite sex of the same species. In 1986 Dr. Winnifred Cutler, founder of Athena Institute, and her colleagues conducted the first controlled scientific studies to document the existence of pheromones in humans. Prior to their landmark research, there were no conclusive indications that pheromones were excreted by humans. In animals, it had been known that pheromones served to promote behavior that perpetuated the species. Pheromones elicit unlearned behavioral or developmental responses from others of the same species – act to regulate sexual and reproductive behavior in many nonhuman mammals. We can see examples of this throughout the animal kingdom. The human body produces chemical secretions that have pheromonal properties.

What does science tell us? Do we produce pheromonal secretions? Men and women do have odor-producing apocrine glands in their underarm, nipple, and genital areas. Also, biochemists have isolated compounds that have pheromonal properties in pigs from the urine and sweat of men and, to a lesser extent, women. So, we give off body odor and our bodies excrete substances that pigs find sexually stimulating.

Assuming the human body can secrete pheromonal substances, are we capable of detecting them? Here, the evidence is a bit more solid. Scientists have found that human infants, children, and adults are able to discriminate between other individuals on the basis of olfactory cues – we can tell each other apart using our noses. It seems possible that we have the capacity to detect pheromones, should they exist.

The question that interests most of us, of course, is whether pheromones actually influence species perpetuation behavior. Certainly many perfumes and colognes contain pheromones or their synthetic equivalents from a variety of mammals, including the musk deer, civet cat, beaver, and pig. Studies find that exposure to these substances either has no effect at all or decreases sexual feelings among adults. So exposure to pheromones produced by other mammals doesn’t seem to do much for us. Pheromones are species-specific. Thus, it really isn’t surprising that exposure to nonhuman pheromones does not directly influence sexual attraction in humans. However, it is possible that these substances have an indirect effect on desire – a scent or odor may elicit a pleasant emotional response which, in turn, may increase sexual feelings. In addition, it is likely that a particular scent or odor that has been paired repeatedly with a sex partner or with sexual activity, for example, a specific brand of cologne or perfume may come to produce a learned desire response. Of course, these types of elicited or learned responses do not constitute a true pheromone reaction.

Science will continue to advance, and the quest to identify a human pheromone will undoubtedly go on. Maybe in a year or two, I’ll be able to post a new, updated entry that presents more conclusive evidence with respect to pheromones. Human sexuality is multifactorial, and much more complex. Our responses are much less biochemically-dependent than those of other mammals. Men and women don’t require the presence of a particular hormone or chemical secretion to feel desire, want sex, or become attracted to another member of the species. No single substance would have the power to produce those animalistic, primal sexual and aggressive behaviors.

Whiff Of Love

 

After long dismissing the search for a human pheromone (pheromones are airborne chemicals which are emitted to attract the opposite sex) as folly, scientists have begun to take a second look at how human body odor influences sexual attraction. The magic scent is not some romantic elixir but the aromatic effluence of our immune system. The only trouble is we don’t give it half a chance. How do we humans announce, and excite, sexual availability? Many animals do it with their own biochemical bouquets known as pheromones. Why do bulls and horses turn up their nostrils when excited by love? Darwin pondered deep in one of his unpublished notebooks. He came to believe that natural selection designed animals to produce two, and only two, types of odors—defensive ones, like the skunk’s, and scents for territorial marking and mate attracting, like that exuded by the male musk deer and bottled by perfumers everywhere. The evaluative sniffing that mammals engage in during courtship were clues that scent is the chemical equivalent of the peacock’s plumage or the nightingale’s song; finery with which to attract mates.

In the following century, rich array of animal pheromones were documented for seals, boars, rodents, and all manner of other critters. Some of Darwin’s contemporaries embraced human uniqueness in this regard as evidence of our inevitable ascendance, as if Nature’s Plan somehow called for the evolution of a nearly naked two-legged primate with a poor sense of smell to conquer the Earth. The French physician Paul Broca—noting that primates’ social olfactory abilities are diminished compared to those of other mammals asserted that monkeys, apes, and humans represent ascending steps from four-legged sniffing beasts to sight-oriented bipeds. Monkeys, he argued, have smaller "smell brains" than other mammals, and apes’ brains are even smaller than that. Among humans, only the tribal "primitives," Broca wrote, could still attach erotic import to the bodily smells of man.

More enlightened researchers dismissed such views as racist tripe. But they still noted that humans engage in very little scent-driven socializing; compared to, say, the urine-washing displays of monkeys; during which urine is rubbed on the feet to attract mates. To make matters worse, humans seemed to lack the hardware for communicating by scent. Pheromone reception in other species is the business of two little pits (one in each nostril) known collectively as the vomeronasal organ. Few scientists claimed to have been able to locate a human vomeronasal organ. Those who did complained that the vomeronasal organ is so small that they could detect it only rarely. But most scientists, without bothering to look, simply dismissed the idea of a vomeronasal organ in humans. It’s been scientific dogma for most of this century that humans do not rely on scent to any appreciable degree, and that any vomeronasal organs found are vestigial throwbacks. Then, in the 1930s, physiologists declared that humans lack the brain part to process vomeronasal organ signals; firmly closing the book on any role for body odor in human sexual attraction. Even if we had a vomeronasal organ, the thinking was, our brains wouldn’t be able to interpret its signals.

Recent discoveries suggest, however, that the reports of our olfactory devolution have been greatly exaggerated. Some suspected as much the whole time. Smell researchers Barbara Sommerville and David Gee of the University of Leeds in England observed that smelling one another’s hands or faces is a nearly universal human greeting. The Eskimo kiss is not just a rubbing of noses but a mutual sniffing. "Only in the Western world," the researchers point out, "has it become modified to a kiss." Hands and faces may be significant choices for these formalities; they are the two most accessible concentrations of scent glands on the human body besides the ears.

Inquisitively, remembering a smell is usually difficult, yet when exposed to certain scents, many people of whom Proust is the paragon may suddenly recall a distant childhood memory in emotionally rich detail. Some aromas even affect us physiologically. Researchers exploring human olfaction have found that a faint trace of lemon significantly increases people’s perception of their own health. Lavender incense contributes to a pleasant mood, but it lowers volunteers’ mathematical abilities. A whiff of lavender and eucalyptus increases people’s respiratory rate and alertness. The scent of phenethyl alcohol (a constituent of rose oil) reduces blood pressure.

Such findings have led to the rapid development of an aromatherapy industry. Aromatherapists point to scientific findings that smell can dramatically affect our moods as evidence that therapy with aromatic oils can help buyers manage their emotional lives. Mood is demonstrably affected by scent. But scientists have found that, despite some extravagant industry promises, the attraction value in perfumes resides strictly in their pleasantness, not their sexiness. So far, at least, store-bought scent is more decoration than mood manager or love potion. A subtle "look this way" nudge to the nose, inspiring a stranger’s curiosity, or at most a smile, is all perfume advertisers can in good conscience claim for their products; not overwhelming and immediate infatuation.

Grandiose claims for the allure of a bottled smell are not new. In their haste to mass-market sexual attraction during the last century, perfumers nearly drove the gentle musk deer extinct. In Victorian England, a nice-smelling young lady with financial savvy could do a brisk business selling handkerchiefs scented with her body odor. So it should come as no surprise that when physiologists discovered a functioning vomeronasal organ inside the human nose, it was a venture capitalist intent on cashing in on manufactured human pheromone who funded the team’s research. That was in the mid 1980s. Using high-tech microscope probes that were unavailable to vomeronasal organ hunters earlier in the century, a team led by Luis Monti-Bloch of the University of Utah found a tiny pair of pits, one in each nostril, snuggled up against the septum an inch inside the nose. The pits are lined with receptor cells that fire like mad when presented with certain substances. Yet subjects report that they don’t smell a thing during such experiments. What they often do report is a warm, vague feeling of well-being. The olfactory bulb that neurophysiologists couldn’t find in the 1930s isn’t absent in human brains at all, researchers recently discovered. It’s just so enveloped by the massive frontal cortex that it’s very difficult to find. This finding, coupled with the discovery of a functional human vomeronasal organ, has ushered in a new chapter of the story of a human pheromone.

For an animal whose nose supposedly plays no role in sexual attraction or social life, human emotions are strongly moved by smells. We appear to be profoundly over-equipped with smell-producing hardware for what little sniffing we have been thought to be up to. Human sweat, urine, breath, saliva, breast milk, skin oils, and sexual secretions all contain scent-communicating chemical compounds. Zoologist Michael Stoddart, author of The Scented Ape (Cambridge University Press, 1991), points out that humans possess denser skin concentrations of scent glands than almost any other mammal. This makes little sense until one abandons the myth that humans pay little attention to the fragrant or the rancid in their day-to-day lives.

Part of the confusion may be due to the fact that not all smells register in our conscious minds. When those telltale scents were introduced to the vomeronasal organ of human subjects, they didn’t report smelling anything, but nevertheless demonstrated subtle changes in mood.

Humans possess three major types of skin glands: sebaceous glands, eccrine or sweat glands, and apocrine glands (A type of gland that found in the skin, breast, eyelid, and ear. Apocrine glands in the breast secrete fat droplets into breast milk and those in the ear help form earwax. Apocrine glands in the skin and eyelid are sweat glands. Most apocrine glands in the skin are in the armpits, the groin, and the area around the nipples of the breast. Apocrine glands in the skin are scent glands, and their secretions usually have an odor. Another type of gland called eccrine gland or simple sweat gland produces most sweat). Sebaceous glands are most common on the face and forehead but occur around all of the body’s openings, including eyelids, ears, nostrils, lips, and nipples. This placement is particularly handy, as the secretions of these glands kill potentially dangerous microorganisms. They also contain fats that keep skin supple and waterproof and, on the downside, cause acne vulgaris. Little is known, however, about how sebaceous glands contribute to human body odor.

The sweat glands exude water and salt and are non-odorous in healthy people. That leaves the third potential source of a human pheromone—the apocrine gland. Apocrine glands hold special promise as the source of smells that might affect interpersonal interactions. They do not serve any temperature-managing functions in people, as they do in other animals. They occur in dense concentrations on hands, cheeks, scalp, breast areolas, and wherever we possess body hair—and are only functional after puberty, when we begin searching for mates.

Men’s apocrine glands are larger than women’s, and they secrete most actively during times of nervousness or excitement. Waiting colonies of bacteria turn apocrine secretions into the noxious fumes that keep deodorant makers in business. Hair provides surface area from which apocrine smells can diffuse—part of the reason why hairier men smell particularly pungent. Is it any coincidence that hair at the arm pit and the genitals sprouts at puberty, when apocrine glands start producing food for our skin bacteria?

Apocrine glands exude odorous steroids known to elicit sexual behavior in mammals. Androsterone—a steroid related to the one that nearly doomed the hapless musk deer—is one such substance. Men secrete more androsterone than women do, and most men become unable to detect the stuff right around the time they start producing it themselves—at puberty. In 1986, the National Geographic Society organized the World Smell Survey to investigate whether people from all cultures experience odor in the same fashion. They distributed over a million scratch-and-sniff cards and questionnaires about subjects’ detection and perceptions of intensity of smells, from banana to the sulfur compounds added to natural gas as a warning agent. Included in the survey was the scent of human androsterone. The steroid itself is not pleasant to smell. Worldwide, those who could smell it rated it second to last in pleasantness—just ahead of the sulfur compounds put in natural gas; a foul-smelling pheromone? It’s hardly what scientists expected to find.

Despite the poor showing of androsterone in smell ratings, Karl Grammer of Austria’s Institute for Human Biology thought it might be the sought-after human pheromone and studied women’s reactions to it. He expected to find that women have a strong, favorable reaction to the smell of androsterone around ovulation, when their sense of smell becomes more acute and when they are most likely to conceive. Changes in female bodies’ estrogen levels around ovulation were suspected may change how women react to androsterone’s smell. Grammer found that women’s reactions to androsterone indeed change around ovulation, but not in the manner he expected. Instead of attraction, Grammer’s ovulating volunteers shrugged their shoulders and reported ambivalence. Androsterone, it seems, offers little hope to men looking for a $19.95 solution to their dating slumps.

The empirical proof of odor’s effect on human sexual attraction came out of left field. Medical geneticists studying inheritance rules for the immune system; not smell physiologists, made a series of crucial discoveries that nobody believed were relevant to human mate preferences—at first. Research on tissue rejection in organ transplant surgery patients led to the discovery that the body recognizes an alien presence; whether a virus or a surgically implanted kidney because the body’s own cells are coated with proteins that our immune system recognizes as "self." But the immune system gets a lot more subtle about recognizing "nonself" intruders. It can recognize specific types of disease organisms, attach protein identifiers to them, and muster antibodies designed specifically for destroying that particular disease and it can "remember" that particular invader years later, sending out specific antibodies to it.

A segment of our DNA called the major histocompatibility complex codes for some of these disease-detecting structures, which function as the immune system’s eyes. When a disease is recognized, the immune system’s teeth—the killer T cells—are alerted, and they swarm the intruders, smothering them with destructive enzymes. Unlike many genes, which have one or two alternative versions like the genes that code for attached or unattached ear lobes, major histocompatibility complex genes have dozens of alternatives and unlike earlobe genes, in which the version inherited from one parent dominates so that the version inherited from the other parent is not expressed, major histocompatibility complex genes are "co-dominant." This means that if a lab mouse inherits a version of a major histocompatibility complex gene for resistance to Disease A from its mother and a version lending resistance to Disease B from its father, that mouse will be able to resist both diseases.

When a female mouse is offered two suitors in mate choice trials, she inevitably chooses to mate with the one whose major histocompatibility complex genes least overlap with her own. It turns out that female mice evaluate males’ major histocompatibility complex profile by sniffing their urine. The immune system creates scented proteins that are unique to every version of each major histocompatibility complex gene. These immune byproducts are excreted from the body with other used-up chemicals, allowing a discerning female to sniff out exactly how closely related to her that other mouse is.

By choosing major histocompatibility complex dissimilar mates, a female mouse makes sure that she doesn’t inbreed. She also secures a survival advantage for her offspring by assuring that they will have a wider range of disease resistance than they would had she mated with her brother. It’s not that she seeks out diverse major histocompatibility complex genes for her young on purpose, of course. Ancestral females who preferred the smell of closely related males were simply outrun through evolutionary time by females who preferred the scent of unrelated sires.

Since humans show little interest in one another’s urine, few researchers thought that the story of major histocompatibility complex in rodent attraction could shed light on human interactions. But then someone made an eyebrow-raising discovery: Human volunteers can discriminate between mice that differ genetically only in their major histocompatibility complex. If human noses could detect small differences in the immune systems of mice by giving the critters a sniff, excited researchers realized, we may well be able to detect the aromatic byproducts of the immune system in human body odor as well.

A team led by Claus Wedekind at the University of Bern in Switzerland decided to see whether major histocompatibility complex differences in men’s apocrine gland secretions affected women’s ratings on male smells. The team recruited just fewer than 100 college students. Males and females were sought from different schools, to reduce the chances that they knew each other. The men were given untreated cotton T-shirts to wear as they slept alone for two consecutive nights. They were told not to eat spicy foods; not to use deodorants, cologne, or perfumed soaps; and to avoid smoking, drinking, and sex during the two-day experiment. During the day, their sweaty shirts were kept in sealed plastic containers and then came the big smell test. For two weeks prior, women had used a nasal spray to protect the delicate mucous membranes lining the nose. Around the time they were ovulating when their sense of smell is enhanced, the women were put alone in a room and presented with boxes containing the male volunteers’ shirts. First they sniffed a new, unworn shirt to control for the scent of the shirts themselves. Then the women were asked to rate each man’s shirt for "sexiness," "pleasantness," and "intensity of smell."

It was found; by Wedekind and his team that how women rate a man’s body odor pleasantness and sexiness depends upon how much of their major histocompatibility complex profile is shared. Overall, women prefer those scents exuded by men whose major histocompatibility complex profiles varied the most from their own. Hence, any given man’s odor could be pleasingly alluring to one woman, yet an offensive turnoff to another. Raters said that the smells they preferred reminded them of current or ex-lovers about twice as often as did the smells of men who have major histocompatibility complex profiles similar to their own, suggesting that smell had played a role in past decisions about who to date. Major histocompatibility complex similar men’s smells were more often described as being like a brother’s or father’s body odor… as would be expected if the components of smell being rated are major histocompatibility complex determined.

Somewhat more surprising is that women’s evaluations of body odor intensities did not differ between major histocompatibility complex similar and major histocompatibility complex dissimilar men. Body scent for major histocompatibility complex dissimilar men was rated as less sexy and less pleasant the stronger it was, but intensity did not affect the women’s already low ratings for major histocompatibility complex similar men’s smells. That strong odor turned raters off even with major histocompatibility complex dissimilar men may be due to the fact odor is a useful indicator of disease. From diabetes to viral infection to schizophrenia, unusually sweet or strong body odors are a warning cues that ancestral female in search of good genes for their offspring may have been designed to heed. In the case of schizophrenia, the issue is confounded—while some schizophrenics do actually have an unusually sweet smell, many suffer from delusions of foul smells emanating from their bodies.

Nobody yet knows what roles major histocompatibility complex may play in male evaluations of female attractiveness. Females’ superior sense of smell, however, may well be due to their need to more carefully evaluate a potential mates merits—a poor mate choice for male ancestors may have meant as little as a few minutes wasted, whereas a human female’s mistake could result in a nine-month-long "morning after" and a child unlikely to survive.

Perfumers who really want to provide that sexy allure to their male customers will apparently need to get a genetic fingerprint of the special someone before they can tailor a scent that she will find attractive. But before men contemplate fooling women in this way, they should consider the possible consequences. The Swiss researchers found that women taking oral contraceptives; which block conception by tricking the body into thinking it is pregnant reported reversed preferences, liking more the smells that reminded them of home and kin. Since the Pill reverses natural preferences, a woman may feel attracted to men she wouldn’t normally notice if she were not on birth control—men who have similar major histocompatibility complex profiles.

The effects of such evolutionary novel mate choices can go well beyond the bewilderment of a wife who stops taking her contraceptive pills and notices her husband’s "newly" foul body odor. Couples experiencing difficulty conceiving a child—even after several attempts at tubal embryo transfer—share significantly more of their major histocompatibility complex than do couples who conceive more easily. These couples’ grief is not caused by either partner’s infertility, but to an unfortunate combination of otherwise viable genes.

Doctors have known since the mid-1980s that couples suffering repeated spontaneous abortions tend to share more of their major histocompatibility complex than couples for whom pregnancies are carried to term and even when major histocompatibility complex similar couples do successfully bring a pregnancy to term, their babies are often underweight. The Swiss team believes that major histocompatibility complex related pregnancy problems in humans are too widespread to be due to inbreeding alone. They argue that in-couple infertility problems are due to strategic, unconscious "decisions" made by women bodies to curtail investment in offspring with inferior immune systems; offspring unlikely to have survived to adulthood in the environments of our evolutionary past.

When Broca and other social Darwinists pointed out that "uncivilized races" were more sensitive to body odor, they may have been correct—insofar as Europeans tend to go to greater lengths to perfume and wash away their natural scents. But this is hardly evidence of European superiority over "less evolved" peoples, as Broca insisted. Paying careful attention to the health of others and their suitability as sires to one’s offspring in the disease-rich tropics, whose cultures Broca derided, actually makes exceedingly good sense.

Perfume; daily soapy showers; convenient contraceptive pills—all have their charms. But they also may be short-circuiting our own built-in means of mate choice, adaptations shaped to our unique needs by millions of years of ancestral adversities. The existence of couples who long for children they cannot have indicates that the Western dismissal of body scent is scarcely benign. Those who find offensive the notion that animal senses play a role in their attraction to a partner need not worry. As the role of smell in human affairs yields to understanding, we see not that we are less human but that our tastes and emotions are far more complex and sophisticated than anyone ever imagined.

How to smell a mate? How does body odor affect a woman’s sexiness?

Scientists don’t know for sure, but they do know that a man’s allure depends in part on how many immune system genes he shares with a potential mate. Since it’s known that women can detect genetic compatibility by smell—it’s not that men can’t but that so far no one knows—the onus is on females to sniff out a suitable squire. Choosing a genetically compatible partner can be difficult in today’s perfume rich postindustrial jungle, and getting your immune system genes profiled can be expensive. Before you run to a doctor for blood work to see whether your mate is a suitable match—and sire for your future children—try listening to your nose. Unfortunately, the sniff test will only work if you’re not taking birth control pills.

Declare a deception-free day for the nostrils. Have your beau shower with fragrance-free soap and wear clean cotton clothing for a day, away from smokers and the perfumed masses. Be sure you don’t have a cold, and that you yourself haven’t been around smokers for a few days. After he spends a day and a night in his cotton clothes, before he tosses them in the direction of the hamper, wrestle them from him and have a "smelldown." Make it a romantic experience. If your man’s shirt doesn’t offend, you should be safe. Find the scent alluring or sexy? Even better! That attraction is nature’s way of telling you he’s a safe contributor to your offspring’s genetic ensemble. If your man’s odor reminds you of your father or of a brother, you may want to consider getting in touch with your doctor and ask about genetic tests before trying to conceive a child. Tell the doctor you’re concerned that you may share a close major histocompatibility complex or human leukocyte antigen, is a technical tag for human major histocompatibility complex. Meanwhile, a deceptively pleasing gift of cologne might be in order. Genetic incompatibility is not the only reason you may find his odor offensive. Does his body scent seem unusually intense? He might have a medical condition that explains the smell. Ask him to bring it up at his next medical checkup. A very sweet scent is sometimes evidence of diabetes or schizophrenia—both of which appear to be heritable. It is wise to discuss these issues with each other, and with a doctor, before having kids. Before you decide that your relationship stinks, check your mate’s diet; a taste for spicy foods or overindulgence in garlic can cause strong body odors. If your mate still offends, don’t head for the hills just yet. Some clothing detergents can prove to be a bad mix with a fellow’s scent. Ask that the next time he visits the laundry, he change brands—and give the stinker a second chance!

The Audacity To Face Our Dissatisfactions

Sunset Dragonfly

Every time we sit down in meditation, we are challenged to face our dissatisfactions. What is really going on in our body-mind? What ideas are we stubbornly holding onto? What are we afraid of? What would we rather not deal with like anger, resentment, longing, dissatisfaction, numbness? What, or who, are we rejecting? What aspect of our lives makes us want to act selfishly or childishly – by throwing a tantrum, blaming others, or refusing to participate? We don’t have to go seeking for our dissatisfactions when we meditate. Zazen, seated meditation, doesn’t have to become a grim session of taking account of how crappy our life is or how flawed we are. We also need to be open to awareness of the joy and positivity in our life; we have to be completely open to awareness of everything as it is. However, we are much more likely to be open to the positive stuff than we are to the negative stuff, so facing the dissatisfactions takes some intention and courage.

I like to think of “opening the doors of my mind” during zazen to whatever might wander in. The Zen ceremony of Segaki ritually enacts this process when the doors of the temple are opened wide and the hungry ghosts or manifestations of unresolved stuff are invited to enter. It is surprising how effective this ceremony is. Many people report unresolved stuff coming up for them as they sit zazen in the day-long retreat that follows the ceremony traditionally. In the evening there is a ceremony to send the “ghosts” on their way, but it often takes much longer to become familiar with a new ghost, learn what it has to teach, and then take the actions necessary to truly send it away.

When I open the doors of my mind as I settle on the meditation cushion, I always feel some apprehension. What am I going to discover? What am I going to have to deal with? Am I going to have to change?

When I finally summon the courage to face my dissatisfactions, I am always surprised to find that no matter how bad it is – it is less anxiety-provoking to face it than it is to avoid it. Finding something behind the door can be scary and might require serious action, but in the long run it’s better than sensing there’s something behind the door but just wondering how terrifying it might be. When we really face our dissatisfactions there is often some sense of relief. In addition, avoiding or denying parts of our reality increases our sense of separation or isolation from our whole life and from the people and situations we encounter. When we are one with our dissatisfactions we are more fully present with everything. When trying to summon the courage to face our dissatisfactions during meditation or anytime it can be helpful to recall the sense of relief or presence that can be achieved by doing so. Sometimes it also helps to imagine the worst that is likely to come through the doors of our mind and ask ourselves if it would be the end of the world; it rarely would be. Alternatively, we might talk ourselves into facing our dissatisfactions by noticing how tired we are of running away from it.

Once we are determined to be still no matter what comes at us, we expand our awareness by letting go of any idea about our life, our body-mind, or what we should or should not be experiencing at this moment. Then our dissatisfactions can arise and find itself recognized and embraced – because, after all, it’s not coming at us from outside, it was already here.

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