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The Media and “CAM”

Recently I have been generally critical of how mainstream media deals with scientific topics. Science is often complex and requires hard work and diligence on the part of a journalist to get the story right. In recent years mainstream news outlets have been downsizing or eliminating their science journalists and tasking general reporters and editors to handle science stories.

Meanwhile, as science progresses it grows more complex and challenging to distill for a lay audience. At the same time there are growing pseudoscientific institutions and social forces making it even more difficult to sort out the reliable from the nonsense. This is especially true, in my opinion, when it comes to medical reporting of controversial treatments and claims.


A recent study conducted by the Health News Review, a website that routinely ranks media reporting of medical news, found that:

In our evaluation of 500 US health news stories over 22 months, between 62%–77% of stories failed to adequately address costs, harms, benefits, the quality of the evidence, and the existence of other options when covering health care products and procedures.

Therefore the media gets the story substantially wrong 2/3 of the time. This is largely a problem of quality control. When it comes to reporting of so-called “CAM” – complementary and alternative medicine, otherwise called “integrative” or “holistic” medicine (all labels useful for marketing and promotion) the media often buy into the marketing propaganda of proponents without seriously questioning it. This would be the equivalent of a political journalist accepting press releases coming out of a presidential campaign without ever questioning the facts or premises they contained.

I was recently sent this article called Local healthcare systems incorporate holistic medicine, published recently in the Toledo City Paper. I have read dozens of almost identical new reports – as if local details are being plugged into a generic template containing all the pro-CAM talking points. This article, therefore, is as good as any as an example of the poor journalism and mindless acceptance of propaganda typical of reporting on such topics.

East Meet West

The article’s author, Kevin Moore, frames his piece as the contrast between “Eastern” and “Western” medicine. Immediately he is establishing the premise, perhaps without realizing it, that different medical treatments are a matter of culture, of genuine alternatives that are a matter of preference only. He writes:

Using plants and herbs for medicinal purposes is the oldest form of healing on the planet. The Chinese began employing natural healthcare for the first time some 4000 years ago. Around 600A.D. Islamic physicians developed a far more advanced system of herbal-based drugs and remedies. These methods contrast greatly to those developed in Europe and America using hardened disciplines such as chemistry, anatomy, and psychology.

In order to emphasize the contrast between East and West he plays a little loose with the fact. Actually Islamic culture was the repository of much ancient knowledge of the hard sciences of anatomy and chemistry, as well as medicine. Also, herbal-based drugs (one characterization the author gets right – herbs are drugs) have been used in Europe and America straight through to modern times. He is creating a false dichotomy between East and West to support his premise.

The real distinction to be made is between science-based medicine and superstition or philosophy-based medicine – something which all cultures had throughout the world. The only rational approach, regardless of modality, is to rely upon science as the arbiter of what works and what doesn’t work, and to dispense with the pre-scientific superstitions and health philosophies of the past – whether it be humoral medicine favored in Europe or Chi favored in Asia.

The CAM Umbrella

Moore writes:

America has recently experienced an almost epidemic interest in these ancient approaches to healing. Traditionally, the subscribers to this “back to Earth” kind of medicine have received the stereotype of unkempt hippie herbalists of the cultish sort who delve too heavily into a certain color-enhancing star-shaped leaf. While certainly amusing to consider, this perception is actually rooted in tremendous ignorance, if not bias. Dr. Mounir Elkhatib, head of Promedica’s Great Lakes Center for Integrative Medicine, said that holistic medicine is becoming a rapidly expanding science within the medical community.

First he establishes what is a straw man, that CAM proponents are viewed (using the passive voice so it is not clear exactly who views them this way) as drug-using hippies. While certainly it seems that the new-age culture has disproportionately embraced CAM, so have upper-middle class suburbanites (those with disposable income) and those who prefer to take a spiritual approach to healthcare. Acceptance of CAM is largely a matter of either ideology or gullibility, not being a hippie.

After setting himself up with a rather lame straw man of the supposed contrary view, Moore then informs us that “integrative medicine” is a “rapidly expanding science.” He takes this premise without question, when in fact this is at the very heart of the actual resistance within the medical community to the modalities that are implausibly grouped under the various CAM banners. Have such modalities been verified by science? The answer is clearly no. All of the major CAM modalities – acupuncture, homeopathy, chiropractic, and therapeutic touch, have yet to rise above the bar of science-based medicine.

Homeopathy and therapeutic touch have essentially a non-existent plausibility and the distribution of clinical evidence is consistent with no real effect. Chiropractic probably has a non-specific benefit for symptomatic acute uncomplicated lower back strain – but the philosophy of chiropractic (innate intelligence blocked by unseen subluxations) has failed to make any progress in 100 years of study. Acupuncture’s core claim – manipulating the flow of chi – is in the same boat as innate intelligence. So far the evidence for efficacy for any indication for acupuncture has been either negative or mixed, but a modest and non-specific counter-irritation type effect, while not established, cannot be ruled out.

What about herbal medicine? The use of plant-based pharmaceuticals is not properly labeled as alternative. Like nutrition, this has been co-opted by CAM proponents to give a vast assortment of unscientific modalities the sheen of legitimacy. What is alternative (meaning unscientific) is using herbs for indications that are not evidence-based, but not herbs themselves.

The Argument Ad Populi

Moore then quotes a CAM proponent, Dr. Mounir Elkhatib (never mind giving equal time to opposing views) as saying:

“In 1993, the New England Journal published an article that surveyed the use of alternative medicines in this country. Almost 40 percent of the public uses at least one kind of herbal supplement, and those people spend close to $11 Billion every year in health food stores. In response, the National Institute of Health started the National Center for Complementary and Alternative Medicine. There is a great deal of research going on, and this area is becoming very evidence based.”

This is highly misleading. The 1993 NEJM article he is referring to is the infamous Eisenberg study, which instantly became the cornerstone of the argument ad populi for CAM. The study showed that 34% of those surveyed had used at least one “unconventional therapy” in the past year. What is misleading about how the study is presented by the media (including Moore’s recent piece) is what Eisenberg considered “unconventional.” Take a look as the results table from the study.

The only substantial numbers in there are exercises and prayer, which don’ t belong there at all. The 34% figure is excluding exercise and prayer, but still includes relaxation, massage, and weight-loss programs as significant contributors, which bloats the numbers. The only hardcore CAM modality that reaches double digits is chiropractic, most of which is for symptomatic treatment of back strain. If the use of straight chiropractic for the treatment of subluxations were pulled out (as it should be) the number would be much lower. Look at homeopathy – 1%, and acupuncture – <1%. These are not impressive (the numbers are likely higher now, but not by much).

But the strategy is clear – make an argument for the popularity of CAM and inflate the perception of popularity by including a wide range of modalities, many of which can be scientific or are, at worst, a bit soft. Then the serious unscientific modalities, like homeopathy, can come along for the ride. In many way it’s a bate and switch, and the media have largely bought it without a hint of journalistic skepticism.

The next statement is a demonstrable historical falsehood – that the NIH started the National Center for Complementary and Alternative Medicine (NCCAM, formerly Office of Alternative Medicine) in response to Eisenberg. What happened was that a few ideological senators (Orrin Hatch, for example) pushed through legislation forcing the NCCAM down the throats of the NIH. This was followed by protest by NIH scientists which resulted in a one time decrease in the NCCAM budget (at that time the OAM), but the political forces soon overwhelmed the scientific resistance and the NCCAM has grown and flourished.

Now CAM proponents have rewritten history, pretending that this was a response to public demand by NIH scientists – and the media happily oblige the fantasy.

Holism

Moore quotes Dr. Elkhatib some more (the article could be an advertisement for Dr. Elkhatib’s clinic):

“All of these treatments are part of something larger that we promote called holistic wellness.” says Dr. Elkhatib. “That is a general attitude of total wellness. Lifestyle is so crucial to this. This includes every kind of well being: physical, emotional, spiritual, sexual, intellectual, and financial wellness.”

The notion that unscientific medicine is more holistic than medicine founded upon sound evidence and scientific principles is one of the greatest marketing scams of recent history. As Mark Crislip has pointed out, science is truly holistic because by necessity it works as a unified system of knowledge that must be internally consistent at all levels. CAM modalities are usually based upon a very narrow philosophy of health and illness, and also are often mutually incompatible with each other. Further, good science-based medicine is appropriately holistic in that it considers the whole person, something which has been referred to as the “biopsychosocial” approach.

I  routines have discussions with my patients (within the confines of science-based medicine) addressing their physical, emotional, sexual, intellectual, and even financial wellness. I also consider their history and treatment in the context of their cultural and social situation. I do not cross the line into their spiritual lives, however. I do not think that is the proper role of a physician.

Scientific medicine is properly holistic. Unscientific medicine is extremely un-holistic – it often neglects the biological aspects of illness. In fact it often neglects the biology that is the true underlying cause of illness, putting in its place a comforting fantasy. It is literally true that “holistic” in the context of much of CAM is nothing more than a clever and successful marketing strategy.

Conclusion

There is much more, but as it is easier to create a misconception than to correct it, I must limit myself to the points above. I have come to expect poor reasoning and factual errors from the promoters of unscientific methods. But I will never accept the low standards of journalism that allow for the gullible presentation of nonsense without even a nod to token skepticism, let alone proper balance. Journalists have been handed talking points by ideologues who are selling products and services, and a belief system to go along with them. They are the same points we have been hearing for years – CAM is very popular, scientific validation is just around the corner, we want to integrate the best of both worlds, etc. A competent journalist should stop to ask – are these claims actually true? Are there any credible critics with another perspective?

Otherwise they become unwitting accomplices to a deadly scam.

Posted in: Science and Medicine, Science and the Media

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70 thoughts on “The Media and “CAM”

  1. Wicked Lad says:

    Thank you, Dr. Novella, for your informative article. I recently heard someone ask a good, pointed question for promoters of herbal medicines that are not supported by rigorous science: if Merck came out with a drug, said it was safe and effective, but that they hadn’t bothered to do scientific trials, would you take it? If not, why would you take an herbal medicine under the same circumstances?

    I wonder about this: either an “alternative medicine” treatment is effective or it isn’t. If it isn’t effective, it’s a waste of money. If it is effective, how do we know what it’s effective at doing?

    Keep up the great work.

  2. apteryx says:

    The “same circumstances” would be a case in which someone suggested that you use a plant never before consumed by humans, or never before used for a particular indication. In that case, of course you would not take it. A better question is, would you take aspirin? Aspirin wasn’t marketed for pain relief based on any Randomized Double-Blind Placebo-Controlled Clinical Trial, as that methodology hadn’t been invented when aspirin was developed. Since it was grandfathered in, so far as I know, it has never been “rigorously” proven to be a pain-reliever. Your belief that it works is based less on science than on extensive human experience.

  3. durvit says:

    For people who haven’t seen it: An Analysis of News Media Coverage of Complementary and Alternative Medicine appraises the quality of media news stories about CAM in Australia.

    There is substantial variability in news reporting practices about CAM. Overall, although they may be improving, the scores remain generally low. It appears that much of the information the public receives about CAM is inaccurate or incomplete.

    Bonevski B, Wilson A, Henry DA (2008) An Analysis of News Media Coverage of Complementary and Alternative Medicine. PLoS ONE 3(6): e2406. doi:10.1371/journal.pone.0002406

  4. durvit – wow, thanks for the additional reference.

    apteryx – aspirin has been around long enough to be grandfathered in – but it has still been studied extensively. FDA approval trials are not the only kinds of clinical trials out there. Aspirin is perhaps one of the most studied drugs in existence. If the original experience with aspirin turned out to be misleading, subsequent research would have discovered that.

    Also – there is a huge difference between detecting an acute dramatic effect and a chronic subtle effect. Human experience discovered the obvious pharmacological plants in the environment – opium, for example. These were the low-hanging-fruit that have already been incorporated into modern pharmacology.

    Over the counter herbs these days are marketed largely for either alleged long-term health benefits, more subtle effects (mental clarity), things that are not directly felt (it boosts the immune system) etc. These are far too subtle for anecdotal experience – as are any potential long term toxic or side effects.

  5. Calli Arcale says:

    Don’t forget my personal favorite pharmacological plants — coffee, tea, and chocolate. These and other plants containing caffeine and similar stimulants have been revered ever since their discovery, and rightly so. ;-) The Internet would certainly not be the same without their geek-fueling potential.

  6. it also seems that every culture discovered the pharmacological effects of ETOH

  7. apteryx says:

    I find it bizarre to see plants like meadowsweet or willow and opium poppy, whose most familiar bioactivity is simple pain relief, being described as having “acute dramatic effects” and being “obvious” or “low-hanging fruit.” Wait, I thought pain relief was one of those nebulous psychological things that was so subject to the placebo effect that a treatment’s validity could not be judged by any amount of practical human experience.

    You are correct that human experience will not reveal all potential “long term toxic or side effects,” especially when those effects are rare. However, the same could be said regarding the long-term effects of food plants (which are often also medicinal plants), industrial “foods,” or pharmaceuticals. For any substance, we cannot claim to know all of the potential harms it might have for every person on earth. That doesn’t mean that we dare to consume nothing.

  8. In Adverse Effeccts of Herbal Drugs, Vol. 3, 1997 ed. by DeSmet, Keller, Hansel & Chandler, the authors state, “There is a statistical ‘rule of three’, which dictates that the number of studied subjects must be three times as high as the frequency of an adverse drug reaction to have a 95% chance that the reaction will actually occur in a studied population.” p.1

    “In contrast to newly marketed chemical drugs, herbal medicines often have a long history of traditional use, resulting in considerable experience with their effects in open populations. Such informal experience is a powerful tool, of course, for the identification of adverse effects, which occur commonly and develop rapidly after the start of therapy. Usually, it will also come to light, which ways of processing and which dosage regimens reduce the likelihood of acute adverse reactions. It can be questioned, however, whether empiricism will identify less conspicuous modifiers of toxicity, such as a concurrent disease, and whether delayed and uncommone adverse reactions will always be recognized.” p. 2-3

    The authors bring this up in their discussion of the need for postmarketing surveilance of both synthetic and botanical drugs. Their books are scientific and include very detailed, well-documented examples illustrating their points and showing how the use of medicinal herbs is not the simple solution to complex health problems that promoters like to believe and which a reporter would never be able to accurately cover in sound bites or a short sweet article for the general public.

  9. apteryx – you created quite a straw man there.

    There is a spectrum of pharmacological effects from botanicals, some easier to detect than others. Obvious acute effects tend to be discovered easily by most cultures. Others are far too subtle for anything other than controlled trials to produce any reliable data. And others are somewhere in the middle.

    An acute relief of pain can be a fairly dramatic effect, and so analgesics in the environment can be discovered by trial and error. But pain is a subjective thing, which is why there are also many traditional modalities that have no physiological effect also in the mix. How do we know which ones really work and which ones only seem to work? Take a guess.

    (by the way – opium has much more than just an analgesic effect, it’s effects are very dramatic)

    It is difficult to sort out the long term risks and benefits of foods and pharmaceuticals (whether they be manufactured or plant-derived). This, of course, does not mean that absent perfect knowledge we eat nothing. What it does mean is that we use the best evidence we have available, and we have a reasonable threshold of evidence for anything that will be marketed with health claims or for medical use.

  10. mjranum says:

    It won’t cheer you up any to know that the media are just as sloppy in every field. I work in high tech (computers/networking) and the media pretty much take press releases from vendors and print them as-is. You could say you had a new networking device that worked on perpetual motion and they’d print it without even blinking.

    I gotta figure stupidity is self-regulating. When a society gets stupid enough, it gets wiped out by less stupid. Until they get fat and stupid in turn.

  11. apteryx says:

    Some people on this board seem to have been frightened watching “The Wizard of Oz” as children. No, I created no “straw man”; others on this board have argued explicitly that where pain relief is concerned, no amount of human experience is acceptable as evidence of efficacy [for non-orthodox treatments]. If you do not share that view, please take the sarcasm as being directed at others and not at you. So, “Take a guess” at how we know which ones work? Well, I might guess that we try them and see what happens. If I am supposed to guess that only a big expensive RCT can tell me whether my headache is better or not, I have to sign on to the premises that (a) peoples who do not have that methodology possess no real knowledge, and (b) that they quite often accidentally happen to use plants that have the bioactivities they irrationally believe them to have. If the simplest explanation is usually the best, the simplest explanation is that they can detect bioactivity.

  12. Fredeliot2 says:

    Some of the ancient herbal remedies were effective because of their vitamin content and people weren’t eating a balanced diet. A good example is dandelion greens, which contain vitamins A and C.

  13. apteryx says:

    Fredeliot2 – Be careful lest you be suspected of woo-ism! Official dogma is that vitamins are useful only to prevent specific deficiency diseases, whereas the claimed medicinal uses of dandelion (as a mild diuretic, in the case of the leaves) have nothing to do with scurvy and the like. You are quite correct, of course, as any number of “spring tonics” functioned to remedy vitamin deficiencies that developed over the winter. Moreover, chronic nutritional deficiencies were endemic in almost any agricultural population, and use of wild foods undoubtedly improved health status.

  14. qetzal says:

    apteryx wrote:

    Aspirin wasn’t marketed for pain relief based on any Randomized Double-Blind Placebo-Controlled Clinical Trial, as that methodology hadn’t been invented when aspirin was developed. Since it was grandfathered in, so far as I know, it has never been “rigorously” proven to be a pain-reliever.

    I guess that depends on what you mean by rigorously. I went to PubMed and searched for randomized controlled trials with the words aspirin, pain, and placebo in the titles. I got 21 hits. I looked at several and confirmed that aspirin generally gave statistically significant pain relief compared to placebo. (At least one, however, found no statistical difference, due to what they considered a higher-than-expected placebo response.)

    Care to bet how much more rigorous the data is for aspirin versus acupuncture?

    P.S. I like how you deny creating straw man arguments, then promptly do exactly that all in the same sentence:

    No, I created no “straw man”; others on this board have argued explicitly that where pain relief is concerned, no amount of human experience is acceptable as evidence of efficacy [for non-orthodox treatments].

    Hint: the part after the semicolon is a straw man argument. Unless you can show where someone on this board said that?

  15. mjranum says:

    I find it bizarre to see plants like meadowsweet or willow and opium poppy, whose most familiar bioactivity is simple pain relief

    Opium is not “most familiar for pain relief” — it’s most familiar for its recreational uses.

    Opium, by the way, actually works – as opposed to accupuncture. That’s why opium addicts would spend fortunes to get their hands on another dose, instead of simply having someone give them an accupuncture “high.”

    Hey, that made me think of something. Since accupuncture and homeopathy and chiropractic claim to be able to cure pretty much anything – why aren’t they being used to get stoned? (Other than the obvious fact that they don’t actually work) But if homeopathy’s underlying “rules” actually worked, I ought to be able to do some mojo with ultra-diluted LSD or something and get really really really really wasted. Right? Funny – I’d think people wouldn’t spend all that $$$ on cocaine if they could get the same bang out of homeopathycaine or accupuncaine.

    My point – I think that, at some level, most people who rely on accupuncture and homeopathy also know it doesn’t work. That’s why you don’t see people getting really worried about overdosing on homeopathic sleep aids. My ex-wife used to take the Bach “rescue remedy” as a sleep aid and was completely unperturbed when I gacked down 30 times the recommended dose. I waited until I should have started to feel the icy hand of death upon me and pointed that out. Most fans of CAM won’t blithely take 30 times a recommended dose of Ambien because they know it actually works.

    I am going to maybe do an experiment and call some local accupuncturists and ask them if they can “make me high” with accupuncture. I want to get accu-wasted.

  16. After reading Apteryx’s comments on experience and pain, I just have to tell you a little anecdote of my own even knowing how Skeptics hate anecdotes.

    A couple of weeks ago my 11 month old Borzoi who has grown exceedingly tall very quickly started letting out blood curdling screams. As far as I could observe, he did it when he was getting up but also when he was laying down. Some days were worse than others. I phoned his breeder and asked if she had ever heard of such a thing. She said yes. He had probably hurt his neck playing and the only thing that would cure him was a chiroprator who also practiced acupuncture. She proceded to tell me of one she had used who got fantastic results. This Great Healer added vitamin E to the needles before inserting them! I didn’t ask if there was an extra charge.

    Neither did I ask for objective evidence of safety and efficacy or try to explain the need for such evidence in evaluating a drug or therapy. I just wanted to get as much relevant information as possible as fast as I could. From what she told me I concluded that the cases she had seen had been self-limiting. Yes, yes, I know. Terribly narrow minded of me.

    I did tell her quite truthfully that the chiros around here are wacky. A friend went to one and noticed a colored light next to a phone that was off the hook. When he asked what that was about, the chiro told him she was doing “light therapy” over the phone for a “patient” a few thousand miles away. My friend never went back to her. My dog’s breeder said, “They use light therapy on horses. It works, but not at a distance.” I thought to myself, Well maybe it doesn’t work for ‘you’ at a distance, but it obviously ‘works’ for some at a distance.

    Next I noticed that my dog’s problem happened when he moved his head. He couldn’t put his nose to the ground. I was thinking a twist, inflammation, growing pains, a fracture or dislocation, cancer.

    I took him to a vet who practices evidence-based medicine. The first thing she wanted to do was X-ray him, but she couldn’t get a good picture because he moved and she didn’t want to sedate him because he had malignant hyperthermia when he was neutered. She didn’t think that sedating him would cause such a reaction but really didn’t want to do it unless she absolutely had to. She said she didn’t think it was cancer or a fracture. We decided to give him a non-steroidal anti-inflammatory. His problem cleared up in a day or two and he has been fine since.

    I believe in evidence-based medicine so i conclude that either the drug worked as it has been shown to do by reducing inflammation, the condition was self-limiting or a little bit of both, but if I believed that anecdotal “evidence” were reliable and had taken the beast to an acupuncturist, I would be quite certain that his “treatment” with or without the vitamin E worked.

    IMO, the history of civilization demonstrates quite clearly that unless a reaction is dramatic and immediate, one cannot accurately determine cause and effect based on personal experience and observation alone.

  17. The media most of us have grown up with is undergoing a major change. It is being displaced by the Internet which gives those who believe in evidence-based medicine a wonderful opportunity to educate the general public, but to do it, they will have to first educate themselves and learn how to effectively teach in the new medium so that they can set up sites that will attract the general public, hold their attention, give them facts and show them how to independently verify the accuracy of what they find.

  18. We keep hearing about how TCHs have used acupuncture for such a long time because they learned from experience that it “worked”. Has anyone ever heard of a serious study by a scholar fluent in Chinese who has actually investigated to see if there have been any TCHs who have used it and concluded that it didn’t work?

    Have any of the proponents even thought that that might be important information to have and something worth investigating?

  19. pec says:

    You don’t understand what “holistic” means. The holistic approach to science or medicine is very different from the reductionist approach.

    One example is the mainstream approach to depression. SSRI drugs result in higher levels of serotonin, which results in lower levels of anxiety, depression, etc. So you conclude that low levels of serotonin are a cause of depression, and that SSRI drugs are a cure.

    You neglect to consider what may have started to throw the system out of balance originally. Maybe traumatic experiences let to negative thoughts and emotions, which influenced brain chemistry, which influenced thoughts and emotions, etc., resulting in a vicious cycle. Or maybe inadequate nutrition, exercise and sleep contributed to general fatigue, which resulted negative emotions, which influenced brain chemistry, etc.

    Many different kinds of problems can interact and contribute to depression (for example), resulting in an out of balance, poorly functioning system. SSRIs do nothing to help restore the balance, and over time they make it much worse. The original depression was a vicious cycle, and so is treatment with SSRIs, which results in addiction.

    If Steve Novella knew anything at all about holistic science he would never claim that reductionist science is holistic.

    There are many examples I could have used other than SSRIs. Cholesterol-lowering and blood pressure-lowering drugs are also non-holistic treatments. They do not address the actual causes of artery disease.

    A holistic approach to health is much more difficult than the reductionist approach. It is much harder to analyze individual patients and try to figure out the origins and evolution of their diseases. It’s easier to follow a set of rules and prescribe standard drugs that do not address the cause or encourage healing.

    If the body is patching up diseased arteries with cholesterol, you should think about why the arteries are diseased, rather than concentrate on lowering cholesterol levels.

    The non-holistic approach is fine when a patient needs emergency surgery or antibiotics to survive. But it makes very little sense to treat chronic diseases with the same kind of approach.

  20. Harriet Hall says:

    pec,

    There you go again! Claiming that doctors don’t consider the underlying causes and only treat the symptoms. That’s a straw man argument. Doctors know prevention is better than treatment. Doctors are far more interested in correcting the underlying causes than in putting on a temporary patch. It’s silly to say that any drug (SSRI, BP, etc.) is “non-holistic” because any drug can be part of a holistic approach. For example, a drug can lower dangerously high blood pressure and ward off a stroke while we are simultaneously considering all the factors that might have raised the BP in the first place and working with the patient to exercise, lose weight, reduce his social and emotional stresses, and do anything else you might want to consider as part of a holistic approach.

    Even in your example of emergency surgery, a holistic approach is the best one. Good doctors try to consider the whole patient, his personality, his emotional state, his social, and family environment, the health of other parts of his body that are not going to be operated on, his beliefs about surgery and about his illness, etc.

    Sometimes science doesn’t have a good answer for “why” someone develops a chronic disease. Some diseases are multifactorial, due to a combination of factors that interacted. Sometimes it is due to back luck, chance, or genetic factors. Sometimes we really don’t yet have any clue about what caused an illness. It’s important to find and correct all the correctable causes we can find. But you can’t turn back history. When a patient is already sick, it makes sense to treat chronic disease with all the tools at our disposal. Throwing out one of those tools because you believe it isn’t “holistic” would be pretty silly. I could argue that the truly “holistic” approach is to treat the whole patient in the here and now.

    It almost sounds like you are confusing “holistic” with a willingness to understand the origins of disease; they are not synonymous. You are talking generalities about “balance” and hypothetical underlying causes. Perhaps you can give us an example of what you mean: how would you go about treating a patient with high blood pressure or arthritis, and what evidence do you have that your approach would be more successful than conventional science-based medicine as practiced by the best clinicians?

  21. daedalus2u says:

    pec, you really don’t know what you are talking about with regard to depression. Depression is a life threatening illness. Many people die from it even while undergoing the best available treatment by experts who know what they are doing. It is the 11th leading cause of death and it causes tremendous suffering in those affected.

    As a life threatening illness, it requires prompt and aggressive treatment by people who are expert in treating it. Treatments with significant possibility of side effects are warranted. Depression is highly treatable by people who know how to treat it. The main impediment to effective treatment is misinformation being put out by people who are ignorant and those with an anti-mental health agenda, such as scientologists.

    It is clear that you don’t know very much about depression, yet you think you know enough to suggest what causes it and how to treat it. SSRIs are not “addictive” in any rational sense of the term. You are ignorant and you have an anti-medicine and anti-science agenda. That is a dangerous combination.

  22. mmarsh says:

    I’ve seen numerous references made to acts of Congress establishing and funding the OAM and NC(s)CAM, but not being familiar with the history and timeline, it’s difficult to track down the actual legislation (say, on thomas.loc.gov). Given the often long tenures of Representatives and Senators, it would be a great service in this election year if you could post pointers to the relevant legislation so that those of us in the U.S. can see how our representation fares on science vs. superstition.

  23. pec says:

    [SSRIs are not “addictive” in any rational sense of the term]

    You are very ignorant. They are extremely addictive, and damaging. And millions of people are taking them, even if they do not have clinical or life-threatening depression. MDs prescribe SSRIs for people who just want to feel better.

    It would be safer and more effective to prescribe heroin.

  24. daedalus2u says:

    Pec, you are dangerously misinformed. You don’t know what you are talking about.

    Addiction: Mirriam-Webster’s

    1: the quality or state of being addicted [addiction to reading]
    2: compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly : persistent compulsive use of a substance known by the user to be harmful

    Dorland’s Medical Dictionary:
    addiction: the state of being given up to some habit or compulsion. strong physiological and psychological dependence on a drug or other agent; see alcoholism and drug dependence

    drug addiction: a state of heavy dependence on a drug; sometimes defined as physical dependence but usually also including emotional dependence (compulsive or pathological drug use). It is often used synonymously with drug dependence.

    SSRIs are not addictive. They produce no physiological habituation or compulsion of use. They produce minor or no symptoms even at 30x overdose.

    http://www.ncbi.nlm.nih.gov/pubmed/9786310

    Can you name any other class of drug (or even food) that produces minor or no symptoms at 30x overdose? I can’t think of any off the top of my head. 30x a dose of alcohol would kill you, as would opiates, nicotine.

    Your notion that heroin would be less harmful is completely wacky. It sounds like something straight out of Scientology.

    Are you a Scientologist? That would explain some of your non-evidence based beliefs.

  25. pec says:

    Yes daedalus2u SSRIs are wonderful. They should be in the drinking water. Oh wait — they are.

  26. pec says:

    Harriet,

    Yes there are MDs who mention lifestyle to their patients. But there is much more to alternative medical science than recommending a healthy lifestyle. You are so removed from holistic thinking you have no idea what I mean.

    For example, instead of looking for ways to prevent the re-uptake of serotonin, which only worsens the imbalance that caused the depression, researchers could look for ways to restore the balance. No, that would not be easy. But if you don’t even try, it will always be impossible.

  27. weing says:

    I think pec is addicted to “holistic” woo. It means whatever she wants it to mean. It could be crystals to restore “balance” , another self-defined term. If it doesn’t jive with reality, then reality is wrong. There is no such thing as alternative medical science. There is either medical science or the alternative, ie, superstition.

  28. apteryx says:

    MDs say that SSRIs are not “addictive,” but they do cause “physical dependency.” The physiological difference is that the user does not develop tolerance; the social difference is that he is taking them due to an MD’s instructions, not by his own choice for the sake of pleasure. However, many people who try to stop taking SSRIs find that they experience withdrawal symptoms severe enough to force them to keep taking it, whether they prefer to or not. They have heard of similar experiences from people who quit drugs such as cigarettes, and heard the medical business attribute those symptoms to the users’ “addiction” (as in the current TV commercial pushing some stop-smoking drug) so it’s understandable if they use the same term for their inability to kick the SSRI habit.

    If I were severely depressed and did not respond to talk therapy or St. John’s wort, I would try an SSRI. I don’t share the Scientology opinion that brain-altering drugs should never be used. But patients ought to be warned of the risks of any treatment, and if the risks include “physical dependency,” that ought to be made clear upfront so that they can decide whether to get on that ride. I have heard of cases in which MDs did not take seriously patients’ complaints of withdrawal symptoms, perhaps because they saw no reason why the patient should not just keep taking the drugs for life?

  29. apteryx says:

    weing wrote: “It could be crystals to restore “balance” , another self-defined term. ”

    Well, the same sort of guff is common from orthodox medicine in areas related to the mind, where they don’t really know all that much about how it works. I recall a commercial a few years ago for some Big Pharma antidepressant – you may remember it, it was heavily pushed – which said [this is not an exact quote, but a paraphrase from memory]:

    “Though the cause of depression is not known, it may be due to a chemical imbalance. Perkium corrects that imbalance…”

    Waitwaitwait – if you don’t even know what the cause is, how do you know your drug fixes it? And promising to fix an “imbalance” of undefined nature and significance, well, sounds rather woo-ish, does it not?

  30. weing says:

    apteryx,
    Yes, it does sound woo-ish. That’s what sells. It works great in advertising. It is not science. These terms, balance, holistic, integrative, etc, are marketing and promotion terms as Steve notes in the post. BTW, I am against direct to consumer advertising, whether by pharma or CAMs. I have had some patients experience withdrawal symptoms from SSRIs. The standard practice is to withdraw the SSRI after about 9 months of remission. The difficulty here is separating withdrawal symptoms from resurfacing of the depression.

  31. pec says:

    SSRIs are over-prescribed. Life is not an endless happy party. Bad things happen and negative emotions are signals that motivate us towards solving our problems.

    The medical industry has convinced Americans that they do not have to suffer anxiety or grief, that miracle cures can erase all pain. If you have unpleasant emotions, it’s because something is wrong with your brain, possibly because of defective genetics, and a pill can fix it.

    That is what many people believe, because that is what your industry has implied.

    I don’t care what scientologists think about anything. If I happen to agree with them on one thing that doesn’t mean I agree with them on anything else.

    SSRIs should only be used for severe clinical depression. And even then their usefulness is very limited, and they probably cause as much long-term harm as short-term good. The drugs do nothing for the underlying problems, and can disturb intricate processes that are not understood.

    A holistic approach to depression research would consider the system in general, not simply the levels of specific neurotransmitters. The brain is not isolated, but is part of the body. And the brain responds to our thoughts and attitudes.

    The materialist reductionist approach is limited and it is not leading towards a better understanding of mental illness or towards better mental health.

    SSRIs are a giant source of profit — addictive drugs will always sell.

  32. Harriet Hall says:

    pec,

    It doesn’t do a bit of good to say future research should study “the system in general” and learn how to “restore balance.” We need to help our patients TODAY.

    Do you know of anyone who was successfully treated “holistically” for depression without antidepressant drugs? How exactly would I go about doing that for one of my patients?

  33. apteryx says:

    Both high-quality SJW products and exercise may provide about as much relief of depression as do SSRIs. Some people have been successfully treated with psychotherapy. Some have even been successfully treated with omega-3 fatty acid supplements. I don’t know whether one would consider any or all of those “holistic,” which doesn’t seem to have a specific definition, but if you should have a patient who wants to avoid SSRIs because he doesn’t wish to wind up impotent or addicted – er, physically dependent – I hope you would suggest that he try some of the above, rather than just telling him to take the drug or suffer.

  34. Mike Kandefer says:

    Has anyone here heard of “Fenestra Research Labs” [1]? They allege that they perform randomized, double blind, controlled clinical trials for a bunch of “woo” products. I’ve been researching the ridiculous claims made about Himalayan salt, and found this website with the following claims:

    “A double-blind placebo clinical study was conducted in 2007, in Las Vegas, NV, to test the body’s reaction to the ingestion of common sea salt versus the ingestion of our PSYMPHONY™ Original Himalayan Crystal Salt®. The purpose of this study was to evaluate Original Himalayan Crystal Salt as a safe and effective all-natural mineral supplement. [...]

    This study was performed by FENESTRA RESEARCH LABS clinical study personnel on sight in Las Vegas, Nevada. The OPTIMAL WELLNESS TEST portion of this research was done using proprietary devices and methodologies developed
    by FENESTRA RESEARCH LABS. [...]

    CONCLUSION

    [...]

    Original Himalayan Crystal Salt®, aka PSYMPHONY™, was shown to be a highly effective product for the normalizing of mineralization in the human body. It has also shown to be effective in helping to stabilize pH and Oxidative Stress numbers in the human body. Hydration indicators showed an average of ten percent increase over the course of this study.” [2]

    I’m not sure what to make of this. The difference between this particular rock salt and the other seems to be huge, according to the study, but it’s couched in terminology I’m not familiar with. They’ve also allegedly tested LifeWave successfully [3].

    The only place that seems to be discussing this particular lab is the Hoax Forum [4]. It seems like a scam in order to give alt med more credibility than it deserves, but what are your thoughts?

    [1] – http://www.fenestraresearch.com/

    [2] – http://www.americanbluegreen.com/study.html

    [3] – http://www.lifewave.com/pdf/Research/Research002-SeefenestraConclusion.pdf

    [4] – http://www.museumofhoaxes.com/hoax/forums/viewthread/4333/

  35. Mike Kandefer says:

    Ok, I know more of what to make of this after perusing their wacky website. I was suspicious of these “proprietary tests”. Apparently they claim to “measure 34 clinical markers in human physiology to a very high degree of accuracy, and conclude the level of “wellness” exhibited by individual clients with specific recommendations for improving areas of concern.” Of course, the results of these tests or how they work aren’t published. The whole company seems to have been formed to give credence to “woo” and also make a quick buck off of individuals hoping to acquire a (false) sense of legitimacy to their products.

  36. weing says:

    I think pec is mixing up the blues and grief with depression. There are criteria that need to be met for the use of SSRIs. In depression, I have seen the SSRIs to be lifesavers. And no, the patients aren’t on them for life. In most cases, they can be safely discontinued without any problem or recurrence of depression.

    Also, organic disease needs to be ruled out as a cause of depression. It is also well known that depression may be the presenting symptom of, for example, cancer or diabetes.

    There are other treatments beside SSRIs and exercise. I refer those patients to the specialists. I don’t think telling the patient to take the drug or suffer is an option. Suicide risk needs to be determined and dealt with.

    The medical diagnosis and treatment of depression are not as simple as implied by the advocates of woo.

  37. pec says:

    “In depression, I have seen the SSRIs to be lifesavers. And no, the patients aren’t on them for life. In most cases, they can be safely discontinued without any problem or recurrence of depression.”

    You are strongly implying that SSRIs can cure depression, since they can be discontinued. But we know that they don’t. So what exactly makes it possible for your depressed patients to stop the SSRIs without the depression returning?

  38. pec says:

    Recently a friend told me I am the only person she knows who is not on psychiatric medication. (Of course, that might say more about her circle of friends, excluding me, than about the general population.)

    But I suspect that, unfortunately, prescription drug addiction has become a serious epidemic. And we really don’t know what the impact will be decades from now — will the SSRI addicts have a higher risk for dementia?

    You are messing with people’s brains, and misleading them into believing you know what you are doing.

    Please, please stop.

  39. Harriet Hall says:

    pec,

    Yes, SSRIs are over-prescribed for people who don’t need them. That doesn’t mean they are bad drugs; it just means some doctors are not using good judgment.

    But antidepressants may also be under-prescribed for people who really do need them and who suffer needlessly or commit suicide because they don’t get life-saving treatment.

    Psychotherapy is great, but sometimes patients are so depressed they are unable to benefit from psychotherapy without assistance from medication. The best approach may be to use both.

    No, people are not addicted to them, any more than patients on hormones are addicted to them. The drugs change the body’s physiology and it takes time for the body to readjust when they are withdrawn. If a patient has withdrawal symptoms, it may be because he still has the depression and needs to stay on the meds; or it may be just a matter of lowering the dose more gradually. Once patients are off anti-depressants they do not have the cravings we associate with addiction.

    The medication controls the symptoms – it does not “cure” depression. Depression, like any illness, runs a variable course and usually will eventually resolve even without any treatment. Patients may just have one episode of depression that resolves with no recurrence. When the illness has resolved, the meds can be discontinued. Sometimes depression resolves and later recurs. Some patients need to continue meds for life to prevent recurrences.

    You still haven’t explained how your ideal “holistic” doctor would procede and how you know the outcome would be better than science-based treatment by a good clinician who considers the whole person.

  40. Harriet Hall says:

    apteryx said,
    “Both high-quality SJW products and exercise may provide about as much relief of depression as do SSRIs.”

    SJW and exercise may relieve mild depression, but they are not effective treatments for major depression.

    That’s part of the disconnect in this discussion. “Depression” is variously used to describe everything from the normal person who isn’t as happy as he thinks he should be to the suicidal patient in the throes of a life-threatening major depression.

  41. daedalus2u says:

    As someone who has been depressed virtually their entire life, I have my own perspective on depression. I didn’t know what it was like to be not depressed until I was in my mid 40’s. That was despite over 15 years of treatment by senior mental health clinicians. I have been on multiple meds, tricyclics, MAOI, SSRIs. Typically they would work for a while and then stop, so we would try something else. I have been on Sertraline for over 10 years and it has worked the best of anything. It was only when I was on a combination of Sertraline, Amoxapine and Serzone that I realized just how depressed I had been my entire life. It was only then that I started looking forward to doing things because I wanted to and not because I had to or was forcing myself. It was only then that I stopped thinking multiple times a day of killing myself. The way we figured out that combination was to look at the side effect profile I was getting from Sertraline, figure out what receptors were getting too much or not enough and pick another antidepressant with a side effect profile that would counter that of the first one then slowly increase the dose.

    I have tried things in addition to meds, eating turkey helps a little, so I eat turkey at least once a day. Sitting in front of a 500 Watt quartz halogen lamp helps a little, so I do that while I eat breakfast. Omega-3 fatty acids help a little so I take flax seed oil every day. What has helped more than everything else combined has been raising my NO level. Since I did that I have never felt better in my entire life. I have eliminated the Serzone and the Amoxapine and have cut the Sertraline in half (to 100 mg/d).

    It was my experience with NO that led me to formulate my low ATP hypothesis of depression, and to see it as the necessary aversive state between the normal “at rest” state and the necessarily euphoric state of extreme metabolic stress. The kind of stress that one gets while running from a bear; where euphoria is the only thing that keeps one running, where to get tired and stop is to be caught and die. If organisms could enter that state easily they would do so and risk death uselessly. I think that is the common final pathway for some of the drugs of abuse, including cocaine, amphetamine, solvent huffing, asphyxiation, strangulation, and the euphoria of near death experiences. Vascular depression is caused by this, the white matter hyperintensities that accompany it are due to ATP depletion reducing axonal transport and the convection of entrained water which shows up as increased diffusion. I think that bipolar cycling between the euphoria of very low ATP (the manic state) and low ATP, the depressed state. Lithium does increase ATP levels. The brain damage that accompanies all of these euphoric states is (I think) due to the shutting off of ATP consuming pathways such as cellular repair and damaged protein disposal to conserve ATP as in ischemic preconditioning.

    I think a possible mechanism for the SSRIs might be ATP conservation due to reduced serotonin reuptake, reduced serotonin release, fewer serotonin receptors being required (less need to be synthesized and transported out the axon). NO is important because it sets the ATP level via sGC. I think the MAOIs reduce superoxide production and increase NO levels. The amount of NO that is important is very small, ~1 nM/L. That is enough to affect blood flow via vasodilation, easily seen in the BOLD fMRI images. What is being imaged is acute changes in blood flow caused by NO release. The background NO level affects the range, onset time and duration of all of that activation measured by BOLD fMRI.

  42. apteryx says:

    Actual suicide is relatively rare, but it’s funny how, in clinical trials, suicidal ideation seems to increase in people on the drugs. Harriet, you are contrasting “mild” with “major” depression; most lay readers will thereby think that “major” means “severe,” whereas in fact any condition that is persistent and is formally diagnosable as depression by DSM criteria is apt to be termed “major.” “Major depression” can be and often is described by research MDs as mild, moderate, or severe.

    Indeed, SJW has been studied in “major” depression and has shown positive results; and in almost every head-to-head trial of SJW and a pharmaceutical antidepressant, they are similar in activity, while the former shows less toxicity. Studies are not hard to find.

    As for exercise, take for example Dunn et al. 2005 (Am. J. Prev. Med. 28:1-8), which found significant benefits in treating “mild to moderate major depressive disorder.” Blumenthal et al. 2005 (Psychosom. Med. 69:587-96) reported that exercise alone was comparable to drugs alone (however, that improvement of both treatments compared to placebo did not achieve significance). Several studies have reported that in patients taking drugs – including severely depressed, hospitalized people – those who receive aerobic exercise programs do far better. There are also at least two studies in older patients showing benefits from high-intensity resistance training. If human beings are intended by nature to use their bodies, and not doing so increases the risk of psychopathology, then the medical profession ought to address that need rather than simply drugging people to make a sessile lifestyle more bearable.

  43. Harriet Hall says:

    Neither exercise nor SJW have been shown to work for moderate to severe depression.

    The idea that exercise might prevent depression is intriguing, but is difficult to assess. Does depression make people not want to exercise, or does not wanting to exercise make them depressed? And how do you get someone to start exercising if he is too depressed to even get out of bed?

  44. pec says:

    “You still haven’t explained how your ideal “holistic” doctor would procede”

    I don’t have an ideal holistic doctor. I am talking about a holistic approach to scientific research. Instead of focusing in on serotonin level, for example, and trying to “correct” it, why not think about what might cause abnormally low serotonin levels?

    We need a more open-minded and creative approach to medical research. The drug companies love the current non-holistic approach, but the rest of us should be skeptical.

  45. pec says:

    Our lifestyle makes it very hard to find time for aerobic exercise, and it’s very easy to forget about it for days, years, decades. Evolution did not prepare us for such an unnatural lifestyle.

    Medical science does not understand much about why exercise influences health, and I don’t think the materialist reductionist approach will help very much.

    The philosophy of yoga and chiropractic might shed some light, if only you would stop trying to block CAM research funding.

    Notice that daedalus2u never mentioned aerobic exercise, and that suggests he never even tried it. Since mainstream medicine has no theory about why exercise improves mental and physical health, it does not get the emphasis it deserves.

  46. Harriet Hall says:

    pec said,

    “Instead of focusing in on serotonin level, for example, and trying to “correct” it, why not think about what might cause abnormally low serotonin levels?”

    Your comment shows how little you really know about it. In the first place, depression is much more complex than a deficiency of serotonin. And medical research has never focused on just “raising serotonin levels.” They have focused on trying to figure out what causes depression, just as you are suggesting. They are looking everywhere they can think to look.

    “The philosophy of yoga and chiropractic might shed some light”

    I’m not aware that philosophy has ever contributed anything to advance science, rather it has sometimes impeded science. Can you even give us an example of how one might go about scientifically testing a philosophical concept?

  47. Harriet Hall says:

    pec said, “mainstream medicine has no theory about why exercise improves mental and physical health”

    Medicine may not have a Theory of Exercise in the sense that we have a Theory of Evolution. But medicine does have lots of testable and tested hypotheses about why exercise improves health. Everything from improving collateral circulation to raising levels of endorphins and brain-derived neurotrophic factor. Everything from the molecular and biochemical level to the cellular level to the level of muscle and bone tissue – and even including the social benefits of exercising with other people. Where have you been? How have you missed all that?

  48. daedalus2u says:

    Actually I have done aerobic exercise and my experience is that if I can only do it sporadically, that the fluctuations in my mood are worse than not doing it at all.

    At one time I had my resting pulse below 40 when I was riding over 100 miles a week. That did not eliminate my depression. Meds worked much better even with the side effects which I had with every med that I was on.

    Meditation does raise NO levels. I am quite sure that is the mechanism by which it has therapeutic effects. Meditation is not something that everyone can do. I have never been able to do it. When people can do it, it takes a lot of time, hours per day.

    apteryx, in 2005 suicide was the 11th leading cause of death. 32,637 deaths. Is that what you mean by “relatively rare”?

    http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf

    Any and every effective treatment for depression always increases risk of suicide when it starts to work. Every drug, every intervention, even talk therapy increases the risk of suicide when it starts to work. Compress the period of the depression intervention “working”, and you compress the risk of suicidality. One of the things that keeps depressed people alive is the stultifying lack of energy that depression causes. If you eliminate that lack of energy before their mood is raised, they just might use that increased energy to kill themselves.

    How long your trial is can make a big difference in how effective an intervention is perceived to be. If you have 1000 patients and 1% kill themselves per month, that is 20 in the first two months and in a year that is 114 deaths. If you treat them with drug xyz and there is an increase to 2% for the first two months then it drops to 0.1% for the rest of the year, that is 40 the first two month and 50 for the year. Which is better?

  49. DLC says:

    I find myself wondering if pec reads Szaz.

  50. pec says:

    “In the first place, depression is much more complex than a deficiency of serotonin.”

    Yes, that was my point. SSRI drugs focus on increasing the level of serotonin, and have been promoted as correcting the brain chemistry that causes depression. I know people who were prescribed SSRIs and their MD explained that it would correct the imbalance.

  51. pec says:

    daedalus2u,

    So you have gone for most of your life, however long that is, without aerobic exercise. If you were not depressed that would be a surprise.

    And you are very wrong about meditation — it does not take hours a day, and everyone can do it. Meditation is simple. If you had ever paid attention to anything besides materialist science you would know that.

  52. daedalus2u says:

    pec, you know nothing of me or my exercise habits and what fraction of my life I have practiced aerobic exercise of what level and what my state of depression was under those circumstances. I have been in states of extreme physical condition. A resting pulse below 40 is a sign of (what I consider) extreme physical condition. For me, exercise was not a panacea. Exercise did not “cure” or “prevent”, or even modestly help my depression.

    Not everyone can do mediation. I can’t. I have tried. Maybe I haven’t tried “hard enough”. My understanding is that meditation isn’t something you can accomplish by trying harder. I am speculating now, but maybe meditation is simple for people such as you who can turn off their ability to perceive reality and manufacture a fantasy world they prefer to live in. I can’t do that. I don’t want to do that. If that is what it takes to be able to meditate I will never be able to. For the work I do my perception of reality has to be exquisitely precise. I actively work at making it so. I appreciate that most people don’t do that and some such as you can’t do that.

    A very common protective mechanism in trauma is dissociation from feelings. That is one source of the constricted affect that accompanies PTSD. When people feel badly enough, it is a protective mechanism to not feel. A mechanism that has its own side effects. I suspect that when people can’t cope with reality they manufacture a fantasy world for themselves that they can cope with. I have no problem with such people provided they don’t try to impose their fantasy world on me, or use their fantasy world to harm others. By advising people who are depressed to reject treatment involving antidepressants you are trying to harm people with your fantasy world.

    It is actually kind of curious that your holistic approach is to abandon reliance on what can be measured, has been tested, and is actually known in favor of something for which there is no evidence. What is holistic about abandoning that which is known to be reliable? It is also interesting how you are trying to blame my depression on my not following your holistic approach. Not a surprise that you reject my observations over many years that exercise didn’t help much in favor of your own speculations. The classic explanation for woo not working. Blame the person not helped by the woo for doing it wrong.

  53. weing says:

    pec,
    If you get your friends to stop using SSRIs, and some of them commit suicide, do you blame it on the SSRI addiction?

  54. apteryx says:

    daedalus2u – I appreciate that your personal attack on pec was in response to her unfounded suggestions about your personal life. However, it’s important to correct the general misperception that meditation has anything to do with “manufacturing a fantasy world.” It does not; that’s “daydreaming,” which studies have shown intelligent people more frequently engage in, incidentally. Meditating means striving to attain either a calm peaceful state (sometimes including deliberately generated loving thoughts towards living things outside one’s own tribe, a good thing in my book) or, less commonly, a state of focused thought on a specific subject. There is no evidence that meditators don’t/can’t have precise “perceptions of reality” or “can’t cope with reality,” and some evidence that they may have better mental function than people who do not meditate.

    Harriet – You write: “The idea that exercise might prevent depression is intriguing, but is difficult to assess.” We were speaking of treatment of existing depression, not prevention. It is hard to assess the effect of any lifestyle factor on prevention of a condition, because, as you note, there will be any number of confounding factors in free-living human beings. However, it is not impossible to study such questions. Where treatment is concerned, exercise is somewhat harder to study than the gulp-a-pill treatments, as patient “compliance” is more of an issue. However, published results are available that show both exercise and St. John’s wort may be effective in MODERATE (not just mild) depression. I point out that exercise has numerous other health benefits and that lack of exercise is unnatural in the strict biological sense.

  55. Harriet Hall says:

    pec said, “SSRI drugs focus on increasing the level of serotonin, and have been promoted as correcting the brain chemistry that causes depression. I know people who were prescribed SSRIs and their MD explained that it would correct the imbalance.”

    That’s an oversimplification and no one doing research on depression thinks of it in such simplistic terms. I really don’t see what you mean by “holistic” research or how “The philosophy of yoga and chiropractic might shed some light.” I wish you would explain what you mean. Can you give us an example of the kind of research you think we should be doing?

  56. pec says:

    Meditation is a natural mental state that occurs spontaneously. We can learn to deliberately enter that state, and no special tricks are needed. One of the easiest methods is to focus attention on your own breathing.

    Meditation has been studied a little by mainstream medicine, but probably not to the extent it deserves. It might be very relevant to the problem of depression.

    Of course meditation might be easier if you have spiritual beliefs and feel connected to something beyond your physical self.

  57. Fifi says:

    Actually awareness meditation requires no spiritual beliefs or faith at all – and having taught people awareness meditation I’ve found that religious beliefs and various expectations can actually get in the way when practicing awareness meditation. One also doesn’t need to believe in God or any kind of woo to have the experience of feeling connected to something beyond one’s self. Most of us feel quite connected to our loved ones (and even people we might quite dislike), our communities and for many the natural world.

  58. Fifi says:

    What I find continually strange about pec’s assertions is that she doesn’t even seem to be very knowledgeable about the things she promotes!

  59. pec says:

    I find the same thing strange about you Fifi. And I never said meditation requires spiritual beliefs — I said it might be easier with spiritual beliefs.

    I don’t think we have any data on this and my guess is that atheists are less likely to meditate. Of course you are an odd exception, meditating on your connection with people you don’t necessarily like.

  60. daedalus2u says:

    apteryx, I was still upset with pec over her AIDS denialism and her irrational dismissal of the AZT study on the other thread (which she has never acknowledged or explained). When a double blind placebo controlled trial with a p less than 0.001 on multiple markers is dismissed, what does that say about the person and their motivations for doing so?

    She is doing the same thing with antidepressants, something I happen to know a lot about both from reading about it and from personal experience. Mental health is no less important than physical health. In some ways it is more important. The quality of life of someone who is depressed can be lower than someone who is merely terminal. Many terminal patients want their life to continue even as it deteriorates. Many depressed people do not. That obvious self expression of the subjective quality of life is simply ignored by those unwilling to try and understand it. Conveniently that ignorance lets them treat depressed people in non-helpful ways.

    Mental health is much less understood and very much less appreciated by people and they are all lumped together. A very large part of the problem of people not receiving appropriate mental health treatment is the deliberate misinformation put out by anti-medicine zealots such as pec. In the not too distant past people with mental health difficulties were shunned, burned as witches and even now are abused. If you are not empathic, it is easy to dismiss someone’s pain when that pain has no obvious organic cause. Stress puts a tremendous toll on the physiology of people exposed to it. Often that shows up as PTSD and as other problems later.

    There is relatively little research work done on meditation, what work has been done does indicate that meditation does raise NO levels. As far as I know there are only 2 ways to raise NO levels, meditation and the bacteria I am working with. All the other techniques don’t work long term, physiology compensates for them and they stop working.

    The specific mindfulness meditation technique that Fifi mentions do work “the best” because the pathways being activated are mediated through NO (i.e. oxytocin). The archetypal bonding mechanism in mammals is lactation. Lactation is highly energy dependant; it requires high liver mitochondria activity (for gluconeogenesis). I suspect that the NO released during lactation facilitates liver regeneration and mitochondria biogenesis in the liver. Similarly brain activity requires high liver glucogenesis too. I think that NO from neuronal activity (that is what the fMRI BOLD signal is measuring, vasodilation due to NO release) stimulates liver mitochondria biogenesis as a feedback mechanism to match liver glucogenesis capacity with brain glucose consumption.

  61. apteryx says:

    That’s interesting; it does seem that meditation has both physical and mental benefits. I’m not sure what to think of your NO theory. It reminds me of the attempts to explain all chronic disease in terms of oxidation or inflammation. Both of those processes are involved in multiple diseases, and antioxidants and anti-inflammatory substances do have demonstrated benefits, but neither mechanism really provides a medical “unified field theory” that explains all disease. If I had to bet, I’d bet that NO is a key factor but not as all-important as you think it will prove to be.

  62. daedalus2u says:

    It is my understanding that contrary to pec’s assertion that having positive thoughts about people one does not like is not contrary to any practice of meditation.

    The Dalai Lama says:

    I’m Buddhist, I’m a Buddhist practitioner. So actually I think that according to nontheistic Buddhist belief, things are due to causes and conditions. No creator. So I have faith in our actions, not prayer. Action is important. Action is karma. Karma means action. That’s an ancient Indian thought. In nontheistic religions, including Buddhism, the emphasis is on our actions rather than god or Buddha. So some people say that Buddhism is a kind of atheism. Some scholars say that Buddhism is not a religion — it’s a science of the mind.

    http://www.phayul.com/news/article.aspx?article=Ocean+of+wit+and+wisdoms&id=18719

    So much for atheists not meditating.

  63. daedalus2u says:

    Oxidative stress is bad because it lowers NO levels. That is the major physiological function of oxidative stress, as a powerful regulator to lower NO levels to shift physiology. In the short term, oxidative stress can be very good, it is what triggers ischemic preconditioning, it triggers an acceleration of metabolism, it triggers an immune response, it triggers the acceleration of the metabolism of xenobiotic chemicals by cytochrome P450 enzymes, it triggers a lot of “stress responses”. That is why stress causes a lowering of NO levels.

    The oxidative stress induced low NO state exhibits hysteresis. When you are in a “stressed state”, you don’t want to use any resources to maintain that state because you want all those resources available for responding to what ever caused the stress in the first place. You need an external trigger to bring the NO level back up. That is what the placebo effect is; it is an external psychogenic trigger that brings the NO level back up. You can achieve the placebo effect through meditation or through the relaxation response. They are essentially the same thing.

    It is only when that NO level stays low for too long that there are the damaging effects of stress. That “damage” occurs because the normal repair processes have been turned off to conserve ATP to respond to the stress. That is why wounds don’t heal as well under stress. Healing is less important than maintaining sufficient ATP reserves to respond instantly.

    Antioxidants don’t work to relieve oxidative stress because there is nothing abnormal or non-physiologic about the oxidative stress in the first place. It is a state that physiology has deliberately invoked, and which physiology will attempt to maintain until it gets the signal it can “stand down” from the stress state. That signal is an increase in NO levels of sufficient magnitude to overcome the hysteresis.

    That is what a lot of non-thermal sweating is attempting to do, particularly at night. Generate NO/NOx from sweat via a biofilm to restore the “at rest” basal NO state. That is why night sweats are often a symptom of disorders characterized by low NO which are (essentially all) made worse by stress.

  64. Fifi says:

    Oh pec, always trying to twist things around. I practice awareness meditation so I don’t meditate “on” anyone or anything – as you’d know if you understood what awareness meditation is. It’s antithetical to staying in and being aware of the present moment. Even in compassion meditations one doesn’t meditate “on” a person or fixate in that way – though certainly plenty of people do engage in practices more akin to visualization where they practice being loving towards those they have difficulty being compassionate towards.

    Clearly you misunderstood what I meant when I said people feel connected. I was simply pointing out that there are many ways to feel connected with our fellow humans and the world in which we live.

    Of course, some people practice what they like to call meditation as an escape from reality but this is really more akin to daydreaming or fantasizing – and is generally a pretty good indication that one’s mind is wrapped up in telling stories and not being present in the moment.

  65. Fifi says:

    Back to the subject of the mainstream media getting the story wrong. Unfortunately over the past 15 years the consolidation of media, the plummeting profitability of print media and the increasingly sophistication of marketers has had an adverse effect on all kinds of reporting. Though, I think it’s important to point out that journalism and the publishing business have always been like this and there have always been ethical and unethical – and competent and incompetent – journalists (just like every other profession). However it’s become extremely difficult to make a living as any kind of journalist who’s a truth speaker and the investigative journalism departments of newspapers have been gutted. It takes time and costs money to do good reporting.

    Publishers own media to have a platform for their views – how much they micromanage depends on their personality and beliefs. Most micromanage a fair amount, and obviously they don’t print stories that might hurt their or their friends’ interests most of the time. Selling papers to make money just isn’t what it’s about anymore (since newspapers don’t make money in the same way anymore and even breaking a hot story doesn’t have the selling power it used to due to the speed of information sharing). Historically privately owned newspapers (and TV) have always been a means to promote a specific viewpoint, not a public service. Which is why public broadcasting – corrupted as it’s become – was and potentially still is the best outlet for views that aren’t associated with a particular commercial interest or one person’s agenda.

    While there’s certainly tons of weak science reporting on CAM related topics (though most CAM-related stuff I see is in the lifestyle section), there’s just as poor science reporting about pharmaceuticals, research and medicine in general (which is even worse now that drugs can be advertised on TV). Political reporting has become pretty damn weak overall too (and almost sheer propaganda in the US). So has a lot of arts reporting. Probably the most insidious and corrupting thing done on TV is presenting pre-made human interest style “stories” generated by commercial interests – with gaps left in so the newscaster can make it look local and like they made it.

    I suspect that there’s a bit of a lack of realism that comes into play when people think about journalism if they haven’t worked in the media. Just like how people tend to have unrealistic expectations of doctors and medicine sometimes. Which is not to say that we shouldn’t hold people up to high standards or have ideals, it’s just good to also acknowledge things as they are.

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