General Healthcare Cost Humour Lifestyle Opinion Pharmacology Psychiatry Psychology Public Health Reflection

Well, Well, Well: Products and services compete for shelf space in trendy wellness market, but are they worth your money?

When a friend recently asked me to join them for a class at Inscape, a New York-based meditation studio that New York Magazine described as the “SoulCycle of meditation”, I was skeptical. On the one hand, I usually meditate at home for free, so paying almost $30 for a meditation class seemed a bit silly. On the other hand, my meditation practice had dropped off considerably since the beginning of the year. Maybe an expensive luxury meditation class was just what I needed to get me back into my regular practice. Stepping off bustling 21st Street into the clean modern space, I heard the sounds of, well…nothing. It was incredibly quiet. Before getting to the actual meditation studios, I had to pass through Inscape’s retail space. The minimalistic shelves hold a variety of supplements, tinctures, and powders that include unique ingredients like Reishi medicinal mushrooms and cannabidiol extract. Many contain adaptogens, herbal compounds that purport to increase one’s resistance to stress, though their efficacy has never been quantitatively proven.[1] These products’ promises run the gamut from shiny hair and stress relief to aura cleansing. I may be a super-skeptic, but even I am not immune to the lures of top-notch marketing. With great consideration, I purchased one of the many magical powders for sale labeled as ‘edible intelligence.’

Since wellness has become trendy, a considerable space in the retail market has opened for associated products dedicated to helping people live their best lives. As Amy Larocca pointed out in her June 2017 article The Wellness Epidemic, “[In the wellness world] a loaf of bread may be considered toxic, but a willingness to plunge into the largely unregulated world of vitamins and supplements is a given.” Even a recent episode of Modern Family poked fun at the wellness trend when Haley Dunphy applied for an ultra-competitive job with fictional wellness guru Nicole Rosemary Page. During her interview at Page’s Nerp company headquarters, Page laments, “People say that Nerp is nothing more than a con-job, a cash grab vanity project from a kooky actress. I want to turn Nerp into the next Disney-Facebook-Tesla-Botox. It’s a world changer.” Though Page is a fictional character, I can’t help but wonder whether the character was inspired by the very real Amanda Chantal Bacon, the founder of Moon Juice, which bills itself as an adaptogenic beauty and wellness brand. Bacon’s Moon Dusts retail for $38 a jar and come in varieties such as Spirit, Beauty, and Dream.

The bottom line is that a sense of well-being needn’t come at the price of thirty-plus dollars an ounce. In fairness to those who choose to spend lavishly, I believe that plunking down a chunk of cash might create an intention to use and derive value from a product, thus positively influencing one’s perception of how well the product works. Rest assured, however, that living with intention and gratitude can be just as easily accomplished without spending any money at all. Carving out time in the day to create a small ritual for yourself can be as simple as spending a few minutes in the morning listening to jazz as you drink your first cup of coffee or allowing yourself to become immersed in a good book before drifting off to sleep. These simple acts allow us to bestow kindness upon ourselves that is especially important in our stressful and busy lives as medical students. My suspicion is that by performing such rituals with intention, we derive much of the same benefit whether our mug is filled with the trendy mushroom coffee or just plain old Folgers.

I’m always thinking about ways I can improve my own well-being, but as graduation approaches I also find myself thinking about how these practices might help my patients as well. One of my fundamental goals as a future psychiatrist will be to help my patients see the value in themselves and in their own lives. I predict that for many of my patients, achieving this goal will depend perhaps on medications but also on the deployment of simple wellness tactics such as I described. I’m not going to lie…I’m still intrigued by many of the wellness products that can be found in places like Inscape, Whole Foods, and the Vitamin Shoppe, especially when I think about the potential benefits they might have for my future patients. I figure that if these products do even half of what they promise to, some of them might even be worth the money. So what happened when I added a sachet of intelligence powder to my usual morning smoothies? Pretty much nothing. At one point, I got excited when I began to feel my fingers getting tingly. Then I realized I had been leaning on my ulnar nerve. Not so brainy after all.

[1] Reflection Paper on the Adaptogenic Concept, Committee on Herbal Medicine Products of the European Medicines Agency, May 2008.


Photo credit: Open Grid Scheduler / Grid Engine

General Lifestyle Reflection


For just split seconds, I am floating, flying, feeling the space pass by. Then the flying ends, subtalar joint and plantar fascia absorbing the first impact of my landing. Gastrocnemius, soleus, and Achilles tendon maintain my stance, and along with my hamstring orchestrate takeoff. Then I am flying again, rectus femoris and iliopsoas swinging my leg forward.

My feet beat the drum of the earth, sarcomeres lengthening and then shortening, orchestrating flight and breath and blood flow. They lengthen and shorten, again and again. Intercostals and diaphragm labor rhythmically, cycling through hunger for air and fleeting relief.

As re-oxygenated blood returns to my left atrium, my attention returns to my thoughts. At first they fought for an audience, demanding my attention as I focus instead on the world around me, but soon it’s just me and my thoughts, as the air streams across my face. My legs stay strong, but beg me to stop. As I finish my run, my thoughts are with me, but whispering politely instead of shouting for attention, willing to leave as quietly as they came.

It isn’t the running, it’s the calm, the quiet, the peace in the cacophony. It isn’t the running, it’s the brisk morning breeze, the bronze fall leaves, the stars between the stars in the night sky. It isn’t the running, it’s me passing through space – a shooting star in the night sky trying to shine bright in the milliseconds I have to add a little light to the world. It isn’t the running, it’s the feeling of perfect harmony as the rhythm of my legs and arms and breath seems to match the rhythm of the world. It isn’t the running, so it is the running.

In the singularly focused chaos of medical school, running was just what I needed to reconnect with nature and the city around me. Earlier in medical school, a friend had asked me if I ran, and I answered, “Nope! Why would I run? I only chase soccer balls and cookies”. I am grateful that we are able to change, and I am now able to see beauty where I could see none before.

Photo Credit: Mark Hesseltine

Emotion Empathy General Humanistic Psychology Narrative Public Health

Guter Mann

This city is so peaceful. As the bikes whiz by, I notice the absence of the cacophony and polluting fumes of traffic. I’m walking down the sidewalk in brown leather shoes and a tucked-in dress shirt while eating bougie gelato. I love gelato. I look up and notice the blue sky. It’s a deep blue and the clouds have distinct borders. I’m in Salzburg, Austria for a conference and I’m loving this city. Just as I marvel at the clean streets and begrudge the abundance of luxury vehicles, I turn the corner and see my sister on the floor asking for money. I immediately cross the street and reach in my pocket to hand her the change I received at the gelato stand. My sister is donning the flag of Islam on her head and I greet her with the anthem of Islam, a greeting of peace. She smiles and says, “Allah yijzeek al-khayr” – God reward you with the good. As I walk away, I smile at the beauty and seamlessness of our interaction.

I continue walking back to the conference hall. I review my rehearsed words as I finish my gelato. My presentation is on the data I generated regarding the controversial use of bisphosphonate anti-resorptives in the setting of chronic kidney disease mineral bone disorder. The nephrologists in the crowd won’t be too thrilled. In my head, I am considering all the different questions I could be asked, when I see another of my friends on the corner of an intersection. As I approach him, he brings his hands together and bows his head. When he raises his head again, I smile at him. I don’t have any more change so I reach into my pocket and hand him 5 euros. He has a cup in front of him, but I decide to hand him the money. I think this might make the money more of a gift than a charity. I can see hurt in his eyes as he tries to find a way to thank me. Reaching out I put my hand on his shoulder and squeeze, pointing up with my other hand, trying to tell him that I will pray for him. While my hand is on his shoulder, he turns his neck and kisses my hand. I say, “No, no!” and withdraw my hand. I feel ashamed. I know I should be the one kissing his hand for accepting my miserly gift of 5 euros while knowing full-well that I have another 10 laying comfortably in my pocket. Ten euros that I will, over the next couple hours, undoubtedly spend on a sacherwurfel from the bakery next to my fancy hotel and then on another helping of overpriced gelato.

Lost in my thoughts of embarrassment, I begin to walk away, and as I do, he yells in German, “Guter mann!” – good man. Halfway across the street, I think to myself, I may not be a good man, but I have the opportunity to try, and so I turn back around.

Ten euros was all the money that I had left on me. But 10 euros was all it cost to earn the respect and love of a man I had only met minutes ago. Excitedly, the man begins to talk to me in German. His name is Damien. (We spend a good 5 minutes on my name. I would say, ‘Mo-ham-mad’, and he would then repeat after me, ‘No-han-nam’). Damien is a father of 3 kids. He was doing well for his family until his wife lost her vision. He said, “Now my heart is still good, but children’s stomachs are empty, so my hand is outstretched.”

I notice the tears in my eyes. I had never heard German spoken before, and I shouldn’t know what he’s saying to me, but I understood every word. Home is where the heart is, and this man is my neighbor. As I leave Damien for the second time, I point up again and then turn my palms up to the Heavens in prayer. He says, “Allah.” And I repeat, “Allah.”

On my second day in Salzburg, I take the long way to the conference center, hoping to run into my friend Damien. I turn the corner and there he is, sitting at the end of the block. My stride lengthens and my steps quicken. As I approach him, I see him leaning left and right, squinting his eyes; he’s trying to see if it’s me. He leaves his corner and yells, “Nohannam!!” while jogging towards me and we embrace each other as brothers and lifelong friends. And as my neighbor and friend embraces me, I realize I may not be a good man, but Damien is willing to show me how to become one.

Photo Credit: Sam Rodgers

Emotion Empathy General Law

Gratitude: A Good Recipe for Holiday Cheer

The “most wonderful time of the year” is often filled with stark contrasts. While glitz and opulence surround us, sorrow and despair seem to grow emboldened. Nowhere is this truer than in a big city, where poverty and privilege so closely intermingle. Minutes after I walked down Fifth Avenue, basking in the glow of the Christmas lights infinitely multiplied in the facets of glittering diamonds displayed on shop windows, I found myself peering down into a simple metal container full of school supplies. This school-in-a-box, provided by the United Nations Children’s Fund (Unicef), was on display as part of an exhibit called “Insecurities: Tracing Displacement and Shelter”. Insecurities represents one installation in the Citizens and Borders series organized by the Museum of Modern Art (MoMA) in New York City. The Citizens and Borders project aims to highlight experiences of migration, territory, and displacement[1]. Standing in front of this school-in-a-box, I thought of our medical school, replete with its high-tech anatomy lab, treadmill desks, and air conditioning system so powerful it sometimes forces us to use blankets in our lecture halls for warmth. I thought of my comfortable bed at home, and of the night table that stands next to it, teeming with books, and of the shelf above it filled with movies.

Once more, we find ourselves in the midst of the holiday season, awash with bright lights and commercial cheer. This year’s winter holidays occur on the heels of an extremely draining presidential election season that left over fifty percent of Americans feeling stressed and anxious.[2] Already this month, I have seen patients who have related somatic complaints to the election, cooking, and spending time with their extended family To add insult to inury, the commercialism of the season which suggests we ought to see the world through the rosy hues of a colored ornament can exacerbate feelings of stress and anxiety in those who are already overwhelmed and not feeling their healthiest.. As a caregiver, I realize that it is important for us all to be especially sensitive this year to patients who may be feeling a bit less than the usual holiday cheer.

Peering down into the school-in-a-box reminded me of how grateful I am for the many privileges in my life. Some of these privileges, like a loving and supportive family, or being born in a country with free speech and democratic elections, are pure happenstance. Others I have worked hard for, like the privilege of attending medical school and caring for patients. It is important, now more than ever, that we have gratitude for our privileges in life, and help our patients extend an outlook of gratitude in their own life.

Gratitude has11522685876_5d27ebdb25_o consistently been shown to have a positive impact on mental health. Dr. Martin E. P. Seligman, a psychologist at the University of Pennsylvania, asked study participants to write letters of gratitude to people in their lives whose important contributions had previously gone unacknowledged. He then quantified the impact of these letters on the study participants’ letter writers by providing them with a happiness score. Unsurprisingly, the mere act of writing the letter and expressing gratitude was found to boost each participant’s happiness score.[3] As physicians, we ought to support many outlets for creative expression, from yoga to painting, as ways to contribute to our patients’ well being, but we also need to consider gratitude as its own kind of healing salve. Whether we encourage our patients to write expressions of gratitude to special people in their lives, or just to reflect on the small blessings in their everyday lives, gratitude should have a place in our roster of medical advice. We cannot and should not strive to take away the things in our patients’ lives that cause them discomfort, anxiety, and sorrow, whether they be personal events or national political outcomes. Good medicine is not about making the world a more comfortable place, but rather, making our patients more comfortable within the world.





Photo credit: Timo Gufler

Emotion General Lifestyle

Thank you for being a patient: A reflection on gratitude and its place in medicine.

I was walking through Target a few days ago when I noticed a banner had been discarded in a pile of clearance items. “Give Thanks,” it read. Assuming that the banner was a Thanksgiving leftover, I quickly moved along to a different aisle. Later that day, I started thinking about that banner, and its lowly place in the clearance bin. Gratitude has become a seasonal commodity. From November to mid-December, we’re reminded to give thanks, be grateful, and celebrate others through food and gifts. Unfortunately, the half-off banner serves as a reminder that the notion of gratitude can become “out-of-season” as we turn the page on the calendar.

One of my personal rules for daily life is to live each and every day with a grateful heart. I think this idea comes from having practiced yoga for more than a decade, where gratitude is a foundational tenant. At the end of almost every yoga class I have ever attended, both teacher and students bow their heads and say, “‘Namaste.” Namaste is a Sanskrit word which, loosely translated, means ‘the goodness in me honors the goodness in you.’ For me, this sacrosanct moment at the end of class is what makes yoga different from any other activity I have engaged in. As the instructor thanks me for allowing him or her to share the practice of yoga, I can both thank the instructor, as well as take a moment to thank myself for taking the time to do something good for myself. In contrasting my own personal attitude of gratitude with the Hallmark-esque notion that gratitude is a seasonal commodity, I began to wonder what place gratitude might have in the practice of medicine.

In my brief time as a student doctor, I have witnessed patients struggling with complex challenges that I never even considered prior to medical school. It’s true that many patients will visit us when they have a stuffy nose or an itchy rash, but just as important are patients who see us when they are struggling to quit addictions, deal with a major life change, or manage their own healthcare on a limited budget. It is these patients, especially, with whom it is imperative that we as healthcare providers work with to build trusting relationships. I believe that the first step of building such a relationship is an expression of gratitude. I want to thank patients for being brave, for reaching out, and for asking to get help. I want to tell them how very grateful I am that they have respected themselves enough to value their health, and for trusting me, or one of my colleagues, to help them make very important and potentially challenging life changes. Essentially, I want to say Namaste.

As we leave behind the snow-dusted magic of the holiday season, we should not let gratitude melt away like a snowman. Gratitude should be a part of our daily lives and a cornerstone of our medical practice. It only takes a moment to let our patients know how thankful we are for being part of their journey to wellness, but I predict that the impact it has on our physician-patient relationships will be long lasting.


Featured image:
The Stethoscope by Alex Proimos