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Hi, I'm Jim O'Shaughnessy and welcome to Infinite Loops.
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Sometimes we get caught up in what feel like infinite loops when trying to figure things out.
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Markets go up and down, research is presented and then refuted, and we find ourselves right back where we started.
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The goal of this podcast is to learn how we can reset our thinking on issues that hopefully leaves us with a better understanding as to why we think the way we think and how we might be able to change that to avoid going in infinite loops of thought.
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With each episode we hope to bring you along with us as we learn together.
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Thanks for joining us, now please enjoy this episode of Infinite Loops.
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Disclaimer: Jim O'Shaughnessy is chairman and Co-Chief Investment Officer of O'Shaughnessy Asset Management, where Jamie Catherwood is an associate.
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All opinions expressed by Jim, Jamie and podcast guests are solely their own opinions and do not reflect the opinions of O'Shaughnessy Asset Management.
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This podcast is for informational purposes only, and should not be relied upon as a basis for investment decisions.
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Clients of O'Shaughnessy Asset Management may maintain positions in the securities discussed in this podcast.
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Jim O'Shaughnessy: Hello everybody and welcome to a special episode of Infinite Loops.
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I am recording this separately from the actual conversation that I had back in May, the two very special people about something that is very special to me, and that is the idea of mind-body syndrome. Now, what's that?
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In the early 1980s, a doctor named John Sarno, who was working at the NYU Rehabilitative Medicine unit became extremely frustrated that he was unable to help most of his patients.
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He was using all of the standard allopathic methods.
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Essentially allopathic means treat the symptoms as opposed to treat the cause.
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And he was really frustrated in his inability to help these people get out of excruciating pain.
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He started developing a theory which changed names many, many times, but it originally was called tension myositis syndrome, but then it got moved to myoneural syndrome by doctors who were looking into the causes of these mind-body syndromes.
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What's fascinating about them is they're almost always ignored because language can sometimes be such a difficult hurdle to get over.
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Because early on they were called psychosomatic problems and immediately anyone hearing psychosomatic said, that's not me.
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I don't have any of those mental health problems.
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Well, they're not mental health problems and the idea of your mind influencing your body and vice versa is actually quite intuitive when you think about it.
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Very easy to demonstrate for example, when people get embarrassed, they flush often, that is a classic example of a physical reaction to an emotional response.
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Being more of a left brain thinker at that time, I had a problem in the late '90s with my neck.
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I had essentially woke up one morning with a frozen neck and could not move it anymore than just a few degrees, and I went the traditional route.
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I went to my main general practitioner who tried a cortisone shot, which didn't work.
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He sent me over to the specialists in the orthopedic field.
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They put me in traction and I looked hilarious in traction because I had to use a home unit on my bedroom closet, and I was quite a comedic figure, at least to my wife and children when they saw me sitting there.
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But the upshot was nothing worked, and it actually got worse and worse, and it was quite painful, and I really didn't know what to do.
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So being a bookshop lover, one of our family activities actually when my kids were younger was every Sunday we went up to a Borders Bookstore here in nearby Stanford and just spent almost the entire day there.
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And our rule was the kids could buy as many books as they wanted so long as they were going to read them.
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And so I went into the medical section, a place where I hadn't been before, and found his book Mind Over Back Pain.
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Now he's written several he wrote several books, he died recently, but I got the book Mind Over Back Pain, and I brought it home and I read it, and my first reaction to reading it was literally to throw it across the room and shout quite loudly so that my still young children could hear it, I've never read a bigger pile of bullshit in my life.
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That's many people's normal reaction to when they first come into contact with this idea that many chronic problems, severely painful and I should note here the pain that you feel is quite real. Dr.
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Sarno pointed out and that's why it had the original name of tension myositis syndrome, which essentially is a slight reduction of oxygen to the affected area of your body that is experiencing the pain.
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And in general, the mainstream medical community either wasn't interested or some actually openly mocked Dr. Sarno.
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And yet his cure rate was quite extraordinary.
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He cured Howard Stern, who I never knew had back a pain that was so severe he had to do his radio show lying flat on his back on the ground because he couldn't do the show because of the excruciating pain.
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Larry David, who had serious problems as well.
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Senator Tom Harkin, for example, actually held a Senate hearing in 2012, in which because he had been cured by Dr.
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Sarno, he thought that we should be taking this more seriously.
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But for whatever reason, the medical community was simply not interested.
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And when I say medical community, I mean the traditional MDs working in rehabilitative medicine, et cetera.
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That is changing now and it's changing rapidly.
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Today we're going to talk with two guests, Dr.
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Michael Donnino, the founder of the Center for Resuscitation Science, and actually the first person in the United States to complete a six year combined emergency medicine internal and critical care.
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Apparently, I have to ask Mike again if he is the only doctor to have all three certifications, but he also has 160 manuscripts published in journals like the Journal of New England Medicine, et cetera.
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So he is quite accomplished and, until experiencing this problem himself was quite a member of what I would call the mainstream medical community.
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Until he himself suffered from a very, very serious pain problem that was ultimately resolved Using Dr. Sarno's techniques.
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He was astounded and he decided to do something about it.
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So one of the things that he is doing right now, which I have supported and will continue to support, are true double blind tests to see whether the efficacy of these various treatments.
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And generally speaking, when I first learned about John Sarno, the treatment was just reading his book.
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I mentioned that I threw the book across the room for the first reading, but I read it maybe five more times, by the fifth time I saw myself on every page of the book.
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It's a certain personality type that gets Sarno symptoms easier than other people, but many, many people suffer from Sarno problems and the costs that they extract from us as a society are astronomical.
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The lost time for work, for enjoying family, for all of those various things is numbers in the high billions annually in the United States alone. And so Dr.
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Michael Donnino, decided that he was going to do a series of tests around whether this type of cure works.
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Well towards the end of Sarno's life he had originally said, if you decide you're going to Google him and watch some of the YouTubes in which he's speaking, he used to say that really knowledge was secure.
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In other words, once you learned about this, the technique for suppressing some emotional problems that caused the pain would go away.
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In the first instance with my neck that's exactly what happened, but it doesn't always. In later videos, Dr.
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Sarno was careful to say that it had been his cumulative experience to see that in about 40% of the cases of people with mind-body issues, they needed therapy as well.
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So my second guest is the therapist that I work with, Liz Wallenstein.
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She has a graduate degree in psychology and counseling from Columbia University and has done post-graduate training directly with Dr. John Sarno.
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Liz is a super interesting person because she herself became interested in the Sarno mind-body problem because she experienced it for herself.
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And one of her quotes that I think is great considering self-understanding and why it's so important is she says, “you can literally turn your biggest problem into the best thing that ever happened to you.
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Pain sometimes helps you to understand that you are in a situation that your unconscious and maybe even your conscious really understands is not the right place for you to be.
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” Now, don't confuse this with the power of positive thinking or any of the so-called self-help movement cures, if you will, for these particular problems.
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As you'll hear when we get into the podcast, the number of problems that they are suspecting as mind-body problems are astronomical.
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And what's interesting is the data on this goes way, way back.
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Ulcers, for example, used to be the thing that high performing people got when they were worrying about things and or when they were suppressing emotions probably around some of those high functioning things that they were doing until it became widely known that ulcers were a mind-body phenomenon.
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The incidence of ulcers in that same group plummeted because according to Dr.
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Sarno's original research, they got the knowledge.
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So they needed a alternate type of pain, and so all of a sudden we were dealing with crazy back pain.
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By the way, this is not just a problem in the Western world, it's universal.
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And another example that springs to mind is they did studies on countries where whiplash from a car accident was covered by insurance and where it wasn't covered by insurance.
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And wonder of wonders in the countries that did not cover whiplash by using insurance, the incidents of whiplash was tiny compared to countries that did.
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So I've always been absolutely fascinated by this particular thing, not only because I myself have suffered from it on and off my entire adult life, but because I honestly believe that we are moving into a period where there may be an even more effective series of treatments available.
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And I personally am going to do everything that I can through donating, through having people on the podcast, to actually putting together groups that talk about this and look at the studies that folks like Mike are doing in the traditional scientific method.
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So, long-winded introduction to two very fascinating people.
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And I hope that if you've never have heard of Dr.
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John Sarno or mind-body syndrome, that if this is your first introduction to it, that you keep it open mind and that you realize that this probably affects a lot more people and probably people that you know much more than many of us believe.
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Finally, there's a good movie that I contributed a small amount to on their kickstart campaign called All the Rage.
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You might have seen me promoted on Twitter a couple of times, but the people who made that movie about Dr.
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John Sarno right before he died also had these symptoms and were cured by Dr. Sarno.
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So I think that it's an amazing technique for people who might be in excruciating pain.
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And I want to underline once again before we go to our conversation with Mike and Liz, is that the pain is very real.
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It's not phony, it's not generated by your mind.
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It is true pain that you feel in your body and realizing that some of this can be affected almost exclusively by your emotional makeup and suppressing of certain emotions might be a revolution now that we have doctors like Mike starting to do double blind test bringing this into the mainstream.
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So it's very exciting for me and I hope that this will be a very enlightening and illuminating conversation for you.
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So, without further ado, please listen to our conversation between the three of us, myself, Liz and Mike. Enjoy.
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Jim O'Shaughnessy: Michael, Liz, welcome.
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Liz Wallenstein: Thank you.
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Michael Donnino: Thank you. It's great to be here.
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Jim O'Shaughnessy: So, Liz, I want to start with you because I had a problem that ultimately ended up needing to be solved surgically, but that through a group of very inconvenient and unfortunate circumstances, had me running around to doctors of various specialties, the upside of that was, neurologically, I'm great.
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But I began to think that maybe this is Dr. Sarno.
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Another thing for our listeners, I'm going to ask your opinion too, Liz, is that in my personal case, I find it extraordinary that the story I just told, right? I got cured by Dr.
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Sarno by just reading his book, and all of a sudden I have a new problem, and I don't think of him at first.
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Is that something you find common, Liz?
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Liz Wallenstein: For sure.
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Because I think it's really hard for people to internalize the idea that probably most of the pain that we feel is mind-body in nature.
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We're so in tune to thinking it as there's something wrong with the body, that for a lot of people, that's just not the first thing that comes to mind. Jim O'Shaughnessy: Yeah.
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And I think that this is really changing.
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Michael, I'm going to bring you in here, because we met because your background is in emergency medicine, internal medicine, and critical care.
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I think it's pretty cool that you were the first person in the United States to complete a six year combined rotation and then be certified in all three.
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But even with all of those incredible credentials, you had a problem and I'd love it if you shared it with our listeners. Michael Donnino: Yeah.
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So, started for me about nine years ago, while I was working in the hospital and doing emergency medicine, as you said, in critical care.
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And I started with this back pain, it was kind of started off and on at first, but then it was more on than it was off.
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And then also this thing, a tingling or a numb tingling sensation, which we term a paresthesia, and it just got to the point where it kind of was getting worse and worse.
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And so like any good physician, I tried to just ignore it at first.
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But ultimately, I started going down the traditional medical path. I had an MRI.
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I saw my primary care physician. I had an MRI.
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Started seeing some specialists.
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Everyone had a different opinion of what was going on.
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One person thought there was something going on in my sciatic nerve and a number of different things.
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Again, the litany of the traditional approaches.
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I had steroid injections, I had a course of oral steroids, I had different pain medications, I was taking a medicine called Gabapentin to kind of to deal with nerve pain.
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None of these things helped.
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I got sent to physical therapy, not once, not twice, but three different times.
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And all this time, week after week, month after month, the pain was worsening.
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Someone said, well, every time...
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Sitting was starting to bother me.
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So, they said, well, it must be the sitting is kind of impinging.
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And so being the perfectionist that I was, I was like, I won't sit. And so I didn't sit. But that didn't matter.
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It just kept getting worse and worse and worse.
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And to the point where I was waking up at night with the pain and ultimately had to go out on partial disability because I was unable to do some of the emergency medicine and critical care.
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And I was just kind of...
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I did a lot of research and I was still kind of trying to do my research from home.
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And at that point I was ready to go seek care from...
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Potentially I was thinking do I need some kind of surgeon?
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I didn't know what the next step was.
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And it was interesting because I'm seeing all these different specialists here in Boston, and my help actually came from a Google search when I was on the computer, and I kept coming across these different people saying in different settings on the internet, don't worry about all this other stuff, just go get this book Healing Back Pain by Dr.
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John Sarno and you'll be fine.
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And I thought, well, there's no way that a book is going to help me in this condition.
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But I was desperate if maybe it would take the pain down just a little bit, I'll take it.
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So, I went out and I bought the book Healing Back Pain by John Sarno, and I started reading it through.
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And kind of very similar to you, Jim, I actually stopped reading it. And when I got to the...
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I said, this is just garbage.
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And then I picked the book back up again, because I started thinking about things and I'll kind of come back to this.
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I picked the book back up and I read it straight through.
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And I wouldn't believe it if it hadn't happened to me, but that next day after I had read the book and I started thinking about a couple things in the book and using some of the techniques, that paresthesia tingling, and I had had that the tingling for literally months, it was just there every waking moment.
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I couldn't really feel it anymore.
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And the pain was cut in half almost.
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And so from then on, I then got better from there.
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I ultimately was back to work within a few days or a week and my pain was gone gone within three or four weeks.
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And it's funny too, as you said, when I put the book down and picked it back up, my wife would often joke, well, Mike is a very meticulous scientist and kind of looks through all these papers very critical and all these type of things.
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But he threw caution to the wind with this.
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Well, it was actually the exact opposite in the sense that I had tried all of these different things. They weren't working.
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The traditional back pain theories didn't make any sense.
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And right before I had picked up this book, everything had been down my left side and I had been told it was probably a nerve problem down that left side.
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I started also having pain on the right. It made no sense.
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The only hypothesis that actually made sense was Sarno's hypothesis.
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And that's why I picked the book back up.
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And that's why I read it straight through.
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And then I ultimately had a life altering thing in terms of my career because I was so stunned as a researcher.
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I went to see all the many papers published on this and there were so few.
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So few randomized trials that I actually decided to move my research into this space and to start doing some randomized trials so you didn't just have to hear my story, but you could actually see a difference based on empiric data.
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Jim O'Shaughnessy: It amazes me, and I'm going to bring Liz back in here, because Liz, you specialize in treating Sarno patients.
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You had some Sarno symptoms yourself and cured them.
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Is this a common tale that you hear from people who, like me, start to work with you? And like Mike?
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Is that kind of the majority or are there different stories leading into it?
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Liz Wallenstein: In terms of what part?
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The rejecting it initially? Jim O'Shaughnessy: Yeah.
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In terms of kind of the go down the traditional path, find Dr.
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Sarno's work, read it, reject it, reread it, and then finally accept it.
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Is that normal or is it different for everybody?
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Liz Wallenstein: That is common.
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I'd probably say what I see the most is people believe it somewhat, and then they kind of have partial or on and off recoveries.
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And in that way, I kind of made my specialty, if you already had some leeway with it, or if you kind of believe, I can help you take your recovery to the next level.
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And I'm a licensed therapist, so through psychotherapy, through emotional, psychological healing, that's how I help people take it to the next level.
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And it's interesting because as I'm listening to Dr.
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Donnino's story, my story was very different in terms of, I didn't have that piece.
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I say I had the gift of youth when it came to this because I was actually a patient of Dr.
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Sarno's when I was 17 years old, a senior in high school.
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And I actually came to him the way the...
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A surprising way that a lot of his clients or patients came to him, which was I had horrible back pain, which didn't make sense for somebody my age.
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And I was trying all these things.
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Nothing was showing up as anything significant.
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And I went to a chiropractor who told me it was from a car accident that I was in, even though I couldn't see the link at all.
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And my brother at the time was five years older than me, was reading a book by Howard Stern.
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And Howard Stern is very vocal about his affection for Dr.
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Sarno and how much he changed his life.
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And so he told me and my parents, Hey, this thing worked for Howard Stern.
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It wasn't anything physical, just working on it emotionally.
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And that's how I got to Dr. Sarno.
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But I had what we referred to as a book cure, which is that ideal cure everybody's going for, which is you read the book and then you're healed.
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And I really attribute that to the fact that I was so young. I wasn't skeptical yet. I wasn't critical yet. I wasn't jaded yet.
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So, I was able to really take it in and have that book cure.
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But for me, I would have recurrences.
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It could be several years later.
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It could be several months later, but it wasn't completely out of my life. And I knew from Dr.
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Sarno that the potential is there for it to be completely gone.
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You should never be somebody who has a bad back, especially when it doesn't make sense, like you're 18 years old, you're otherwise healthy.
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So, I was always determined to have that, that I just didn't want to have it at all.
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And it was also changing.
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I would get it as IBS eventually, or I would have nausea, other things like that.
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So, for me, I was always on the quest of, how do I get rid of this completely.
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And that's when I turned to psychotherapy for it, and I was amazed by what came from it because you really feel...
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When you're on this end, you really feel like you're experiencing a miracle.
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The fact for real physical pain to completely become eliminated and you didn't do anything physical for it, it was all in your mind.
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I mean, you're like, wow, it's really mind blowing.
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But also and this is the reason why I chose to do this work as a therapist, I like to joke that initially I thought to myself, being a therapist is pressure enough that people are coming to you in distress and you're supposed to take it away.
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So, I said, do I really want to make it worse on myself that I'm going to tell people, not only will I take your emotional pain, I'll also take away your physical pain.
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Why would I want to do that to myself?
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Put that kind of pressure and expectation on?
26:53
But the reason why I love this work and why I love doing this work is because of how transformative it is, that what you learn about yourself in the process, what you become aware of, is so life transforming that I would really attribute all the best things in my life right now to starting in my recovery.
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The things I learned about myself, the things that I committed myself to.
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So, the fact that you get to change your life story, you get to feel more powerful over your life, coming from just having this horrible physical pain, is why I do this work.
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And I think that people who kind of are attracted to working with me, that's why they're in it.
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I like to say, it's amazing that you get rid of your physical pain, but it's also amazing that, through the process, you can change your entire life for the better. Jim O'Shaughnessy: Yeah.
27:46
And I think that that is a really important part of this.
27:46
My wife, if I start on one of these things, like “you know Jung said”, and she's just like, "I know what you're going to do.
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You're going to tell me all about the integration of your shadow and all this sort of stuff."
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But the fact is that this has always been something that absolutely fascinated me.
28:08
And it's not just humans, by the way.
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If you do research and you look at things like where you stand in a hierarchy.
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Take chimps, for example.
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When one of the lesser males goes after the alpha and beats him, his body undergoes physical changes. He stands more erect.
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This one's a little weird, but his testicles descend.
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And even the tenor of his scream at the other members of the tribe changes.
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These are all physical changes that have... These are chimps.
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These have nothing to do with what, you know, a Jung, for example, would say about us far more complicated humans.
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But one of the things that I think is possible here, and one of the reasons why I am still so deeply interested and committed to this type of research, is I think that we are moving towards a place where we could have a integrated cure, in quotes.
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I hate to use that term, but like you said, transformation, I think is even a better way to put it.
29:19
And personally, I'm an empiricist, I'm a quant in investing, which is pure data.
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Everything I look at is all data driven.
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In fact, I think that many of my Sarno symptoms started as a late teen when I decided that I had to shut off the emotional part of my being.
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And I did that for a variety of reasons, but one was I felt kind of out of control.
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And I was the type of person back then who really felt emotions.
29:53
I could walk into a room and be bowled over by the emotional energy that was coming.
29:59
And then if you want to be in the stock market, your biggest enemy for the most part is your fight or flee instinct.
30:06
You make the decision at the exact wrong time, et cetera.
30:06
So, I was naturally drawn to the more empirical, data-driven side of the market.
30:12
And that's why I think Michael's work is also so important.
30:19
I love Jung, Jung said something along the lines of, until you understand and integrate your conscious with your unconscious or subconscious, you will look at everything that happens to you and you will call it fate.
30:30
I love that quote because it just is so impactful and you see so much better if you manage to partially...
30:37
Because I don't think anyone can completely integrate the two.
30:45
But through this integration, that's why when I talked to Michael, I was very excited because I was looking it up and I think that the first statistical studies peer reviewed was done by a doctor in 2007, and he found that the Sarno group had a 54% reduction.
31:00
Am I getting that right, Mike?
31:11
Michael Donnino: I'm not sure.
31:13
So, that might have been...
31:13
So there were some case series or where they, yes, saw reductions.
31:19
It might have even been to that level in the past.
31:19
But they hadn't had a control group.
31:24
And that's something that... Yeah.
31:24
And that's something that we kind of introduced and was introduced recently by our group and another group where we actually had a control group.
31:28
And I wonder too, if I should just step back for one second and just so everybody listening and watching is... How this kind of...
31:37
How I put this together, is looking at this and kind of segue off what you had just said about this relationship between the emotions in a physical response.
31:43
So, we've kind of turned this a psychophysiologic reaction.
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And physiologic meaning physical, and psycho coming from the mind.
31:54
But you can actually, when you look around, you see this in everyday processes.
31:58
So for example, if someone gets embarrassed, that emotion of embarrassment causes a physical change.
32:03
You get actually flushing or redness of the skin.
32:10
That's because your capillaries are filling with blood.
32:10
But you don't have any control over that.
32:14
So it's a psychophysiologic response.
32:14
If you're about to give a big talk or a big sporting event, and you have butterflies in your stomach, another example of a psychophysiologic response.
32:23
So we see this all around.
32:23
So what basically this hypothesis is, is that chronic stress intention is not properly processed and whatnot.
32:28
And repressed emotions can actually do the same thing, causes a psychophysiologic response, where you can actually have pain syndromes.
32:38
Actually, one other really cool thing is that if someone walks in a room and they're happy, you're going to see their facial muscles have contracted in a certain way, right?
32:48
They don't think about it.
32:48
It's an emotion that causes the facial muscles to contract.
32:52
Well, so, too, in some ways, if you're having repressed anger or other kind of emotions is why not your back muscles contracting in an adverse way, right?
32:57
So this psychophysiologic response is one of the key things to explain where this comes from.
33:08
And then to this day, as you said, yeah, there's been some work in the past that has shown that there's been reductions, but there really hadn't been a control group.
33:12
So what we introduced was we actually did a randomized trial where we looked at the improvement of Sarno's approach, versus we did a usual care group where they just continued what they were usually doing.
33:22
And then we actually threw a third group in there that was getting a mindfulness therapy.
33:26
So they thought they were getting the treatment, but they actually weren't.
33:30
But they were getting another psychological based treatment, which was cool, because it not only was a placebo, but it also was an active comparator, because there's some data out there to show that psychological treatments can help.
33:43
So within that, and it was only pilot in the sense that we had 35 total patients, and now we're doing the next big step.
33:49
But with that, we actually had 64% of people on a scale of zero to 10, with 10 being the worst, by the end of the protocol, 64% in the treatment group had zero pain.
34:02
And if you looked at the control group, it was only 11%.
34:02
And in the mindfulness group where we tried to fool people, 25%.
34:08
And if you flip that to zero or one, then our therapy, which we call PSRT, or psychophysiologic relief therapy, went up to close to 75%.
34:21
So if you think about that, three quarters of people with chronic back pain were actually essentially pain free.
34:25
As you mentioned, before I did this, I did research and I've probably done 15 plus clinical trials.
34:31
I could never get treatment effects like this.
34:31
The treatment effects that I'm seeing here are just bigger than what I've seen in my other areas in emergency and critical care. Jim O'Shaughnessy: Yeah.
34:42
And that's why I'm so excited about this point in history, I think, because as I said, in my own story, that was back in the mid '90s.
34:49
And if anyone was talking about Dr Sarno, it was usually with derision.
34:55
And he just really did not get any respect from his colleagues at NYU.
35:02
Obviously, they respected him enough to leave him in the position.
35:02
But even that celebrity power of a Howard Stern or a John Stossel, or Senator Harkin actually held hearings in 2012 on this. And Dr.
35:19
Sarno went and testified. Michael Donnino: Right.
35:21
Jim O'Shaughnessy: And it just seemed to me, as I was watching it, now, obviously I had some motivated reasoning going on here.
35:28
I believe that this can be very helpful.
35:28
And so I'm going to look at this stuff and confirm my priors, right?
35:33
My priors being this stuff really works, and why are all of these other people kind of ignoring it, even when they're having Senate hearings, when big, huge celebrities like Howard Stern and Larry David, one of my favorites are cured by Dr. Sarno and still nothing?
35:49
And to me, again, maybe this is, again, my priors, I thought, "What we really need here is what you're bringing, Michael.
35:57
We need the skeptical..."
36:03
And by the way, I am all in favor of being skeptical. I am all in favor. Skeptical isn't cynical.
36:09
There's a big difference between those two.
36:09
Skepticism is you keep an open mind, but trust but verify, so to speak. But it wasn't just me. It wasn't just you. It wasn't you, Liz.
36:20
I talked to many, many people who experienced this same kind of what I called miraculous recovery, at least with the neck, for example.
36:29
And I saw it in other people. And so, by the way, Dr.
36:36
Sarno himself and many of his associates and other people who've written about this, there are all sorts of equivalents for this, skin problems, gastrointestinal problems.
36:49
You often will cure one, like you said, Michael, it went to the other side when it went here.
36:55
Those are all, and I'm going to ask Liz to amplify this, but those are all signs that it probably is a mind-body problem, because if all of a sudden all of the pain was going down the right side and that's where the tingling was and that's where everything else was and then it goes to the left, you might open your mind to, "Wait a second."
37:13
Now, also, I think one of the things that Dr.
37:21
Sarno stressed, and I know you do as well, Liz, is you really do need to go to your doctor first, your medical doctor first to rule out a serious problem, right?
37:28
One of my things that I did was I put off a hip problem, which ultimately led to having to have an entire hip replacement, because I was so deep in thinking, "Okay, it's Sarno. It's Sarno. It's Sarno."
37:43
And then I needed to go back to the first principle, which Dr.
37:48
Sarno, which you, Michael, and I know you do, Liz, is first rule out all physical only problems.
37:53
But Liz, do you think that this time, and what I'm hoping for, what Michael's doing right now, are you seeing this as a different, more hopeful time for this type of thing? Or am I wrong?
38:08
Am I just too enthusiastic? Liz Wallenstein: No.
38:13
I definitely think it's a very hopeful time.
38:15
And I think the next trap that we need to avoid is people will think it's progressive to treat it holistically.
38:23
So then they might have more of a leaning on acupuncture or some of these more holistic interventions, but they're still use using the idea that there's something physically wrong with the body.
38:36
And that's always the main problem.
38:42
And in doing this work and helping people heal this way, there's two main things that we pay attention to.
38:47
And one is what's going on for that person emotionally?
38:47
What may they not be confronting that their body is asking them to pay attention to?
38:54
That's why I like to think of this as a calling.
38:59
Your body's trying to communicate something to you.
38:59
And I try to help my clients to hear what is it that their body's trying to communicate to them. So that's one.
39:08
But the second thing is doubt.
39:08
A lot of my clients will say to me, "Okay, I've come to believe.
39:14
I believe it, but I still have some pain.
39:14
Even if that pain has gotten better, it's still around."
39:19
Well, that's when we need to look at what's happening in the mind in terms of doubt.
39:25
If you're still holding onto some level of doubt, that can be complicating the healing process.
39:25
So you have this idea of people opening up their mind to, "Okay, there could be other things."
39:37
But if there's still some kind of reliance on, "There must be something physically wrong," or, "I must treat this physically," it will always complicate the process.
39:45
So it's becoming more and more open to the idea that there doesn't have to be anything physically wrong, even though your body is doing something to create the symptom. Jim O'Shaughnessy: Yeah.
39:58
And that's a difficult point to...
39:58
It's one that I've struggled with, right?
39:58
Because I think that, as Voltaire said, "Doubt isn't a pleasant condition, but certainty is absurd."
40:07
And so every way, and this is now my career impinging on my life, everything we do at my firm and I do in investing is based on probabilistic thinking, right, and not deterministic thinking.
40:22
And so many of us are zero, 100, yes, no black, white, whereas I think the continuum.
40:31
And I'm sure you, Liz, would know this very well.
40:37
The continuum is where we really live, right? It's not black or white.
40:42
We live in the gray zone, so to speak.
40:42
And it's difficult for people to both understand that, but then understand what you just said, which is the aspect of doubt and how it plays into this.
40:55
I try to gamify these things in my mind, and it's like if you've ever read The Screwtape Letters by C. S. Lewis.
41:02
It's about a young demon, was getting letters from his older colleague Screwtape.
41:08
And one of the things that he does... It's a very old book.
41:13
One of the things that he does in that is basically say that the way to get these humans to really come on our side is to create doubt, is to create, "Maybe I'm wrong."
41:29
And so it's interesting for me, the dichotomy between it working very well, at least directionally over time, to be a probabilistic investor, to use empirical numbers, to be totally devoid from what...
41:42
For example, I don't watch any financial news. I don't have a Quotron.
41:42
I don't have any of that.
41:49
And we've done pretty well.
41:49
So I think that is a different extreme of emotions.
41:55
I used to joke that the four horsemen of the investment apocalypse are fear, greed, hope, and ignorance.
42:01
And only ignorance is not an emotion.
42:01
Fear, greed, and hope have wiped out more people's money in investing than almost any other thing.
42:07
And that brings me to the other part that is you just can't put an empirical handle, unless Michael's going to correct me here, but on...
42:20
Basically, human beings, we're domesticated primates and we are fear based.
42:20
And there's a good reason why we're fear based, because while cultural evolution has pretty much tried to keep up with all of the changes, we're still optimized for a world that doesn't exist anymore, right?
42:37
If the bush on the Savannah is rustling, we're optimized to run away, because that could be a lion that's going to jump out and eat us, right?
42:45
And so if you want to reframe that, all of us living today are the results of millions of years of success.
42:51
But on the other hand, we're all descended from cowards in a way, because we are the genetic emergence of those people who were like, "Oh, I'm going to run away because that could be a lion."
43:09
Michael, I'm going to ask you first.
43:09
How do you, as an empiricist, as one doing a double blind test and all of that, how do you build this in to those studies?
43:24
Michael Donnino: I understand your question, but how do you build in the concept that, of the- Jim O'Shaughnessy: Well, like Liz, it would be what I would call squishy data, right?
43:36
Getting pain down to zero, that's amazing, that's awesome.
43:36
But how do you build in the way Mother Nature has genetically programmed us?
43:43
And how do we know, how can you isolate, I guess, to better ask the question, how can you isolate those variables?
43:49
So for example, the fight or flight, the doubt that Liz was talking about, the playing havoc, because it certainly happened with me, and my guess is it happened with you and with you, Liz.
44:02
Is there a way to, or that's just over here? Michael Donnino: No.
44:11
Well, it'd challenging to measure per se.
44:11
I do think that it would be interesting to know, because I have noticed.
44:19
And our techniques in terms of getting people better start out with addressing those exact issues.
44:23
And it does seem that people who are able to just accept things like, "Oh, wow. Okay. I get it.
44:29
Check," and move forward, they get better extraordinarily quickly.
44:34
And the people who are, "Eh, I'm not so sure.
44:34
I don't [inaudible]," that's where you struggle a bit.
44:39
And maybe that's the answer, to actually...
44:39
At the beginning, you could probably do it even as a simple scale of where people stand on, what their beliefs are in terms of do you think this is going to get better.
44:53
Where do you stand on the physicality of it?
44:53
But our techniques include these kind of concepts.
44:59
So one of the things we do is we start out with what we call inconsistencies.
44:59
So before this, most people don't even think of these concepts.
45:06
The human mind creates associations.
45:06
We're all about cause and effect.
45:14
And a lot about Sarno's approach is actually goes by some of this conditioning.
45:20
So for instance, it's not uncommon for people to come into the emergency department and they'll say, "Oh, I have abdominal pain."
45:24
And they'll say, "Oh, it's because of...
45:29
," and they'll come up with the last thing they ate, a ham sandwich or whatever it is.
45:33
You go ahead and get a CT scan, and they have appendicitis.
45:33
It has absolutely nothing to do with what they ate.
45:38
But the human mind is always trying to build that cause and effect.
45:42
And just like Pavlov's dogs, you can actually condition somebody.
45:42
So with the Pavlovian dog model, every time there's a bone and you pair it with the bell, next thing you know, all you need to do is ring the bell and the dog salivates.
45:53
Well, same thing with the pain syndrome.
45:58
If you can actually condition, to me, sitting, I condition sitting to bring on the pain.
46:05
And that's what happens with these people.
46:05
So it's not just a psychophysiologic response, but it's also this conditioning that happens.
46:10
So now, they come into the program and they start thinking about this differently.
46:16
No one's ever brought these concepts up before.
46:20
And one of the first things we do is start making people think of inconsistencies.
46:24
And I had a wonderful inconsistency just the other day.
46:24
Someone, she said she had only been listening to this for an hour and a half.
46:28
And she said, "It's the bizarrest thing.
46:28
I'm staring at my cell phone, thinking of all the work emails that I'm missing, talking to you, and my back pain just increased." Jim O'Shaughnessy: Yeah.
46:41
Michael Donnino: She said, "I never had thought of anything like that in my life."
46:42
And so that inconsistency, that oddness, and that then starts down the path of, "Okay, this is a psychophysiologic response."
46:47
And we start building these inconsistencies and such. Jim O'Shaughnessy: Yeah.
46:56
The challenge that I have, it's just something I know, is Dr.
46:56
Sarno himself got much better results when he excluded people who said categorically, "I do not believe that this works or could work or that there is any connection between the mind and the body." Michael Donnino: Right.
47:19
Jim O'Shaughnessy: And again, as a researcher, we share some traits of the way we do stock market research and the way you do medical research.
47:22
We always want to avoid a self-selected sample, right? Michael Donnino: Yeah.
47:30
Jim O'Shaughnessy: So that's a bit of what's going on here.
47:31
And what I'm just anticipating is pure materialists are going to look and they're going to say, "This is nonsense.
47:38
This is a self-selected sample.
47:38
And of course they're going to get better, because they think that they will," oddly confirming what we're saying here, but using it as a bludgeon to say, "This can't be considered scientific in the idea of that.
47:58
The hypothesis, the thesis needs to be tested.
47:58
It needs to be replicatable using the same methodology in other subgroups et cetera."
48:06
We all know the various ways that this happens. So it... Michael Donnino: Yeah. Jim O'Shaughnessy: Yeah.
48:18
What's your response when the doctor down the row from you is like, "Michael, I love you, man, but this is bullshit?"
48:23
What are you going to say?
48:26
Michael Donnino: Well, I think there's two things.
48:27
One is that by setting up a group where people think they're getting the intervention, if that's all that it took, they should all be getting better, but they're not.
48:40
Some of them are, but the majority of them are not.
48:43
And so we're able to then set up that scenario, and that's why we actually have this three group model.
48:48
We have the complete, usual care and they think they're getting nothing.
48:48
Then we have another group.
48:53
They think they're actually getting the therapy, and they should theoretically get better if thinking they're getting the therapy is all it takes.
48:57
And then we have our group.
48:57
So I think that's an important distinction.
49:00
And that's how we handle things in an empiric way, by creating that third group.
49:04
Jim O'Shaughnessy: That's very [inaudible]. Yeah. Go ahead, Liz.
49:07
Liz Wallenstein: I could just say something to that also.
49:09
My response to that is that doctor will say that until he needs it, because, let me be frank, but most of the way that people come to this is through desperation, through, "I've tried everything else and nothing works," through, "I don't want to have surgery unless I absolutely am sure that I need to," through, "I'm out of all my other options."
49:28
That is the way that a lot of people come to this.
49:33
And when I was saying before your body's trying to communicate something to you or to see it as a calling, I think that's where the people that you're describing are going to need to stretch themselves, that this reliance on, "I need really strong or tons of empirical data," only somebody who's not in the throes of pain is going to really hold onto that, because most people come to this through desperation.
49:56
And that's the only way they believe it, is through experiencing it. Jim O'Shaughnessy: Wow.
50:00
That is such a great point, because it certainly applies to me and Michael, from listening to your story.
50:03
And Liz, you were younger, so maybe you got that benefit of not having all of these biases and prejudices already built in.
50:14
But I like both of those.
50:14
Especially on the research side, that third group, Mike, I think is very, very wise, because in my line of work, we call it people who are doing honest minded data mining.
50:27
In other words, they're not trying to mine the data, but it goes under a variety of names, P hacking, looking for statistical significance.
50:40
And the way you have to design the model so that that is minimized, at least in finance, is pretty specific as to what you can and can't do. I love your third group.
50:54
We actually did that in portfolios.
50:54
We would compare them not only to indices, because indices are human created, right?
50:59
The S&P 500 is not a passive index.
50:59
It's selected by a committee that's Standard & Poor, same with the Dow Jones industrial average.
51:07
It is selected by a committee of editors at the Wall Street Journal.
51:12
And they are likely to exhibit all the foibles of human beings and human nature.
51:19
So one of the things that we did in the research that I ended up not publishing, it's available for people who are really hardcore about this, but didn't publish it in my books just because it would confuse even a dedicated researcher.
51:37
What we did was just do random portfolios that were just selected by random number generator.
51:42
And we would contrast those with the index, with the methodology that we were studying.
51:50
And, but I also want to come back to this idea of cause and effect pattern seeking.
51:57
So there's a great book called The Status Game.
51:57
And the author is Will Storr.
51:57
And he goes very deep into this idea of the human brain, or, actually, he would argue the conscious part of our brain.
52:11
As my friend Rory Sutherland likes to say, "The conscious part of our brain thinks it's the Oval Office, when, in actuality, it's the press office."
52:16
In other words, it is the one that's looking for all of the...
52:22
like your, "It had to be that ham sandwich that I had," when in fact it was actually appendicitis.
52:27
We always try because of our very nature.
52:27
Very bad things happen to human beings, if you remove the illusion of control from them.
52:35
So, one of the worst punishments you can give is solitary confinement, and we are a social creature, and that's kind of the subject of The Status Game, but he gets into the weeds about why is this happening?
52:49
Why is the physiology also impacting this, in terms of why do we just keep playing these games?
52:54
And he comes to the conclusion because it's baked into our DNA, and we sort of have to.
53:01
And anyway, the idea that we are recognizing and creating meaning where no meaning exists, right?
53:16
It's the Rorschach test, right?
53:16
There's nothing there, and my limited understanding of the Rorschach test is it isn't so much what is there, it's what the person sees there that is of interest to the clinician, or the psychotherapist.
53:32
That I guess would be a question, I don't want to start talking about Rorschach tests, because I want to stay front and center on Dr. Sarno.
53:38
Liz, so, one of the other parts that we haven't even talked about is the sheer loss of...
53:51
Far apart from what the individual is losing in terms of their life, in terms of you can't sit, for example, Michael, with you.
54:00
I read another book, The Great Pain Deception, and he gets a little preachy, but again, I don't even think I could've made it as far as that guy made it, and all the things that he went through, but he also focuses on, as did Dr.
54:20
Sarno, to a lesser extent, not only of what we're losing personally, but what we are losing in terms of our ability to make contributions to society, both economic and noneconomic, our abilities to pursue a job or a career, a calling, like you would say, Liz, they're just in the stratosphere.
54:40
And if you just want to be an economist about all this, we're losing billions, and billions, and billions of dollars to these psychosomatic illnesses, or mind-body I prefer, and it's kind of like there's this wonderful little short video of this preacher, old time preacher, and he's just shouting, "Wake up, wake up, wake up!"
54:58
And so, I mean, Liz, on the psychological side, are you finding greater acceptance?
55:02
Are people waking up to this idea, whereas maybe 10 years ago, they would've been much more resistant?
55:15
Liz Wallenstein: They're waking up to it, but I'm glad that you're talking about this, because you're right, in terms of people tend to just get stuck on the pain part, but the greater casualty of it is that you can't be present in your life.
55:22
And so, you're so preoccupied with the pain and the fear of, "Will I ever be better?
55:29
When is it going to come back?"
55:34
, that it affects everything else in your life.
55:34
So, that is a big hazard, but I'm sorry, remind of me the question again?
55:39
Jim O'Shaughnessy: It was are people in your practice, you've been doing this for a while, are you finding that people are now more open-minded to this avenue, or is it the same as when you began practice? Liz Wallenstein: Right.
55:52
So yes, they're more open, but Dr.
55:54
Sarno was very big on that this presents itself in trends.
55:54
So, he wrote a lot about the back because at the time, it showed up a lot in the back, and then when people were more regularly working on their computers, carpal tunnel became a big thing.
56:07
Lately, we're hearing a lot of bladder type things, and I noticed a lot of those things kind of happening around the Me Too movement, when there was a lot of news about sexual harassment and things like that, and I felt there must be a correlation that people are experiencing things in their genitals, as we're talking about all these sexual things that are happening that are problems.
56:34
So, I think the next big trend that we're really confronting now is not just presenting physically, but through mental health.
56:40
A big problem today is that you call something anxiety or depression, and then it's just there's kind of this hopelessness around it, "Well, biochemically, I have something wrong with me, and so, I can't do something," or "I just have to take a medication for it."
56:51
This is the next level of "There's something wrong with me and I'm just stuck with it, because I can give it a label, because I can give it a diagnosis."
57:03
So, that's the thing that really, from my perspective, needs our attention now, is not just how it shows up in pain, but how it shows up in mental health, and not to dismiss it by just giving a diagnosis and say, "Hey, try some medication for it," just like we're saying with the body, but to say, "Okay, we need to explore this and see what's going on.
57:23
Is this a symptom of something larger in your life?
57:23
Maybe there is more that you can do to treat this, or feel like you have more power over this, if we look at it bigger picture, and not just give it a diagnostic label."
57:35
Jim O'Shaughnessy: Yeah, and that makes a lot of sense, and one of the other things that I have been noticing is sort of, and this is anecdotal, so I could be wrong, but the seeming increase in learned helplessness, where we have people just surrendering their agency and saying, "I am helpless.
57:52
I can't do anything," and I think what a life killing thing for that to happen, because if you take somebody's agency away from them and they become, Michael, to your point, Pavlovianly conditioned to believe that they're helpless and can't do anything about it, what a horrible thing to come out of these types of things.
58:17
So, I think personally, and why I wanted to have you both on today, is I completely agree with what you just said, Liz.
58:25
Obviously, I've been seeing you for a couple of years, so I think the work is very important and can be very helpful, not by the way, just in that aspect of your life, but in all aspects of your life, because you become more self-aware, you become more aware of others as well, and how you interpret things, everything.
58:49
It's really a great exercise that I would recommend highly, but Michael, where do you see this going?
58:55
You've been looking mostly at backs on the scientific study.
58:55
Are you going to branch out and start to look at gastrointestinal problems, at all of what Sarno would call the equivalents? Michael Donnino: Yeah. Yes, we are.
59:07
We're starting to expand, and one thing, just to kind of pick up on the previous comments, is that in a weird way, I've often said having back pain actually was the best thing that could've happened to me in my life, right?
59:16
Because like everything that you both just said, it was the blindness between kind of what was going on, and to relationship between conscious and subconscious and whatnot, and just to kind of be able to have more awareness and change a number of things in your life is tremendous.
59:42
So, I think that's really important, and we also have some empiric data coming out on things you just mentioned.
59:48
The back pain folks, also when you look at enjoyment of life and interference of other activities, across the board, it was interfering with all these different activities, and when we were able to bring them through this program, you started seeing all of that improve, and then as you say, expanding into other areas, and then picking up also as mentioned about how things can kind of move almost with things that are going on in society.
1:00:08
I spent the better part of the last couple years as an emergency critical care physician, I was in the hospital, dealing with people who had definite physical injury from COVID.
1:00:18
There was people on ventilators and all that type of stuff.
1:00:23
But another interesting phenomena has evolved, people who were not in that category, had maybe mild COVID, or maybe were asymptomatic, never hospitalized, but they have all sorts of symptoms, headaches, and chest pain, and shortness of breath, and back pain, and you start to look at it, and interestingly enough, I actually pulled up a whole group of symptoms, and I showed somebody this and I said, said, "Wow, this is long COVID.
1:00:53
This is exactly what I'm experiencing."
1:00:53
I'm like, well, that's interesting.
1:00:57
These symptoms were pulled from an article on post- traumatic stress disorder in soldiers from about 50 years ago.
1:01:02
And so, all of these things may be manifestations of the mind-body syndrome, but it's challenging because as you mentioned, is that there's a...
1:01:09
And so, like I said, I like mind-body syndrome or psychophysiological, because there's almost a stigma to the whole thing, but it's a very human thing, and I think that's the more important thing, and that there's a science behind it, of things get conditioned beyond your control.
1:01:28
And so, I think that's important. So, we are expanding.
1:01:33
To that end, we're actually doing a feasibility look at this long COVID, just to see if our protocols kind of help in that area.
1:01:39
We're looking at repetitive stress injury is the next one too, as you mentioned.
1:01:44
So, actually, Jim, we're really grateful that you had supported our research.
1:01:50
We also had a supporter, Adam D'Angelo, who he is the CEO of Quora, and openly posts on his blog about a repetitive stress injury that he was having.
1:01:58
And so, we're kind of starting to look into that area of repetitive stress injury.
1:02:03
And another big one that I'm really interested in is migraine headaches, because so many people suffer from migraine headaches, and we started noticing that people who had migraine headaches who were in our back pain programs, their migraines started getting better.
1:02:20
So, I think there's just so much opportunity with whether it's migraine headaches, or repetitive stress injury, irritable bowel syndrome, and the list goes on.
1:02:28
I think it's very important, as has been said a couple times here, is that first thing is you want to make sure you've been cleared and there's nothing physically wrong that can be very clearly identified, but once that is done, there is just really quite a number of
1:02:45
different things that this can apply to, and as you said, I mean, the amount of people who are, not only as an individual and a person, but you think the societal in terms of people who are unable to work or unable to kind of engage, it's an enormous impact, and the opportunity for [inaudible]. Jim O'Shaughnessy: Jim O'Shaughnessy: Yeah. Liz? Liz Wallenstein: Yeah.
1:03:04
I think a big question that people are looking to answer now also is it's TMS, Dr.
1:03:11
Sarno focused a lot on pain, but we need more clarity around illness.
1:03:11
So, not pain directly, but illness, and that's something in my unofficial research, and nothing empirical, but just observing and experimenting a little bit that I've been looking at, is the relationship to pain.
1:03:26
So, I mean, relates to illness.
1:03:26
So, all these kind of vague illnesses that we're attributing to autoimmune, Lyme, things like that, it seems the, again, the vagueness is indication that there's got to be more to this.
1:03:40
It can't just be something physically in the body, and the question that I don't know if Dr.
1:03:45
Donnino could speak to this at all, but a lot of the people doing the research are trying to answer is, it partially a mind-body thing?
1:03:54
Is it 100% a mind-body thing?
1:03:54
Is it 100% not a mind-body thing, or which is which?
1:03:58
And for myself, something that made me very passionate about this question is about five years ago when I was 37, I was diagnosed with cancer.
1:04:03
I had Stage 4 Hodgkin's lymphoma, and I kind of felt prepared for the moment in terms of years of using mind-body attitude towards my health.
1:04:18
And so, here's an example where I wouldn't call it mind-body, because something that is classically mind-body means there's no physical intervention needed, and you can get 100% better without any physical intervention.
1:04:28
Then we have the equivalents, which are partial.
1:04:32
So, I wasn't going to not take chemo.
1:04:32
I was taking chemo for the cancer, but along with it, I used a lot of my mind-body thinking, and I went from Stage 4 cancer, to cancer-free in just two months of treatments, and I really attributed to that that I took a holistic approach in terms of combining the physical medical with where my mind was at, where my emotions were, and doing emotional, spiritual, mental work, along with the physical.
1:04:57
And so, I think that that's a real thing to look at taking these concepts into the future, is how much of illness can be traced to the mind-body connection, and how do we plug that into the equation? Jim O'Shaughnessy: Yeah.
1:05:15
I mean, that's why we're here right now, frankly, because I think I am very, very optimistic that we have in place now a variety of things from technologies, for example.
1:05:28
I think for example, virtual reality used in conjunction with some of these other precepts, both medically and from the psychological side, is going to be really helpful for people, because our brains, we don't understand how we're conscious.
1:05:42
This is an area that has absolutely fascinated me forever, and when you first read that, it's kind of like, "What?
1:05:57
We don't know how or why we're conscious?"
1:05:57
And then when you go under anesthesia, is there a scientifically proven replicatable reason as to why anesthesia works?
1:06:06
That's murky as well, and yet, it works very well, and aspirin, again, wouldn't be approved by the FDA today because they couldn't basically prove it.
1:06:19
So, I personally think, and why I'm so excited about the next 20 years in this, is that we have new technologies, we have new attitudes, in many regards, we have what I think is vital and why I was so interested in Michael's work, we got to get, in my opinion, the primary, what I would call, and I don't mean this in any way, insulting, Michael, but more conventionally minded healthcare providers.
1:06:48
We've got to get them on board, and the way to get them on board is people like you, Michael, who have credentials, like your introduction is going to eat up five minutes of the podcast.
1:07:02
You are super highly credentialed in this, and which also leads me to another question as we're talking, what do your colleagues think about this, Michael?
1:07:15
Michael Donnino: Yeah, it's very interesting, because as you mentioned, Dr.
1:07:18
Sarno largely, a lot of his colleagues kind of rejected some of these things.
1:07:26
I actually have gotten a much different reception.
1:07:32
People have been very receptive.
1:07:32
I mean, I put together a presentation that brings through the concepts in a logical hypothesis-driven fashion, and then show the data that we have, and this is also in the backdrop.
1:07:44
I think it helps that a lot of them who I'm presenting to, I've been showing clinical trials and data for years, and so, now I'm actually bringing you through in this area, and showing the empiric data, and the reception has been great on a couple different levels.
1:08:01
On one level, I have actually had more than one occasion where I've been giving a talk, and either during the talk or afterwards, one of the other physicians comes up and says, "By the way, this happened to me."
1:08:12
That has happened now on multiple occasions.
1:08:12
So, there are more people out there among the physicians that have had an experience than are recognized, that's the first thing.
1:08:22
The second thing is I've had people come up and just say, "I've been practicing medicine for 30 years, and I couldn't put my finger on some of these things. This makes sense."
1:08:28
The reason is because you see these inconsistencies and whatnot over the years, but you can't put your finger on it, and so, this now explains and provides a hypothesis for mainstream medicine as well.
1:08:45
Once you kind of start to bring in the science behind it, and when you bring in the concepts of Pavlovian conditioning and whatnot and explain how these things work, that's a lot more palpable, and people are able to understand, so. Jim O'Shaughnessy: Yeah.
1:08:58
Yeah, I think, and one of the things that I am excited about, is if we can get traditional minded doctors, and traditional and experimental minded people on the psychological side working hand in hand, because I think Liz's point, I think is quite valid.
1:09:10
I mean, yes, it's N equals one, as we would joke in my research for the stock market, but it's pretty hard to not be impressed by somebody with Stage 4 lymphoma that manages to holistically, you had the treatment, it's like you're not advocating don't get the chemo, but the ability to have that work so well in concert with the other.
1:09:39
My hopes are ultimately that a bunch of brilliant people like you two working with others, where I'm good at funding things, I guess, and so, but if we get people who can do that with the real brains, my hope is that a process can occur where you can even cure people who resolutely don't believe in that cure.
1:10:00
Maybe that's a bridge too far, and/or maybe break down or introduce to them a manner in which they can say, like your doctors in the audience, "You know what?
1:10:18
That's happened to me, and all these smart people are saying that I should [inaudible]. Maybe I'm not weird."
1:10:25
Because I think one of the other things that people often think, is that "What are other people going to think about me, and how am I going to come off?"
1:10:36
And so, the wonderful thing about aging is that you realize that other people are very rarely thinking about you at all.
1:10:43
But I think that that kind of combination could truly be, in my opinion, revolutionary, in terms of the quality of people's lives.
1:11:00
And so, I think that being open-minded about this is all to the good.
1:11:00
Liz, you mentioned, and as did you, Michael, it's not like this is anything new, by the way.
1:11:09
Norman Cousins wrote a book, called I can't remember the name of the book, Liz, you might remember, where he basically was given a terminal diagnosis.
1:11:18
I think I'm getting the author right.
1:11:18
It was basically laughter therapy.
1:11:18
What he did was he checked himself out of the hospital, checked into a hotel.
1:11:23
Back in the Paleolithic Era, you needed a TV with a VHS, but what he did was have them bring all of the comedic movies that he loved.
1:11:39
So he loved the Marx Brothers, and he loved Mel Brooks, and essentially, all he did was watch these movies all day long, laughed all day long, and prolonged his life.
1:11:45
And I think for a while there, he was actually completely free of what they said was a terminal diagnosis.
1:11:56
And again, if you dive into this, there are really incredible studies.
1:11:56
I'm not remembering the author of this study, but they took a group of older people, I guess they were all above 85 or 90, and they all moved them offsite from where they were.
1:12:10
They were in a nursing home, and they moved them to a new site, and everything at the new site was from 40 years ago.
1:12:16
So, the TV was playing, I Love Lucy, Life Magazine and Look Magazine were there, the music was big band, et cetera, and the results were staggering.
1:12:32
Men who walked in needing canes, walked out cane free.
1:12:32
They actually measured them, and many of the people ended up leaving an inch and a half taller, than when they went in.
1:12:47
I mean, and so that gets into, I guess an adjacent part of this, which is the power of the placebo.
1:12:55
For example, I have read again, I'm not an expert, but there seems to be a lot of conclusive evidence that most of the effects of SSRI inhibitors or uptake, for depression, is actually coming from a placebo effect.
1:13:10
Do you know about that, Mike?
1:13:10
Am I right or am I wrong?
1:13:12
Liz Wallenstein: I got to tell you, the studies do show that people with depression, the only ones that have really been helped by SSRIs, are the ones on the very severe, severely clinically depressed, it's been shown to not really be that effective with people unless they're severely clinically depressed.
1:13:23
I don't know if that plays into what you're talking at.
1:13:28
Jim O'Shaughnessy: Yeah, and I actually think that what I like about this, I like your idea that this should be presented as a continuum, right?
1:13:35
So over here, you got shot in the stomach, that's all physical you need a great doctor like Michael in the emergency room to make sure that you're going to make it through that horrible event.
1:13:49
Okay, so you get shot, it's not because you're maybe having doubts about things, it's because you have a bullet in your belly.
1:14:00
And then all the way over to some of the things that are just like truly, narcissistic personality disorder, borderline personality disorder, which are in the DSM as you can say that those are mostly mental.
1:14:14
I think where the true advances that are going to be made here, is in this middle area Liz, that you described so eloquently, whereas, "Yeah, I have cancer. Yeah, I need chemo.
1:14:28
I'm not going to reject that.
1:14:28
But if I marry it to these mind-body techniques, which have been proven to work, outcomes just get much, much better," agree?
1:14:40
Liz Wallenstein: Yeah, sure.
1:14:40
And what I wanted to say before is, like you were saying before with Dr.
1:14:42
Donnino, he'll be so valuable hopefully in terms of convincing other clinicians, convincing people who are treating other people, but we also need work on the patient's end in terms of, I think it was Dr.
1:14:52
Gabor Maté I heard say this, he is a psychiatrist who works and wrote a lot about the mind-body connection.
1:14:58
But he said people are trying to make doctors out as the bad guys here, but the doctors are only giving the people what they want.
1:15:09
And people want to just treat their symptoms with a pill.
1:15:09
They don't want to look inside.
1:15:16
They don't want to do work.
1:15:16
They don't want to be introspective.
1:15:16
So that's part of this work also is helping people to overcome that challenge of just quieting the noise, turning away from distraction, and having the patience and kind of self-discipline to look within and do the inner work that's needed to heal and be healthy.
1:15:35
Jim O'Shaughnessy: Wow, that's such a great...
1:15:38
I could not agree with you more.
1:15:38
And it's right, it takes a lot more time and it takes a bigger commitment and so many people, especially in America, have this, "I want it solved now, give me a pill, do surgery, just make it end."
1:15:49
And so Michael, where do you see, so let's say your research continues to bear fruitful findings, what would the next step be from the sort of institutional medicine perspective?
1:16:04
Would it be incorporated into medical school? What would it be?
1:16:11
Michael Donnino: Yeah, I mean, I think so.
1:16:13
I mean, I think that the next step would be as you continue to show that these techniques work and to start to introduce this into different therapeutic programs.
1:16:22
Because at present, if you look at back pain, for instance, we're potentially doing a number of things that actually in studies have shown not to work, whether it be, steroid injections or that type of thing, they haven't been proven yet.
1:16:41
So I think that the move would be to start to incorporate this and to mainstream medicine and to be able to teach these concepts and the approach.
1:16:49
And I think as you were both saying about this, that continuum is extraordinarily interesting too, because on the one side there's things that look like they kind of seem to fit well into this mind-body box.
1:17:01
And then the other side like you said with the gunshot wound, a good example, but some of these other things like you mentioned is that, clearly things like defined autoimmune disease and inflammatory bowel syndrome, clearly those have a physical thing that needs at this point to have a treatment based on a physical side.
1:17:23
But could there also be this blend where, if you step back a few steps, could there be a mind-body connection that got to that point?
1:17:30
Or that could be used to help alleviate that.
1:17:35
One neat study that I saw in the New England Journal of Medicine.
1:17:35
And this is with a much minor thing, like a cold and everyone, as most could probably recognize, when we were isolated for a while, clearly there's a physical viral component to a cold and most people didn't get colds in 2020 because we stayed away from each other, right?
1:17:51
But at the same token, some of us have noticed you sometimes get a cold when you're kind of, run down if you will.
1:18:04
So how do you put those two together?
1:18:04
They did a really interesting study where they actually took the rhino virus, which causes the cold.
1:18:08
And they actually, and I don't know who would've volunteered for this, but nonetheless they put the rhino virus up people's nose, and they actually had measured their levels of stress beforehand.
1:18:16
So everybody had the rhino virus, everybody got the cold, but the people who actually manifested the symptoms, were the ones who had higher levels of stress.
1:18:28
And so there is this combination of yes, something can be physical, but yes, there also can be a mind-body interaction.
1:18:33
So I think that whole, exploring that continuum, is going to be important and interesting as well.
1:18:39
Liz Wallenstein: Yeah, and I also love the idea you bring up as mind-body is preventative health.
1:18:42
Yeah, and I also love the idea you bring up as mind-body is preventative health. Because that's something that I'm keeping an eye out for also is, using the cancer example, cancer, there is something that happened pathologically in the body, but do we kind of prime the body in
1:18:59
terms of that happening or that being significant, because of where our mind is, because of what our mental health is, and what things can be kind of prevented by proactively having good mental health or systematically or regularly attending to what's happening on the inside, for me. Jim O'Shaughnessy: The other thing that you mentioned often,
1:19:18
Jim O'Shaughnessy: The other thing that you mentioned often, Liz, is some people conflate the idea of you've got to think positively, to the idea that you bring up often, not necessarily, you have to be neutral about your thinking.
1:19:28
In other words, and I don't mean neutrality as a bad thing.
1:19:33
I mean, you have to be willing to be open to that, but this idea that you can just say, "I'm going to win," maybe not, right?
1:19:49
Liz Wallenstein: Yeah because you have to be sincere.
1:19:51
I think that these things don't really work if you don't really mean it.
1:19:51
So if you say, "Everything's going to be okay," but inside you're full of fear and doubt, it's not going to matter that you're saying everything's going to be okay, but it's about being open.
1:19:59
I don't know what tomorrow's going to be, but it doesn't have to be bad.
1:20:04
I could be better tomorrow.
1:20:04
I'm afraid that what I'm doing isn't going to work, but it's possible that it would, let me just put one foot in front the other and see.
1:20:12
That's that example of neutral over positive, because you don't want to be disingenuine, because then it's just another way another coping mechanism, another way of fooling yourself, which is what the symptoms are.
1:20:23
So you kind of want to be where you are and trust that it can work from that place.
1:20:28
Jim O'Shaughnessy: Yeah, and we could do another two hours because that tips over into spirituality, right?
1:20:31
And sort of Zen Buddhism and when you read, which I've read a lot about, that type of spiritual practice, not that I am a Zen Buddhist, I'm not.
1:20:44
But very interesting in terms of all of them, Daoism, which I do sort of subscribe to, stoicism, Zen Buddhism, et cetera.
1:20:51
This notion of sincerity, is mentioned time and time and time again.
1:20:58
And you put it in the right way Liz I think, because being sincere means if you honestly don't believe it you're and you're lying.
1:21:13
I mean, that would be another great study at what happened to Russians under the Soviet Union, Pasternak, I think had something where he said, "If you have to lie daily and say things that you know are not true," he says, "It plays havoc with not only your mental wellbeing, but with your physical wellbeing as well."
1:21:34
And so this idea of these horrible regimes from Hitler to Stalin, to Pol Pot, all of them, you see these and the talk about physical suffering, this is real physical suffering.
1:21:51
When we were in Cambodia, we had as a guide, the gentleman was my age.
1:21:57
So he was 16, I guess, while Pol Pot was committing genocide and of his class of 60 students in his school, he was one of only two that survived.
1:22:06
And Pol Pot wanted to kill anyone who was intellectual, in any way, shape, or form.
1:22:13
And anyway, that the idea of sincerity, I like this idea because I've always had little, positive affirmations.
1:22:22
Well, if you don't believe them, they're not going to work, right?
1:22:28
And so people always say to me, "Oh, well, you're very optimistic," and I'm like, "Yeah, but I'm a rational optimist."
1:22:34
As a rational optimist, you anticipate that you're going to continue to run in to a huge variety of new problems.
1:22:46
And as we discover more and more, we'll have newer and better problems, but we're always going to have problems.
1:22:54
And so this idea of pie in the sky utopia well, it doesn't exist, not as long as we humans who are still running human OS, and by the way, that's one of the things that I have found when I talk to people about this, because I work with a lot of people as a kind of a mentor, not just finance, but tech people in a variety of things.
1:23:10
And one of the things that I found is if I set it up as, "Listen, this is universal.
1:23:19
It affects me, it affects you, if you're a human being and running human OS, you're not the exception."
1:23:27
I'll see them visibly relax.
1:23:34
Because again, it's back to this idea of someone's feeling like you are different. You're screwed up.
1:23:40
No, you're a human being. And guess what?
1:23:40
We have a lot of awesome things and we've got these quantum computers that are letting us do all these nifty things, but we also have a lot of things that could improve and be improved upon. So thank you both.
1:23:58
Michael Donnino: Thank you, for supporting- Jim O'Shaughnessy: It's my pleasure, thanks guys. Bye.