Update: a follow-up post is here, for those who want more on Qi Gong, placebo effects and the like.
Well, we don’t even know who the new FDA commissioner is going to be under the Obama administration, but people are already making their bid for a change in direction. In Friday’s Wall Street Journal, you can find Deepak Chopra, Rustum Roy, and Andrew Weil with an op-ed titled “Alternative Medicine is Mainstream”. I think you can go ahead and silently append “. . .And Deserves Serious Mainstream Funding”.
My hopes for this piece were not high – Deepak Chopra, for one, I consider to be an absolute firehose of nonsense. Both he and Andrew Weil should be whacked with sticks every time they say the word "quantum". But they manage to avoid that one here - the op-ed turns out to be a marbled blend of things that I can agree with and things that make me raise both eyebrows. Its general thrust is:
1. Chronic diseases related to lifestyle (diet, physical habits, etc.) account for a large percentage of health care costs. These could be ameliorated or downright prevented through changes that don’t involve medical procedures.
2. “Integrative medicine” (by which the authors mean, among other things, plant-based diets, yoga, meditation, acupuncture and herbal therapies, have been shown (they claim) to help with such lifestyle changes, and with less expense. The definition of integrative medicine is not provided, nor is the boundary line between it and "regular" (disintegrative?) medicine drawn.
3. Therefore, the incoming administration should make these a big part of the health care system as soon as possible. Did we mention the funding?
Now, I can’t argue with that first point. Cardiovascular disease and Type II diabetes could both be much smaller problems if people in the industrialized nations would just eat less food (and better food) and exercise more. The editorial makes it sound as if no one believes this or has ever heard of such a thing, but come on. No one’s heard anything else for decades. However, it seems equally clear that jawboning people about this issue does not do nearly as much good as one might hope.
Whether “integrative medicine” is any more effective is something that I would very much like to see someone prove. The authors seem to be familiar with a bunch of well-controlled studies that I haven’t heard about, and I invite them to trot out some data. But some of the statements in the op-ed make me think that my cardiovascular health won’t be able to stand it if I hold my breath while waiting for that. For example, we have:
”Chronic pain is one of the major sources of worker’s compensation claims costs, yet studies show that it is often susceptible to acupuncture and Qi Gong. Herbs usually have far fewer side effects than pharmaceuticals”.
Studies show, do they? Is there really a believable study that shows that Qi-freaking-Gong, of all things, is good for chronic pain? Ancient hokum about “energy fields” and “life force” does the trick, does it? My idea of a good trial of Qi Gong would involve one group of patients getting the full hand-waving treatment according to the best practitioners of the art. The other cohort gets random hand motions from a system I will gladly invent on request, and which I will have to be forcibly restrained from naming Don Ki Kong. It’ll be full of talk about holistic energies and connections to the universal flow, don’t you doubt it, and I’ll round up some impressive-looking worthies to administer the laying on of hands. Their passes and taps will be carefully screened by the Qi Gongers beforehand to make sure that none of them, according to their system, have any chance of actually having any effects on the Qi (assuming that any of them can agree). We call that a controlled trial to investigate placebo effects.
And I hardly know where to start with those beneficial herbs. The literature I’ve been reading has been showing that many of the herbal treatments show no effects when they’re looked at closely – St. John’s Wort, Echinacea, and so on. The larger and more well-run the trial, the smaller the effects go, in too many cases. But I have no problem with the idea that plants and plant extracts can have medicinal effects, of course: they’re full of chemicals. My whole career is predicated on the idea that taking chemicals of various sorts can alter one’s health. Where I jump off the parade float is at the nature’s-bounty-of-beneficial-herbs stuff, the idea that things are somehow more benign because they come from natural sources. Vitalism, they used to call that. It’s hooey. Strychnine. Ricin. Come on.
The editorial is full of fountains of happy talk like this one:
Joy, pleasure and freedom are sustainable, deprivation and austerity are not. When you eat a healthier diet, quit smoking, exercise, meditate and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep. Your brain may grow so many new neurons that it could get measurably bigger in only a few months. Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent -- similar to the way that circulation-increasing drugs like Viagra work.
Calling Dr. Love! All I have to do is change one letter in my last name, and I'm in business, expanding brains and other useful body parts. Unfortunately, that first sentence typifies a lot of thinking in this area. It's one of those "isn't it pretty to think so" statements. As far as I can see, deprivation and austerity have been the norm for most people throughout most of human history, even though they were eating natural foods and getting lots of exercise and fresh air. And one of the big reasons that people put on weight is that they have the freedom to experience the joy of tasty food a bit too often. No, this is noble-sounding stuff, but there's nothing behind it.
Update: Orac's take, with more on those "studies".