Your Wondrous Nervous System

Including Excursions into

Evolution and Epigenetics

Gunnar Backstrom, PhD

GB

Pub

lishi

ng

(Front figure by Persian)

Copyright © 2010 by Gunnar Backstrom GB Publishing, Sweden

ISBN 978-91-975553-9-5

Preface

This book was written in order to provide facts and ideas about essential aspects of life. The number of pages was reduced to a minimum, and instead there are references to articles on the web, traceable by means of Google key words.

I wish to thank Wikipedia Commons for their generous copyright policy as regards illustrations. In particular, thanks go to the artists who in turn have ceded their legal rights to Wikipedia for general use.

New Harbinger Publications have kindly permitted me to include figures and case histories from Clair and Amber Davies: The Trigger Point Therapy Workbook.

The television company MEZZO that provides us with operas, ballets, and concerts around the clock, have contributed two snap-shots of their screens.

As a reader, I have found that books generally contain much un-necessary numbering, which not only is redundant but also makes the text tiresome to read. This made me choose a minimalist system for internal references. Strictly speaking, the page number is the only coordinate required.

In this book, p.62 means the figure on page 62. Only rarely are there more than one figure on a page, and anyway the risk of ambiguity is exceedingly small. For such cases, p.62 2 would point to the second figure on page 62. Another simplification is that figures are discussed in the current text, just before of after the figure.

I finally wish to thank Olof Zettervall, MD, my old friend from our Alma Mater, for his help in avoiding embarrassing medical mistakes.

Gunnar Backstrom professor emeritus of physics

.

Contents

Introduction 1

The Peripheral Nervous System 3

The Autonomic Nervous System 8

Nervous Control in the Intestinal Channel 9

The Five Basic Senses 11

The Sense of Sight 11 The Sense of Hearing 14 The Sense of Taste 15 The Sense of Smell 15 The Sense of Touch 16

Receptors Limit Free Will 18

Superorganisms 18 Mankind as a Superorganism 19

Amazing Accord between Senses 22

Piano Virtuosity 22 Violin Virtuosity 27

Theatrical Virtuosity 31

Ambiguous Pains 33

Pains Transferred to Leg and Foot 34 Appendicitis 35 Chest Pain 35 Gall Stones 36

Curious Muscular Pains 38

What is a Trigger Point? 39 A Short, Practical Handbook 42 Massage Techniques 43 Tender Trigger Points 46 Neck Problems 47 Front Side of the Neck 48 Shoulder Blade Trigger Points 49 Surprising Forearm Pains 50 Confusing Abdominal Muscles 52 Various Back Pains 53 Could it be Hip or Knee? 55 From Lower Leg to Foot 56 Calf Muscles Cause Foot Pain 57 Summary of Trigger Point Properties 59

How Does Referred Pain Arise? 61

Sternocleidomastoideus Muscle 62 The Scalenus Conundrum 62 Infraspinatus Pain Distribution 63 Brachialis Muscle 64 Extensor Carpi Radialis Brevis, Extensor Digitorum 64 Adductor Longus and Brevis Muscles 65

Extensors Digitorum Longus, Hallusis Longus 65 Gastrocnemius and Soleus Muscles 66 Summary of Referred Pain in Terms of Sensors 66

Strength Training 68

Electro-Stimulation 69

“Energy” Medicine 72

The Placebo Effect 75 Tests of Medicines 76 Tests of Surgical Interventions 77

Behavioral Therapies 79

Cognitive Behavioural Therapy 79 “Energy” Psychology 80 The Practice of “Energy” Psychology 83 Physicist’s Reservations about Mumbo-Jumbo 90 Musical Addressing Instead of Tapping? 91 Preventive Medicine before Invasive Medicine 92

Biological Evolution 94

The Age of the Earth 95 The Origin of Life 96 Primitive Life 97

The Core of Heritage 99

Evolution by Natural Selection 103

Natural Selection among Humans 105 Cell Modified for a Purpose 108 Stem Cells to Cure Serious Illnesses 109

Epigenetics 110

Epigenetic Effects in Humans 111

Consequences of Epigenetics 113

Far-Fetched Ideas 113 Beliefs and Epigenetics 114 Epigenetic Medicine 115 The Importance of Nurturing 117 Role of the Nervous System in Epigenetics 118 Anatomy in Elementary School 121

Last Chapter 123

Why Are We Waiting? 124 Having Had Enough 125

Sources 127

Index 128

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Introduction

Our body manages without much effort on our part. The most essential processes that keep us alive are automatic and cannot even be controlled by our conscious mind. After chewing the food we do not have to worry about transporting it through the intestinal canal. When we need rest, we generally feel sleepy. When the body re-quires food, we get hungry. Lack of water makes us thirsty, and so on.

The skeletal muscles, on the other hand, are mostly governed by the will, which permits us to move around. The will originates in the brain (cerebral cortex, p.2 , Nat. Inst. for Aging), which sends orders to some 200 muscles on each side of the body. The brain is also the seat of our inner character, or personality.

Much has been written about the structure of the brain. The functioning of this organ is at the center of current medical re-search, carried out by the use of advanced electromagnetic and ra-dioactive techniques. There are frequent reports about the location of various emotions and capabilities. These deep insights are the results of daring projects, where our brain is used to understand the workings of other brains of similar design. Although the facts uncovered by this kind of research are of immense importance for surgery, the individual concerned has little control of specific parts of his brain. We only exploit its power to experience the surrounding world and to give instructions to our limbs. The tool for this activity is the peripheral nervous system, which is the main subject of this work.

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The image on the front cover shows the brain and the spinal cord, the latter being well protected by the vertebral column. The spine is shown from the side in p.3 (vsion), including the formal numbering of the vertebrae. The various parts of the brain and the spinal cord form the central nervous system (CNS).

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The Peripheral Nervous System

The schematic below (p.4 , Beckley Chiropractic) depicts the brain components and the spinal cord, situated inside the vertebral column. This central nervous system radiates nerve stems and fibres to various organs. The latter, secondary network constitutes the peripheral nervous system.

The lines drawn to the right in the figure indicate, in a simplified scheme, the nervous connections to various organs. The eye, which has to transfer a rich stream of information, connects directly to the middle brain. The brain stem communicates with other organs inside the head.

Organs below the uppermost rib, from the heart and lungs downwards, are controlled directly by nerves from the spinal cord.

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Figure p.5 1 (Debivort) below is a cross section half-way up the spinal column, showing more details of the vertebra and the spinal cord, containing white and gray matter.

The picture beside (p.5 2, Gray’s) illustra-tes how the spinal cord radiates nerve stems to the left (similarly to the and right). The back (posterior) horn of the spinal cord receives in-going (sensory) nerves. These nerves report on the state of the body and the outside world.

Outgoing (motor) ner-ves leave the spinal

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cord towards the front (anterior) side. They send orders to muscles and other organs.

As shown in figure p.5 1 the spinal cord contains a central core of gray matter, surrounded by white matter. The gray matter is responsible for the communication with the peripheral units. It resembles an H-shaped beam, which connects to the roots of the radiating nerves.

The white matter consists of fine nerve fibers that send informa-tion up to the brain and also receive motor orders to peripheral organs. The number of nerve fibres contained in the white part of the spinal cord has been estimated to be as large as 10 million.

The two nerve stems leave the spinal column through channels between the vertebrae as illustrated by figure p.6 (Debivort). Each of these stems serves its own half of the body, and both eventually branch out into fine nervous fibers.

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Sensory nerves radiate from the spine to various points on the skin. Such a sensor can send signals to the brain about the mecha-nical, chemical, and temperature status at the endpoint. The nervous sensors are organized into distinct superficial areas (dermatomes), one for each vertebra (Google: dermatome anatomy wiki).

Figure p.7 below (Ralf Stephan) indicates the mapping of sensors on the skin. Numbness on a particular dermatome bears witness of damage to the corresponding part of the spine.

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The Autonomic Nervous System

The brain unloads some of its decisions to local sites that handle frequently occurring processes. An important example of this is digestion. When we are hungry the brain makes us produce saliva, which the tongue mixes with the food to achieve the first chemical breakdown. The result-ing lump is swallowed and then transferred automatically to the stomach via the esophagus tube (p.8 1, Arcadian). During this pro-cess a flap (epiglottis) prevents

food from diverting into the windpipe (larynx).

The stomach contains an acid that is kept at the optimal temper-ature and pH-value for activating the enzymes used to break down proteins. The acidity also kills many undesirable micro organ-isms. Already at this stage of par-tial digestion some substances are absorbed by the wall of the stom-ach to enter the blood stream.

When the processing in the stomach has come to an end, the food stuff is transferred to the

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duodenum (p.8 2, US Gov.), where it is mixed with juices from the gall bladder and the pancreas. At this stage, the acidity of the

contents is decreased to neutral for optimal efficiency of the newly added enzymes. This stage of the process takes care of the fats.

The absorption of remaining food nutri-ents continues in the small intestine, which is narrow but very long. The substances

absorbed here are taken by the blood stream into the liver for removal of toxins and for further treatment.

In the next, wider duct (colon) (p.9 , Dflock) water is absorbed and leaves waste substances, which are later expelled from the rectum.

Nervous Control in the Intestinal Channel

The above digestive mechanism illustrates that many processes take place automatically and in the right order. After leaving the mouth by the closing flap, a lump of food is driven through the esophagus tube without conscious effort on our part. The tube contains layers of ring-shaped and longitudinal muscles that are periodically con-tracted to move the material down into the stomach. There the acidity and temperature are measured and adjusted to assure optimal working conditions for the digestive juices.

When the processing in the stomach is finished, the ring muscle at the lower end opens to move the almost liquid foodstuff to the

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duodenum, where acidity is again adjusted to favour the function of the various enzymes.

During the remaining absorption, rhythmic muscular contraction of the guts serves to mix the contents and transport them along the nine meter long digestive canal. In summary, the digestive process constitutes a sophisticated chemical factory.

In the above paragraphs we have seen examples of regulatory action in the human body. The blood stream is normally kept at a constant temperature of 36-37 ºC during sleep and 37-38 ºC when awake. Bacterial or viral infections may increase the body temperature by 2-3 ºC, which is commonly named fever. There are indications that fever is a symptom, rather than a disease, and that it helps conquering invading microbes. It also promotes production of white blood cells for the same purpose. Bacterial bone infections (osteomyelitis) are known not to involve fever and become chronic, taking an extremely long time to heal.

A little-known fact is that cholesterol is produced in the liver and in several other organs of the body and that it is essential to the proper function of cell membranes. Although there are several internal sources of production, the body maintains the concen-tration of cholesterol in the blood at a constant level. It is virtually impossible to modify this concentration by dietary changes.

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The Five Basic Senses

By tradition we count five senses, viz. sight, hearing, smell, taste, and touch. A sixth sense is that of balance, which originates from a special organ in the inner ear. We also detect an imbalance, however, by sensing the gravitational forces on the body.

The Sense of Sight

The eye is the organ that transmits a picture into the central nervous system. Figure p.12 (Rhcastilhos) shows the components of the eye. Light passes through the transparent cornea into the pupil and then into the lens, which displays an image onto the retina, the crucial light-sensitive organ. The pupil is the opening correspond-ing to the aperture of a camera. The size of this aperture is gov-erned by the iris, which contains both radial and ring-shaped muscular fibers. The diameter of this aperture is regulated by these fibers according to the light intensity reaching the retina.

All the information about brightness and color is transmitted to the brain via the thick optic nerve, containing a million nerve fibers.

The lens only yields a sharp image of objects that are at a certain distance from the eye. A young person normally sees things sharply if they are at a large distance, but the eye automatically adapts to a closer distance, more suitable for reading.

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The lens (partly hidden behind the iris in the following figure)

(p.13 , Gray’s) is suspended by a number of fibers that connect it to a ring-shaped ciliary muscle, which contracts when we wish to read. The radial fibers then slacken and permit the lens to contract into a thicker shape that refracts the light to produce a sharp image on the retina.

As we get older, the lens gradually turns stiffer, restricting such accommodation. Most of the time, the annular ciliary muscle re-mains in its relaxed state, which means that the lens is under persistent radial stress and grows thinner with age. This is probably the main cause of far-sightedness in old people, a problem which of course can be corrected by appropriate eyeglasses.

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The tension in the ciliary muscle is controlled via the peripheral nervous system. The impulse to read arises in the brain, and we do not have to think of the lens and its radial musc-les in order to obtain a sharp image of a book page. The ccom-modation is auto-matic, within certain limits.

The size of the aperture in the iris screen is controlled by the amount of light that falls on the retina. The optic nerve reports this status to the brain, and the peripheral nervous system commands the muscles of the iris to increase or decrease the aperture accordingly. When we enter from the sunlight into a dark room everything looks dark at first, but the automatic process restores vision after a few minutes.

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The Sense of Hearing

Hearing depends on a specific organ, the ear, which converts sound waves to information that can be transmitted to the brain through the auditory nerve. Figure p.14 (Brockmann) shows the auditory canal and the eardrum (membrane), which detects the pressure vibrations of the air and makes them available to the auditory nerve by means of several mechanical devices, i.e. hammer, anvil, and stapes (stirrup).

On the nerve side there are very sophisticated acoustical canals. These semicircular canals detect rotary motion of the head, which helps us keep the balance.

The ear is simpler than the eye in the sense that there is not much scope for adaptation, except that extreme outbreaks of sound (at a disco, for example) are automatically moderated by dedicated muscles behind the eardrum.

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Sound has intensity and frequency, and both of these properties can vary with time. The result may constitute a meaningful mes-sage that we call music. Since the two ears generally are exposed to different sound images, we can sense the direction from which the sound comes. This is termed stereo reception.

The Sense of Taste

The organs for sight and hearing register the physical properties of light and pressure, but taste is a reaction to the chemical environ-ment in the mouth (p.8 1). The receptors of the basic tastes (sweet, salty, sour, and bitter) reside mostly on the tongue but are also present on other surfaces of the mouth.

There have been suggestions that the burning sensation of alcohol is also a taste, and in Eastern countries strong spices merit this special mention.

The mouth cavity also detects the texture (crispy, soft, etc.) of the food. These properties should rightly be classified under touch.

The Sense of Smell

Smell (olfaction) is similar to taste, in the sense that it detects chemical substances, in particular fumes and gases. The sensors for smell reside in the upper cavities of the nose (p.16 , US Fed. Gov.). Its surface consists of receptor cells sensitive to various kinds of chemical substances. Different cells detect a range of different molecules, and the brain receives a combined signal from all of these cells, which is transmitted to the brain stem (p.4 ) and analyzed by the cerebral cortex (p.2 ). It is this combination of signals that constitutes an odor or smell. There are thousands of variations in this combined property, which is an essential

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component in food quality.

Eating is accompanied by experiences of taste, texture and smell of the food. On the basis of this information we judge whether it is poisonous or safe to swallow. We also assess a more subjective quality, i.e. whether this nourishment is pleasant to consume. This evaluation expands into the vast subject of gastronomy.

The Sense of Touch

This sense is more complex and more general than the previous ones. By touching we usually mean putting a part of our body in contact with an object, either fluid or solid, sensing its position and surface structure.

In medicine one now speaks of the somatic sense as whatever is reported by sensory receptors. Such receptors reside on the skin and on mucus membranes, in skeletal muscles, in bones and joints, as well as in internal organs and blood vessels. Information passes via nerves to the spinal cord (p.4 ) and from there to the brain.

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Each somatic sensor reacts to a specific state in the body. Thermo-receptors report the temperature at a specific point of the body. Mechanoreceptors are sensitive to forces on, and tensions in, the muscles.

There are also chemo-receptors that transmit information about the chemical state in a region, such as acidity.

Somatic sensing is usually almost instantaneous, but there are exceptions. If you stub a toe against a piece of furniture, for example, the painful signal is felt several seconds later.

It has been proposed that there are special nerves that signal pain (nociception) to the central nervous system. This does not seem to be a necessary hypothesis. A thermo-receptor, for example, could report temperature on a wide scale, involving sensations of cold-lukewarm-warm-hot-burning. A sensation of heat above a certain threshold would be interpreted by the brain as painful – and potentially harmful.

A similar scale may be proposed for mechanical and chemical sensations. The latter may involve traces of broken cells, which signal serious damage.

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Receptors Limit Free Will

Most people assume that we can decide what to do in the next moment, but are we really that free? Our senses report about the environment, which includes other living organisms, both plants and animals. We notice their existence by our senses: we can see, hear, smell, and touch them.

Animals have nervous systems that are similar to those of humans; they notice that we exist and react to our presence. They may even taste us.

Plants do not have nervous systems similar to those of animals, but some of them have devices to detect insects and to capture them by a snap. If attacked by animal predators trees secrete chemical substances that ward off the aggressor. Such effects are focused by a new field of research named plant neurobiology.

We humans share space with all living organisms, and we interact more or less with all species. Each individual claims a minimum territory where it feels free to collect food, or simply avoids being threatened by others. To observe and being observed (and being reacted to) definitely puts restrictions on our will to move and to act.

Superorganisms

In the animal world there are creatures of an unusual kind. They may seem to be individual insects, but they are in fact socially

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organised to form colonies. The foremost example of these is provided by termites.

Already in the tender age of larvae the termites are prepared to become workers (p.19 1, Stock), which will provide food (cellulose) for all the members of the colony. Others have especially forceful build that makes them soldiers, adequate for defending the nest from attacks by invaders, mostly ants.

A third caste carries wings and could mature into reproductive insects. Normally the queen is the only member of the family that lays eggs, often thousands a day. The workers take care of the newborn larvae in a special nursery. The different castes in this society thus have dedicated tasks, required for the survival of the colony.

Termite nests are partly subterranean but may rise to mounds several meters above ground, housing thousands of insects (p.19 2, Stock). Such a building created by the inhabitants may be regarded as part of the colony, since it is essential to the survival of the species.

Mankind as a Superorganism

The termite mound above may remind us of a Manhattan sky-scraper, but this is only a superficial likeness. Man is not confined in a single building but connects with human life on a global scale.

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Wherever there is life, the effects of it are now noticed on a grand scale.

It once began with overseas transports, involving robbery, but also fair trade. Seamen brought home china, spices and tea. The next step was the building of roads that connected cities and nations. Trucks, automobiles and coaches set this network in motion. Airplanes added speedy and long haul transportation. Foodstuff can now be sent to other continents the same day. All this are achievements of mankind.

On a local scale man has created extensive pipe networks for the distribution of water and for the elimination of waste. Electric energy is made available in every building by a network of cables. Other cables connect people by telephone to facilitate trade. More recent innovations have established high-speed computer com-munication by optical fibres, radio, and satellites. The World Wide Web now makes information available over the entire globe. Photos regularly taken from cruising satellites keep a global record of environmental problems, such as floods, hurricanes, forest fires, and possible attacks by nuclear weapons.

The sophisticated communications of today constitute a peri-pheral nervous system, created by mankind, for the service of the human organism. The latter may be regarded as consisting of man himself, including his domesticated animals, his machines, and devices for trade and communications (Stock, 1993, Metaman). This is now a world-wide system, analogous to a living organism. It digests raw materials and uses its arteries for circulating the resulting utilities, (metals, plastics, and foodstuff) to where they are most needed. Waste is finally excreted and partially reused.

The various kinds of machines produced by man are essential parts of the superorganism, which is subject to evolution in much the same way as we observe among biological species. All products are tried and evaluated by individual users, but only a fraction of

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them survive several years on the market. Competing companies soon introduce improvements in some detail or other, and an Eastern country may suddenly offer a better model at a lower price.

Successful products spread by individual decisions over all continents and virtually all countries. On the way, a product may specialise according to the needs and customs of the end users. The production of a complicated machine may require collaborative efforts between factories that have optimised a particular com-ponent, which can serve numerous end producers. The manu-facture of a Toyota car, for example, actually requires contributions from a hundred associated companies.

Individuals who are to build and maintain Metaman must be highly specialised by education and training. It would not do to establish a caste for a special position in society, which has been the tradition in India. That system does not take individual capabilities into account and hence fails to fully capitalise on intellectual resources. The Western alternative has been to make young people compete for jobs that are attractive on account of working con-ditions and income.

The wealth of data collected daily by Metaman’s electronic acti-vities is continuously interpreted by the central nervous system, which in this case is distributed over the entire globe. The response is generated by an enormous number of individuals in a more or less democratic order. They express their preferences mostly by innumerable individual acts of buying and selling. Longer-term decisions are reached by governments sensing the preferences of the national populations.

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Amazing Accord between Senses

A virtuoso musical rendering is truly admirable, if you become aware of the many roles played by the nervous system. In this process there is an intricate cooperation between various parts of the brain and peripheral nerves, ingoing as well as outgoing.

Piano Virtuosity

An accomplished pianist (p.22 , SVT1) keeps the entire musical score (p.25 ) in her mind while executing the piano part of a

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concert. There is no time for turning over the note papers, even if they were available during the concert. Nor would there be time for reading and interpreting all notes, usually thousands of them, when so many other details need attention. Several notes have to be played simultaneously, which often makes the piano a quartet or even a sextet.

Piano music is executed by means of the keyboard (p.23 , Wikipedia), by striking the white and black keys as given by the symbolic stave shown just be-low. By tradition this is a sys-tem of five parallel lines. As a first step, the concert pianist must thus translate the notes into black and white piano keys.

The main characteristic of a musical sound is its pitch (frequency, or vibrations per second), its duration, and loudness. The pitch of a note is indicated by its position on a stave. The above figure shows only a small part of the piano keyboard, comprising one octave, which starts with C and ends with the upper C1, which vibrates at twice the frequency of the first one. The basic pitch step in Western music is a half-tone, having a frequency (pitch) about 5.9 % higher than the preceding one.

As we see from the lower part of the figure, there is no place on the stave for the black piano keys. For this reason a special sign ( ) has been introduced to shift a note a half-tone higher (sharp), as demonstrated by figure p.24 1 (Jono) below.

For a piano score, only the modifier is necessary in order to indicate all tones on the scale. In spite of this, a special sign for a half-tone lower (flat) than a given white one has been used. There is also a sign for restoring a sharp or flat to a natural (white key).

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The following score (p.25 , Chopin) is a typical one for the piano, where there are no less than five flat signs at the beginning, valid for the entire stave.

The number of flags on each note stem indicates the duration of the tone. An additional flag shortens the duration by one half. The pianist may control the loudness by the force he uses when striking the key, but there are also pedals (Ped. in p.25 ) to damp the sound or to make it last longer.

The piano amateur is of course initially confused by all the sym-bols that modify tones on the five-line stave. From figure p.24 2 it is evident that a stave of seven lines and their inter-spaces could hold all the notes of the octave (Backstrom, 1981). Ob-viously, certain pairs of notes now fall on the same height on the stave, being identical on the piano.

The following example (p.24 3) illustrates this principle, applied to a theme by Prokofieff, with C at the bottom line of the 5-line stave.

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The bottom line of the seven-line stave (p.24 3) is chosen to re-present an A and the top one A1, one octave higher, but that is an entirely arbitrary decision. This alternative stave describes a melo-dy in an intuitive way, because the vertical position directly indi-cates the pitch. After some training a person would be able to sing directly from such a score.

Shifting the pattern of notes of a musical piece vertically on a seven-line stave changes each tone by the same number of half-tones, which means that most of us still would hear the same melody. Some rare individuals have absolute (perfect) pitch, and hence they should notice a difference in expression.

In order to enjoy music one must at least have a sense (and memory) of relative pitch, since the emotional effect of music is created mostly by changes in pitch and duration. The rational arguments for the seven-line stave seem compelling, but every new generation of musicians learns the traditional system and then has no desire to part with it. Furthermore, the entire Western musical literature is written in the old way, and the conversion to a new system might seem appalling. This, however, would be an easy task for a computer.

A professional pianist could play directly from a score like p.25 , but in the case of an opus that must be executed at high speed it would probably be preferable to learn it by heart. In fact, this seems to be the standard procedure. Then the piece first becomes stored in memory as an aural musical image (sounds), and the brain just orders the hands and the fingers to execute it accordingly.

Playing the piano on the basis of an aural image involves ex-tensive use of the nervous system. Motor nerves transmit the stimulus from the brain to the muscles responsible for moving the arms, hands and fingers. This is by no means a simple process, because it involves large-scale motion of the hands and smaller but highly accurate displacement of the fingers, alternating between

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white and black keys. The signals from sight, hearing, and touch receptors are essential to ensure the proper execution. A piano concert involving half an hour of rapid finger work is an un-believable demonstration of the achievements of the human nervous system. This kind of virtuosity is of course only possessed by a minute part of the population, and it requires daily training starting from childhood.

An extremely demanding task is to play a piece for two grand pianos, where the musicians have to execute a score while syn-chronizing accurately with the other pianist (p.27 ).

A pianist must always rely on an accomplished piano tuner, who arranges for each key to yield accurately the specified tone. After proper tuning by such a specialist the musician must trust his instrument, since he cannot correct a false tone.

Violin Virtuosity

A violinist may have to face a complicated score (p.30 , Paganini), but he mostly produces one tone at a time, occasionally two but more rarely three. On the other hand, he is entirely responsible for the tuning of his instrument, which he may even have to improve

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during a concert in response to local temperature change.

The violin (p.28 , Sotakeit) has four strings (G, D, A, E). The violinist usually starts by making the A string sound in agree-ment with the other instruments in the or-chestra. The E string can next be tuned by ear, and further ad-justment may be made by sounding the A and E strings together, lis-tening for the pleasant accord resulting from a pitch ratio of 3/2. A similar fine adjustment may be applied to the pairs D-A and G-D.

Once the tension in the violin strings has been adjusted by pegs and fine tuners, it becomes possible to play the basic four tones, but all the others must be produced by fingering the strings on the board. To do so requires an extremely precise interaction between the finger muscles, which control the free length of the string, and the ear, which senses the pitch compared to the basic tones. The accomplished violinist can achieve this without exposing the lis-teners to a single false note.

To play the violin, one can either draw the bow across the string (arco) or pluck it by a finger (pizzicato). One can use a variety of ways to modify the tone in the arco mode, foremost by the standard vibrato. This is a pulsating effect obtained by oscillating the fingertip that stops the string against the board. By lightly touching a string at half-length it is also possible to increase the pitch by one octave, changing the quality of the tone as well.

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The motion of the bow controls the duration of a tone as well as the modes legato, staccato, and spiccato, et cetera. The violinist employs several procedures to obtain the desired musical im-pression. Having his ear practically on top of the violin he may correct a small mistake in intonation before it becomes noticeable to the audience.

The violinist’s task (p.29 , Mezzo) may seem simpler than that of the pianist, if one only watches the execution. None of them can take the time to read the score (p.30 , Paganini) during the performance, but the difficulties are of a different kind. The pianist has to handle a larger number of notes, but the violinist must work continuously to obtain the correct pitch, which exacts extremely precise fingering. Both thus make the most remarkable use of their nervous systems.

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Theatrical Virtuosity

Mankind has always wished to communicate its social situation for the benefit of later generations. At an early stage of development this took the form of imitation, or simple reflection of the behaviour of others. The properties that could easily be imitated were facial expressions, voices and general body language. Although all this no doubt originated from the brain, it could only be made visible as effects of motor nerves.

The imitation of existing personalities evolved into narration of fictional interactions between persons, often based on real situa-tions that some author had experienced. This resulted in a script corresponding closely to the score that a musician has to interpret.

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The resulting theatrical performance would be based on a printed account to be executed on the stage or in front of a camera. The presentation of a drama by a film is superior in the sense that each scene can be brought to perfection, and that all viewers come equally close to the leading actor (p.31 , Hedebyborna, SVT1).

Pursuing the analogy between the actor and the musician we may note that the basic script, be it a novel or a theatrical drama, can hardly be consulted during the performance. The actor thus has to store all the details of expression in memory and concentrate entirely on the presentation.

The instrument available to the actor is his whole body, with its two hundred skeleton muscles on each side. Of course, the facial muscles and the voice are of primary importance for expressing emotions, but the limbs also contribute significantly to the body language. The other actors on the stage complete the orchestra.

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Ambiguous Pains

Although there are many examples of unbelievable accuracy of our senses, there are also situations where the nervous system cannot be trusted. One of these occurs as illustrated by the following cross-sections of the lower end of the spinal column (p.33 , Debivort).

The left part shows the normal state of a vertebra, where the spinal cord and the nerve roots are exposed by a cut through the protective membrane. The disc separating the vertebrae has a strong annulus around the pulpous matter inside. As a result of excessive load on the spine this annulus may break (figure to the right), leading to the extrusion of the soft interior of the disc. The resulting pressure disturbs the somatic nerve and causes severe pain.

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Pains Transferred to Leg and Foot

The following picture (p.34 , Edave) shows a scan by magnetic resonance imaging (MRI), where a disc clearly protrudes to deform the passing nerve stem. This irritates a close-by nerve root and may cause violent pain, (sciatica), in the lower part of the spine. This is, however, not the only consequence of the defect.

In most cases a dislocated disc also sends pain along the leg (on the same side) all the way down to the foot. This occurs because the injured nerve stem contains a bunch of sensory fibers that continue downwards to the lower end of the body.

Even if the nerve stem is pinched in the lower part of the vertebral column, the brain interprets the signal as arising from the distant ends of the nerve fibers located in the leg or

the foot. This is the best-known example of referred pain.

The sciatic nerve stem can also be irritated by events at lower sites of the body. On its way through the region of the hip the stem passes close-by horizontal muscles, and in some individuals it may even penetrate the piriformis muscle. In this region it may hence be exposed to forces that would be registered by the brain as a sciatic ailment. Carrying a thick wallet in the back pocket is another classical cause of such pain.

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Appendicitis

Appendicitis is an inflammation of the appendix (p.35 1, US Publ. Dom.), a minute organ attached to the beginning of the colon. It is the most common cause of severe bowel pain.

In the initial stage of the inflam-mation, the pain is not centered on the appendix, but is felt in the region of the navel. This is an-other example of the occasional inaccuracy of the central nervous system in interpreting somatic sensor signals.

As the inflammation progresses there will be persistent pain in appendix region as well.

Chest Pain

There is a particular form of pain (angina pectoris) that signals lack of oxygen in the heart muscles, a gentle forerunner of a heart attack. It is recognised as a burning or strangling sensation across most of the upper part of the chest.

In the picture to the left (p.35 2, JHeuser) the most intense pain has been indicated by a darker hue and this part obviously starts above the heart and extends over a much larger area. In many cases it may even reach out into the region of the jaw and

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into the left arm. This is additional evidence of pain transferred from an injured organ to a distant location.

Gall Stones

The gallbladder is lodged in the liver, as shown in p.36 (Wikipedia). The liver produces bile, which neutralises the partly digested food entering the duodenum (p.8 2) and prepares fatty substances for further chemical treatment. Bile enters the intestinal tube directly from the liver but also from the gallbladder, which stores bile for situations when a large quantity must be urgently injected.

If the gall bladder has not been frequently emptied, the bile even-tually stalls and begins to crystallize into blocks similar to amber. These objects are constantly pushed by newly formed bile, and a large stone may happen to get stuck at the end of the common bile duct. This event is signalled by acute pain and may often cause nausea and vomiting.

One could expect that the pain from a trapped gall stone would be sensed as coming from the exit of the bile duct, but that is not always the case. The pain may also radiate towards the right shoulder, and the author has visited three emer-gency rooms with these symptoms (in three dif-ferent cities, including

Mountain View, CA), and the physicians were unable to recognize this ailment.

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My symptoms may not have been the most typical ones, but they are nevertheless fully described on the web. The doctors were content, however, to diagnose it as a possible heart problem.

All of these facts indicate that the brain locates pain at the sensor end of a nerve fiber, even if the stimulation occurs at a different point along the line. The human body has millions of nerve fibers, and the distribution of them may be somewhat unique to each individual. Hence it is not easy to find detailed evidence of how this happens. As we shall see in the next chapter, however, there are numerous reports of referred pain that everyone may experience first-hand.

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Curious Muscular Pains

Much has been written over the last century about muscular pain, which is estimated to be responsible for most of the suffering of human beings. The numerous medical reports on this subject have

been summarised and analysed in two impressive volumes (Simons, Travell, and Simons 1999), com-prising nearly 2000 pages (p.38 ). This careful work was pioneered and mostly completed by Janet Travell, MD, who was the White House physician during the Kennedy and Johnson administrations.

This admirable treatise is clear and very well written, but it is mainly addressed to the medical profession. In spite of this, these basic books have not been seriously discussed by

physicians. The reason could be that doctors in general do not believe in trigger points, which is the central object discussed. In fact, this term may not have been wisely chosen, since it makes you think about the Wild West and the associated weapon romanticism. In addition, physicians prefer to prescribe pills and use high-tech apparatus, rather than their hands, to remove pain centres. The handiwork is left to the therapist caste. Possibly much of the information on trigger points is also too recent to have made its way into the curricula of medical education.

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What is a Trigger Point?

A trigger point (TrP) can occur in any of our 400 skeleton muscles. It can be overstrained by occasional or repetitive load, with the result that a small region of the muscle fails to relax after being used. This nodule or contraction knot may be as large as a pea but often much smaller.

An observable knot is the combined effect of local contraction and swelling of individual muscle fibers, as indicated in p.39 , (Davies).

The main signature of a trigger point is that it is very tender to the pressure of a knuckle. The swelling may occasionally be large enough to be detected by the touch. An indirect effect of a TrP is stiffness in the whole muscle, or at least in a taut band along the muscle. Such a large-scale defect is easily felt when palpating the muscle. The patient is also aware of the ensuing reduced range of motion. This state may last for months or years, with stiffness as the only symptom clearly noticed. This is referred to as a latent TrP.

An active trigger point not only brings stiffness, but also referred pain, often very intense, to an area close to the nodule or at some distance from it. The examples of referred pain discussed in the preceding section give some clues about how this transported pain may come about. We shall return to this question later.

The patient himself easily recognises a trigger point by the intense pain he feels when it is pressed. The necessary force may be exerted by a physician, but the pain remains subjective. Thus it could just be a product of imagination. There are, however, objective observations that confirm the existence of a TrP.

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The most direct detection of a nodule is to probe it with the needle of a syringe. It then appears to be an object that is small and so hard that it tends to bounce off the needle. This observation is frequent when trying to inject TrPs with an anaesthetic prior to treatment by cooling or stretching.

A therapist having some experience in this field can often iden-tify a TrP by the swelling associated with it. This assumes, however, that the nodule is not deep inside the muscle. He may also notice a stiff band along that particular muscle.

An electron microscope was employed to investigate the gracilis muscle from a dog, having exhibited signs of tender knots. In the picture beside (p.40 , Davies) one can clearly see a TrP between the

white arrows. The detailed structure of the surrounding muscle is also visible.

Trigger points have also been detected using an ordinary optical (light) microscope. The samples were then stained by certain che-mical substances that help to increase the contrast between parts of

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different structure or composition. One group of researchers applied these techniques to recently diseased patients that had palpable nodules in the gluteus medius muscle and found clearly visible knots under the microscope.

There have been extensive works to detect muscle knots by needle electro-myography. This technique involves measuring the electrical voltage by needles introduced into the muscle. Nodules confirmed from the outside were shown to emit signals in the micro-volts range. Disturbing the muscle by a needle, however, does not seem to be a satisfactory diagnostic method. The same may be said of high-resolution ultrasound imaging, which irritates the muscle.

It is well known that muscle knots are associated with an elevat-ed temperature on the surface of the skin (hot spots). Thermography by infrared radiation proved to be the most successful procedure, but the results are still not entirely convincing signatures of a TrP.

Magnetic resonance imaging (MRI) would seem to be eminently suited for diagnosing muscle knots. High-resolution versions of this method are now available and have been utilised in many scientific works, but so far no studies of muscle nodules have been reported.

In summary, the most satisfactory confirmation of TrPs so far is by microscopic examination of slices taken from organisms recently diseased. In living patients one can observe a nodule by probing with a needle. Other methods for confirming the existence of such objects are less convincing.

The extreme tenderness of a nodule may, however, be confirmed repeatedly by the physician by observing the reaction of the patient. Another convincing fact is that the TrP – with its associated pain and dysfunction – may be removed by direct treatment of the knot, as we shall see later.

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A Short, Practical Handbook

Anyone who has seen the standard work by Simons et al. (1999) will be looking for a popular and down-to-earth guide. Fortunately there is such an alternative (p.42 ).

Clair Davies was a successful piano tuner, who found that his profession left him with an extremely sore back, so painful that he had to abandon his vocation for good, while his services were still in high demand. Climbing under and over grand pianos is an exhausting occupation. He consulted a massage therapist that put him on the right track, but she moved from his region before he was completely cured.

He had occasion, however, to notice her impressive reference literature, viz. the two volumes by Travell and Simons. His only option was to start studying these books himself, and he later joined the Utah College of Massage Therapy to acquire formal education. During the classes he had occasion to relieve some of his fellow students from pains they had suffered for a long time. He soon expanded his consulting services to previous colleagues in the piano tuning business.

During the last years of his life he wrote the book shown beside. Apart from explaining the nature of trigger points in everyday language, he added solid advice about treatment. He first pointed out that pain killers only mask the problem and hide the warning signal that something is wrong. One must acknowledge the pain and look for the cause of it.

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He noted that the treatments suggested by Simon et al. were strictly clinical and could hardly be carried out by the patient on his own. The instinct of the piano tuner made Davies prefer a more practical approach, taking advantage of appropriate tools to facilitate self-applied therapy.

Massage Techniques

Davies introduced a massage procedure that anyone can carry out without access to complicated medical instruments. The principle is to apply a series of short, deep strokes over the tender nodule, in order to move blood and lymph that has been stalling in this area.

This type of massage may be carried out using finger tips or knuckles, but this could in turn cause damage to those parts. There are tricks for supporting one hand by the other one to reduce such risks. The best is, however, to employ simple mechanical tools to exert the force necessary. A tennis or hard rubber ball is efficient if supported by the floor or a wall. For work on the back side of the body there is a special, curved tool, called the Thera Cane.

The massage should not last more than twenty seconds, but it must be repeated several times a day. The goal is not to remove the trigger point, but just to assist the body in doing its repair.

The following two figures (p.44 , p.45 , Mikael Häggström) show the major skeleton muscles.

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Tender Trigger Points

The figure below (p.46 , Davies) shows a particularly difficult pair of muscles named sternocleidomastoideus. They both have their origin in the mastoideus, the bony node behind the ear. One branch goes to the collar bone (clavicle), the other to the breast bone (sternum). Skeleton muscles are symmetric, so there is a corre-sponding group on the other side of the neck.

The picture shows possible locations of trigger points in the muscle connected to the breastbone. Such points hurt violently when pres-sed. If they are active they also send referred pain to the regions shown by the areas sha-dowed by diagonal lines. Thus referred pain might occur at the top of the scull, over the eye, behind the ear and in

some parts of the jaw. The referred pain occurs on the same side of the body as the trigger point.

These muscles are frequently overstrained, and the following history (from Davis&Davies) describes how dramatically these trigger points can act. “Kate, age fifty-one, was a case that illustrates the unexpected effects that sternocleidomastoid trigger points can have, and the dramatic and swift relief that can occur with appropriate treatment. She’d lived with pain in the jaws since the age of nine, when she’d had several teeth removed to compensate for a small jaw. She also had frequent headaches and pain deep in her left ear.

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One day, while reading an article about myofascial pain that suggested neck muscles as the source of many mysterious symptoms, she began feeling these muscles with her hand. She was startled to find a big knot on the left side of her neck that she had not realized was there – she said it felt just like an egg. While she was massaging her muscle, she experienced a relief in her jaw that was so sudden and intense that it frightened her. The side of her neck felt like it was expanding like a balloon. She ran to look at it in the bathroom mirror, but she could not see any swelling or anything else wrong. Then she noticed the pain in her ear and jaws was gone and her bite felt different. Her jaw felt like it had shifted position. Her dentist, after inspecting the change, told Kate that her jaw dysfunction had some-how resolved itself and she now had a proper bite.”

The astonishing aspect of this case is how long-lived and serious the consequences of trigger point can be.

Neck Problems

The levator scapulae muscles shown below (p.47 ) connect the verte-bral column with the shoul-der blade (scapulae) and serve to elevate the latter. Tender knots frequently occur in this area, as witnessed by this case history. “Tony, age thirty-three, had typical levator scapulae trou-ble. He’d had constant pain

and stiffness in the right side of his neck ever since a fender bender three months earlier and couldn’t turn his head to the right at all. His insurance was paying for physical therapy, but the stretching and traction only seemed to be making his pains worse. Electrostimulation helped but it didn’t last.

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Massage to Tony’s levator scapulae muscles cut through his pain at once and gave him his first relief. He was shown various ways to do the massage himself, which he was encouraged to do several times a day. Within a week, his pain was gone. In three weeks, he could turn his head again with a full range of motion.”

Innocent factors may cause problems with these muscles, such as sleeping on your side without proper support for your head, or typing while looking at your original text. Holding your phone clamped between your head and shoulder is also risky, as well as having backpacks and purses suspended by shoulder straps.

Front Side of the Neck

There is a group of muscles, the scalenes, which connect the verte-bral column with the upper ribs. As demonstrated by the following series of figures (p.48 ), knots on these muscles may cause a curious distribution of referred pain. It extends far over the front side of the body, but also reaches the other side. Hence, massage on the aching area would have no effect at all.

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The following case histories are cited from Davies&Davies.

“Hong Sun, age thirty-one and a ballet dancer, complained of constant ache in his upper back at the inner edge of his left shoulder blade. It felt good to reach over his shoulder and massage the place with his fingers, but it didn’t stop the pain. He had had the pain for several years.” “Amy, age seventeen, had been a serious student of the cello, but she’d to quit playing because of weakness and numbness in her shoulders, arms, and hands. Her parents believed the problem might be related to an accident in the swimming pool that had strained her neck. Thousands of dollars of medical tests had turned up nothing.”

The cure of these ailments was of course simple once the tender

nodules had been found.

Shoulder Blade Trigger Points

The infraspinatus (p.49 , below) is perhaps the most afflicted muscle of the human body. Its knots yield referred pain in the most unexpected place – on the reverse side of the arm!

“Kim was a thirty-two-year-old professional tennis coach who had lived with pain in both shoulders ever since she began playing tennis as a child. Diagnosed with rotator cuff tendonitis, Kim had had numerous steroid injections and was going for physical therapy almost weekly. Despite the treatments, pain kept her from

playing most of the time. She was very concerned that several of her young players were eveloping shoulder pain very similar to her own. ‘I make them play through the pain just like we were told to do at their age,’ she

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said. ‘I’m afraid they’ll end up as tennis cripples like me, but I do not know what else to do. They want to play so badly.’

After a massage therapist had shown Kim how to self-treat her shoulder with a tennis ball against the wall, she became free of shoulder pain for the first time since the age of fourteen. She felt that the best part of the new trick was that she could pass it on to her students.”

Surprising Forearm Pains

Problems with forearms and hands are very common, since they are often overstrained in everyday toils. We shall see that it is not obvious where to apply massage. Here is another case from Davies&Davies. “Libby, age forty, suffered with chronic pain in her shoulders, arms, and hands. In addition, her fingers felt numb, stiff and swollen. When she went out walking on her lunch hour, the swelling in her hands became so uncomfortable that she often held them up in the air for relief. Her doctor had urgently recommended carpal tunnel surgery to arrest the condition before it got worse. He did not know whether it would help her shoulder pain but said it was worth a try. She felt like she was in a corner and didn’t know what else to do but to go through with it.

On the recommendation of a friend, Libby decided to try triggerpoint therapy before committing to surgery. Massage immediately decreased the pain in her shoulders and the numbness and swelling in her hands. After three massage sessions and some coaching she was able to continue massage herself. In six weeks, most of her symptoms were gone. Some of the pain in her forearms and hands tended to come back after working all day at the computer, but she was able to minimize it with the massage techniques she had learned.

Libby was able to determine that although her job with an insurance company had made all her symptoms worse, her problems actually had started with whiplash she’d suffered in an auto accident three years earlier. Triggerpoints created in her scalenes (p.48 ) by the accident accounted

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directly for many of the symptoms and had predisposed muscles in her forearms to trigger points on their own.”

The brachialis muscle (p.51 1) lies under the better-known biceps, and they actually share the work of bending the elbow. There are two common locations for knots on this muscle, but the referred pain is nowhere near the origin, but occurs mainly in the thumb.

In the case of knots in the extensor digitorum (p.51 2) there may be some pain close to the upper attachment of the muscle, but surprisingly the middle fingers also ache. Neither of the pain areas responds to massage, but the nodules (black dots) do.

The extensor muscles serve to straighten the hand. The extensor carpi radialis brevis (p.52 1) and extensor carpi ulnaris (p.52 2, to the right) have similar functions. For both of them the referred pain is some 25 centimetres away from the trigger point. In neither case

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would it help to treat the aching area. Applying massage to the nodule (black) is what is required.

Confusing Abdominal Muscles

The psoas and iliacus form a muscle pair (iliopsoas) within the ab-domen, connecting the vertebral column to the hip (p.53 ). The presence of trigger points (black dots) may cause unexpected pain in the lower back and also in the groin on the front side. Davies&Davies present the interesting case history below. “Dawn, age thirty-nine, was a massage therapist and the owner of her own massage clinic, employing several other therapists. She also taught a daily aerobics class that included vigorous stair-climbing routines. To her great annoyance, the exercise that she depended on to maintain her health usually left her with low back pain. She also had pain and stiffness in her groin when she walked. She told a friend, a fellow therapist, about her concern. ‘I know it’s classic repetitive strain, but no way am I going to give up aerobics. If I don’t keep myself in shape, I balloon up like you

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wouldn’t believe. I do lots of stretching, but it doesn’t seem to be doing what it should.’

During massage, her friend discovered that Dawn’s iliopsoas muscles,

which did so much of the work in the stair-climbing routines, were as hard as rocks and hypersensitive to touch. Pressure on the trigger points actually reproduced her groin pain. The friend showed her a technique for

massaging her own iliopsoas. Within days, the pain in her low back and groin were gone. She was able to help a client with a related problem right away.”

Various Back Pains

There are several muscles that could cause extreme pain if only slightly damaged by overload. One of them is the quadratus lumborum (p.54 1, below), which connects the bottom rib with the hip. “Eileen, age forty-seven, had suffered spells of excruciating low back pain ever since hit by a car twenty years earlier. The pain extended downward into her left buttock and hip. Her problem was made worse by her job,

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which entailed standing most of the day on a concrete loading dock. Only an hour of standing made her back hurt so bad she could hardly keep her mind on her work. Sometimes she could not work, stand, or even sit up-right. Her only relief came from lying down.

‘I have had lots of chiropractic and physical therapy but, lordy, it just gives me more pain. I take all kinds of pills just too keep going. How else am I going to be able to work?’

Trigger points were found in

Eileen’s longissimus and quadratus lumborum muscles on her left side, where she felt most of her pain. Three sessions of massage cut her pain by 75 percent. She subdued the rest of the pain with a tennis ball and a Thera Cain.

Another muscle that often causes back pain is gluteus medius

(p.54 2, below). The area of referred pain depends on where the trigger point is located. It may be as shown here, or it may be centered right on the spinal column.

“Duane, age thirty-nine, was totally incapacitated with intense low back pain after moving a heavy couch by himself. ‘It was on the curb. I was afraid somebody else would get it if I took time to find help.’ Now he couldn’t sleep because of the pain and he hadn’t smiled for two days. The curve was gone from his lower back, his pelvis was locked in a forward thrust, and he could hardly walk. He was sure that he’d done horrible damage to

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his spine. He’d been to the emergency room where he’d been given muscle relaxants and a painkiller; he’d been to the chiropractor twice. Nothing helped.

Three days after deep massage to his buttocks and low back muscles, Duane was walking erect with very little pain. His hips were free and the curve had returned to his back. He was sleeping too. ‘If my back starts hurting in the night, I just reach for the tennis ball and work on it right there under the covers,’ he said. ‘Why didn’t the doctor tell me about that?’”

Could it be Hip or Knee?

A pair of muscles, the adductor longus and brevis, attach the thigh-bone to the pubic bone. Taking overly long steps or keeping the legs far apart can create knots on these muscles. The resulting referred pain (shadowed) is often misread as problems in the hip or the knee.

“Beverly, age fifty-two, had to stop her early morning walks at the mall because of the intense pain she had begun to have deep in the right groin. On an X-ray, the cartilage in her hip appeared to be thin. She was told that, without an operation, her hip would only get worse and she’d probably end up in a wheelchair. She was assured

that a hip replacement was common now and that her assurance would pay for it.

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As a last resort before scheduling surgery, and at the urging of a friend, Beverly went to a massage therapist. She was sceptical that anything so trivial as massage could help such a serious condition, but her friend pointed out that she had nothing to loose. Horribly painful spots were found in Beverly’s inner thighs. Pressure on the trigger points in her right leg sent pain to her hip that was just like the pain she got from walking. The therapist showed her how to massage her own thighs and arranged for two follow-up sessions. In three weeks, the deep pain in her hip was gone and she was able to resume her walking in the mall.”

From Lower Leg to Foot

When walking it is essential to raise the foot after each step for-ward, in order not to drag it and trip over. One important muscle that con-tributes to this function is the tibialis anterior (p.56 ). Its pattern of referred pain is extraordinary. The pain in the big toe is reminiscent of gout, which is normally caused by deposition of urate crystals in the joints. The treatment is, however, completely different.

“Andy, age eighty, had chronic pain in his big toe. His toes also tended to catch on steps and on the edge of carpets, causing

him to trip unexpectedly. He had almost fallen several times. Falling and breaking his hip was his greatest fear. So for safety he had begun using a cane. The doctor prescribed medicine for gout, though the tests hadn’t strictly confirmed that gout was the problem. The medicine didn’t seem to help, however, and Andy’s toe continued to hurt.

Trigger points were discovered in the muscles of the front of Andy’s lower leg. Pressure on one particular spot reproduced the pain in his toe exactly. After the massage the pain was noticeably diminished. He found

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he was able to massage the spot himself with the rubber tip of his cane. With continued self-applied massage as needed, Andy stopped tripping over his own feet and his “gout” soon disappeared.”

A neighbouring muscle on the front side of the lower leg is

extensor digitorum longus (p.57 ), which helps to raise the foot. The referred pain from the trigger point, indicated by the dot, occurs at the top of the foot on the same side.

“Ben, age forty-six, had constant pain in the top of his left foot and the lower part of his shin. His ankle was so weak that he had difficulty raising his foot. Any attempt to do so greatly increased the pain. The immediate problem was that he was unable to pull up with his foot to shift gears on his motorcycle. As a consequence, he’d had to drop out early from a long-anticipated weekend tour with his motorcycle club.

Triggerpoints were found in the front of Ben’s left lower leg, in muscles being overused in shifting gears. Tightness in the muscles caused pressure on the nerve that supplied motor impulses to the muscles, leaving them unable to make a strong voluntary contraction. Self-applied massage immediately stopped the pain in the top of his foot and over several weeks brought back the strength in the muscles.”

Calf Muscles Cause Foot Pain

Trigger points in a strong pair of calf muscles (p.58 1, below) named gastrocnemius are known to provoke unexpected pain in the sole of the foot.

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“April, age twenty-two, was to spend five marvelous weeks travelling around Europe after graduating from college. Unfortunately, during her first two days, she walked everywhere in shoes with two-inch platform heels and developed disabling pain in the arches of her feet. Every night in the hostels and hotels, she soaked her feet in hot water and gave them a good rub, but the next day, after walking only a short distance, the pain came back as bad as ever. She knew the high heels were bad for her feet, but it didn’t seem to help much to change to low heels after the pain started. The pain actually seemed to get worse, and it was ruining her vacation.

A guidebook suggested massaging her calves to get rid of her foot pain. It made no sense to April, but she tried it anyway out of desperation. Amazingly, it worked. She made time at night and in the morning to massage the backs of her legs and then to carefully stretch them. Her feet, legs and ankles responded by getting stronger with walking and climbing instead of reacting defensibly by developing trigger points. Within a few days, pain ceased to be a problem.”

The next example concerns the soleus muscle (p.58 2), which is partly covered by the gastrocnemius. A triggerpoint sends pain to the heel on the same side.

“Jeffrey, age fifty, lived in a pleasant neighbourhood near his job and enjoyed the walk to and from work, but he began to have sharp pain in his heels and had to go back to taking his car. The backs of his heels were extremely sensitive to touch, so much so that he had to hang his feet over the edge of his bed at night. At a medical clinic, he was told that his bone

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spurs were the cause of his pain and that surgery was the only solution. Massage to Jeffrey’s soleus muscles in the calves ended his heel pain.”

A final example of referred pain from

afar is the flexor digitorum longus (p.59 ), a muscle that serves to press the foot against the ground. A knot in it creates pain in the forward half of the sole.

Summary of Trigger Point Properties

A contraction knot (nodule or TrP) generally is the result of occasional or repetitive overstraining of a muscle. The knot may be the size of a green pea or smaller, and it does not relax spon-taneously. This object is recognised by an extreme tenderness to concentrated pressure, for instance by a knuckle or a finger tip.

If the nodule is large enough and close to the skin the swelling may be identified by the touch. A secondary effect of its existence is stiffness in a larger part of the muscle, appearing to the touch as a taut band. This stiffness, and the resulting restricted mobility, is typical of a latent TrP.

A triggerpoint may suddenly turn active, which means that it creates persistent referred pain, close to the TrP, or often at a considerable distance from it. In some cases, touching the TrP im-mediately reproduces the referred pain.

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A physician may easily probe the tender spot by means of a syringe to find a small object, so hard that it becomes difficult to penetrate with the needle. That is the most direct way of confirming the presence of TrP nodule.

A muscular nodule is readily recognized by the patient, but doctors have systematically remained sceptical. The subject of trig-gerpoint therapy has surreptitiously been equalled to acupressure, which is completely wrong.

The recently developed technique of high-resolution magnetic resonance imaging (MRI) would be well suited for studies of TrPs, but so far it does not seem to have been used for that purpose.

The existence of TrPs has been confirmed by several methods, but the physiology of this object is still hypothetical. Known facts and medical intuition have led to the following model, reduced to its simplest terms. The muscle first contracts strongly to carry out work, but at the maximum tension fibers become damaged, so that a minute part of the muscle remains taut after the rest of the muscle has relaxed. This remaining mechanical tension impedes blood circulation and causes shortage of oxygen inside the nodule. The transport of waste products from the object is similarly impeded, with the result that the system cannot spontaneously unlock itself. Frequent short sessions of deep massage, however, can bring oxy-gen in and eliminate the waste products. The body’s own defence collaborates with repeated massage to eliminate the TrP completely.

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How Does Referred Pain Arise?

We have already seen examples of pain in regions where there is no obvious cause (p.33-37). In these cases a somatic nerve is probably irritated somewhere along its extension, and the brain interprets the interference as pain at the end of that nerve fiber. Could this also be the explanation of the many well-established pain patterns asso-ciated with triggerpoints, where pain appears far from the nodule in question?

According to the accepted hypothesis, a trigger point (TrP) is a delimited object inside a muscle that has been damaged by per-sistent or repeated overload. The TrP is described as a stiff, swollen nodule with impaired blood circulation, and hence oxygen star-vation. The border of this object is supposed to contain waste products, which added to the oxygen deficiency produces intense tenderness to pressure.

It seems reasonable to assume that a nearby sensory nerve could be mechanically irritated by such an enlarged nodule and also influenced by its chemical waste.

The following is a survey of possible mechanisms for referred pain in terms of peripheral nerves. It has been suggested that the central nervous system (CNS) might also be involved, but unfortunately the details of CNS fibers are even less known.

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Sternocleidomastoideus Muscle

Let us return to the example on p.46. Here, trigger points are found to occur near the central fibers in the muscle and referred pain could be felt in several (shadowed) areas of the head.

The sternocleidomastoideus muscles shown below do not contain somatic nerves that continue beyond the attachment be-hind the ear. Thus, the expla-nation for the referred pain must be found elsewhere.

A trigger point causes per-sistent tension in the muscle, as well as swelling in a band including the nodule. The fa-cial nerves come very close to the tense sternocleido-mastoideus muscle, which could possibly irritate it mechanically. A Color Atlas (Kahle Werner et al. 1993) shows details on p.115, including the various branches of the motor nerves serving the scalp muscles. These branches agree very well with the known locations of referred pain.

Such pain could also be delayed muscle soreness caused by per-sistent contraction of the scalp muscles. This mechanism for referred pain has not been confirmed, however.

The Scalenus Conundrum

Triggerpoints in the scalenus group of muscles (p.63 1) refer pain farther away than in the above case, but the situation is still somewhat similar. All three scalenus muscles need not have all the

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indicated nodules on the same occasion, and hence the pain response may be more varied. These muscles run very close to the upper part of the spinal column, where they neighbour the cervical plexus nerves and branch out over the same side of the shoulder and the upper front of the ribcage (Kahle et al. 1993, p.67). Schematics of the nerve supply on p.75 and p.77 are in reasonable agreement with the shadowed pain distributions in the figure.

Infraspinatus Pain Distribution

The colour atlas of the nervous system (Kahle et al. 1993, p.68-69) shows that this muscle is supplied by a nerve stem starting at C5, C6, and C7. This gives out branches to the flexor muscles of the upper arm. These muscles on the front serve to bend the arm at the elbow, in agreement with the pattern of referred pain (p.63 ).

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Brachialis Muscle

Again the colour atlas (Kahle et al. 1993, p.68-69) suggests that the nerve stem (C5, C6, and C7) branches out into the forearm as far as the thumb. This could possibly explain the pattern (p.64 1) of re-ferred pain.

Extensor Carpi Radialis Brevis, Extensor Digitorum

According to (Kahle W. 1993, p.76-77) the radial nerve emerging from the lower neck vertebrae activates the lower arm extensor muscles (p.64 2). From there the nerve branches out, and one part

finally reaches the area of the wrist, which corresponds to the observed pain location.

One of these bran-ches might refer pain to the middle fin-gers, as in the right part of the figure.

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Adductor Longus and Brevis Muscles

The nerve atlas (Kahle W. 1993, p.84-85) demonstrates that the obturator nerve sup-plies the adductor mus-cles and then sends branches to the skin of the lower part of the thigh (p.65 1). There is no indication of influ-ence in the region of the hip, however.

Extensors Digitorum Longus and Hallusis Longus

Part of the sciatic nerve becomes the common peroneal nerve (Kahle W. 1993, p.86-87), which sup-plies the ex-tensor muscles. The latter nerve then branches out to reach the upper surface of the foot and the great toe. This could account for the referred pain (p.65 2).

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Gastrocnemius and Soleus Muscles

One portion of the sciatic stem is the tibial nerve, which supplies both of the muscles below (p.66 ). According to the nerve atlas (Kahle W. 1993, p.88-89) this nerve gives off branches to the heel and the sole of the foot as suggested by the pattern of referred pain.

Summary of Referred Pain Mechanisms

After the model of sciatica (p.34) it seems natural to attempt an ana-lysis of referred pain in terms of irritation of a somatic nerve by a muscle knot along the line towards the sensor point. As shown above, however, it is difficult to trace the pain to a given sensor fiber. Even if these nerves may be expected to follow the course of motor nerves, this need not be so. A colour atlas could hardly be expected to show all sensory fibers, probably millions of them, and in three dimensions!

Referred pain does not necessary have to be caused by per-turbation of a sensory nerve. An alternative hypothesis is that a triggerpoint could disturb a motor nerve by chemical or mechanical

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means, thus inducing persistent tension in the muscle that it serves. This in turn could provoke delayed pain or soreness, similar to the reaction after intense training (Google: delayed pain training wiki).

It seems that we must accept empirical knowledge of the pain distribution without access to a precise explanation in terms of single nerve fibers. Empirically established maps on the corre-spondence between trigger point positions and regions of referred pain seem to be rather similar between individuals. These maps are all that is needed for practical therapy.

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Strength Training

We have about four hundred skeleton muscles that the brain can command to contract via the motor nerves. It is interesting that we are also able to influence the size and strength of these muscles simply by using them close to their limit.

In resistance training the muscle works against a force, either caused by gravity or by some specially designed machine (p.68 , Shustov).

An isotonic exercise makes the muscle move, thus spending energy. In an isometric exercise, on the other hand, the muscle is simply tensed and then kept still in that state for a certain time. The latter procedure can be performed against a floor or a wall, or with one limb against another, without use of any machine.

The purpose of muscular training is to strengthen muscles as well as adjoining tendons, ligaments, joints, and to increase bone toughness. The most visible result, however, is increased muscle size.

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In both isotonic and isometric exercises the muscle chosen is stimulated by will-controlled motor nerves, while sensory nerves measure the resulting muscle force by signals from the muscle itself or a tendon connected to the skeleton. The general strategy is to progressively load the muscle to its maximum. The increase in size may be clearly noticeably within a month or two.

After a training session muscle soreness may set in, delayed by 1-3 days. Researchers seem to agree that such pain is caused by minute tears in the muscle. The fact that there is a time delay suggests that the soreness is not caused primarily by the damage, but by the ensuing healing, which might be responsible for the desired strengthening of the muscle.

Training thus develops the size of the muscle, but does this necessarily mean that it can produce a larger force? In my gym I once talked to an athlete that possessed an impressive muscle mass, perhaps improved by anabolic steroids. I asked him if he noticed any further strengthening as a result of his frequent hard training. His answer was: “I do not get any stronger; I simply have to exert myself more.” Could this mean that the intensity of the motor sti-mulus was barely sufficient to exploit the increased strength of the muscles?

There is a documented story about a man doing some repair under his car. His garage jack suddenly slipped, and he was caught under the load. His old mother saw his predicament and did not hesitate to lift the car by her own hands to let her son loose. Could it be that we do not exploit the full potential of our muscles because the brain does not normally produce sufficient motor stimulus?

Electro-Stimulation

Transcutaneous (“through the skin”) electrical nerve stimulation is a way of replacing motor nerve signals from the brain. This effect was

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demonstrated already by Galvani in 1786, when he made a frog leg move to the beats of an electric spark.

In a modern apparatus, a small alternating voltage is applied between two conducting plates on a muscle, and with proper choices of voltage and frequency this can stimulate the muscle to contract. The plates are first smeared with a water-based gel to im-prove electrical conduction to the skin. Then these plates are held pressed to the skin by an elastic belt, and a pulsed voltage is applied. The ensuing contraction will be felt as muscular tension and may also be observed as momentary swelling of the muscle according to the intensity of the stimulus.

Electro-stimulation has long been used as a means of reducing pain, and battery-driven electronic devices (TENS) are now on the market for this purpose. Pacemakers stimulate the heart muscles by a similar mechanism.

In recent years electrical stimulation has also been employed for strength training after orthopaedic interventions. Some advantage over results of a reference group has been reported, but the difference was not dramatic (Fitzgerald G. K. et al. 2003).

The physical training industry has developed an apparatus that sends short electrical pulses to the muscles of the body (p.70 ), in particular those in the belly and the back. There is no doubt that the muscles are ten-sed by these pulses, since the contractions are clearly felt and

seen. The promotion documents show pictures of stomach muscles before and after a period of treatment. The difference may seem im-

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pressive, but there is no guarantee that only electric stimulation had been used between the two snapshots. The world is waiting for clinical tests in support of this new method. The question also remains whether the motor nerve stimulus will be compatible with muscular size.

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“Energy” Medicine

Some methods of pain-reducing therapy were invented and fre-quently used several thousand years in advance of traditional Western medicine. The best-known example of these ancient pro-cedures is acupuncture, which involves sticking needles into particular points on meridians of the body (Google: acupuncture wiki).

This treatment has since been developed into acupressure, where the invasive needles have been replaced by pressure applied to key points on the skin (Google: acupressure wiki). Detailed instructions and maps regarding acupressure therapy are found on the web (Google: acupressure points Stanford).

The above, related techniques are referred to as Traditional Chi-nese Medicine (TCM). They seem to have no physiological basis whatsoever. Usually they are discussed in terms of energy flow, which is supposed to be imbalanced or hindered by illness. There are even mentions of energy harmony, which is unknown to physics but is claimed to be occasionally defective in the human body. The treatment aims at correcting such faults.

Another ancient, non-invasive treatment is yoga, which is practiced particularly in India and Japan (Google: yoga wiki free). This method aims at controlling the mental and physiological state by bodily postures and meditation. The underlying theory refers to wandering energies and currents, positive as well as negative, but no such properties can be measured by known means.

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During the last decades there have been many initiatives towards the creation of new medical procedures that focus on conscious control of the body, especially for the purpose of preventing illness at an early stage. This fumbling for novel approaches generally lacked scientific underpinning, which made therapists grope for impressive concepts from physics (Google: energy medicine wiki).

Energy has been known and used in physics for centuries, but it seems to have the esoteric quality required to gild any irrational medical procedure. In fact, energy exists everywhere in your body, and its origin is the light radiated by the sun, mostly transferred to the food you eat. Such interventions are still discussed in terms of energy balance in the body, as if this were something one could easily measure and correct. These new treatments are offered under the name of energy medicines, but the “energy” part means nothing to a physicist.

Many authors refer to other well-known and venerable physical concepts such as electric charge, electric current, electrical conductivity, electromagnetism, and piezoelectricity. These words are employed to lend credence to many far-fetched thoughts. For instance, the heart emits a barely detectable electromagnetic wave, which is supposed to be a messenger from the heart to the brain. Nothing is said about the much stronger stray fields in our en-vironment, which would distort or even drench any such signals. A pulsed magnetic field is claimed to have a healing effect in cases of Alzheimer’s and Parkinson’s diseases.

The human body contains many connective tissues that support internal organs. Some of these have been found to be semi-conducting, which is supposed to explain how an acupuncture inter-vention on the ear can influence an organ inside the bowels.

Several organs have been found to be piezoelectric, i.e. to develop electric charges in response to pressure applied to a point on the skin. This is proposed to be a way of communicating with the

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interior of the body by pressing or tapping on the skin at certain points. Such points are characterised by much lower electrical resistance than other parts of the skin. They are believed to be identical to the key points occurring in acupressure therapy.

Some concepts abstracted from physics have been misunder-stood and over-interpreted by medical users. One such example is quantum physics, which is crucial for understanding phenomena inside atoms and molecules. This has led to confusing ideas like “the infinite probabilities of a quantum universe” and “quantum conversation” (Church 2007, p.168, p.256). No physicist will be convinced by similar invocations in support of a new medical treat-ment.

A recent mathematical theory considers elementary particles to behave like vibrating strings. Unlike many other theoretical constructions this is not based on reliable facts, and the results of the theory have not been verified experimentally. Some of its fea-tures, however, are prone to trigger the imagination. One such idea is the existence of many parallel universes in space-time. This may be used to “explain” anecdotes of healing by prayers from a remote site, and even at a totally different time. For such wild notions I blame colleagues in physics who describe current thoughts in their discipline as a niche of philosophy.

Even if the underpinning of energy medicine is shaky, many anecdotal cases of miraculous healings have been recorded. It is known, however, that the human organism can heal itself spontaneously. This means that a positive result is not necessarily an effect of healing. There are hardly any records of attempts that did not succeed.

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The Placebo Effect

The term placebo is Latin for “I shall please”, while nocebo is the opposite. In a medical context it means that a treatment against an ailment usually tends to be successful just because the patient expects it to be so. We have all noticed how evil symptoms almost vanish as soon as we take a seat in the doctor’s waiting room.

Some test results are astonishing (Church 2007, p.98). A number of people were served drinks of gin and tonic, but others received only tonic. The conversation soon became typical of that in a bar room. Those who obtained the alcohol-free drink looked slightly intoxicated, like the others. Afterwards, they were prepared to swear that they had consumed an alcoholic drink.

In a formal investigation of the placebo effect the standard pro-cedure is to divide the suffering participants into two groups by random choice (Google: placebo effect wiki). They are all given sugar pills, but to one group the doctor says, “These pain killers may or may not make you better, we do not know.” In front of the other group he is more affirmative, “We expect these pills to reduce your pain.”

After a day or a week another doctor interviews the patients individually, without knowing to which group they belong. The results generally show that the group instilled with positive expectations report reduced pain. These consequences of pure expectation have made it difficult to assess the effectiveness of medical interventions, in spite of precautions taken in the evaluation.

The very existence of a placebo effect has been questioned following a review of numerous trials already performed (Google: cochrane reviews placebo). After considering the statistical status (possible bias and misinterpretation) the authors conclude that none of the existing experiments clearly show evidence of a placebo

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effect. Of course, this does not mean that placebo effects could not exist, but trials undertaken so far have not been careful enough.

Tests of Medicines

When a new medicine is to be tested, strict precautions must be taken to exclude possible placebo effects. Some participants obtain the new pill, while others get a counterfeit substance looking and tasting alike. Some physicians conducting such tests hesitate to deceive participants by giving them useless pills. The intensions behind such experiments, however, are honourable since they serve to inform the public about the effects of medical treatments.

It is important to avoid suggesting (consciously or subconscious-ly) to a participant what type of pill he is served, since this could influence his expectations and interfere with the test results. For this reason double-blind trials have been introduced (Google: double-blind wiki). The participants suffering from a certain ailment are secretly divided in two groups by random choice. The list of individuals chosen for each group is only available to one person, (or a committee), none of which is allowed to meet the participants. The participants themselves and the persons evaluating the ex-periment do not know to which group each individual belongs.

The two groups are given different pills, either the new medicine to be tested or another that is believed by the profession to have no medical effect. It is essential, however, that the inert pills have the size, taste, and colour of the active substance.

Those who have access to the lists of participants distribute the pills, real or faked, through nurses that do not know which are real. The results of the treatment are analysed by physicians who have not been told which individuals have obtained faked medicine.

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It may be shocking to learn that a popular antidepressant (Prozac) needed repeated tests to show that it was better than placebo. The same was true about other brands containing the same chemical substance. Of course, it could be difficult to evaluate remaining depression with a credible level of precision. Who could answer reliably to the question: “Do you feel less depressed now than a week ago?”

Tests of Surgical Interventions

The usefulness of surgery may also be investigated by double-blind procedures. One group of patients undergo surgery employing the best methods known, while those in the reference group only are subjected to an incision and stitching that simulates a real inter-vention.

In such cases the surgeons have to know if a real of a sham operation is to be performed on a given individual. They are not allowed to meet the patients before the operation, however, in order not to disclose by body language which intervention is to be undertaken. The physician who is to evaluate the results must not know if a real or token surgery was carried out.

An interesting trial of knee surgery has been described in the literature (Church 2007, p.176-178). It concerned patients suffering from arthrosis of the knee, and the real operation involved cleaning out traces of the damaged cartilage and inserting an artificial disk. The knees of the control group were incised through the skin on either side of the knee cap, just as with the others, but nothing was done to the interior of the joint.

The result of this test was unbelievable. The individuals that were subjected to pretended surgery did as well as those that were given the real intervention. Some of them could hardly walk before and were able to run afterwards. They were completely convinced

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that the operation was successful! There is always a risk of misinter-pretation, however. For instance, it cannot be definitely ruled out that skin incision increased the secretion of joint liquid.

There have also been extensive reviews of medical research reports in general (Google: ioannidis evolution translation). One author points out that a hundred basic research articles have made promises of therapeutic or preventive interventions, but only one of those have resulted in clinical use.

A general observation was that the failure to translate basic reports into clinical procedures could be due to poor commu-nication between research and application teams.

The authors also suggest that there is excessive basic research of moderate credibility. The use of citation statistics to indicate quality is also frequently misleading, since medical journals tend to prefer citation from their own pages.

The close involvement of pharmaceutical companies paying for trials introduces another source of error.

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Behavioral Therapies

The psychoanalysis pioneered by Sigmund Freud more than a hundred years ago has since been modified in several steps. The subconscious level in human psychology is still recognized, but the once all-important role of sexual inhibitions is no longer in the fore-ground. Nor is there today much preoccupation with dreams. Classical psychoanalysis aimed at illuminating every dark corner of human memories and traumas, and the treatment has been known to take years, if it ever becomes crowned by success.

Cognitive Behavioral Therapy

The officially recommended and much used behavioural therapy goes back to a maxim by the Greek philosopher Epictetus, “People are not disturbed by events but by the view they hold about them.” A central principle of cognitive (thinking) therapy is that you, the patient, are responsible for the way you feel and act (Joseph, 2009). You are invited to examine your thoughts and beliefs, and to confront them with reality.

Your goals in life are obstructed by emotional and habitual atti-tudes that have been ingrained by years of misuse. Many of these obstacles have been provided by reactions due to other persons, your family in particular. The diagnosis consists in detecting the interfering factors and unhealthy beliefs that hinder you in achieving your goals. Negative automatic thoughts may be unconscious parts of your internal dialogue.

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Cognitive treatment employs two physical tools, i.e. muscle relaxation and deep breathing, which is used in conjunction with mental re-education and visualization. In order to replace un-healthy beliefs with more productive ones, you are recommended to breath in deeply, hold it for a few seconds and then expire gently. Next you imagine the worst-case scenario that may interfere with your immediate goals. This may be painful, but while you keep this picture in mind you recite your healthy counter-statement forcefully and energetically. For instance, you could say, “I want this healthy belief and not the old one.” You repeat this procedure several times, until the new and useful belief has almost erased the old attitude. In order to make these simultaneous acts easier, you could record the affirmation on audio and just listen to it.

Cognitive behavioural therapy demands considerable intellectual effort on the part of the patient, which effectively rules out a large fraction of persons who could profit from it. They need to adopt the Socrates method of reasoning and in a typical case the guidance of a therapist would seem necessary. This kind of therapy has, however, shown its worth in numerous interventions, and the healing pro-cess has generally taken much less time than the original Freudian psychoanalysis, even if it requires many session with a therapist.

Cognitive behavioural therapy has proved successful in con-trolled evaluations and is today a widely employed treatment.

“Energy” Psychology

This section introduces a rather novel type of psychological therapy that focuses on getting rid of fear, guilt, shame, jealousy, and anger. Other goals are to change unwanted habits and behaviour. In addition, it enforces your abilities to love, succeed and enjoy life. In short, it attacks problems that are important for everyday life.

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Although “energy” psychology has its origin in cognitive be-havioral therapy it is different in the sense that the patient does not participate in a series of intellectual dialogues with the therapist. He only has to understand the psychological shift this procedure is supposed to create. The upshot is that several sessions with the therapist may be condensed into a single one, to be continued by the patient alone.

Energy psychology has its roots in ancient Chinese acupuncture, and it has thus inherited the needs to evoke magic scientific terms, “Energy moves, energy stalls, or it lacks balance and harmony”. All this is totally irrelevant to the success of the procedures, which have developed directly from empirical observations. (Feinstein et al., 2005). If anything, these token explanations of the mechanism of the therapy cast doubts on an otherwise valuable contribution. A few successful cases are related below.

Like in many other important discoveries there is a trait of serendipity, which means stumbling on significant facts while you are eagerly looking for something else (Roberts, 1989). In 1980 Dr. Roger Callahan had a patient suffering from intense water phobia. She had visited therapists for years without noticing any improvement. She also had some complaints about stomach disorders, and out of curiosity Callahan tapped on the acupressure point just below the eye, which is the upper endpoint of the stomach meridian. The patient immediately announced that her disturbing ideas about water had vanished. She went to a swimming pool and started to splash water about. There was no more fear, headaches, or nightmares.

The early results of energy psychology baffled many psycho-logists that were present at a conference event in South Africa. A woman participant admitted, with some embarrassment, that she feared the short walk through the grassy area towards her nearby cabin because of the snakes.

Dr. Feinstein proposed an experiment to find out if energy psychology could save this colleague from her phobia. After she had agreed, a handler brought in a snake that she could safely view at a distance of a few meters.

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She was comfortable with this, as long as she did not look at it, since she had already “left her body”, a psychological defence mechanism well known to all participants.

After less than half an hour of treatment she walked up to the snake and even admired its beauty. Finally she asked if she could touch it, which she forced herself to do.

A few days later, on a nature walk, a colleague asked if she was worried about the snakes. She was surprised, not even having thought about it. Two years later her snake phobia had not returned.

Could this recovery have taken place spontaneously? No, be-cause this woman had suffered from persistent snake phobia until she participated in this conference and the intervention took only half an hour, followed by years of normal attitudes. Could this anecdotal cure be explained by the placebo effect? Perhaps, but the result is nevertheless of equally great value to the “patient”. The only caveat is that this treatment could have been staged by agreement between the key persons. The wealth of similar examples, however, makes this suspicion untenable.

Another convincing success (Feinstein et al., 2005, p.14) of the new therapy concerns a Vietnam War veteran who had to be admitted to a hospital for the long-time insomnia caused by his many painful military memories. His parachute jumps had resulted in a serious case of height phobia, which became the first focus of the treatment.

He was asked to think of a specific situation involving heights. This immediately made his fear level increase, to the point that the hair on his legs was literally standing out. While keeping the terror of facing the heights in his mind he was instructed to stimulate a series of acupressure points by tapping with his fingertips. After fifteen minutes of this routine there was no visible fear reaction. He was then asked to climb onto the fire escape and look down. To his own amazement he did not fear heights any more.

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His many other traumatic war memories were treated in a similar way and some issues were left for the patient to take care of in his home. Finally they had the benefit of a generalization effect: Remaining painful memories had lost their emotional charge. During a follow-up conversation on the telephone two months later he could report that he also had got rid of his insomnia

Some twenty patients in that hospital were treated by the same team, and they almost immediately recovered. In several cases their emotional problems had already resisted years of psychotherapy.

In the year 2000 an international team treated and cured a hundred Kosovo victims using a form of energy psychology. They suffered from posttraumatic wounds after witnessing torture, rape, and massacre of their loved ones. The success was testified by the local chief medical officer, who stated that the healing was still in force after five months.

All these anecdotes of successful energy interventions have been met by scepticism by psychotherapists, who are known not to be-lieve in quick cures. Their business strategy usually consists in letting time work for them, bringing patients to an unending series of visits to the clinic.

Energy psychology has been applied to various kinds of emo-tional difficulties, such as unwarranted fear and anger, feeling of guilt, shame, grief, jealousy, rejection, isolation, and frustration.

The Practice of “Energy” Psychology

The many achievements of energy psychology have been thor-oughly documented, and to my mind the astonishing results are trustworthy. We now ask ourselves how these wonders are achieved. Fortunately www.amazon.com offers an excellent book (Craig, 2008), written by a seasoned therapist in the field (p.84 ).

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This particular variety of energy psychology is aptly named Emotional Freedom Techniques (EFT). A successful procedure invol-ves the following quick steps (Feinstein et al., 2005, p.34-64).

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1. Setup 2. Reminder phrase with tapping on acupressure points. 3. Tapping sequence with repeated reminder phrase.

A problem the pioneers initially stumbled on was certain un-conscious reservations or negative attitudes with about half of the patients. They did want to change a habit, for instance, but deep within they wished to keep it for its advantages. Alternatively, they did not fully believe that such a simplistic cure could be effective. In order to avoid the risk of failure from these trivial causes they made the patient pronounce a phrase as an introduction (setup) to the standard formula. The setup part for food addiction could run as follows.

1. “Even though I eat when I am anxious, I deeply love and accept

myself.” This may seem to be an obscure (or outright ridiculous) formula, but in practice it may make the difference between success and failure. Of course, the setup phrase must be modified according to the current goal. The final part may also be replaced by “I know deep down that I am a good and worthy person.”

2. The reminder statement should consist of the crucial part of the setup phrase, such as “Eating when I am anxious.” While you pronounce these words, preferably in a normal, but if necessary in a silently voice, you also tap on an acupressure point, or a selection of such points. You could also add a mental image while articulating this phrase.

3. You finally repeat the reminder statement while tapping on acupressure points.

The book by Feinstein et al. provides more details about the acu-pressure tapping procedure. These steps only take a few minutes to perform. Traditional Chinese medicine refers to twelve meridians, essentially vertical curves that run from the upper part of the body towards the toes or the fingers. The full-body map of these meridians is clearly reproduced by a chart from BarCharts Inc.,

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available from www.amazon.com. Figure p.86 shows part of this chart indicating the meridians and the acupressure points (by numbers) on the reverse of the right hand. The meridians visible here are SI (Small Intestine), TW (Triple Warmer), P (Heart Sac), and LI (Large Intestine), and LU (Lung).

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The ancient Chinese meridians have not been confirmed by post-mortem or surgical investigations. The acupressure points indicated in the above figure (p.86 ) are claimed to be spots of lower electrical resistance, and this feature can be verified be means of the small instrument below (p.87 ). If the tip is pressed against the skin while the metallic electrode is held by a finger, this tool emits a series of bleeping sounds that change to high-pitch chirping when a low skin resistance is encountered. Even if these crucial points can be detected by measurements, there are no physical facts to indicate that they belong to a common meridian.

Anyway, this pen is quite useful for finding acupressure points that should be tapped during an EFT ritual. There are two points at the edge of the hand (3 and 4 on the SI meridian), also called the karate chop points, that could be used for the first trials. The next figure (p.88 ) shows how to detect one of these points.

Among thousands of successful EFT interventions two more case histories would be worth mentioning (Craig, 2005).

Kelly participated in one of the public presentations. She obviously suffered from asthma, which was evident to everyone sitting around her, because of her constant snoring. After the event she requested help to conquer her fear of speaking in public. During the standard treatment focused on public speaking she made the astonished remark that her breathing had eased, showing no signs of asthma. The latter was not the target of the exercise, but it was a bonus that no one expected.

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Audrey was a severely disturbed woman, who had been abused physically, mentally and sexually and had an assortment of emotional problems that conventional psychotherapy could not sort out.

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She also felt guilty about having burnt down her own house. She must have fallen asleep one night with a candle burning. Her cat knocked over the candle, which caused the fire. She blamed herself for this episode. After giving her the usual EFT treatment I asked her to tell me about her house burning down. To the surprise of her therapist and me she said simply, “It was not my fault”, and then went on to other issues. Her guilt had thus disappeared in a few minutes. EFT can be so powerful that the changes often leave a normal attitude.

It appeared that Audrey also had insomnia. She slept only about two hours per night, and even for this short rest she needed the aid of drugs. I had her lie down on the therapist’s couch and then applied EFT for sleeping. Within a minute she was sound asleep. A half hour later she was still snoring loudly. No drugs, no pills…

The next case story was told by Dr. Silvia Hartmann (Church, 2007, p.75).

When I had my home remodelled I noticed that one of the construction workers had a strange skin condition on his arms. Asked about it he said, “That’s my psoriasis. Had it for years.” His arms were full of peeling skin with sore red tissue and fluid beneath it. He went on to explain, “I guess it started about three years ago, when my girlfriend told me she was pregnant.” His doctor had told him that there was nothing to be done. He agreed to try EFT, and she showed him a routine to follow three times a day. While tapping as instructed he was supposed to say, “I want to get over my psoriasis!” Two weeks later, his skin had healed on both arms, except for a small patch on his elbows. He since used the same approach to overcome lower-back pain that had troubled him for years.

Unbelievable as it may seem – even to the therapists themselves – EFT has also proved to be effective against headaches, back pain, stiff neck and shoulder, joint pains, cancer, chronic fatigue syn-drome, lupus, ulcerative colitis, allergies, itching eyes, body sores, rashes, constipation, irritable bowel syndrome, eyesight, muscle tightness, bee stings, urination problems, morning sickness, sexual dysfunction, sweating, poor coordination, carpal tunnel syndrome,

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arthritis, numbness in the fingers, stomach-aches, toothaches, trembling, and multiple sclerosis!

Physicist’s Reservations about Mumbo-Jumbo

It is understandable that proponents of a new therapy try to imbed it in impressive concepts with a scientific ring. People with at least basic knowledge of physics, however, find their evocation of energy outright ridiculous. When the Chinese invented acupuncture some five thousand years ago, they used the term “qi” for “life energy”, which unfortunately came to be translated by “energy”. This is now an established concept in physics, but it was completely unknown to the Chinese thousands of years ago.

It is utterly confusing to read claims that energy is circulating along meridians that are not even closed curves. No one has suggested how this energy could be measured, and even less how the speed of circulation could be assessed. The models used as a basis for energy medicine and energy psychology are nonsensical and cast unnecessary doubt on procedures that seem to work well in practice. They are liable to cause psychological reversal in the client.

The literature on energy psychology does not ask if it is essential to tap on various crucial points while pronouncing the affirmations. It is stated that tapping on several points is better than tapping on one only, but what happens if one abolishes all kinds of tapping? This question is relevant for comparison with cognitive behavioral therapy.

It could be more appropriate to discuss “energy” psychology in terms of information technology. The primary goal is to send an oral or mental message to the brain, but the human brain might not be well adapted for the purpose of talking to itself, and it might need a nudge from sensory nerves to make it notice the incoming signal.

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Sensory nerves exist practically everywhere on the skin and need not have any relation to ancient acupuncture. Perhaps one could speak of addressing a particular centre in the brain? Recent advances in brain scan make it possible to observe how various parts react to stimulus from the peripheral nervous system.

Musical Addressing Instead of Tapping?

Tapping and the associated mumbo-jumbo unfortunately destroys the image of EFT. It is tempting to look for other alternatives that offer more reasonable associations. For example, one could use music superimposed on the vocal or mental affirmation, or else sandwich music and vocal interventions. Needless to say, no one knows whether that kind of addressing would yield the desired effect, but practical therapy experiments and brain research are there to decide.

A few percent of the world population are tone-deaf, but these people are at least sensitive to rhythm and lyrics. The others can enjoy polyphonic music and a few percent at the other end of the scale can even keep track of all the instruments in a big orchestra. Musical addressing must take these differences into account by choosing musical phrases or pieces that have a chance of pene-trating to the emotional level. The research techniques of brain scan might help to select preferences for each type of individual.

A menu of music and affirmations combined could be made available on the web, and sound files could be transferred to MP3 players that easily deliver affirmations of various kinds as required.

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Preventive Medicine before Invasive Medicine

The present cost of healthcare in the U.S. is overwhelming. The spending per person is three times as large as in Great Britain, twice as large as in Canada, and almost twice that in Germany and France (Church, 1005, p.152-255). This is in spite of the fact that 12 % of the U.S. population presently does not have health insurance. This generous spending has not even promoted health, because infant mortality in the U.S. is higher and life expectancy is lower than in the other countries mentioned above. About 20 % of the Americans suffer from diagnosable mental disorders.

It would be wise to reverse the order of healthcare interventions. One should not wait for such serious symptoms that the emergency room would be the right address. The first steps in the treatment should be preventive and occurring on a daily basis. We should spend 20 minutes daily on aerobic exercise, including improvement of flexibility and muscular strength. This is more important for health than participating in a yearly marathon.

Many American citizens are grotesquely overweight and for most people a reasonable diet would be an essential preventive medicine. Over the last few decades the official philosophy has been that eating fat makes you fat, while consuming vegetables do not make you green (Ravnskov, 2009). As a result the shelves in the supermarkets are filled with low-fat products, where the fat has been replaced by hydrocarbons, and sugar in particular. Everything made of flour and sugar is fattening, and a meal mainly based on such foodstuff makes you hungry again within a couple of hours. Fat and protein should be present in all meals.

Balanced doses of physical exercise and varied diet constitute a baseline of preventive medicine that do not cost much and have no side-effects. The same may be said about “energy” medicines such as meditation and acupressure.

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“Energy” psychology has acquired an acu-ridiculous image by offering unbelievable descriptions of human physiology, but it is nevertheless an efficient therapy for rapid cure of stress, traumas, phobias, addictions, and slight depression. Some success stories are truly miraculous. The emotional status achieved also favours your physical well-being. If the “soft” treatment should fail, there is always recourse to the longer and more costly cognitive behavioral therapy and conventional psychotherapy.

Triggerpoint therapy is an excellent means of removing acute pains – without any side effects. It might require an initial visit to a specialist, but you can continue the treatment on your own, once you have been shown the ropes.

Acupuncture may be useful but is definitely invasive. It once happened that a therapist ran the needle into the heart of a patient – with fatal consequences.

The hospital should be your last (and costly) resource. When you step into the emergency room you enter an area of potent arsenal, from heavy drugs to high-tech surgery. Especially the latter can perform wonders that radically and permanently eliminate your disease, but every surgical intervention involves some risks. An operation on the vertebral column, for instance, may damage crucial nerves and put you in a wheelchair for the remainder of your life. Last but not least, you expose yourself to hospital-made bacteria that may kill you.

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Biological Evolution

If we consider how thought has developed from pre-historic times, judging from archaeological discoveries and written documents, one fact stands out as crucial. Man has always felt awe of past times and deep respect for older and particularly powerful persons. No doubt these attitudes have their origin in the close relations with parents and other caretakers. The idea of an omnipotent, omni-scient, wise, and perhaps benevolent ruler seems to have been thoroughly engraved in man’s central nervous system since thou-sands of years. This divine figure is usually endowed with man-like properties in other respects.

Another property inherent to mankind appears to be a supreme curiosity about the many astonishing facts of nature. Religions probably arose from the will to understand the surrounding world. These attempts brought a sketchy scientific model with a moralistic super-structure. Early religions involved several competing gods, but Mose reduced the number to one and warned his Israeli people of serious consequences if they failed to adhere to his favourite.

A few thousand years ago there was practically no air pollution and little urban lights, which made stars and planets shine with an intensity that we can hardly imagine today. This ever-changing nightly picture, visible from everywhere, naturally came to be considered as the home of the Great Ruler. Many even believed that He tried to show us his intentions by celestial signs. This is an early example of the superstition that arose from the lack of factual knowledge.

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The Age of the Earth

One of the most remarkable superstitions concerns the origin of the Earth and life on our planet. The creation of the whole universe is described in the Old Testament as a one-week achievement of the Creator, finished some ten thousands years ago. This story is told in a book that has always been considered to be holy, and he who would not believe it once risked being stoned to death. People are still being harassed for not accepting the teachings of Scripture on the grounds that it is old.

The ancient ideas about creation constitute a theory, but any be-lievable theory has to fit the facts observed by humans. Partly because knowledge might be dangerous to discover, assembling relevant facts has taken a long time.

One important sector of research is geology, the study of rocks and soils. Some materials found in nature contain layers of different colour and chemical composition that evidently must have been deposited yearly. Counting these layers gives information about the age of a certain part of the Earth. Sediments at the bottom of the Mississippi River permitted researchers to count a hundred thousand annual layers, on top of rocks that were even older. The presence of shellfish remains indicates that some regions of the continents once were under the surface of the sea.

Radioactive elements were successively discovered about a hundred years ago, and the detailed analysis of the radiation from rocks has born evidence about their age. Some specimens turned out to be a thousand million years old, in serious contradiction to the proposed one-week creation.

The shapes of opposite coast lines suggest that the African and South-American continents were once united. This possibility is supported by the similarity of animal species and fossils on either side of the South Atlantic and by the similarity of rocks (Dawkins,

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2009). Radioactive measurements date the beginning of this separation to about 200 million years ago. This continental drift is still in progress, as demonstrated by repeated, accurate distance measurements.

Attempts have often been made to discredit scientific research as being close-minded. Scientists gain their renown, however, by showing that their colleagues have been wrong, whereas religious proponents are encouraged to find support for the holy principles. The result is what we could expect.

The Origin of Life

Greek philosophers, in particular Democritus, held the view that matter was not continuous but consisted of small units named atoms. It is not clear on what grounds they arrived at this idea. If the question had been worded, “Is it possible to divide matter in infinitely small parts?” any chimpanzee would have had 50 percent chance of providing the right answer. The question was simple, but the full answer turned out to be complicated to an extent that no philosopher in the antique world could have imagined.

One hundred and fifty years ago most chemists did not believe in the existence of atoms, although they had demonstrated that there were many chemical elements, each having a completely different character. Around the year 1900 it became clear that nature held 92 different kinds of atoms, differing in size and properties. Each chemical element had its own kind of atoms. The remaining question was whether living organisms consisted of ordinary atoms, or a “living” variety.

The chemical elements found in plants and animals are mostly carbon (C), hydrogen (H), nitrogen (N), oxygen (O), phos-phorous (P), and sulphur (S), or in short “CHNOPS”. These

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chemical elements were all available in the oceans before the advent of living systems.

In the middle of the 1900s experiments were performed where lukewarm water, loaded with “CHNOPS”, was stirred while being irradiated by ultraviolet light, normally present in sunshine. The mixture soon turned brown, and chemical analysis disclosed that this treatment had produced amino acids, known to be the building blocks of animal proteins. This was an important step toward explaining how life came about.

Other significant facts of evolution have emerged as by-products of geology. Investigating soils and rocks researchers unexpectedly found traces of early life. Some rocks, which could be dated by radioactive measurements to be about three thousand million years old, contained dead one-cell creatures (Google: cyanobacteria). Younger stones exhibited larger organisms that once lived in the oceans. Researchers still keep finding fossils, i.e. dead animals where organic matter has gradually been replaced by minerals provided by streaming water. In this way one can follow the evolution of animals from the seas to land-crawling creatures, to birds and mammals.

We have also learnt from fossils that dinosaurs once dominated the Earth, but that they vanished about 60 million years ago, probably stricken by some natural catastrophe.

Man-like creatures have existed for 4 million years, and our own kind (the wise homo sapiens) has walked the planet for about 200 000 years, nearly fifty times as long as recorded history.

Primitive Life

According to the generally accepted theory of creation the oceans could generate amino acids (the building blocks of proteins) and

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these in turn could combine with each other to create extremely complicated molecules. It may have taken many millions of years for these elementary molecules to combine into a cell that could extract nutritious chemicals from the sea water and energy from the Sun. It finally also became able to reproduce, and by pure accident the first living entity came into existence.

The fact that this process of creation had taken such a long time guaranteed that the pioneer cell initially was alone, having no threatening predators or competitors. The first cell then reproduced by splitting into two identical ones and these in turn reproduced to fill the oceans with living matter within only a few years.

Figure p.98 beside (LadyOfHat) illustrates a possible constitution of a single-cell bacteri-um. It could also be of rounded shape. The flagellum is a whip-like part that serves to move the cell around in a liquid. The central nucleoid contains a DNA molecule carry-ing instructions for du-plicating the cell. This crucial process is mediated by RNA, a molecule derived from to DNA.

In a more advanced version of a single cell this heritage aggre-gate is enclosed in an inner capsule (nucleus) protected by a double membrane. Figure p.99 (TenOfAllTrades) shows a microscope image of three cells, where the specimen has been soaked in a spe-cial chemical agent that makes the nuclei visible by assuming a dis-tinct hue. The cell to the left is caught in the process of replication.

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An extensive series of experiments has been carried out with coli bacteria over many generations (Google: lenski evolution coli wiki). The results illustrate the effects of mutations, and com-binations of these, with astonishing cla-rity.

In later stages of development cells of the first generation have combined with others to form multi-cell units, still having the ability to reproduce.

Everything from algae to plants and humans beings consists of cells, which collaborate to provide nutritious matter where needed in the organism.

The Core of Heritage

No matter if a cell has a nucleus or not, its DNA molecule contains the instructions necessary to make new cells of the same kind. The copies become identical to the original, except in some rare, accidental cases (e.g. mutations).

Inherited properties have been known and exploited in farming for as long as history can record. Everyone knew that goats begot goats and olive trees begot olive trees, a process which we now call genetic transfer. The deeper mechanism of genetics, however, re-mained obscure until the middle of the 1900s. Without the discovery of X-rays and their use for molecule imaging it would still have been a mystery.

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The figure below (p.100 , Brian0918) shows only a minute section of the DNA molecule. Its structure is like a ladder with twisted sidepieces, or a spiral staircase. The steps (rungs) are as short as 0.000003 millimetres, but the ladder is over a metre long. It may involve at least a hundred million steps. In order to fit inside the cell, the DNA molecule must be fold-ed and rolled into a tiny package.

The molecules in the rungs between the twisted backbones carry the gen-etic information, which nowadays can be read and decoded in detail. Each rung consists of a pair of four different base molecules (named C, G, A, T in p.100 ). The pair CG happens to be about equally long as TA, but other combinations would be too short or too long to fit the ladder.

The overall sequence of C, G, A, and T along the ladder thus con-stitutes the genetic instruction for a new cell. In fact, only the base molecules attached to one of the two side pieces are necessary, since A, say, must be connected to a T. A strand of such instructions having a common purpose is called a gene. The total collection of genes in a cell is called a genome.

The DNA molecule produces the proteins required for a copy of the cell by means of a secondary molecule, named RNA. Initially, RNA is just a backbone similar to one side piece of the DNA ladder. This string receives a copy of the base molecules attached to one of the DNA side pieces. In this process, T is replaced by a different molecular base, U.

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DNA or RNA genetic instructions are present even in a virus particle, which is not considered to be a living organism, since it

cannot nourish on its own. A virus may be a hundred times smaller than a bacterium, but in many cases it has been possible to reveal its structure by electron microscope images. Figure p.101 1 (Graham Colm) is a schematic of a virus that is known to infect tobacco plants. It has the shape of a tube containing the genes, surrounded by a twisted

sheath of identical protein molecules, packed as densely as possible.

“Lifeless” organic molecules actually contain a crucial element of importance for evolution. Most of them attract each other at close range by sharing one or two electrons. Particularly strong bonds occur between molecules of the same kind, since their similar shape favours close contact.

Another simple example of a virus is shown below (p.101 2, Graham Colm). It consists of a shell of protein molecules protecting the DNA, this shell being symmetrically ordered by chemical bonding. A triangular pattern of six molecules per side is just visible on the electron microscope image, and the geometrical symmetry is that of a regular polyhedron, composed of triangular sur-faces. The easy bonding of organic molecules may be seen as the “extended index finger” of all genetic in-structions.

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The virus particle below (p.102 ), Graham Colm) is of an unbelievably complex de-sign considering its small size. Its polyhedral head contains the DNA and the body has six legs. It cannot move, but when the virus encounters a bacterial cell it sticks to it and injects its genes into the bacterium, thereby killing it. At the same time the virus starts to replicate. This type of virus has been used as a substitute for antibiotics.

Biological evolution took a dramatic step when there were living organisms of two sexes. After that there was no longer a simple split of cells, leading to a copy of the original. The offspring then had access to genes from both parents, and the result became a shuffled mixture of properties. With a virtually unlimited supply of genetic material, an enormous increase appeared in the variation of traits occurring in nature. This became the basis of the adaptation of life to the most different climatic conditions.

The birth of an organism begins with a fertilized egg containing heritage from both parents, and all this material is stored in the DNA molecule of the first cell created. The rest of the process is pure replication. Initially, all cells in a given individual have iden-tical DNA in their nuclei.

It has been found that even organisms as primitive as flatworms have some sort of nervous system. The latter is not only essential to the functioning of the organism but could also play a key role in the creation of new traits.

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Evolution by Natural Selection

A Swedish botanist, Linnaeus, did some groundbreaking work on the relationship between various kinds of plants. Later, the Austrian monk Mendel made crucial discoveries about heredity while growing peas in the convent garden (Google: gregor mendel wiki). He found that properties pass on to the next generation according to fixed rules for this simple case.

Finally, Charles Darwin extended this work to animals (Google: charles darwin wiki eng). He observed innumerable species in various parts of the world and was astonished at the variations in size, colour and other properties of related animals that inhabited different regions. His knowledge of the wide variation of inherited traits in both plants and animals led him to the principle of natural selection.

All individual animals are in competition with others for nourishment and a sexual partner, and both are necessary to generate offspring. Only those that are successful in these respects will transfer their properties to the next generation, which is why this principle has been called survival of the fittest. Each generation thus becomes better fit to live under the existing circumstances. Tall parents tend to get tall offspring, and these might prefer to mate with a tall partner. If mice lived in a secluded region, such as an island with no dominating predators, they might have reached the size of elephants after thousands of years. Individuals cannot adapt to existing circumstances, but generations do.

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Fossil history indicates that new species of plants and animals appeared but often vanished at a later time. The cause of the disappearance remained a mystery until the principle of natural selection was proposed by Darwin. The simple basis of this idea is that the various individuals living in a given region compete for food and water. Groups that cannot defend their territory and their sources for subsistence are doomed to starve and finally vanish. Physical strength, courage and fighting skills are thus determining qualities for survival, and most of these traits are inherited by the following generations.

Access to food and water is not sufficient, however, for the sur-vival of a species. Organisms must also reproduce, which requires certain talents for mating. It may not seem difficult for a male to attract a female in heat, but every little distinction helps. Some birds sport large feathers with flash colours, and if mating takes place the attractive traits become available to the next generations of male birds.

Fighting between males seems to be a frequent ritual as an introduction to mating. This act measures strength and endurance of the competitors, and the winning male carries his superior properties further by heritage. The usefulness of such properties in the survival of the species lies in successful defence of the territory and of the descendants.

It has often been suggested in biological TV programs that the female prefers the winning contestant on grounds of the superior traits that he can transfer to the offspring. Evidently, it is assumed that females have taken an introductory course in genetics – and passed! In fact, once the potential partners have tested their strengths, the loser withdraws and the female has no more say in the matter of choice.

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Natural Selection among Humans

Humans probably arose on the African continent where we left our closest animal ancestors, (Google: ardi wiki) some 4 million years ago. This continent was populated by dangerous animals, and the early humans mainly survived by eating what the hunters left on the fields, for example bone marrow from kills. They were not as strong as some apes, but they had the advantage of walking on two legs, which left their hands free to carry food and to handle tools. In particular, their thumbs were opposable. This meant that the thumb could be used to grip with any of the four remaining fingers, which greatly increased the practical use of the hand.

Another human trait, in later versions of development, was a mental ability of a unique kind. Recent research has revealed that we have long underestimated the intelligence of chimpanzees, suri-cates, and even ravens. Humans are foremost, however, in planning and in collaboration with other individuals in major enterprises.

Most importantly, we stand alone as regards sophisticated com-munication. No other species have sent messages to later generations in the form of paintings, sculptures, and architectural masterworks. Nor have any other mammals invented scripture corresponding to the enormous number of spoken languages. Writing has in turn made science possible by providing a record of past achievements, available to all researchers on the globe for their continued contributions.

When human DNA molecules were first mapped for their in-formation contents, researchers were astonished to find that the number of genes came out as small as 32 000. The complexity of the body, and the nervous system in particular, made them expect five or ten times that number. This surprising fact has not yet been explained, but the solution to this enigma might lie in the chemical helpfulness of the organic molecules created by the DNA-RNA mechanism.

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The electron structure of the proteins produced on command by the DNA is such that their molecules easily stick together to form a long chain, which would be required to produce nerve fibres, for instance. Not all of the structures so created would be functional, but natural selection could abstain from the useless aggregates. According to this hypothesis the DNA would only indicate the way to go and leave some details to chemistry.

Another thought that may be worth pursuing is that an engineer probably would have arranged genetics differently. Why cram all the information about an organism into the DNA, instead of only the features that are to be changed? The basic properties are already available in the mother’s body, and only the contributions from the male parent need to be introduced. In reptiles the embryo is en-cased in a hard shell during its development, which would hinder all exchange of biological information. This is not the case with mammals, however.

Figure p.106 (Magnus Manske) shows the uterus and its connection to the womb by two thick blood vessels. After passing through the mother’s lungs the oxygen rich blood is sent to the embryo through the outgoing artery. The other tube returns the blood, stripped of the oxygen and various nutrients. This life support is well known, but the question is whether fur-ther agents might be trans-ported to the embryo.

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The mother’s blood stream normally contains stem cells and possibly also proteins produced by the her DNA. All these contain designs of body parts that could be communicated to the embryo.

Two hundred years ago a couple often lost one third of the young offspring from under-nourishment or illness. Child death may have been tragic, but it provided better lives for the remaining offspring. The surviving children had more food, space, parental care, and generally better chances for adult life. Natural selection meant weeding out the frailest individuals in the family.

A century ago medical care was not easily available outside urban areas, not even in the Western countries. Transports to the hospital were slow and costly. Today, urgent cases are moved by helicopter within an hour. There is now practically no obstacle to urgent surgery when required. Children that are born several months too early are placed in incubators and “rescued” to an uncertain future life. In the names of religion and democracy all possible measures must be taken to lengthen the life of the citizens. An undesirable consequence of this over-exploitation of medical technology is that old people may have to wait in extended misery for death to occur.

Biologists have asked themselves how natural selection could foster empathy, a property that we often observe in the animal as well as in the human kingdom. In terms of the theory of evolution this is really easy to understand. Some individuals may simply find pleasure in caring for others, who appear to be similar. This is a trait that obviously favours survival of the flock, and after many generations this behaviour would become the inherited standard. Everyone in the flock finds pleasure in grooming; thus it is not a vulgar tit for tat.

The token empathy we show populations of remote countries by a yearly offering from our national budget does not seem to help evolutional survival. Nor do we get any advantages by saving

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“endangered” species such as ice bears and rare butterflies. This mostly favours romantic ecology fans that actually live off their campaigns for public spending.

Knowing how evolution has created the animal kingdom it is reasonable to ask if humans will ever acquire properties that are better adapted to their environment. The answer is definitely no, because there is today practically no selection of the fittest. Nor can we expect the world to reach consensus on plans to allow natural selection. This Achilles heel carries the gloomy expectation that humanity has no future. A meteorite hitting the Earth might well finish us first, however.

Cells Modified for a Purpose

A cell just produced by a fertilized egg (stem cell) contains all the instructions necessary to make a copy that is good for all purposes. It is well known that such cells can move with the blood stream to body parts in need of repair. In order to be useful such cells then have to acquire specific properties, depending on the organ to be re-paired. Muscles require another type of cells than the intestinal tube or the bones. A stem cell may transform into other modifications, similar but adapted to a given function in the body (Google: Cell Types). This specialization does not modify the total DNA contents of the cell (genome), however. There are over two hundred known cell variants for a wide range of uses: for bones, intestinal organs, various glands, muscles, blood and nerves, and so on.

Stem Cells to Cure Serious Illnesses

The use of stem cells against illness not tractable by ordinary methods has been proposed and tested on animals (Google: stem cell treatment). The current exploitation of cells from human embryos

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for research purposes has been criticized by religious fanatics, however, which has stalled the practical applications of this resource.

A recently invented method, however, transforms a patient’s own skin cells into stem cells (Google: skin stem cells 2009) simply by exposing these cells to certain proteins – the converse of spe-cialization. The resulting stem cells could possibly be used for the treatment of serious illnesses (p.109 , Mikael Häggström).

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Epigenetics

During the past century the theory of biological heritage taught that the DNA molecule in the cell determines all the properties of the offspring. Genuine twins would thus be identical in all respects, and so it appeared in many recorded cases. Today this model has to be modified, however, because it is evident that subtle changes of the chemical environment of a cell can influence how genes express the heritage. Molecules that are small enough to penetrate the protective membranes around the cell and its nucleus can inhibit the transcription of certain genes into proteins. This is now an eruptive field of research that yields astonishing results yearly (Google: epigenetics wiki).

Systematic work began with experiments on a particular variety of mice that had yellow coats and an abnormal appetite. They often succumbed to cancer or diabetes and died early. Their offspring were prone to the same defects. By feeding the pregnant mothers a diet containing methyl groups (–CH3) the researchers found that they could inhibit the expression of the defective traits. The pups were then brown in colour, slender and in good health (figure in Google: epigenetics scitable). The astonishing fact discovered was that their offspring in turn possessed the same qualities. The DNA molecule remained the same, but its expression became modified by attached side groups.

It appeared that it is not only chemical substances that can change the expression of genes, but also life experiences. In a series of studies researchers noticed that some rat mothers kept licking and grooming their pups, whereas others did not. The brood that

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had received extra attention from their mother behaved very dif-ferently, e.g. being less fearful than the rest. An even more inter-esting fact was that the next generation assumed the new nurturing style. They also exhibited differences in the hippocampus part of the brain. The properties of the offspring thus changed, while the DNA remained the same.

In further studies they injected acetyl groups (-C=O with a methyl group attached) directly into the pups of negligent mothers, and surprisingly, these also became well-behaved. On the other hand, injecting methyl groups into the offspring of the more loving mothers produced the opposite result.

Epigenetic Effects in Humans

Among humans there are genuine twins that look alike but have very different health records. This can only be attributed to dif-ferences in their life conditions. Dr. Marcus Pembrey at the Institute of Child Health in London found many cases of serious illness in children that could not be explained by classical theories of herit-age.

Many years later a fortunate object for study was discovered in northern Sweden. (Google: overkalix new heredity). For many centuries the small village of Överkalix had been effectively isolated from the neighboring population because of differences in language and ethnicity. In addition, the clerical office had kept detailed records – not only of births, deaths, and the causes of deaths – but also of the volume of harvest and the price of crops. In this near-polar land weather conditions could change violently from year to year, and famine was never far away.

Analyzing the clerical records of Överkalix researchers revealed that if a father starved during early puberty, his son was less likely to succumb to vascular diseases. Conversely, if the father enjoyed

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an abundance of food during this formative period the son’s risk of fatal diabetes was four times higher. Similar facts were discovered concerning grandmothers and their son’s daughters. Generally, the hereditary response to living conditions was found not to be symmetric with respect to sexes. The results showed that life experiences can influence the heritage of at least two following generations.

A similar opportunity of studying epigenetic effects of life condi-tions was offered by the Dutch famine during the German occu-pation in 1944-45 (Google: dutch famine 1944 wiki). Mothers who starved during the final trimester of pregnancy were more likely to have babies that later developed diabetes, after being exposed to improving food availability after the war.

Studies have also established that Jewish mothers that suffered severe stress in the Nazi death camps passed psychological dis-orders to the following generations (Google: stress holocaust survivors).

Epigenic mechanisms cast new light on the specialization of stem cells sent around the body to repair various organs. It now seems reasonable to suppose that each organ contains molecular fractions capable of penetrating the membranes of the stem cells, thereby modifying the stem cells as required for the repair.

For the last fifty years the central dogma of genetics was that the properties of an individual are determined by the DNA molecule. Now we know that experience such as famine, affluence of food, too little parental attention, stress, and sexual abuse may influence a child’s future life – and be transferred to later generations.

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Consequences of Epigenetics

Epigenetics has revealed that certain chemicals may modify the ex-pression of a gene, while leaving the actual DNA molecule un-changed. The epigenetic change is transmitted to later generations, but other chemicals can be used to restore the unperturbed state of the DNA molecule.

Studies of mice disclosed that the expression of certain genes may be inhibited by injection of appropriate chemicals into a mother during pregnancy and that this modification transfers into the next generation. Human heritage is similarly influenced by famine or affluence during pregnancy or (in the male) during a sensitive stage of adolescence.

The above discoveries raise new questions about the dangers of chemical pollution. Do we have to guard ourselves against all molecules that could have epigenetic consequences? The recent products of nanotechnology (Google: nanoparticle wiki) constitute potential threats.

Far-Fetched Ideas

The findings of epigenetics open a world of completely new per-spectives. This in turn has led to a general euphoria in certain medical circles, and an attitude of “anything goes” is flowering. Well established facts of physics are used to suggest the most hair-raising medical hypotheses.

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An example of these daring ideas is an anecdote about healing by prayers in California for the benefit of a patient in Toronto, Canada (Church 2007, p.183-194). The unexpected positive outcome was explained by electromagnetic waves being transmitted from the body of a medicine man. Similar cases of successful anonymous prayers for AIDS patients have also been reported. The possibility of spontaneous healing does not seem to have been considered.

Electromagnetic waves have been suggested as a high-speed mechanism for communication between the brain and other parts of the body. The current neurological view that signals only propagate by electrochemical transmission along nerve fibres is considered to be too slow to explain how athletes can play cricket, for example (Church 2007, p.143).

The argument against electromagnetic signalling is that such waves are extremely common in our environment. All our house-hold machines and the electric power lines emit strong waves that would interfere seriously with the assumed communication bet-ween human organs. In particular, such interference would com-pletely mask all remote communication. If electromagnetic waves cannot be the in-body messenger, why not consider electronic conduction that we depend on for telephony?

Beliefs and Epigenetics

In an interesting series of studies (Church 2007, p.58-68) a resear-cher measured the blood quality of AIDS patients, e.g. the concentration of virus on the one hand and helper white blood cells on the other. These are objective markers, less biased than sub-jective ones, such as the level of depression or optimism declared by the patient. A clear-cut conclusion of this study was that patients that believed in a benevolent God improved much faster than those that believed in a punishing God.

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Prayer and meditation may be seen as ways of giving oneself encouraging messages. Many reports accordingly show health improvements as results of these supernatural means. Visualization is closely related to such methods of self-messaging, and many anecdotes of miraculous recoveries have been reported.

Epigenetic Medicine

Epigenetic theory promises entirely new medical possibilities. If pregnant mice can be made to produce better offspring with in-heritable traits by adjusting their diets, could this be achieved with human beings as well?

Animal studies have also indicated that direct injection of methyl or acetyl molecular groups into an existing individual can result in epigenetic shifts that are transferable to the next generation. It is not known, however, if such interventions are effective within the human kingdom.

It is a well-known fact that the brain has the key to a rich dis-pensary of chemicals that are released as required in critical life circumstances. If we are threatened by assault the brain’s response is to increase blood circulation in the muscles, at the expense of that in the intestines, enhance blood clotting and dilate the pupils. The response to actual injuries is the secretion of endorphins, our body’s instant painkiller. The origin of this chain of measures is our ap-praisal of the threat, i.e. our emotive state. In other words, conscious emotions may produce chemicals that make the body more capable of defence or escape. Appropriate molecules are also automatically provided for the repair of various organs.

Dopamine is another potent substance that has profound effects on the psychological state of a person, and also on some phy-siological functions. For instance, it increases the heart rate and the blood pressure.

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Epigenetics also opens the perspective of producing medically active substances, such as dopamine, by conscious invocations. The brain may be stimulated to deliver crucial chemicals by the action of peripheral sensors or even by thoughts or words. The strange mumbo-jumbo exercised in Emotional Freedom Therapy (p.84) might well fall under these headings.

It is not known whether the “energy” medicines work by pro-duction of healing proteins, but this could probably be decided by repeated blood tests. The effects of the peculiar gestures used in EFT may also be investigated in a similar way.

The promising science of epigenetics is still in its childhood and significant results may be expected in the years to come. In order to search for epigenetic expression in blood samples an extremely efficient technique has been developed (Google: DNA microarray wiki). Using nanotechnology thousands of different DNA fractions (original and epigenetically modified) are distributed as a regular array on a plate (p.116 , Paphrag).

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When the above plate is exposed to a blood sample, molecules will stick to the corresponding target on the plate, and others can be washed away. By chemical preparation one can arrange to make the selected DNA material visible by colour. In this manner the results of epigenetic treatment would become readable.

The Importance of Nurturing

We have seen that the licking and nurturing of mice by their mothers influence the behaviour of the offspring. It is only natural to ask oneself if a similar influence exists among humans. Does attentive nurturing of children make them better adapted to the realities of everyday life?

There are reports by the police and the social departments that children rejected by their mothers and hence sent to a series of fos-ter homes are frequently attracted to drugs and crime. This is not a surprising fact, and it speaks strongly for measures to avoid un-wanted pregnancies, which put stress on the mothers and are an additional financial burden on the family. This in turn increases the risk of general family dysfunction and divorce.

Assuming that the epigenetic effects of nurturing apply to hu-mans as well as to mice they would transfer to the next generation and from there to the following one. If nurturing or direct injection of suitable chemicals should prove successful within the human kingdom, the reward could be generations of peaceful and forgiving individuals, a possible preparation for a better world (Church, 2007, p.267-270).

Conscious release of a particular substance that can penetrate a fresh stem cell, thereby modifying its genetic expression, is of course a project that deserves advanced research.

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Role of the Nervous System in Epigenetics

Darwin´s principles of evolution have been verified in numerous different ways and are no doubt valid. They explain how plant and animal species become eliminated by competition if their properties are not optimized for the environment. That accounts for the destructive side of evolution, but what are the processes that create desirable traits in a given situation?

The most radical change of the DNA molecule is caused by the temperature of a human body, which is at about 37 ºC, much higher than zero Kelvin (-273 ºC). At this elevated temperature there is always some random motion that may cause an atom to slip out of its positions in a large molecule such as DNA. By a similar cause a small molecular group might escape into a stem cell to block the expression of a gene. In both cases such a rare event is accidental and would seldom produce desirable changes.

The major event that creates new DNA is the sexual fertilization of an egg. In this process genetic material is derived from both parents in a random manner, which produces somewhat different properties for each new individual. In the animal world the strongest and most tenacious male wins the ritual struggle against the competitors and is awarded the opportunity of mating. Even if strength is an important quality in the wild it does not necessarily bring other useful properties into the next generation. For example, a long neck helps to reach the leaves of tall trees, and poisonous saliva paralyzes the intended prey.

Any mating male usually has one important quality, viz. that he has in fact survived in that same geographical region and can be expected to contribute useful genetic properties. In a very long time perspective a full range of desirable qualities would perhaps become available for future generations. The question is whether evolution has taken shortcuts in this lengthy process.

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In the preceding chapters we have seen how sophisticated and powerful our nervous system is. The central part of it organizes the peripherals that supervise all the body organs and all the processes essential to life.

Food entering through the mouth is sorted and digested auto-matically, while malfunctions can be detected and signalled to the brain. Digestive juices are introduced as required and are kept at the proper acidity and temperature. The nutrients are moved automatically along the digestive channel.

The five basic senses constitute the main link to the outside world. Of these, the eye is the most advanced organ, delivering an immense quantity of visual information directly to the brain. On the whole, however, there are ten times more outgoing motor nerves from the central nervous system than there are ingoing sensory nerves. We probably know only a fraction of the potential functions of these signal lines.

The somatic nerves send information to the brain about the mechanical tension in muscles. This is used for guidance during strength training (p.68), where the target muscles are brought near the current load limit. In this case, persistent conscious action may increase the volume and strength of muscles. Conversely, it is known that non-use of a muscular group will cause weakening and finally degeneration (atrophy). In one of the first theories of evolution due to Lamarck (Google: evolution lamarck free wiki), these mechanisms were supposed to create new species with properties better adapted to the environment. Investigations later showed, however, that acquired modifications of muscles were not inherited by later generations.

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Figure p.120 (Beth Ohara) shows the muscles linking the hip bone to the pelvis and the sacrum. The hip joint is of course exposed to strong forces, which make this support essential. The surpris-ingly large number of them gives the impression that this set of muscles have been tested for strength and found insuffi-cient, so an additional muscle had to be inserted. Both ends of a muscle always attache to a bone.

If evolution changed a ver-tebrate from walking on four

legs to walking on two, this would have required modifications of the hip support on the basis of tension measurements made by sensor nerves. Classical genetics teaches that the exact configuration of muscles around the hip is determined by the DNA molecule, but it has been pointed out that the number of genes known would not be sufficient to specify details such as muscle shapes and attach-ment points on the skeleton.

Epigenetics opens new opportunities of evolution based on data recorded by the peripheral nervous system. A giraffe finds that it has to stretch its neck to reach the particularly nutritious leaves at the top of the trees. The conscious elongation of the neck could perhaps train the neck muscles to reach higher branches, but the modified neck would not be heritable according to classical Darwinian Theory.

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Considering the miraculous efficiency of the nervous system it is hard to accept that it should have no influence at all on heritage. In view of epigenetics, however, one could imagine that a pregnant giraffe, that made conscious efforts to reach treetops could produce offspring with an improved neck. By a similar hypothesis a male giraffe in its adolescence could also transfer its aspirations as epi-genetic heritage.

Anatomy in Elementary Education

The importance of identifying and preventing organic problems by being aware of what is going on inside us leads to thoughts concerning the education of young people. The praxis in various part of the world may vary, but as I remember from my first six school years the main focus was on plants and animals rather than on humans. I am not suggesting that these “lower” forms of life should be less important, but there are strong reasons for studying human anatomy as soon as an adequate amount of elementary chemistry has been assimilated.

Dealing with plants first could have been motivated by evo-lutionary arguments, but that seems improbable. It could have been the notion that plants are easier to understand, but we now know that all forms of life are surprisingly similar in structure. The choice of plants for the early parts of the curriculum could rather have been preferred because the salient facts of sexual functions were less embarrassing to discuss.

One relevant reason for starting early with human anatomy is that facts and phenomena are observable near at hand, which is not the case with history or mathematics. There are several advantages of an early acquaintance with one’s own body. Being aware of its parts and their purposes makes it possible to evaluate pain and dysfunction at an early stage. An important example is the detec-

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tion of trigger points (p.42), which could help to eradicate the source of the pain.

Knowledge of the human body may also generate curiosity about the structure of more primitive species and the evolution of life in general – for those who can tolerate it.

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Last Chapter

Even if prevention of illness and soft methods of treatment should be preferred to strong medicine and surgery, we may finally arrive at a stage where nothing but invasive intervention is available. We may finally lose our mobility, our independence, the ability to express our wishes, our hearing, and eyesight. The choice now seems to be between being a burden to your family or to retire into an institution for the care of hopeless cases. There we may associate with others in equally serious, but perhaps different, kinds of misery. Visits from family and friends become increasingly rare, which is understandable.

Patients waiting for the end are not an inviting spectacle for the staff of an institution for senior citizens. They may have disgusting habits and obnoxious behaviour, which tend to irritate the em-ployees. There are reports that the latter often respond by harassment, and even violence.

The reader may now object that these are not typical cases; “My uncle died from a sudden heart attack!” Yes, only a few percent of us should have to face long-time pain and final humiliation. The problem is that we cannot possibly predict who these persons will be. No one can. The day you find out that you are unfortunate it is too late to prepare for alternatives.

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Why Are We Waiting?

The time from the onset of incurable illness until the end of life is a deplorable period for the suffering patient himself as well as for his friends and family. It may last for weeks, months, and years, but it seems to be generally understood that life should go on until “natural” death sets in.

The question is who should decide if your life is worth living. This is in fact a personal preference that no doctors, priests or politicians have the right to question. America is a land of indi-vidual freedom, without slavery and oppression. You may move to any state, set up business or take an employment, marry and divorce. You may indulge in drugs and commit serious crimes such as murder, which could lead to a death penalty. This capital punishment only requires the signature of the Governor.

The most certain fact of life is that we are all going to die. If you are run over by a truck or happen to fall from the top of a skyscraper, no official signature is necessary. If you are sent to the emergency room, the hospital does not need any formal agreement to try saving your life, even if it should be obvious that extended existence would be a misery. The law is very firm on this point, since the physician might possibly gain personal advantages from your death. In this situation, however, it may not be possible to inquire what the patient wishes, and the political establishment may even consider that his life or death does not concern him. Higher principles are at stake.

The highest principle is of course God’s will, according to the beliefs of four Americans out of ten. Every person, however, has his way of interpreting God’s preferences. Most people firmly believe that the hospital is forbidden to shorten a person’s life, but many think it is allowed to extend it. Doctors generally hate losing a patient, and for obvious personal reasons. Many who have religious inclinations even think that extended life with pain and humiliation

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is God’s method of punishing the sinners, just in case Purgatory and Hell should not really exist. Some people even think that all pain is a divine punishment, and by perfectly sound logics they refuse anaesthesia during surgical interventions.

Warning: If you are under 16, or believe that Christ was crucified in order to erase all our sins, only to come back to reassemble our bodies from the waste of thousands of worms, and then condemn us to eternal pains, then you should stop reading this book instantly.

Having Had Enough

Knowing what is involved it is tempting to abstain completely from the last, bitter stages of life. We never asked to be born, and it seems to me that we have no obligation to go on living if it does not suit us. Personally I believe that Paradise is now and that there are no horrors such as Purgatory or Hell awaiting us. I have woken up from anaesthesia over twenty times in my life, and I know that there is nothing dramatic in dying. It is just like going to sleep at night, having no guarantee to wake up in the morning.

Not so long ago suicide was forbidden by law, but nowadays it is perfectly legitimate. Political powers try to make self-deliverance as difficult as possible, however, no doubt due to religious influences. The methods they leave to citizens either require weapons or are potentially painful, and the remains are awkward to watch for family and friends. The Hemlock organisation (www.hemlock.org) has given much thought to the problem of dying with dignity. There is an excellent book and a detailed DVD disk devoted to this subject (Humphrey, 2002).

The most rational aid would be a set of two pills, one to put you to deep sleep and a second one containing a deadly poison in a metal capsule, designed to dissolve in the stomach after a few minutes. It may be doubted, however, that the development of such

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a medical aid would be tolerated by the political stratum. Nor would it enrich the pharmaceutical industry.

A moderate way out has been found in the Netherlands. In many states the law rules that the patient has the right to forbid medical interventions. For instance, he can refuse forced nourishment and drink. Without liquid, death will occur after about a week, and to avoid suffering during this period the patient can demand to be treated with sleeping pills or anaesthetic. This mode relieves the physician of all responsibility, and the nation avoids costs that can be far better used for other citizens.

The remaining, crucial problem is that a person with an incurable illness may not be in a condition to express his wishes. He might be unconscious or just unable to speak. Fortunately, we can make our will known in writing, as has traditionally been done about finan-cial possessions, and organs can also be bequeathed to whoever needs them after one’s death.

Forbidding medical interventions by a will is a natural step to take. First, however, the law must be revised to recognise the ultimate wish of a citizen, even when it concerns more essential issues than his earthly belongings.

The world population now appears to be very anxious about environmental hazards, such as air pollution, global heating, de-forestation, and over fishing. No one seems to find the cause of these problems in the overpopulation of the planet. Indiscriminate saving of lives will only aggravate this situation.

Any person who voluntarily abstains from medical care in what he considers to be a hopeless condition should be honored for his empathy. The resources spent on long-time suffering could be better used for treating younger people that are queuing for medical care. Self-deliverance should thus be met with explicit official respect, rather than contempt.

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Sources

Backstrom Gunnar, 1981, A Rational System of Musical Notation, 24, Annales Academiae Regiae Scientiarum Upsaliensis. Church Dawson, 2007, The Genie in Your Genes, Elite Books. Craig Gary, 2008, The EFT Manual, Energy Psychology Press. Davies Clair and Davies Amber, 2004, The Trigger Point Therapy Workbook, New Harbinger. Dawkins Richard, 2009, The Greatest Show on Earth, The Evidence for Evolution, Free Press. Feinstein David, Eden Donna, and Craig Gary, 2005, The Promise of Energy Phychology, Penguin. Fitzgerald G. K. et al., 2003, J. of Orthopaedic & Sports Physical Therapy, 33, 9, p.492. Humphry Derek, 2002, Final Exit, Dell Publishing. Joseph Avy, 2009, Cognitive Behavioral Therapy, Capstone. Kahle Werner et al., 1993, Color Atlas, Human Anatomy Vol. 3, Nervous System and Sensory Organs, Thieme. Platzer Werner, 2004, Color Atlas, Human Anatomy Vol.1, Locomotor System, Thieme. Ravnskov Uffe, 2009, Fat and Cholesterol are Good for You, GB Publishing. Roberts Royston, 1989, Serendipity, Accidental Discoveries in Science, Wiley. Simons David, Travell Janet, and Simons Lois, 1999, Myofascial Pain and Dysfunction, The Trigger Point Manual, Williams & Wilkins. Stock Gregory, 1993, Metaman, Simon & Schuster.

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Index

A abdominal pains 52 acupuncture 72 age Earth 95 amino acids 97 anatomy in school 121 appendicitis 35 autonomic nervous system 8 B back pains 53 behavioural therapy 79 brain 1 C calf muscles 57 cells 98 chest pain 35 cholesterol 9 colon 9 D Darwin 103 DNA molecule 100 dopamine 115 duodenum 8 E electrical resistance 87 electromagnetic waves 114 electron microscope 40

electro-myography 41 electro-stimulation 69 emotional freedom tech 84 endorphins 115 energy medicine 72 energy psychology 81 epigenetics 110 epigenetic medicine 115 esophagus 8 evolution 94 F famine 111 foot 56 force feeding 126 forearm pains 50 G gall stones 36 geology 95 H hearing 14 hip 55 I invasive medicine 92 K keyboard 23 knee 55

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L larynx 8 leg 56 M magnetic resonance imaging 41 massage techniques 43 meridians 86 metaman 20 microarray 116 mouth 8 mumbo-jumbo 90 muscles 44, 45 musical addressing 91 musical notes 23, 24 musical sharp, flat 23 myofascial pain 38 N natural death 124 natural selection 103 neck problems 47 neurobiology 18 nociception 17 nurturing 117 O origin of life 96 overpopulation 126 P peripheral nervous system 3 piano virtousity 22 piezo-electricity 73 pitch 23 pitch, relative, perfect 26 placebo effect 75 preventive medicine 92

Q quantum physics 74 R radioactivity 95 rectum 9 referred pain 39, 61 religious belief 114 S scale 23 sciatica 33 self-deliverance 125 shoulder blade 49 sight 11 smell 15 spinal cord 3-6 stave 23 stave, 5-line 23 stave, 7-line 24 stem cell 108 stem cell cure 109 strength training 68 stomach 8 superorganism 18 T taste 15 temperature 9 tender trigger points 46 termites 19 test, surgery 77 theatrical virtuosity 31 thermography 41 touch 1 trials, double-blind 76 triggerpoint 39 triggerpoint therapy 42

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V violin tuning 28 violin virtuosity 27 virtuosity 22 virus 101 O optical microscope 40

U ultimate wish 126 Y yoga 72