“Mediating mushrooms” really does summarize for me the change from April to May here in Madison
No not the weather but a weekend where I had the opportunity to attend two conferences in town that really stimulated my own intrigue about some important palliative care issues.
The first was the 10th Annual International Bioethics Forum at the BioPharmaceutical Technology Center entitled, “Manifesting the Mind, Further Explorations of Human Consciousness.” Speakers from around the world gathered with Bill Linton of Promega, to explore issues of the mind. The speakers on the second day moved into a discussion of psychedelic drugs, initially with Dr David Nichol’s expose on the role of the serotonin 5-HT2A receptor in cognition and consciousness. Dr Franz Vollenwelder from Switzerland reported their work with psychedelics, especially psilocybin (found in magic mushrooms) and ketamine, in the treatment of mood disorders. Dr Stephen Ross, from NYU, then lead a discussion of the role of psychedelics in easing the transition at the End of life.
Dr Ross shared both a historical perspective as well as the results of a recent double-blind, placebo-controlled pilot study, where 12 patients with advanced cancer and anxiety were given a moderate dose of psilcybin. Dr Grob and colleagues showed, using vailidated anxiety measures, a positive trend towards improved mood and anxiety over 6 months. (Arch Gen Pyschiatry. 2011; 68 (1): 71-78). The authors encourage more research and Dr Ross currently has a study that tests psilocybin-assisted psychotherapy to treat patients with anxiety, depression, pain, and existential distress associated with advanced or terminal cancer at NYU.
Now Dr Ross spoke about the enormous amount of psychological and existential distress that patients with a “terminal” cancer may experience near the end of life, and it was significant that Dr Richie Davidson, from the UW, was the last speaker, addressing the “Emergence of Contemplative Neuroscience.” Richie has been studying the impact of meditation on neural function and structure with evidence that these central changes can produce peripheral biological changes that may be consequential for health. This is the group who have been doing extensive testing on Buddhist monks with thousands of hours of mediation practice. Perhaps we don’t need a medicine, perhaps we can expand these horizons with meditation.
Now I am not one of those experienced meditators. I struggle, falling to sleep for a power nap (some say I am sleep deprived. I say it is years of training to catch sleep when you can). I do a lot of contemplation on the bike. But I actually missed Richie’s talk because I went to ‘retreat’ being held by UW Health entitled “Compassionate Health Care, transforming trauma.”
Colleagues in Integrative Medicine had invited Jim Finley PhD, a psychologist, to Madison to lead this event. Jim had spent time with Thomas Merton and he himself has searched many spiritual fields with his own practice particularly in Christianity and Buddhism. Jim’s bottom line: we can become more compassionate clinicians, more engaged and in tune with our patients, through the power of contemplation. Meditation is a process that may assist us in that contemplation, but there are other practices as well. What Dr Finley was recommending is what I think many of us attempt to do when we, as palliative care, clinicians, are in the room; full awareness of the patient and the dynamics with the family, picking up on the non verbals and the un-said, giving all a voice, especially the patient. Perhaps not new, but certainly providing a method for some to develop and maintain this awareness, while also looking after one self as the clinician.
The mind and consciousness are certainly important players in our palliative care work. Both experiences raised my thinking about the role of contemplation for clinicians and patients alike. I am intrigued that a substance may help in addressing anxiety at the end of life but introducing controlled substances for this purpose into healthcare will not be without its challenges.
I am open to considering both pharmacological and contemplative methods and have agreed to participate in more research through our palliative care program. Perhaps each will add to the other, helping us understand not only potential benefits but also potential mechanisms.