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UNDERSTANDING AROMATHERAPY

The patient lies immobile on a cold bench ensconced in a large metallic tube. Doctors and nurses bustle about, adjusting dials, double-checking procedures, watching the clock. Occasionally, someone attempts reassurance, patting her shoulder and saying something like, "It will only take thirty minutes or so." The patient blinks. Above her head, the large Magnet Machine whirrs into action. The space seems to close rapidly around her. Will the Magnet Machine confirm the presence of cancer? A large tumor? Inoperable? Terminal? The whirring becomes louder, the pitch higher, and the space smaller. Her hands sweat, her heart thumps, her stomach sinks. Thoughts rush again to the possibilities as the Magnet Machine emits a large "clank" above her head. Cancer? Inoperable? Terminal? She can't take it anymore. She signals to the doctors. She wants out. But she gets...vanilla.

Magnetic Resonance Imaging (MRI) tests for the diagnosis of cancer can be an anxiety-ridden procedure for many patients. About one out of five do not complete MRIs due to claustrophobic reactions. Not only does this delay necessary diagnosis, but, at $1,500 per imaging session, the average fifteen minute delay costs over $60 million a year.

Many methods have been used to calm patients down. Anti-anxiety drugs are sometimes used, but they can have unpleasant side effects. Relaxation techniques have been tried, but they are time consuming and not always effective. A path-breaking experiment conducted by Dr. Sharon Manne at Memorial Sloan-Kettering Cancer Center, however, found that exposure to heliotropin, which has a vanilla-like scent, significantly reduced patients' anxiety during MRIs.

Manne's finding joins a burgeoning literature indicating that there is more to the sense of smell than meets the nose. Research by the chemical and medical industry has found strong evidence for what folk medicine has always claimed: odors can do many good things, such as reduce anxiety, promote health and well-being, heal the skin, and improve digestion. Vanilla to relax! Rose for emotional work! Hazelnut for skin care! Word is getting around. In late 1997, the Massachusetts Board of Registration in Nursing voted to include aromatherapy as part of a nurse's approved medical tool kit. "It was incredible how many nurses were calling us up to ask about aromatherapy," says Elizabeth Lindberg, the Board's nursing practice coordinator. Aromatherapy has gone mainstream.

Yet, sniffer beware: modern aromatherapy is still in its infancy. While it promises to be a major complimentary therapy in coming years, learn about its uncertainties before bathing in the aroma of the day.

Odors are all around us-silent, invisible shock troops wafting through the atmosphere to give advanced warning to the brain that something is out there-good or bad. We run toward Mom's apple pie because it "smells good" and is healthy. We avoid the smell of a dead animal in the woods, because it is diseased. A quick, sharp inhalation can take you back to your childhood and unleash memories that have been tucked away for years. The olfactory sense is crucial for survival. Without a sense of smell you would not smell smoke or a natural gas leak. Animals with a diminished sense of smell are as handicapped as the blind. In parts of Italy, only black sheep are raised, because white sheep cannot smell St. John's Wort, a poisonous plant to some animals.

Given the importance of smell, it seems only reasonable to conclude that exposure to certain scents might have implications for health and well-being. Thus speaks the Aromatherapist. Aromatherapy is generally defined as the use of essential oils (fragrant, highly concentrated, volatile extracts from plants) to achieve therapeutic effects. While once considered waste products, it is now understood that essential oils are part of the plant's immune system. Some essential oils are incredibly complex, containing hundreds of constituents so small that they cannot be accurately analyzed. When inhaled, essential oils enter the bloodstream through the lungs. The oils will last up to one day in the body (depending on such things as viscosity, concentration, and application method).

How aromas affect the human body remains a mystery that science has yet to adequately address. Dr. Sharon Manne's report concerning the use of heliotropin on MRI patients is a study of scientific caution. She notes that the relaxing effect is psychological in nature, because the fragrance could have elicited reactions (i.e., thoughts, images, emotions) that were incompatible with sensations of anxiety. On the other hand, Manne could not actually measure physiologic reactions of the heliotropin, because it would have interfered with the MRI procedure.

Interestingly, the more a patient enjoyed the smell of heliotropin, the more he or she had less anxiety during the MRI, lending credence to the theory that aromatherapy is really a mind-nose game. Dr. Avery Gilbert, scientific affairs director of the Olfactory Research Fund, argues that in all likelihood, aromatherapy's effects are psychological, not pharmacological. The problem, Gilbert notes, is that inhalation is an inefficient way of getting the oil to do whatever work it does, because the concentrations of substances entering the bloodstream in vapor form is very, very low compared to other avenues such as ingesting it or having it massaged into your skin. "The human sense of smell is down to parts per billion. It doesn't take very much to get a sense of smell. So, I think the effect is not pharmacological, but psychological."

Psychological effects could be mediated by past emotions, what Dr. J. Stephen Jellinek, a fragrance expert in Germany, calls the semantic mechanism. "A person may have smelled lemon oil when drinking a cool glass of lemonade on a hot summer day," Jellinek says. "Upon smelling lemon oil later, the person once again experiences the refreshing effect of the drink now associated with the smell of the oil. The effect occurs even if the whole process takes place subconsciously." But even with a pleasant smell like lemon, the emotional feedback can be potentially harmful. Dr. Michael Scholes, President of the Los Angeles-based School of Aromatic Studies, recalls one class in which he passed around citronella. "A woman got up in the middle of the class, left the room, and never came back," Scholes recalls. "I called her back and got no response. Then, three weeks later, she called back and said that she left the class because she could not stand the smell and could not breathe. She told me that she had a therapy session and discovered why she did not like that fragrance. As a child, when she was bad, her mother used to lock her under the sink with the cleaning fluids. And guess what the smell was under the sink? Lemon!"

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