The Rabbit Effect: Live Longer, Happier, and Healthier with the Groundbreaking Science of Kindness - Hardcover

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Dr. Kelli Harding is an assistant professor of psychiatry at Columbia University Medical Center. She is a diplomat of the American Board of Psychiatry and Neurology, as well as boarded in the specialty of psychosomatic (mind-body) medicine. Kelli works in the emergency room at New York-Presbyterian Hospital, and has appeared on Today, Good Morning America, NPR, The New York Times, Medscape, WFUV’s Cityscape, and US News & World Report.

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The Rabbit Effect

Introduction

What Are We Missing in Medicine?

The path to helping people as a doctor seemed straightforward when I arrived at medical school at the University of Rochester. On the first day of my first year, I sat anonymously in the auditorium with ninety-nine other classmates. Clad in spotless white coats, we prepared to cloister ourselves inside the walls of the Strong Memorial Hospital complex. Everything we needed to know about the inner workings of the human body lay within—or so I thought.

For the next four years, my classmates and I followed the well-worn route to the knowledge of medicine: peering through microscopes, cramming for exams in silent library cubicles, and racing through a maze of fluorescent-lit corridors to see patients. During this time, I caught glimpses of daylight reflected off white linoleum. I rarely felt the sun on my skin, the wet grass of spring, or even the bustling city beyond the brick fortress of the hospital complex. Through these intense and completely immersive years, which extended through residency and fellowship, the world outside the hospital seemed irrelevant to my work as a physician. If it weren’t for the white rabbits, I might never have walked out the sliding doors of the medical center in search of a new perspective on health.

As a medical student on the hospital wards, I noticed odd patterns with patients, observations unmentioned in my medical books. Two patients with the same diagnosis would have two very different courses of illness; one would become gravely ill, while the other carried on an almost normal life. Others I saw had medically unexplained symptoms; I’d search and search, but there was nothing in my texts that supplied a reason for their reported ills. Initially, I felt a vague sense of discomfort with these inconsistencies. I didn’t have the narrative or framework to understand them, so I tried to ignore the puzzles they posed. But the nagging feeling that I was missing something in my diagnoses refused to go away. I had accounted for all the usual biomedical explanations. What were the hidden factors in these individuals’ health that I wasn’t seeing? I was determined to investigate further.

My first suspect was mental health. I wondered if the mysterious interaction of the mind and body could explain why some patients fared better than others. Since no residency-training program addresses the interaction between mental and physical health directly, I self-designed my course of study. First I immersed myself in internal (adult) medicine training at Mount Sinai Hospital in New York City, followed by psychiatry residency training at Columbia University’s Irving Medical Center. I remained at Columbia for a National Institute of Mental Health (NIMH) biological psychiatry research fellowship and focused on medically unexplained symptoms. I also became boarded in psychosomatic medicine (consultation-liaison psychiatry). I was a woman on a mission.

Trying to tease apart medical and psychiatric diagnoses is my area of specialty. Clinically, I made the emergency room my home, seeing patients with both acute medical and behavioral concerns. While this means I’ve seen more than my share of people found naked on New York City streets, it also has provided a front-row seat to both the power and the limits of traditional biomedical knowledge. Despite the fact that I’d trained in a specialty that gave me more insight into people’s minds, I still felt I was missing something. Connections between medical symptoms and mental states seemed clear, but why did some people fare so much worse than others when, medically, that shouldn’t have been the case? I wanted to understand the different underlying conditions that influence the course of a disease. And then one day, much like Alice, I followed a white rabbit.

“You might want to look at the rabbit studies,” Dr. Arthur Barsky suggested. With his carefully side-parted hair, round tortoiseshell glasses, and fatherly demeanor, Arthur was a combination of Clark Kent and a doctor from a black-and-white 1950s medical drama. A member of the Harvard Medical School faculty, and one of my mentors during my fellowship at Columbia, Arthur revealed his secret identity through his research—he, too, was fascinated by medical mysteries. And he dared to question whether answers to a patient’s health problems always lie within the traditional boundaries of medicine.

After my fellowship ended, Arthur and I reconnected at a scientific meeting at a symposium I moderated for Dr. Elizabeth Blackburn, the Nobel Prize–winning biologist who discovered the molecular nature of telomeres, the protective caps on our DNA involved in life span. After the meeting, Arthur and I started a series of conversations that began with telomeres and the aging process. Our conference calls, which stretched over years, became a critical part of my education, beyond what’s listed on my CV. We brainstormed about clinical curiosities: patients who defied expectations and did well despite terrible diagnoses; curious coincidences such as the increased odds of dying on one’s birthday, or in the six months after a spouse dies, or following a broken heart or a surprise party. We discussed patients who get better with inert medications (the placebo effect) and patients who develop severe side effects from pills with no active ingredients (the nocebo effect). How exactly did the mind affect the body? What else might contribute to physical symptoms?

Between our calls, I’d scour the medical literature for studies on the little-understood topics we discussed, such as the relationship between telomere length, premature aging, and life purpose, and then summarize findings for the next discussion. Arthur and I explored the limits of medical understanding, rooted in science and open to possibility. It was Arthur, through his suggestion of the white rabbits, who helped me escape my limited view of health from inside the hospital’s cocoon. By then, we’d both become increasingly obsessed with understanding the mystery: What are we missing in medicine that’s crucial to health?

In medicine, including psychiatry, when we ask what we are missing, we usually find the answer through a research trial or a new drug. The breakthroughs that result from this kind of biomedical research, especially in recent decades, have had substantial consequences for our health. High-tech modern medicine is indisputably superb at keeping someone alive when crisis strikes. Advances in trauma surgery save countless lives. Biomedical advances also transform death sentences into chronic diseases.

In fall 1995 a physician told a razor-thin thirty-seven-year-old man named Robert to get his affairs in order because he had less than a few months left to live. Over two years later, when I attended a fund-raiser in Washington, DC, I met Robert, looking dapper in a tux. Robert’s turnaround from AIDS was miraculous. He had put on weight and even developed a bit of a belly, a side effect of the medicine. He bought season tickets to the Kennedy Center with friends and was back to playing Chopin on the piano. The revolutionary class of medication for HIV called protease inhibitors had arrived on the market just in time to save him, and countless others. Many individuals like Robert have discovered life on the other side of a death sentence thanks to biomedical advances.

Yet, despite our scientific progress, Americans are remarkably unhealthy. In 2016 the United States...