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How Is Alternative Medicine Like Earmark Spending?

I recently watched a special news report about John McCain leading the charge towards making legislative earmarks illegal. The Economist defines earmarks this way:

Earmarks, for the uninitiated, are spending projects that are directly requested by individual members of Congress and are not subject to competitive bidding.

Most Americans are rightly upset about the practice of slipping pet projects into larger, well-vetted, and consensus-built legislative initiatives. They know instinctively that it’s morally wrong to sneak in personal favors and appropriate tax payer dollars to special interest groups without allowing others to weigh in. I certainly hope that McCain and his peers will succeed in discontinuing this corrupt practice.

Coincidentally, just after I watched this news report about earmarks, I went online to catch up on my blog reading. The first post I encountered made reference to an opinion piece written by Deepak Chopra, Andrew Weil, Dean Ornish, and Rustum Roy in the Wall Street Journal. Chopra et al. were asking Americans to redouble their efforts to adopt healthy lifestyles (including wholesome diets and regular physical activity) as a means to promote good health and avoid disease. At the end of the article they slipped in a plea for President-elect Obama to consider integrating alternative medicine practices (which included everything from healthy diet to meditation and acupuncture) into a government-sponsored approach to health.

Obviously, healthy eating and regular exercise is sound health advice – and an approach that mainstream medicine has been promoting for decades (well, technically millennia). What irks me is that they seem to suggest that this is “alternative medicine” that they (without help from the medical establishment) are fighting hard to have it included (or integrated) into general practice.

There is nothing “alternative” about healthy diet and exercise. This is mainstream, science-based medicine. The problem with Chopra et al. is that they argue for obviously healthy behaviors and then integrate them with placebos  in some kind of guru’s proprietary recipe for good health.

Why not promote what has been shown to work – healthy diet and regular exercise – and leave out the placebo treatments? Why must “good health” be inexorably linked to specific culture-based practices? Why should people feel pressured to practice yoga, distract themselves by sticking needles in their ears, or participate in Eastern meditation to be well?

As I’ve argued before, we need to disintegrate integrative medicine, and adopt practices based on their individual scientific merits. Adding unproven (and in many cases, disproved) alternative medicine practices into science-based medicine is no different than accepting earmarks in legislative spending. As we anticipate lean times in healthcare, we must carefully consider the evidence for improved outcomes of every potential treatment we fund with our tax dollars, including expensive devices and procedures. Therapies like energy healing, homeopathy, meditation and acupuncture should not be “slipped in” to a government-sponsored approach to wellness without being fully vetted by the scientific medical community.

I can only hope that influential people in Washington will connect the dots between earmarking and certain alternative medicine practices, and say “No!” to both.

Posted in: Nutrition, Politics and Regulation, Science and Medicine, Science and the Media

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17 thoughts on “How Is Alternative Medicine Like Earmark Spending?

  1. MedsVsTherapy says:

    I agree. However, you might want to do some background reading on meditation and on yoga. Each of these shows evidence-based promise for a handful of conditions. I believe in EBM and am not a true-believer in any of these. It is just very promising that mindfulness meditation may help in a few clinical issues including as an expansion for cognitive interventions for depression and as yet another helpful strategy for quitting addictions. Yoga shows promise for a few things including: along with other physical therapy-type interventions, being equal to or superior to back surgery for various back pain conditions, for carpal tunnel syndrome, and (along with other physical therapy type interventions) for preventing knee injuries in young athletes.

    One common ingredient in the psychology-type problems may be simply the effects of deep breathing. “Grounding” (basically, in-the-moment reality self-talk to combat catatrophising) and “distraction” have long been recognized as cognitive strategies for stemming panic attacks. Deep breathing, as part of mindfulness or yoga, is definitely preferable to anxiolytics.

    Brain activity as measured by EEG, can be modified with mindfulness. There is a lot of emerging research concerning different patterns of brain activity when people are calm, and able to use brain power, versus more in panic/emergency/stress mode (to over-simplify: frontal lobe versus limbic). I believe there is a good case to be made that mindfulness meditation (when done right – which is a challenge to assess) may shift the brain activity from panic to thoughtful focus. I also believe that this is a skill that can be trained and taught. I also believe that the deep-breathing may even develop to be a classically/Pavlovian-conditioned cue to have this change happen. These are many dots that need to be connected, but hey, it is just a matter of developing hypotheses and testing them one-by-one. If I am wrong abt any of these or other dots (I believe the connections between cortisol/pro-inflammatory cytokines and mood states may be a function of this brain-activity type of explanation), I am not afraid to say I was wrong – because I am not financially invested in this, as Chopra and Weil are, and because it is not part of my spiritual/cosmological/supernatural/theistic views of the universe, which it is for Chopra and may be for Weil.

    I myself do not believe there is some cosmic, supernatural benefit from mindfulness or yoga. I believe the beneficial effects could eventually be determined, and I have my guesses about what some of these components will be.

    I just give a couple brief ideas and examples so that evidence-based and science-based people do not throw out the baby with the bathwater – same theme as your post. Keep your eyes out for emerging bits of evidence on the benefits of these behavioral activities as potentially valid treatments for a range of significant medical problems and conditions.

    Should yoga be taught in elementary schools, as a couple news stories have shown? I really don’t think so. I myself believe that the people advocating this are probably very weak in explaining why they would come up with an idea like this. My suspicion is that the advocates buy into a cosmic, and vague, well-being/wellness idea (in other words, they believe in the woo and have a powerless group upon whom to impose their woo).

  2. johnilya says:

    “It’s time to move past the debate of alternative medicine versus traditional medicine, and to focus on what works, what doesn’t, for whom, and under which circumstances. It will take serious government funding to find out, but these findings may help reduce costs and increase health.”

    I like that paragraph, isn’t that what scientists and medical professionals do everyday? Wouldn’t Chopra and co be out of business if the debate ended?

  3. Zetetic says:

    Yoga exercises for carpal tunnel syndrome?

    I Googled and found a web site that promotes exercises for the “Permanent Carpal Tunnel Cure”:

    www–carpaltunnel.com

    They attribute carpal tunnel syndrome to “postural muscle imbalance” that is “A Hidden Disorder That Generates All
    Your Carpal Tunnel Pain AND Secretly Destroys Your Body”. The web site is chock full of anecdotal testimonials and the usual altie statements about how mainstream medicine doesn’t have the right treatments for carpal tunnel syndrome.

  4. Alexander Han says:

    Re: earmarks, earmarking isn’t per se bad – often communities know what projects they need, and what really needs funding, so restricting funding to specific projects can be a better idea than throwing money into a general fund for agencies which might fund the project or might fund something unrelated. Earmarking has been significantly corrupted by the undue influence of business interests, etc., and the counterbalancing force of constituent interests has been steadily eroded by population growth without expansion of representation. These are the root problems we need to address.

  5. Jules says:

    Didn’t Dr. Gorski write something about how yoga was beneficial as a mild, low-impact exercise? I get that it’s hard to separate the physical from the meditational from the downright weird aspects of the practice, but knocking on the whole practice of yoga is like a homeopath pointing to the one case where a science-based treatment didn’t work as it was planned and calling conventional medicine poison.

    Now, as far as your question “Why must “good health” be inexorably linked to specific culture-based practices?” Because a lot of what comprises American and Western culture is inherently unhealthy–for modern man.

    Let me enlighten you with the recipe for traditional Dutch pea soup, a thankfully-once-a-year concoction that my boyfriend cooks up every December 31st to celebrate New Year’s with (it’s not limited to New Year’s, but you’ll see why neither of us can stand having it otherwise): 3 kg of split peas; a few carrots; a celeriac, peeled and cut up; one or two ribs of pork; a chunk of smoked pork fat; a chunk of unsmoked pork fat; a sausage. Add water, cook until it’s a nice mash and your spoon stands up unassisted. Eat with dark brown “bread”, spread with mustard, and a slice of smoked bacon.

    This used to be standard fare in the Netherlands, in the days before tractors. It was quite healthy for a farmer who could easily expend 3-4000 cal/day working his land. But for your typical office worker? This is the exact opposite of a healthy diet. The traditional diets that include a lot of whole grains, veggies, where meat isn’t emphasized? Comes from the Far East, where there was never much meat to be had, except by the very rich.

    There are tons of other factors: the influx of farmers in the 1800s from Norway, the popularity of salt pork, Ray Kroc idolizing Henry Ford. But essentially, McDonald’s isn’t Chinese. The Whopper isn’t an Indian construct. And no real Italian would call the grease-soaked stuff pushed by Dominoes “pizza”.

    I hypothesize that it is because Americans don’t have a traditional cuisine that the food is so unhealthy: when there is no traditional cuisine, you tend to gravitate towards consensus tastes–sweet, fatty, maybe salty–the tastes that we are, to some extent, genetically predisposed to enjoy. Now, look at your traditional McDonald’s meal, and tell me that you’re surprised that people think Japanese culture is healthier.

  6. Fifi says:

    Meds – One of the problems is that there are many different kinds of meditation and yoga. So far it’s only awareness and compassion meditations that have been scientifically studied (the experiments with the Buddhist monks), and studied on people who have dedicated their lives to meditating. There is increasing amounts of research being done vis a vis awareness meditation and chronic pain, it will be interesting to see what happens when non-monks try meditation. My experience – entirely anecdotal – was that it was useful for some people with chronic pain but we’ll see what the science says. Meditating is a mental activity and all mental activities develop the area of the brain they’re associated with (the infamous London cabbies being an example). In many ways, awareness meditation is very much like cognitive therapy in that it allows one to become familiar with their thoughts and feelings. That said, most reputable Zen and meditation teachers will suggest a student go see a psychologist if they’re having psychological issues. The more cult oriented version – which often involve ecstatic and trance meditations not awareness meditations – will rail against medicine (and are likely to call themselves a “science” – something Buddhists don’t do).

    Yoga, which I also practice, can be even worse in terms of culty thinking and pseudoscience. There are also many types of yoga – from Bikram and Kundalini to Kripalu and Hatha and they can be quite different from one and another. Yoga is also technically much more than just asanas (postures). It’s a philosophy that includes it’s own medical theories and biology based on chakras. I enjoy yoga, I find a good stretch and focused workout does me a world of good (but so does climbing) since my work is sedentary. Really, a lot of it has to do with focusing and breathing and this isn’t limited to yoga – a lot of physical activities can provide the same benefits. A lot of the anti-science and anti-medicine propaganda comes from yoga cultists like Yogi Bhajan (now dead, head of 3H0/Kundalini yoga) and Osho (now also dead, previously know as the Bagwan Shree Rajneesh before he fled the US and changed his name) and their followers. A lot of the followers don’t understand that it isn’t actually science or “a” science they’re learning but rather a religious philosophy (the religious aspects of yoga are downplayed in North America for the most part to make it more marketable, except by xenophobic Fundies who consider it the gateway to Hell!).

  7. Fifi says:

    Jules – Actually Americans do have all kinds of traditional dishes and regional cuisines (some of them quite rich but you can blame some of that on the French!) Food became an industry in the US, the promise of the 50s was women wouldn’t have to cook (or wash clothes by hand anymore) so you got TV dinners, frozen meals and carnie food at home, take-out and so on and, I suspect, a lot of people just forgot or never learned how to cook. All of this was pushed via advertisements promoting it as “quick and easy”, kids cartoons and so on. It became about how to use the cheapest ingredients and make them tasty (more sugar and/or salt, and fat, was the answer). American supermarkets are both awesome and scary in the immense variety of total crap they sell in huge sizes! You can tell a lot about a nation by their supermarkets.

    Of course, most people in the world don’t eat like Americans (even us Canadians right across the border are more moderate – must be all those decades of Participaction adverts promoting exercise and a sensible diet!) American culture and some Americans’ biggest issue seems to be with needing to blame others for the state of their bodies and anything else they don’t like rather than taking personal responsibility for themselves and social responsibility for their society (since ads may sell things but it’s individual people buying the crap and demanding more of it for cheaper).

  8. wertys says:

    @Fifi and Medvstherapy

    I agree that mindfulness is looking like a genuine contender for best-practice treatment in chronic pain, and also depressive illness, where here in Australia there is a major project underway to evaluate the specific use of mindfulness techniques in early relapse prevention in depressive illness.

    My impression is that the chief benefit of mindfulness is not that it has a specific neurochemical effect per se, but that it enables more adaptive coping behaviour and lessens that ability of negative cognitions to impact upon the person’s overall mood. It is difficult to teach this approach even to motivated participants, but many chronic pain patients are also fairly alexithymic, ie that they have difficulty in identifying their own emotional states. These folk have a lot of difficulty with cognitive strategies as clearly the link between emotional and behaviour is not their strong suit.

    Much of my time is spent in trying to change health-related behaviour and I can say for a fact that the main problem is not that people don’t understand what they have to do. The problem is in changing their behaviour to actually do it. Having a gimmick or some type of schtick to motivate the change in behaviour is important for people who don’t feel able to make the change themselves. This is often referred to as having an ‘external locus of control’ for health. As long as people continue to believe that they just have to ‘turn up and have something done’ to be healthy, they will continue to fall for SCAMs which promise great results that they can’t deliver. The challenge for SBM is to finds ways to facilitate motivation to change and make it easier and more socially approved to have healthy or adaptive behaviours.

    Oh, and I agree about earmarking. It is an abuse of democratic process.

  9. Alexander Han says:

    Also, the other point re:earmarking: the Economist is just wrong when they say that earmarks are necessarily noncompetitive – one can earmark funds for a project subject to a bidding process as easily as you can earmark funds for noncompetitive crap. Again, the problem is that politicians’ incentives are heavily weighted toward abuse, not the fact that funds can be appropriated for specific projects.

  10. Fifi says:

    wertys – “it is difficult to teach this approach even to motivated participants, but many chronic pain patients are also fairly alexithymic, ie that they have difficulty in identifying their own emotional states. These folk have a lot of difficulty with cognitive strategies as clearly the link between emotional and behaviour is not their strong suit.”

    I found this to be very true! (Subjective impressions alert!) Helping people to understand how to identify emotions – what feelings “feel” like, if you will and the associated postures and physical expressions, the body language innate to certain emotions/feelings – was a lot of what I did when working in a pain clinic (there were psychotherapists who deal explicitly with individual issues, my role was of a more general, though still personalized, nature). The general public can be just as clueless about emotions and mind/body but it’s a less urgent issue since they’re not dealing with chronic pain and the attendent depression.

    I could go on about this at length so I’ll restrain myself from flinging out hypotheses based upon anecdotes and subjective observations! One anecdote before I do though – we had one patient who had previously practiced Transcendental Meditation who was actually quite difficult since what he was doing was not awareness meditation (being a detached observer of one’s feelings and thoughts) or even compassion meditation (focusing upon generating a feeling of love and calm, or compassion..a bit more like visualization really) but actually detaching himself from feeling or thinking (I have no idea if this is how TM is taught – it seems pretty cult-like from my outsiders perspective – or if it was his personal version, either way it wasn’t useful to him and only served as another way to avoid his feelings). This experience – and my own experiences with different forms of meditation – has led to me suspect that what form of meditation is learned is very, very important vis a vis chronic pain. (All the research I know about uses Buddhist/awareness meditations – whether it’s observing monks meditating or teaching meditation to people with chronic pain.) I’d suspect that individual susceptibility to suggestion and being prone to hypnosis (by the self or another) has some impact on how success meditation is for individuals. Either way, the brain has plasticity and what we focus on develops our brain physically and becomes easier to focus on. While it may be “hard” while we’re at the early stages since we’re changing a pattern and essentially forcing our mind/brain to “take another route” than the easy “regular” one, it does get easier as learn new mental habits. Essentially meditation can be a form of cognitive self therapy (though it’s useful to have an actual therapist to guide one if it’s all new territory). A lot of what psychotherapy does is give us new experiences of relating and behaving so we do actually have a choice and aren’t stuck in a pattern that we grew up with but isn’t constructive anymore (even if it was useful and preservative when we were children).

  11. Jules says:

    @ Fifi

    IMO, a country that has a strong culinary tradition (France) would take a lot longer to surrender to convenience foods. That’s why I say that the US doesn’t really have a strong culinary cuisine. Sure, there are pockets of culinary excellence–the Deep South, New Orleans, New York, San Francisco–but on a national level, there is no American food, except McDonald’s and Coke. If I say Greek food, you think of olives and feta cheese and maybe yogurt. British food–anything that shouldn’t be called food. Chinese food–spicy, perhaps sweet, with tofu. You get the idea. There’s something to be said about the prevalence of fast food when pissed-off Pakistanis raze a McDonald’s instead of the US Embassy…

    Re: your points on meditation, I agree wholeheartedly that the type of meditation you practice really influences what you get out of it.

  12. clgood says:

    Earmarks. Accupuncture. Get it? Ear marks? RIOT! Thanks for a great post and a better pun!

  13. Fifi says:

    Jules – EVERY nation has convenience foods (cheap, quick things to eat on the go). It’s always tempting to blame someone for things but really it has a lot to do with class and industrialization. Meat, butter and refined sugar and flour were historically the foods of the wealthy (and they had the expected diseases, gout being a favorite one that often comes up in old novels and so on) and the non-wealthy generally ate less “refined” foods (whole grains, much less meat extended with vegetables, etc). We now all live like the kings and queens of yesteryear in big mansions, with machine servants so we don’t do any chores really, we don’t walk because we have cars, and we have an excess of refined food and meat at every meal….it’s really a simple matter of doing the math.

    In America, the expansion of waistlines seems quite linked to The American DreamTM. Constant growth and expansion are integral to the American DreamTM – which confuses capitalism with democracy – including increasing wealth, bigger and bigger houses (the size of many American homes is simply ludicrous) and things, etc. The American system is predicated upon constant expansion and growth – sustainability is unacceptable because it removes growth and profit. Americans have so much stuff they don’t need that corporations spend more and more of their money trying to sell more and more stuff nobody needs or even really wants until they’re told they do, which makes all that stuff cost much more than it needs to (advertising is expensive). But Americans also want a “deal”, so to cut costs they close down factories in the US and get things made in China where they don’t have to consider people, the environment or ethical business/manufacturing practices (this is also good for business because crappy things made by people who don’t care break faster and need to be replaced).

    There’s plenty of healthy American food in pre-50s cookbooks and a thriving American culinary scene today.

  14. Jules says:

    @ Fifi,

    It wasn’t the presence of convenience foods, but their prevalence, that I was commenting upon, and whether it’s “taken over” the national cuisine. “American food”, to someone from, say, the Netherlands, means grease-soaked pizza and/or hamburger and fries (admittedly, a poll of exactly 1, my boyfriend). And you’ve gotta admit, with the Golden Arches everywhere, it’s not hard to see why that should be. Especially once you leave the cities…

    The tradition of “meat and potatoes” is about as Traditional American food as I can think of. I’ll admit, this is doing a serious injustice to the cuisines of New Orleans, Maine, and other pockets of fine dining

  15. Fifi says:

    Jules – Most people have inaccurate stereotypes about other nations’ eating habits if they only have a superficial knowledge or aren’t well travelled and aren’t mindful of not stereotyping. I’d suspect that your boyfriend’s idea of what people really eat in China and India is inaccurate as well (if he’s not Chinese or Indian and educated about Chinese and Indian food…though Malaysian and Indonesian tend to be more common “ethnic” food in Holland since they were Dutch colonies).

    The “tradition of meat and potatoes” actually predates America – it’s quite pan-European. The French and British also really like meat and potatoes, for instance, but this applies equally to most Eastern and Central European culture (where, not surprisingly, a great deal of Americans come from originally). There also, industrialization brought the opportunity to eat “high class” refined foods (instead of course peasant food) and more meat. It’s worth understanding the real history of food rather than getting caught up in propaganda and myths (many of which come out of America) about food. The food and CAM/spa industry actually have a very long and intertwined history and share roots in Battle Creek Michigan.

    http://www.faqs.org/nutrition/Ar-Bu/Battle-Creek-Sanitarium-Early-Health-Spa.html

  16. Fifi says:

    In fact, you seem to be promoting a stereotypical view of Chinese food (spicy, sweet with tofu) that has little to do with what Chinese people in China eat (a lot of meat when they can and, instead of potatoes, rice). China is a conglomeration of regiions with local cuisines that are quite distinct from each other. Meat, of all kinds, is highly sought after (once again, it’s a signifier of wealth).

    I suspect, in the case of American culture, part of it may be that a culture that has no sense of communalism and social responsibility also seems to generate a rather profound lack of personal responsibility (perhaps because one never learns how to moderate and share/assign responsibility well in relation to others and this is echoed in one’s relationship with oneself…though that’s purely conjecture on my part).

  17. Fifi says:

    Jules – And the French love McDo and have all kinds of junk and unhealthy food of their own. One very distinct difference between America and most of the rest of the world is portion size – American portions are much, much larger (even at McDonald’s). Super-sizing is about greed and gluttony, and the American desire for quantity over quality. A lot of this has to do with American social values, which ties into lack of decent public education, profit-driven healthcare and a government that privileges corporations over the needs of the population (and treats corporations as the “providers”). A little bit of regulation of advertising and industry – and weeding out all the corporate/political corruption of what are theoretcally watchdog agencies – would go a long way in the US.

    As for a McDonald’s being blown up in Pakistan – it’s easier to do than blow up an embassy, it’s entirely consistent with the Taliban/Fundamentalist war against American culture and corporatism/capitalism (they do indeed hate America’s way of life, just as Fundie Christians in the US and abroad do too), and it’s going to generate headlines that play well with people such as yourself and kiddie anarchists so are good PR, and it also discourages young Pakistanis who aren’t Fundies from consuming non-Fundie culture. It’s as much an attempt to oppress and control Pakistanis as it is an attempt to send a message to America.

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