Monday, April 1, 2013

By Stephanie Innes, Arizona Daily Star, March 31, 2013

You'd have thought it was a rock concert, not an arthritis lecture.

The University of Arizona's Living Healthy With Arthritis was packed with 370 people early on a Saturday morning last month. More than 50 people couldn't get in.

A similar talk at the Arizona Inn a few weeks later quickly sold out. A third lecture with the same keynote speaker at Tucson's Festival of Books this month was standing room only.

Dr. Esther Sternberg, an international star in mind-body research, is a scientist who draws a crowd.

Sternberg, recently hired by the famed UA Center for Integrative Medicine, applies hard, evidence-based medicine to quantify how emotions affect the immune system. By measuring physiological responses, she's using scientific rigor to show how stress makes people sick, and the way activities like prayer and tai chi can make them well.

Part of Sternberg's draw is that she shares a very personal story about how she became open to concepts about the brain that, as a scientist, she once avoided.

The UA spent nearly two years recruiting Sternberg to Tucson from Maryland, where she was a leading neuroimmunologist at the National Institutes of Health. She's now the first-ever director of research at the local integrative medicine center, which was founded by author and holistic health expert Dr. Andrew Weil.

Integrative medicine combines alternative health strategies like meditation with mainstream treatment. The UA center is relying on Sternberg to give the field something it desperately needs - scientific proof that it works. Her job is to quantify the effect of mind-body interventions ranging from acupuncture to a daily walk. If she can do that, she will be doing groundbreaking work in advancing healing strategies that some mainstream physicians have dismissed as hocus pocus.

"We really need to be able to show that integrative medical care is both cost effective and clinically effective. If we don't do that, then it's not going to be able to broadly weave its way into the complexity of health-care systems," the center's executive director, Dr. Victoria Maizes, said.

"She's been working on noninvasive ways to measure people's well-being. Think about it. If someone is meditating, you can't exactly then draw their blood. Almost all of us tense up," Maizes said. "Her research is really innovative and cutting edge in terms of giving us new tools to measure people's overcall state of health as opposed to illness."

Named top physician

Sternberg, a board-certified rheumatologist, is in a good position to give alternative therapies a big dose of credibility.

In 2005, the National Library of Medicine named her one of 300 female physicians who have changed the face of medicine. She's a stickler for science as the only truth.

"It feels like I am an exciting startup company in Silicon Valley," Sternberg said in a recent interview in her Tucson office. "It hasn't just started, but it has that enthusiasm and sense of commitment for the mission for getting integrative medicine into the mainstream of medicine."

Her goal is to create a tool kit for mind-body interventions by providing the scientific rationale for using them.

Sternberg was attracted to the UA Center for Integrative Medicine's focus on prevention and well-being.

"That fits not only with my views, but with the view of the World Health Organization, which has defined health as far more than the absence of disease," she said. "It includes the environment. It includes social and behavioral interactions."

As Sternberg describes it, life is stress, stress is life. But by reducing stress, we can help our bodies to do their job healing.

"You can't get rid of your genes. You can't get rid of bad things that happen to you. But you can do healthy lifestyle changes and integrative approaches that can help you cope with whatever the condition is," she said.

Those interventions could also result in health cost savings. Interventions such as guided imagery before surgery may reduce the amount of pain medication a patient needs.

"The brain has its own anti-pain pathways and if you can activate those pathways with another way, you might be able to need less drugs," she said.

One thing Sternberg will not be doing is studying outcomes of herbal remedies, which Weil has long recommended. Other researchers at the center are studying the effectiveness of supplements.

Sternberg is sticking to the brain-immune connection. What she's found is that the the brain's hormonal response to stress plays a role in the body's susceptibility to autoimmune inflammatory disease, and to how severe it becomes.

She has brought a research team that includes Eve Edelstein, who is a neuroscientist and architect, plus two researchers from the National Institutes of Health: electrical engineer and pain and spirituality expert Perry Skeath and immunochemist Min Jia. Jia is developing a new generation of sweat patches that measure physiological and molecular connectors between the brain and immune function.

Skeath noted that the team will be collecting solid evidence from the ground up, and they will measure not only the body's response to stress, but the mind's response as well. Ultimately there will be clinical trials, but the process to get there will require patience.

"We are doing studies in poorly understood phenomena," he said.

Her own experience

A Montreal native who earned her medical degree at McGill University, Sternberg began her career as a family practitioner. She served on the faculty at Washington University in St. Louis and in 1986 became a senior scientist with the National Institutes of Health, where she was section chief of neuroendocrine immunology and behavior at the National Institute of Mental Health.

Sternberg willingly shares anecdotes about her own history with an autoimmune disease, which began with a flare-up of inflammatory arthritis as her mother was dying of breast cancer.

"My grandmother had lupus, my mother rheumatoid arthritis, my cousins have all kinds of different autoimmune diseases," she said. "When I went through a period of extreme stress, I developed arthritis. It turns out I have one of the genes that predisposes me to developing arthritis. So it's not surprising I developed that condition. And it's also not surprising from the research that I did that I developed it during a period of extreme stress."

Sternberg was supposed to go into the hospital for knee biopsies and begin taking an experimental drug for her arthritis. Instead, she skipped the hospital and accepted her neighbors' invitation to spend 10 days on a Greek island. In Greece, she swam, walked, socialized and spent time looking at the ocean. Her arthritis began to heal.

"I just felt so much better," she said. "I had this 'aha' moment. I had been doing it all wrong back home - working 24/7, eating french fries and cheeseburgers for lunch. I wasn't exercising, and I was stressed."

She shared her story in a 2009 hourlong PBS special called, "The Science of Healing with Dr. Esther Sternberg."

"That personal experience is really what tipped me over the edge," she said. "I knew what stress was in an intellectual and academic way. But until I personally experienced it myself, I didn't know what stress making you sick was."

Biomedical focus

At that point, Sternberg began paying more attention to Weil's work.

"I was on this journey myself of evolving from somewhat of a skeptic to a believer," she said. "I was a very biomedically based researcher. I think I and many of the researchers in this field tried to distance ourselves from what might have been called less scientifically based approaches like meditation."

Sternberg has written two popular books about her research - "The Balance Within: The Science Connecting Health and Emotions," and, "Healing Spaces: The Science of Place and Well-Being."

In 2010, the UA center brought Sternberg to Tucson as a guest speaker and screened her PBS special at the Fox Theatre. There was not a single empty seat. That's when Maizes first approached her about moving to the Southwest.

"I had the sense maybe she was considering a change," Maizes said.

While she was excited to be a part of the UA Center for Integrative Medicine and to work with other research disciplines, Sternberg knew very little about Tucson and wasn't sure whether she'd like it. She describes herself as a big city East Coast girl who loves the snow.

But she's been happy here and has made a five-year commitment to the UA.

"I thought the desert would be just sand and pebbles," she said. "Tucson is gorgeous - a rich, hauntingly beautiful, variegated, textured landscape. And I can't stop looking at the mountains. Talk about a healing space. The view of the mountains, from wherever you are, is stunning, healing and calming."

Architecture and health

Though architects have long thought the design of a building can have a healing effect, Dr. Esther Sternberg is collecting hard evidence to prove that's true.

Sternberg is leading the creation of the "Institute for Place and Well-Being" with the University of Arizona's College of Architecture, Planning and Landscape Architecture.

"The professions of architecture, planning and landscape architecture have evolved to a point where design really needs some grounded evidence to confirm some thought we've had for a long time," college Dean Janice Cervelli said. "In order to get to that level we need to engage with scientists like Dr. Sternberg."

Cervelli says Sternberg's knowledge of design is "rare and extraordinary."

"You just don't see scientists and doctors that have that depth of appreciation and knowledge on both sides," she said. "It's such an amazing combination."

In addition to advising national bodies like the American Institute of Architects and the U.S. Green Building Council on health and design, Sternberg lectures about the subject around the world. Last summer she spoke at a conference in Lourdes, France, a place known for pilgrimages and miracles. She says it's possible that a beautiful location like Lourdes could actually dull the brain's pain path and contribute to healing. Her talk got the attention of the Roman Catholic Church and in the fall she traveled to the Vatican where she met then-Pope Benedict XVI and spoke about bringing spirituality and healing into hospitals, regardless of faith.

Sternberg has brought a research team with her to the UA that includes Eve Edelstein, who is both an architect and a neuroscientist. Edelstein had previously been conducting research at the University of California-San Diego, where she worked on using electrophysiological brainwave recordings to track the human response to design.

"Most of the outcome measures of how the built environment affects health have been traditionally subjective scales - happy and sad scales -how do you feel in this particular space?," Sternberg said. "We are taking it to the next level."

Contact reporter Stephanie Innes at 573-4134 or