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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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In the Pipeline

« Poor Equipment Revisited | Main | Lack of Experience, You Know »

January 12, 2009

An Alternative Prescription From Chopra, Roy, and Weil

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Posted by Derek

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".

Comments (70) + TrackBacks (0) | Category: Press Coverage | Snake Oil


COMMENTS

1. Anonymous on January 12, 2009 9:52 AM writes...

When's Michael Moore going to go after the alternative medicine industry?

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2. retread on January 12, 2009 9:54 AM writes...

One of the joys of being retired from medicine is that I no longer have to explain to patients why these things are unlikely to work. I find the stuff amusing now. It's always fun to shop at Whole Foods and watch the credulous in the health aisle (which is quite extensive -- for the same reason that makeup takes a lot of floor space in Macy's -- it's extremely profitable). The clientele is likely the most upscale and educated you are likely to find in a grocery store. Where is Ambrose Bierce when you really need him?

The profession, since at least the 60s, has been advising people to lose weight, stop smoking, exercise a bit, with neglible result -- see the various NHANES studies, so anything the holistic practitioners can do to promote it, is OK. The profession may have even caused some of this by telling people to cut out fat. Unfortunately we have to eat something and most people substituted carbohydrates, which bounces blood sugar around and (which some researchers think) increases appetite.

You might be amused by reading the following paper -- it really happened. [ J. Am. Med. Assoc. vol. 279 pp. 1005 - 1010 '98 ] A paper from a 10 year old girl demolishes therapeutic touch, a practice by which 'healers' of various persuasions are able to sense human energy fields (whatever they are) and use them to cure disease. The sad thing is that some 80 nursing schools teach it.

Cynical types, such as Derek or the readers of this blog would never have gotten into the door to do such an experiment.

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3. MarkySparky on January 12, 2009 10:05 AM writes...

"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."


If I lift weights regularly while listening to The Star Spangled Banner sung in Hindi, I bet I'll gain muscle mass. Any bets as to the mechanism?

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4. Max on January 12, 2009 10:15 AM writes...

If universal health care ever gets a grip on the U. S. you can bet these are the people who will make every effort to infiltrate the system and impose their ideas on all of us. Every country that has a national health care system also has lifestyle police. The offerred explanation is that costs can be better controlled if people live healthy lives.

Obama wants all medical records computerized.

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5. Anonymous on January 12, 2009 10:20 AM writes...

Content is content, and good content will get you read. But good writing is good writing and when combined with good content will get you read widely. This is a commentary with good content but "Firehose of nonsense..", "Don Ki Kong.."is well written. Kudos.

Zz
"Dying is easy, comedy is hard."

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6. Hap on January 12, 2009 11:08 AM writes...

The lack of data (and the appearance that the lack of data is not a problem) does not endear me to their position. Getting people to give up the things people like in the amounts they want them is the hard part, and it would be helpful to see if it works in populations not already unlikely to need the help.

I think it would help if Congress would repeal the portion of the act which allowed supplement makers to market without evidence of effect - the concept that if something claims to have an effect there should be evidence of such would be helpful to weed out the unuseful parts of holistic medicine and to get rid of the ones willing to use the lack of claims enforcement to sell their snake oil. I know you can't make people think, but getting rid of much of the haystack would make it easier to find the needles.

I don't think universal health care would impose the "holistic medicine" theory on everyone - it would more likely go the way of some companies to fine and preclude coverage if you do things whose consequences are expensive to treat, and that would be hard because many of your voters are in the set of people doing precisely that.

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7. daen on January 12, 2009 11:12 AM writes...

"If universal health care ever gets a grip on the U. S. you can bet these are the people who will make every effort to infiltrate the system and impose their ideas on all of us. Every country that has a national health care system also has lifestyle police. The offerred explanation is that costs can be better controlled if people live healthy lives."

Well, Max, I very much doubt you have the slightest idea what you're talking about. Universal health care does not imply having "lifestyle police". Does the NHS in the UK have "lifestyle police"? It does not. France? Wine. Denmark? Smokers' paradise. Spain? Wine AND smoking. I've lived under both the Danish and British health care systems, and my parents now live under the Spanish system, and we have very little to complain about. I think you should look forward to it, even though the costs will inevitably be high, but that's sort of implied by the word "universal". The knock-on economic benefits of not having a large proportion of the population unable to work through sickness and unable to afford treatment, on the other hand, will be significant.

My aunt, in the US, recently had a hip replacement which went wrong. It currently costs my aunt and uncle $2,000 per day for care, which they can ill afford, because of a mistake, which they will only be able to get back through legal recourse. Don't tell me your system is more efficient and/or better when so much money ends up in the hands of investors, administrators and lawyers instead of in hospitals, and don't knock other countries' systems until you've tried them, particularly if you're knocking them for the wrong reasons.

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8. Jose on January 12, 2009 11:15 AM writes...

Did the WSJ really put the phrase, "Your sexual organs receive more blood flow, so you may become more potent -- similar to the way that circulation-increasing drugs like Viagra work." into print? Where, exactly, are the flying monkeys?

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9. Lev on January 12, 2009 11:19 AM writes...

Qi Gong vs.Don Ki Kong study would need a "do nothing" third group. I bet that waiving hands regularly for 20 minutes a day (in absolutely any style or lack thereof) *would* do good things to one's health. ;-)

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10. gary2 on January 12, 2009 11:43 AM writes...

It's good to have a diverse critique of these issues. I do have a few questions. The mainstream approach to health, big pharma, has quite a few unanswered questions. From what I've read ..... big pharma spends twice as much on marketing as they do on R&D..... the people in the F.D.A. can hold stock in companies they pass judgement on ...... the number of lobbyists in D.C. representing big pharma (2005) was about 1,275, big pharma spent ( 2007 ) $190,000,000 on federal lobbying. A medical professor from John's Hopkins did a study that showed more people in the U.S. went to alternative medical practitioners than to allopathic physicians. People are not happy with our present form of medical treatment ...... most specifically chronic illness solutions.

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11. RB Woodweird on January 12, 2009 12:05 PM writes...

gary2 sez:
It's good to have a diverse critique of these issues. I do have a few questions. The mainstream approach to health, big pharma, has quite a few unanswered questions. From what I've read ..... big pharma spends twice as much on marketing as they do on R&D..... the people in the F.D.A. can hold stock in companies they pass judgement on ...... the number of lobbyists in D.C. representing big pharma (2005) was about 1,275, big pharma spent ( 2007 ) $190,000,000 on federal lobbying. A medical professor from John's Hopkins did a study that showed more people in the U.S. went to alternative medical practitioners than to allopathic physicians. People are not happy with our present form of medical treatment ...... most specifically chronic illness solutions.


Aaaaaaand..... what are your questions?

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12. Anonymous on January 12, 2009 12:09 PM writes...

Well, gary2, how much does big alternative medicine spend on marketting vs. R&D? Can FDA regulators (or congressmen) own stock in suplement companies? How many lobbyists are in Washington representaing alternative medicine? So more people went to alternative medicine practitioners - what was the proportion that actually got better compared to the mainstream medicine? You seem t be arguing that big pharma behaves badly, and alternative medicine providers will behave goodly. Alternative medicine is absolutely prone to the same abuses as big-pharma medicine (I bet your average Qi Gong practioner (whatever that is) would have no trouble prescribing a never-ending, ever-escalating regime of tests and treatments, if you let em; heck, my barber would be more than happy to keep taking money as long as I'm willing to give it to him). Big pharma, however, actually has to show some data to support their claims. Whether the data is right, relevant, true, is another problem entirely. Alternative medicine sellers need do NOTHING to support their claims. Maybe some do, more power to them, then we can use the scientific method to try to understand and perhaps improve the alternative methods.

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13. Steve on January 12, 2009 12:17 PM writes...

As far as the use of "quantum" these guys aren't the dangerous ones by any means. Most people realize they're using it as a buzz word. I'm more worried about the crazy physicist out there like Fred Wolf. Though I must admit I love Fred's books. It's like reading hard scifi.

Here are few that appeared in "What the Bleep"
* William A. Tiller
* Amit Goswami
* John Hagelin
* Fred Alan Wolf
* David Albert

Also Andrew Weil's medical advice as far as diet seems pretty sound.

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14. milkshake on January 12, 2009 12:25 PM writes...

It is not true that St Johns Wort does nothing - It can make your eyes hurt like hell! I was faintly aware that there is a photo-toxic compound in the herb, but only after two days of extreme eye photo-sensitivity I figured out that my "conjunctivitis" was caused by this natural organic supplement, taken in recommended doses. When you buy a dietary supplement/herb remedy, you are at the mercy of the manufacturer (potency, adulteration and contamination). FDA looks at it only after people get sick.

I am not worried that homeopaths and yogis will sway the new administration - Obama surrounded himself with people that are savvy and pro-science.

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15. MTK on January 12, 2009 12:33 PM writes...

I have no problem with any medical treatment that anyone else wants to use. Unless I have to pay for it. If I as a taxpayer do have to pay for it, then I want some hard data which will support it's use. I am in favor of investing in the health and well-being of our citizens. Investing, not just spending. So once again give me some legitimate data that supports that investment.

The catch-22 here, of course, once something is studied and verified, it would no longer be alternative and therefore lose some of it's "effectiveness".

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16. Sarah on January 12, 2009 1:14 PM writes...

And along those lines, the Chicago Tribune has an article today that basically advises the public to get rid of all body-care products. The reasoning behind this? The presence of trace amounts of carcinogens, or potentially carcinogen-forming molecules. The part that bothered me the most is that the author doesn't provide any sources other than the book from which she takes the claims.

http://featuresblogs.chicagotribune.com/features_julieshealthclub/2009/01/10-chemicals-to.html

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17. JSinger on January 12, 2009 1:15 PM writes...

I'm confident that a few tens of millions invested in rigorous studies of the more plausible "alternative" stuff would yield much more than would extending NIH paylines to fund a bit more borderline same 'ol, same 'ol. The problem is that NIH has been supposed to be doing that already with NCCAM and they've never taken it seriously enough to enforce real rigor there.

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18. RoadNotTaken on January 12, 2009 1:37 PM writes...

to be fair, Qi Gong as it is practiced by millions, is pretty simlar to Tai Chi or Yoga -- that is, it's basically a low-impact exercise routine. you can make as much fun of it as you want because of all the spiritual silliness, but i'd bet that most people that spend a half-hour per day doing breathing and stretching-type exercises will tend to be pretty healthy.

if you visit public parks in Asia (i've seen this in Thailand and Vietnam and heard similar stories about China) they're full of old people doing Tai Chi and Chi Gong-type stuff in the mornings. not so here in the US. there's plenty to take issue with in the article, but it's also probably pretty worthwhile to have public discussions about how to encourage exercise and healthy living. when you make fun of anything practiced by spiritualists you're being every bit as simplistic and close-minded as people who instinctively distrust anything that comes from pharmaceutical companies.

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19. emjeff on January 12, 2009 1:43 PM writes...

I remember about a year or two after DSHEA was passed (which insured that dietary supplements would be regulated as foods, and so could say almost anything in their advertising), my father calling me in a huff, asking how these "hucksters" could get away with their advertising. He was astounded when I told him how the law was basically slanted toward the "natural" supplements industry. Now the question: How did a 68 year old meat cutter from Baltimore end up seeing through this crap, while Andrew weil (M.D., Harvard) still buys it hook, line and sinker?

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20. emjeff on January 12, 2009 1:51 PM writes...

"Heart disease, diabetes, prostate cancer, breast cancer and obesity account for 75% of health-care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle."

How is breast and prostate cancer preventable by "lifestyle" changes?

What f***ing nonsense...

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21. SRC on January 12, 2009 1:57 PM writes...

C'mon, guys, use some imagination!

Let's not fight 'em - let's join 'em!

Take a few mg of a statin, say, dissolve it in a swimming pool of water, and sell it to the dingalings as a homeopathic formulation. COGS...zip!

I know. It's a gift...

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22. RB Woodweird on January 12, 2009 2:32 PM writes...

Sarah, I followed the link and read the ChiTrib article. Now I think there has never been a funny chemical joke, and I kill on sight any chemist who makes a chemical pun, but this was the appropriate time to bust out a link to www.dhmo.org. So I did, Bob forgive me.

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23. BD on January 12, 2009 3:30 PM writes...

PS - of course I'm disappointed the WSJ author did not cite any sources. This practice is too often the norm in popular reports on topics in science or medicine. This problem is often (but not always) confounded by authors' lack of technical understanding, especially in hard sciences.

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24. AR on January 12, 2009 3:47 PM writes...

@emjeff:
DSHEA actually ended up providing _more_ regulation of the industry in many ways. It established 'Good Manufacturing Practices' set by the FDA to ensure the quality of the products, as well as commissions to analyze the claims made on labeling etc. It also provides for the director of health and human services to take any product off the market if it is posing a hazard. All of these were harder to do when dealing with supplements as 'food' items.

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25. Michael Tinkler on January 12, 2009 5:47 PM writes...

I decided that if I didn't get tenure I was going to move south to Ithaca and set up as a practitioner of Traditional Galenic Medicine. You know - lots of humors and temperament talk, herbal healing, hot baths, prescribing Thai food for phlegmatic constitutions and ice cream for the choleric.

I coulda made a fortune!

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26. Wavefunction on January 12, 2009 6:54 PM writes...

Ah...the mentally deficient Chopra and Weil and their followers. All that remains is for them to now team up with Kevin Trudeau. And let's also whack Larry King and CNN along with them who insist on calling upon Dr. Chopra and Dr. Phil as resident experts on all matters ranging from rat hair in your shampoo to serial killers and terrorists.

The WSJ is gradually descending into becoming a forum for quacks. First there was Karl Rove roving about how George is an intellectual who has read 196 books in two years. And now this.

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27. TFox on January 12, 2009 7:35 PM writes...

99% of so-called "alternative" medicine is alternative for a reason. But the molecules don't care whether they are sold under DSHEA or FDAMA, or were prescribed by a witch doctor or an MD, they have the same biological effects regardless of what we call them. I used to work for a biotech which, before collapsing, tried out the herbals business. One interesting feature of the regulatory environment is that, if a substance *can* be sold under DSHEA, there is no economic incentive available for doing the gold-standard clinical trials. The trial is expensive, the drug version is harder to sell, and your competitors can keep selling the identical stuff as an herb. As a result, any hypothetical effective herb will remain a DSHEA herb on the marketplace, where sellers are prohibited by law from mentioning any evidence of efficacy. Rational consumers therefore have to do a great deal of careful literature reading before reaching conclusions. My takes? Echinacea: probably garbage, just wash your hands and get more sleep. St John's Wort? Effective, but with enough side effects, including severe ones like drug interactions, that you really ought to be under a physician's care anyway. Once you're there, there's lots of choices, and SJW is unlikely to be best. And besides, should a depression med *ever* be OTC? Ginseng? Effective, but for about the same indications as coffee, and not as good. Antioxidants / polyphenols? Maybe, but no more so than eating more vegetables. The rest? Largely placebos, but some are actively harmful. Be careful...

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28. provocateur on January 12, 2009 7:44 PM writes...

If you beleive in it so much why dont you guys start an industry and prove it through clinical trials....nt difficult...and I am not being sarcastic!

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29. Marilyn Mann on January 12, 2009 9:31 PM writes...

Great post.

Here's a similar one by Orac:

http://scienceblogs.com/insolence/2009/01/the_three_musketeers_of_woo_meet_dartagn.php

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30. Marilyn Mann on January 12, 2009 9:32 PM writes...

Great post.

Here's a similar one by Orac:

http://scienceblogs.com/insolence/2009/01/the_three_musketeers_of_woo_meet_dartagn.php

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31. The Necromancer on January 12, 2009 10:51 PM writes...

You present some perfectly valid criticisms of the alternative healing paradigm. One quibble. Your use of the word "vitalism" is way off. It is more than just an idea of the healing power of natural remedies derived from plants. Vitalism has a long and under-appreciated history in the west, and was foundational in debates about the role of chemistry in understanding life. It has evolved, and forms of neo-vitalism are represented in the concept of holism and in an awareness of the inherent complexity of living things. True, it is also associated with notions of vital force and Qi, but that sells the concept short. It is a critical stance in the face of unbridled reductionism and mechanism and the complete dominance of modern molecular biology in understandings of the living.

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32. Zak on January 13, 2009 1:58 AM writes...

I completely agree with your opinion of "alternative medicine," and would love to see the outcome of a randomized double-blind trial with your Dong Ki Kong. However, to be fair, you have to give Chi Gong the same shot that the big pharmas have: the ability to perform any number of clinical trials, hide the results of ones that don't make the case, and only publicize the ones that happen to offer evidence they're looking for.

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33. john on January 13, 2009 4:45 AM writes...

Well - I hope you can find a scientifically verified cure for how sick this negative speil made me feel. What about the word 'integrative' do you not understand?
To call the work of Weil and Chopra nonsense, shows extreme uneducated bigotry. I guess Hippocrates was also wrong because he couldn't back his findings with laboratory tests? Why does every idiot feel that science is the new religion. Did you not hear that 150,000 deaths per year result from scientifically proven, licensed, prescribed medicines.

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34. daen on January 13, 2009 5:16 AM writes...

"I guess Hippocrates was also wrong because he couldn't back his findings with laboratory tests?"

Yes, Hippocrates was wrong. Illness is not caused by an imbalance in the four humours.

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35. Kitty on January 13, 2009 6:12 AM writes...

Qi Go