Its amazing that Bruce Rabin stays calm. After spending the day running from meeting to meeting at dizzying speeds, hes sitting in his office, fingers pressed together at the tips, legs stretched in front of him, eyes closed. Only moments ago, in the middle of a staff meeting, he shrieked: Oh! I have musicI forgot to turn on my music! Now, soothing sounds of harps and flutes blossom from speakers hidden in the spidery plant that dangles from the office ceiling. Just sit back, Rabin tells his staff, sit back. So they do. The immunologist, the exercise physiologist, the nutritionist, they all sit back.
Though he exudes an almost eerie air of serenity, Rabin, professor of pathology and psychiatry at Pitt, is Dr. Stress. Hes spent the past 30 years researching the physiologic effects of stress on the body. And hes discovered that the effects arent good. His work made him the ideal candidate to take charge of the newly christened UPMC Health Enhancement Program (HEP), which is a joint effort between UPMC and the School of Medicine.
HEP plans to offer stress-reduction programs that will help people stay healthy longerand heal more quicklyby maximizing their bodies immune systems. There will be exercise classes for treating depression, tai chi sessions for balance, meditation for stress management, and music therapy for accelerating healing in locations such as emergency rooms and patients hospital rooms. These kinds of practices are considered by some to be on the fringe of medicine. But not to Rabin.
Isnt it relaxing? Rabin yells over the music emanating from his plant. Its designed to be relaxing. He closes his eyes again, peaceful in a dimly lit sea of earth tones: Brown and tan shag-carpet art, soft brown couches, even a brown and tan background for the email program perpetually open on his computer screen.
When Rabin steps outside his office, he trades earth tones and music for lab coats, stark white rooms, giant centrifuges, and walls of microscopes. His routine usually revolves around attending meetings, teaching courses, delivering lectures, being interviewed about stress by national publications such as Newsweek, and organizing workshops on smoking cessation, weight loss, and pastoral care. He also oversees the UPMC Clinical Immunopathology Laboratory, which runs the majority of immunologic tests for most UPMC hospitals.
From the outside, it seems his world is fractured in two: The hard science of his lab work and the soft science of alternative medicine. But according to Rabin, nothing could be further from the truth. Standing in his lab, with technicians and graduate students bustling around him, he says, Given what I do, this may look odd, like you should be in the office of a psychologist, not an immunologist. But the lines between immunology and psychology are blurred.
Rabin is a psychoneuroimmunologist, a complicated name for a scientist who studies the impact the brain has on the immune system. So, in fact, his immunology lab makes perfect sense. In his laboratory, he has made several important psychoimmunologic breakthroughs that have been reported in more than 200 peer-reviewed papers, and a textbook thats referred to as the gold standard for the field. It is no wonder hes considered a pioneer in the field.
When you talk to Bruce, youre talking to a world class immunologist, says Ronald Glaser, professor of molecular virology, immunology, and genetic medicine at Ohio State University and himself a recognized world-leader in psychoneuroimmunology (PNI) research. Twenty years ago when he came into the field, he was talking about stuff nobody believed in. The scientists and psychologists who were out there in the early days took a lot of heat, because there wasnt any good science to explain what they were doing. Now there is. And Rabin played an important role in it.
In the late 80s, through work with animals, he showed with hard science that stress weakens the immune system by stimulating specific regions of the brain. When stimulated, these brain regions cause the body to increase production of norepinepherine and cortisolætwo hormones that suppress the immune system. He later replicated these findings in humans and found that by simulating stressful situations, he could cause a marked decrease in their immune function, which he measured through extensive blood tests.
Beyond weakening the immune system and leaving people more susceptible to everything from the common cold to autoimmune diseases and cancer, recent studies by others in the field now show that cortisol kills neurons. So people with chronic high levels of stress begin to show cognitive impairment earlier than people with low levels of these hormones.
People with demanding stress-filled lives seemed doomed. But Rabin soon found that exercise makes the body more resistant to stress: By regularly activating through exercise the same hormone-producing pathways that stress stimulates, the body becomes resistant. As a result, the pathways become harder to stimulate with stress. This means that the more regularly a person exercises, the less susceptible they are to the physiologic effects of stress (though he warns that vigorous exerciseælike running marathonsæcan actually have the opposite affect by over stimulating these pathways and causing immune suppression in the same way that stress does). Rabin has shown this again and again through clinical research on volunteer subjects, and with HEP he can finally bring his science to the public on a large scale.
That is no small accomplishment. This field was met with intense ridicule as it got off the ground in the late 60s and 70s. However, because of research like Rabins, its becoming increasingly accepted as a field of good science. And other immunologists are thrilled to see it taken seriously.
A program like [HEP] is where medical science needs to go, says Keith Kelley, professor of immunophysiology at the University of Illinois. The basic research in PNI, which Bruce was instrumental in getting done, has clearly documented the biology of the links between the brain and the immune system. Its shown that the systems talk to one another. To move this out of the lab and into this next phase while integrating it into an entire health system, thats pushing the envelope a little bit. And if anyone can pull it off, its Bruce Rabin.
This next phase of PNI research goes beyond offering proven health enhancement therapies to patients; it will also move the science of PNI into its next chapter through collecting hard data on the clinical application of its science: Who utilizes it, how frequently, and how it affects their overall health.
With this program, Bruce is in a position to really make a significant impact on moving the field forward by illustrating the clinical relevance of the science, says Ron Glaser. Were trying to do the same here at Ohio State. But were not having the same success, because we dont have the same level of institutional support. This says something not only about Bruce, but about Pitt and the mindset that they have there.
Because its often associated with controversial alternative medical practicesælike homeopathy, acupuncture, and herbsæsome people are quick to criticize programs like HEP. This is why Rabins program doesnt have the words complementary or alternative in the name, which was a very conscious decision. The way he sees it, theres nothing complementary or alternative about HEP, and its just plain wrong to say otherwise.
What we have here is a problem of definition, says Donald McBurney, a psychology professor whos one of the few outspoken critics of complementary and alternative medicine at Pitt. No one agrees on what were going to call complementary medicine, alternative medicine, or just medicine. But for McBurney, theres a simple division: medicine is based in science; complementary and alternative medicines arent. Take therapeutic touchæthe ancient practice of laying on hands in order to heal. To date, there have been no scientific studies into the efficacy therapeutic touch, and no hints about the ways in which it supposedly boosts immune system function, ergo: its alternative.
McBurney has a favorite saying that goes something like this: Alternative medicine is just the politically correct term for quackery. McBurney firmly believes this, and he thinks its important to keep quackery out of clinics. The difference between medicine and quackery is science, he says, so comparing things like herbs and therapeutic touch, which have no scientific base, to things like exercise therapy is like comparing apples to oranges. If were talking about exercise to relieve depression, thats science. If were talking about therapeutic touch, thats quackery. If Bruce Rabin sticks to science with his health enhancement program and keeps the quackery out of it, I have nothing to say but more power to him.
According to Rabin, skeptics like McBurney have nothing to worry about. All the things we do have a scientific basis, thats why we dont use the term complementary and alternative medicine. If it works and its safe and effective, its medicine. Rabins normally reddish face gets redder as he cracks a mischievous grin. If its not proven [scientifically], you can call it anything you want to call it, but we aint gonna do it. His staff snickers, and the one they call the exercise lady quietly sings the Twilight Zone theme song: Do-do-do-do, Do-do-do-do.
Rabins face falls deathly serious. His forehead creases, and his thick, dark gray eyebrows angle down at the center as he raises a finger and holds it in the air. The room falls silent, and Rabin recites one of his favorite mantras: Humor is an important part of our work. Then he giggles, and the room explodes with laughter. But hes not joking: One of his research endeavors will investigate the therapeutic benefits of laughter through bringing teams of local comedians to visit hospitalized patients.
There are so many other possibilities, some evolving daily.
Only hours before playing music for the staff in his office, Rabin and Irene Cain, executive director of HEP, who he affectionately describes as being sutured to his hip, sat at one of their 10-or-so daily meetings. Much of their current efforts focus on getting their program out into the community through libraries and other easily accessible spots. As part of this effort, they met with a local health club owner over lunchsalads all around, of course, dressing on the sideæand discussed strategies for offering exercise programs for health enhancement.
Between bites, the health club ownera trim, tanned man in a suit as carefully put together as his bodyæput down his fork. He folded his arms across his chest, bolted up from his chair, then sat back down. Then he rose, this time slowly, and lowered himself down again, and repeated the motion five times. Rabin and Cain put down their forks and watched intently.
Chair squats, the man said as he picked up his fork again. Anyonecan do them at home, and I dont care what kind of shape youre in, do that 20 times, and youre going to feel it. Rabin and Cain look at each other and nod: Good idea. And once people master that, the club owner says, have them hold a soup can in each hand to make it a little tougher.
Though HEP will offer programs for everything from exercise to treat depression to nutritional therapies for boosting immune function, much of its energy is focused on reducing the negative effects of stress. A subject Rabin knows intimately.
He used to have an aversion to birthdays with zeros in them. Then when he hit 40, he took a hard look at his career, which had focused strictly on diseases, and he realized there were more healthy people in the world than sick ones. He decided that instead of joining the masses in looking for disease treatments, he could do more for the world by keeping healthy people from getting sick. This was the early 80s, and stress was the latest buzzword. People everywhere started grumbling, Im so stressed out. Id see mothers in grocery stores yelling at their kids. Thats when I got emotionally attached to stress.
Rabin devoted decades of his career to researching the basic science behind stress and the immune system, and with HEP, he finally has the chance to put his science to clinical use.
We teach people how to cope with stress in a healthy way. We dont say, quit your job, go live in the Rocky Mountains. Thats not practical. People have to learn to live with the unavoidable stresses of life, and make sure their work brings satisfaction, not stress.
This is exactly what Rabin did at 40. And among other things, it helped him get over his aversion to zero birthdays (a good thing, since this year is the big six-zero). The fact that he exercises regularly (well, almost regularly), and meditates often (well, pretty often) helps him maintain his calm.
But he has another secret: I always emphasize that the number of years old you are is meaningless. What affects your health is your immunologic age, but what affects your immunologic age is your psychologic age. So creating an environment to live and work in, and having the faith that youre making a difference by contributing to the betterment of society, that helps you keep a young psychologic age. And when you do something like that for a living, youre not working any more
its not a job, and its not a hobby. Its just a joy.
Its a good thing Rabin knows so much about combating stress, because he still has his share of personal battles. In the middle of his health club meeting over salads, squeezed between two other meetings back-to-back, his cell phone rang. He scrambled to answer it, fumbling with the phone, apologizing. Im sorry, my daughters dilating, I have to get it. He is expecting his third grandchild, with a fourth on the way. Hes armed with a plane ticket to Arizona, so he can hop on board when the time comes. Like an expectant mother, he drives around town with a suitcase in the trunk of his car.
He also has three offices scattered around Oakland, yet he almost always answers his phone, regardless of which number you call: If hes in a meeting at, say, his Childrens Hospital office and you call his office in Forbes Tower, chances are, hell still answer the phone (his secret: call forwarding). When he answers, he doesnt waste time on formalities like hello. He just says Rabin, and gets to business. Colleagues sometimes joke about not knowing which office to find him in, and he tells them it doesnt matter. Im in all of them.
Rebecca Skloot is a Pittsburgh-based freelance writer. Her first book, HeLa: The Immortal Cells of Henrietta Lacks, will be published by Times Books next year.
Rabins Guinea Pigs
Bruce Rabin shakes his head and laughs as a group of 20 or so senior citizens bicker over who gets to move chairs. I need the exercise, one of them yells.
Get your own exercise, a woman quips back. Dont try to steal mine.
Oh, theres plenty to go around, Rabin says, grabbing a chair off the stack and adding it to the circle thats forming around him. The seniors, who call themselves Rabins Guinea Pigs, laugh as they arrange chairs in a hallway of the Carnegie Library of Pittsburgh in Oakland, where theyll soon commence their weekly meeting.
Rabin, professor of pathology and psychiatry at Pitt, organized this group as a pilot project for a program that will be offered through UPMCs new Health Enhancement Program. Through these groups, Rabin hopes to keep seniors healthy by teaching them to cope with problems like depression and stress management, and helping them maintain meaning in their lives.
Exercise is an important part of the group, but its only a small part of how they spend their time. They attend classes to learn about computers, so many now keep in touch with disparate friends and family through e-mail. And they infuse meaning into their work by helping each other adjust to personal issues and by using the skills learned in their group to teach others: several members recently began teaching computer seminars to their peers throughout Pittsburgh.
Keeping busy without a clear purpose is okay, says Rabin, but its not rewarding. Its just busy activity while you wait to die. And if theres one thing certain about Rabins group, its that they are all busy, and none are waiting to die. Far from it.
Theyve developed a reputation after getting kicked out of the museum for loud, rambunctious yoga sessions. Now theyre often spotted in the middle of the social sciences section at the Carnegie Library doing tai chi or meditating in the hallway.
Each week, after negotiating their chairs into a circle, the group dives into the discussions that helped bond them from the beginning. They nibble on muffins, giggle, and talk about everything from sex and aging to end of life. Then they meditate. As Rabins voice echoes in the hall, several from the group sneak reassuring peaks at their friends across the circle, then they squeeze their eyes tight and let go.