Love Is a Much-Debated Thing

As Huey Lewis and The News notably taught us, “The power of love is a curious thing.” Recently Medscape ran an interview with Dr Dean Ornish, a clinical professor of medicine at University of California, San Francisco, and founder of the nonprofit Preventive Medicine Research Institute. Dr Ornish discussed the concept of love as an underused lifestyle recommendation and a source of healing. He then outlined the health implications associated with a lack of real connection to other human beings, and went on to describe some of the measures he was taking to encourage a human connection in medicine. The interview received many impassioned responses, overwhelmingly positive, regarding “the touchy-feely stuff.” Here, we provide a sampling of the feedback. [Editor’s note: Some comments have been edited for clarity or length.]

Healthcare professionals spoke out in favor of love and a more humane philosophy of treatment. One internist was eloquent:

Affection heals, or significantly contributes to overcoming not just heart disease but just about any disease. Allopathic medicine, while extremely successful in certain situations, tends to ignore this essential fact with many chronic diseases. Too many people have never experienced true unconditional love and affection, and this lies at the core of their health problems.

A preventive medicine specialist also saw this approach as the perfect antidote for an overly mechanical view of medicine, saying, “Doctors should work as doctors, not as technicians. The magic touch with a holistic approach yields better outcomes than treating patients as business clients with a quick-fix approach.”

Another healthcare professional looked to the news to support this policy, saying, “After reading about the number of people killed by guns—strongly related to an endemic lack of connection and community—this article was a breath of fresh air. We have a system that is anxious to use and pay for the fanciest machinery, but not for attentive, hands-on approaches to helping people change.”

A cardiologist cited historic precedence for this kind of treatment but also raised a warning flag:

The Catholic Church got it right: confession (via a connection to someone) is good for the soul. We physicians can slow down and spend more time with the patient, and get connected. But that will result in my problem: an enormous pay cut. As difficult as it may seem, pick and choose your ethics carefully, they will likely spread throughout your life.

A primary care physician offered a pithy maxim: “To be a healer you need to connect at a visceral level. All physicians should strive to be healers.”

Nurses, too, came out in favor of keeping an eye on the humanity of patients. One nurse wrote, “I am a palliative care nurse and I see the difference that touch and compassion can make every day.”
One primary care physician, however, did not see the value in all of this tenderness. In particular, he had pointed criticism for the kinds of programs described by Dr Ornish, saying “We are turning humans into plus-size bonobos—I thought the goal was to advance our evolution. I would feel better too if I paid all that for a group hug.”

But a cardiologist fired back, defending the use of empathy in healthcare on grounds both humanitarian and financial:

My patients are more likely to follow recommendations when they feel that I care about their outcomes, which I do. As a profession, we have lost the ability to show them that we care. It’s not rocket science; it should already be part of your life and work (billable) practice.

Another cardiologist questioned the style while supporting the substance of Dr Ornish’s approach, saying, “I applaud the article but object to relegating this essential practice of medicine to ‘touchy-feely stuff.’ Providing the best care is what we should be doing as a matter of course. If you call it ‘touchy-feely stuff,’ you may as well just call it ‘cooties.'”

An internist offered a heartfelt personal account:

I just lost a dear friend who was immensely popular; worked pretty much 24/7. He was only 59 when he died and I feel he’d been depressed all his life. His favorite quote was: “The only thing worse than being alone is wanting to be.” What does that say about the state of medicine today?

A retired pediatrician bemoaned the direction that modern medicine has taken. “Now we are being told not to waste time or touch patients but to spend millions on investigations. It made me quit a few years earlier than I would have wished. I wonder whether our planners and managers ever think about humanity as such.”

The last word goes to a preventive medicine specialist who wryly underscored the pressure of modern practice. “Love and connection? That sounds wonderful. What’s the CPT code for that?”

Migraine in Men Not Uncommon but Not Always Diagnosed

It is not uncommon for men to suffer migraines, but they are less likely than women with this condition to consult a doctor, and if they do, they are less likely to be diagnosed with migraine.

Those are some of the conclusions of a study on sex differences in migraine burden presented at the American Headache Society (AHS) 58th Annual Scientific Meeting.

“While migraine is more common in women than in men, it does afflict 6% of American men,” said Richard Lipton, MD, professor and vice chair of neurology, Albert Einstein College of Medicine, and director, Montefiore Headache Center, New York City.

“The myth that migraine is a women’s disease may contribute to the stigma of migraine and certainly denies men access to medical care.”
Dr Richard Lipton
Dr Lipton reminded physicians that migraine is “very common in men” and that men may be reluctant to talk about their headaches.

For this Chronic Migraine Epidemiology and Outcomes (CaMEO) study, participants with migraine completed a baseline survey and a second online survey 3 months later.
Researchers assessed sociodemographic information; headache features; headache-related disability, using the Migraine Disability Assessment Scale (MIDAS); symptom severity, as measured by the Migraine Symptom Severity Score; cutaneous allodynia, using the Allodynia Symptoms Checklist; and treatments.

Of the 16,789 respondents, 25.6% were men. The mean age of respondents was 42.0 years for men and 40.8 years for women.

The men reported fewer headache days per month than women (4.3 vs 5.3; P < .001).

MIDAS scores were generally lower in men (P < .001). Whereas 24.1% of women were in the highest MIDAS category, only 15.7% of men were in this category.

Higher MIDAS scores among women suggest that their migraines have a more severe impact on their daily life in areas such as time lost from work or school and social and leisure activities.

Sex hormones contribute to the increased incidence and severity of migraine in women, Dr Lipton noted.

“The risk of migraine in women increases with sexual maturation,” he said, adding that there may also be sex differences in symptom reporting.

Interestingly, migraine is more common in boys than girls before puberty. The risk “takes off” in women after the onset of the menstrual cycle, said Dr Lipton.

“But our major points are that migraine is common in men even though it is more common in women and that it is severe in men even though it is more severe in women.”

Significantly fewer men than women in the study reported allodynia (32.6% vs 49.7%; P < .001). Allodynia is defined as experiencing typically nonpainful stimuli ― for example, wearing a hat or laying your head on a pillow ― as painful during a migraine.

“Allodynia develops as a response to attack frequency and severity and is one of the pieces of evidence that migraine is worse in women,” commented Dr Lipton.

Men were less likely than women to report seeing a physician to manage their headaches (28.6% vs 31.1%; P < 0.01).

Although men generally seek medical care less often than women for a range of conditions, in the case of headaches, “the myth that migraine is a women’s disease may make men with migraine more reluctant to seek care,” said Dr Lipton.

If men in the study did consult a physician, they were less likely than women to receive a migraine diagnosis (59.2% vs 77.7%; P < .001), suggesting that migraine is underdiagnosed in men, said Dr Lipton.

As for treatment, 24.1% of men and 28.2% of women reported using prescription medications to treat headaches (P < .001). Men and women used prescription preventive treatments in a similar manner.

Benjamin W. Friedman, MD, associate professor of emergency medicine, Albert Einstein College of Medicine, who is a colleague of Dr Lipton’s but was not involved in the current study, commented on the findings for Medscape Medical News.

“It is interesting that there were both patient-related reasons (lower levels of consulting) and physician-related reasons (failure to diagnose) for men obtaining appropriate treatment for migraine less frequently,” Dr Friedman noted.

“Men do seem to experience migraine differently than women. This is reflected elsewhere in the medical literature,” he added. “Epidemiologically, even though men experience migraine less frequently than women, this is still a highly prevalent illness that affects hundreds of millions of men worldwide.”