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The One True Cause of All Disease

Note: This is a slightly modified version of an article that was published in the magazine Skeptical Inquirer, Volume 34, No. 1, January/Februrary 2010. It is reprinted here with the kind permission of the Committee for Skeptical Inquiry.

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Chiropractors, homeopaths, naturopaths, acupuncturists, and other alternative medicine practitioners constantly criticize mainstream medicine for “only treating the symptoms,” while alternative medicine allegedly treats “the underlying causes” of disease.

Nope. Not true. Exactly backwards. Think about it. When you go to a doctor with a fever, does he just treat the symptom? No, he tries to figure out what’s causing the fever and if it’s pneumonia, he identifies which microbe is responsible and gives you the right drugs to treat that particular infection. If you have abdominal pain, does the doctor just give you narcotics to treat the symptom of pain? No, he tries to figure out what’s causing the pain and if he determines you have acute appendicitis he operates to remove your appendix.

I guess what they’re trying to say is that something must have been wrong in the first place to allow the disease to develop. But they don’t have any better insight into what that something might be than scientific medicine does. All they have is wild, imaginative guesses. And they all disagree with one another. The chiropractor says if your spine is in proper alignment you can’t get sick. Acupuncturists talk about the proper flow of qi through the meridians. Energy medicine practitioners talk about disturbances in energy fields. Nutrition faddists claim that people who eat right won’t get sick. None of them can produce any evidence to support those claims. No alternative medicine has been scientifically shown to prevent disease or to cure it. If it had, it would have been incorporated into conventional medicine and would no longer be “alternative.”

Are these practitioners treating the underlying cause, or are they simply applying their one chosen tool to treat everything? Chiropractors treat every patient with chiropractic adjustments. What if a doctor used one treatment for everything? You have pneumonia? Here’s some penicillin. You have a broken leg? Here’s some penicillin. You have diabetes? Here’s some penicillin. Acupuncturists only know to stick needles in people. Homeopaths only know to give out ridiculously high dilutions that amount to nothing but water. Therapeutic touch practitioners only know to smooth out the wrinkles in imaginary energy fields. They are not trying to determine any underlying cause: they are just using one treatment indiscriminately.

How do you define “cause”? We don’t know what “causes” gravity, but we understand enough about how it works to overcome it with elevators, airplanes, and rockets to the moon. We may not know what ultimately “causes” asthma, but we know enough about the causes of airway constriction and inflammation to devise effective treatments.

Let’s take a simple example: strep throat. The symptom is throat pain. Doctors don’t just treat the pain – they do a throat culture, they determine that a strep infection is causing the pain, and they treat the infection with an antibiotic. But what caused the strep infection? The body had to host the bacteria and respond to their presence by developing symptoms; the bacteria had to be capable of multiplying in the human body. The patient had to be exposed to another person who had a strep infection, who in turn had caught it from someone else – involving a chain of social and epidemiologic causes. The bacteria had to evolve from ancestor bacteria and the human from ancestor animals. In order for the life to develop, the circumstances on the early Earth had to be propitious. Keep going. The Earth had to have formed and cooled. Stars had to have created the necessary carbon, nitrogen, and other elements that were not present in the early universe. Keep going, and you will end up saying these words from the theme song of a popular TV show: “It all started with the Big Bang.” If you really want to be picky, you could go one step further and say the real cause was whatever caused the Big Bang. (But what caused that cause? Turtles all the way down?)

So you see, “cause” involves a chain of causation and there can even be several simultaneous causes. “Cause” can mean pretty much anything you want it to. But however you look at it, doctors definitely do not “just treat symptoms.”

Philosophy has studied causation. Aristotle said everything had four causes: material, formal, efficient, and final. And he introduced complications: proper (prior) causation and accidental (chance) causation. Potential or actual, particular or generic. Reciprocal or circular causality as a relation of mutual dependence or influence of cause upon effect. The same thing as the cause of contrary effects when its presence and absence result in different outcomes. He recognized that the subject of causation was complicated.

Alternative providers are more “simple” minded. They often claim to know the one true cause of all disease. That is curious, because medical science defines several categories of causes falling under the mnemonic VINDICATE:

V – Vascular
I – Infectious/inflammatory
N – Neoplastic
D – Drugs/toxins
I – Intervention/iatrogenic
C – Congenital/developmental
A – Autoimmune
T – Trauma
E – Endocrine/metabolic.

And sometimes more than one cause is involved: a traumatic injury gets infected. Where science finds complexity, alternative medicine imagines simplicity. As H.L. Mencken said:

For every complex problem, there is an answer that is clear, simple—and wrong.

Some homeopaths claim to treat “genetic” illness, tracing its origins to 6 main genetic causes: Tuberculosis, Syphilis, Gonorrhoea, Psora (scabies), Cancer, Leprosy. Bet you didn’t know tuberculosis was genetic! Neither did I. Science classifies all these as infectious except for cancer, which is neoplastic. Homeopathy disregards science and redefines “genetic” to suit its own inscrutable purposes.

Science finds many causes for disease and sometimes more than one cause for a given disease. Pseudoscience has identified the one true cause of all disease – many times. I did an Internet search and found the following 69 one causes of all disease. This is not an exhaustive list but rather an exhausted list (I stopped when I got tired of searching).

Toxemia
Subluxations
Oxygen deficiency
Psora
“Fearful, tight and negative minds”
Obstruction of ch’i along the meridians
Refined sugar
“Fault of awareness”
Grains in the diet
False beliefs and fears
“Imbalance”
Ama due to aggravated doshas
Stress
Anger
Modern medicine
Some morbid agent, producing irritation and inflammation
Arrogance
A “non-perceivable but very real attachment to the material aspect of creation”
Inadequate nutrition
A congested colon
“All disease is a learned experience which we can un-learn.”
“All illness is in our minds,” and we can cure it with faith in God, meditation, or whatever.
Spiritual vital force and its dynamic derangement
Holding on to energy within the physical, emotional and spiritual bodies that is not in harmony with us
Impairment of movement of the bones of the skull
Bad health habits
Nerves too tense or too slack
God
Lack of life
Witchcraft
Miasms
Poor sanitation
A shock experience that catches us completely off guard
Cellular memories
An excess or insufficiency of nervous tension
Poor digestion
Weak digestive fire
Exogenous toxins
Morbid matter
An unbalanced life style
Disharmony in the equilibrium of Yin and Yang
A breakdown of the immune system
A weak “immine” system
Malnutrition
Free radicals
An imbalance of electrons in the cellular atoms
Emotion
Sin
Food abuse
Allergies
Ignorance of reality
Dis-ease on any level (physical, emotional, mental, soul or spiritual) is incorrect vibratory rate(s), patterns which are not appropriate, or blocked energy pathway(s) within or between the various levels of existence
Repletion
The blood
Morbid humors
Poisonous chemicals
Emotional trauma
“Allurement” of the mind by sense objects and its “willfulness” in gratifying these desires
Toxic metals
Cold
Blocked nerves
Our inability to adapt
Overeating
Poverty
Food acidity
Violation of natural law
Liver flukes
Breaking taboos

And my favorite: “the United KKK States of America is the root cause of all disease…”

It never seems to bother them that others have found different one true causes. In his book Voodoo Science, Bob Park describes a press conference following a meeting to discuss government funding for alternative medicine research:

Perhaps the strangest part of the press conference consisted of brief statements by individual members of the editorial review board of what they saw as the most important issues for the Office of Alternative Medicine. One insisted that the number-one health problem in the United States is magnesium deficiency; another was convinced that the expanded use of acupuncture could revolutionize medicine; and so it went around the table, with each touting his or her preferred therapy. But there was no sense of conflict or rivalry. As each spoke, the others would nod in agreement. The purpose of the OAM, I began to realize, was to demonstrate that these disparate therapies all work. It was my first glimpse of what holds alternative medicine together: there is no internal dissent in a community that feels itself besieged from the outside.

When scientists encounter two mutually exclusive claims, it bothers them. They experience cognitive dissonance and try diligently to find evidence to reject one of the hypotheses and leave a winner. They eventually reach a consensus. Alternative medicine pseudoscientists don’t seem to mind cognitive dissonance. They are content to look for evidence to support their own chosen treatment while blithely disregarding competing claims. They don’t want to look for evidence that something doesn’t work. While each claims to know the one cause of disease, they don’t seem interested in looking for the one truth.

Live and let live? Create your own reality? Truth is only relative? The same thing may be simultaneously true for me and false for you? Maybe it boils down to a mutual tolerance of delusions (OK, I’ll believe that you are Jesus if you believe that I’m Napoleon). For the cynical, follow the money: “I won’t interfere with your livelihood if you don’t interfere with mine.”

I can play the cause-finding game too. I’ve discovered the one cause of all the “one cause” theories: a deficiency of critical thinking skills combined with an overactive imagination. And, of course, a failure to test beliefs using the scientific method.

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56 thoughts on “The One True Cause of All Disease

  1. What a beautiful account of the absurdity of the alt med community. It would be interesting to know how many people fall into each of your two categories.

    (1) I’ll believe that you are Jesus if you believe that I’m Napoleon).
    (2) follow the money: “I won’t interfere with your livelihood if you don’t interfere with mine.”

    My experience is that most homeopaths really seem to believe what they say. A while ago I posted something about the homididal pretence that homeopaths can cure serious infectious diseases, I was surprised when one of the people I’d mentioned, Kate Birch (vice-chair of the North Americn Society of Homeopaths) turned up at my office in London. She didn’t want to shoot me, but to give me a copy of her book. She seemed quite genuinely to believe that her sugar pills could treat malaria, rabies, diphtheria, smallpox, anthrax and polio.   If you listen in on homeopathic discussion groupls, you will never detect a moment of doubt that they really can do all of these things.
    On the other hand, nutrition faddists seem very much more enthusiastic about selling you ‘supplements’ that won’t help with conditions that you probably haven’t got anyway.
    Robert Parks book, Voodoo Science, has a lovely discussion of the "road from foolishness to fraud".  It’s hard to beat his famous aphorism

    “Alas, to wear the mantle of Galileo it is not enough that you be persecuted by an unkind establishment; you must also be right.”

  2. mxh says:

    Another cause of one-cause theories is the presence of gullible people who easily part with their money.

    Nice post. Another question to think about is why so many cinsumers buy in to more than one of these mutually exclusive one-cause theories. If you really believe in homeopathy then why would you accept accupuncture also? But many alternative health nuts buy into everything but real medicine.

  3. zeno says:

    Succinct and brilliant!

  4. Steluta says:

    Inflammation is the common link between such debilitating conditions as Alzheimers, heart disease, cancer, and arthritis?

    Body Ecology believes that one of the main causes of inflammation is low-grade bacterial, viral, and fungal infections in the bloodstream and organs like the stomach and gastro-intestinal tract.

  5. DevoutCatalyst says:

    Some flavours of alternative medicine promise a long life in the here and now. And when it doesn’t come to pass for the adepts, wtf. It’s hard out there for a guru.

  6. alison says:

    I’m also interested in how Alternative Realists reconcile their multiplicity of One True Causes, so I asked the question of someone I know who makes a living practising acupressure and chiropractic and cranial osteopathy AND homeopathy. I was told “it’s possible to have different healing modalities based on different theories because if you look behind the words they use they are all saying the same thing”. Apparently the way it works in Alt-land is that devotees of Therapy A are able to agree that Therapies B-Z are not mutually exclusive but different ways of expressing the same underlying idea, whatever that is. So the practitioners of each therapy see the others doing the same as they do, but using different words and different techniques to do it. The person I was speaking to believes that all interventions done with therapeutic intent, whether an alternative therapy or a standard science-based one, have the effect of ‘moving the energy’ in the patient.

    I went on to point out that I could see some sort of internal logic in this, in the same way that religious people can all agree that they have underlying beliefs in one or more supernatural being or beings, though they disagree about the details and the form of worship, and so on, but that being an acupressurist and a chiropractor at the same time was a bit like someone being a practising Hindu and a practising Christian at the same time, which seems unlikely.

    David – I know more than I really should about these Alternative Realists and my experience is that most of the ones that do it for a living are in both of those categories. A lot of it really is about mutual support against the beastly sceptics, as Bob Park was suggesting in the piece that Harriet quoted.

    I didn’t get any reply to this. It’s always the same – they stop talking or change the subject, and you never know whether your devastating argument has made them stop and think, or whether they have just dismissed you as one of those cold, hard, two-dimensional scientific beings who have no emotions and see everything in black and white.

  7. Michelle B says:

    Thanks for posting your excellent article here.

    The appeal of alternative medicine is due to how easy it is to use and practice because it is not regulated. And it is not regulated for the most part because it is not medicine. How can nonsense be regulated?

    Because it is not regulated, it can become whatever you what it to become: an all-purpose cleaner that will keep any house clean; an authentic method because it has been around for so long; sticking it to the military/industrial complex; god’s way to cure; an psychologically comforting quest because you don’t need to deal with harsh reality; a way to beat imperfection that will inflict others, but not you; the undeniable delight derived from the realization that many hard-working, studious folks are wrong and you are right because of your gut-based ability to get at what is true right away; the kind, considerate, and humble group cooperating with nature against them who with great hubris worship superficial artificiality; on and on and on.

  8. Dave Ruddell says:

    I can’t believe you left liver flukes off the list!

  9. Harriet Hall says:

    Dave Ruddell said,

    “I can’t believe you left liver flukes off the list!”

    I can’t believe I did either. I could have sworn it was there, or at least “parasites.” I had to re-read the list 3 times to convince myself you are right. Thanks for noticing.

    I will edit the post and add liver flukes. I will also add one an anthropologist pointed out to me: breaking taboos.

  10. Zetetic says:

    Harriet – You forgot the Devil and all his minions! There was, of course, a time when everything was blamed on demons. Seems some current day faith healers still think so!

  11. windriven says:

    The one true cause of most of society’s ills is an overabundance of morons. Under the new improved health care plan, adult consumers should self-select into one of two different health care systems: science based or alternative. But once the choice is made there is no changing.

    I suspect this would result in a sharp decrease in the total size of the herd followed by a renewed appreciation for the value of science.

  12. Malnutrition must cover all the various specific nutrient deficiencies, such as vitamin C, D, magnesium, iodine, etc.

    Seeing as we all know healthy people don’t get sick, the one true cause of all disease must be poor health. :)

  13. Fascinatingly, Samual Hahnemann first believed that coffee was the root cause of pretty much all ‘modern’ ailments. He appeared to later blame his mystical miasms. (chocolate was not too good too) My guess is that he could not give up his chocolattes.

  14. jmm says:

    The serious criticism of modern medicine still remains, however farcical some its expressions. That is, does modern medicine go far enough back through the chain of causation. A cause of much (although not all) of modern disease is behavior, which is not even listed in VINDICATE. A cancer may be caused by smoking. Diabetes or heart disease may be caused by diet and lack of exercise. A broken leg may be caused by stupid excessive risk-taking. Modern medicine does precious little to address these causes effectively.

    To address these deeper causes obviously involves delving into the psychology of the patient, including “normal” patients as well as those whose mental state is considered pathological. It therefore requires a different concept of “disease”. Some (but certainly not all) of these one true causes can be read as statements about that psychology, whether expressed literally or metaphorically/spiritually.

  15. EricG says:

    jmm

    interesting question, but I think it has to be tempered with some additional questions. namely:

    to what extent is the medical practitioner required to look back in order to assert causation? What role is even practical in the application of causation? is what is presented in the exam room not sufficient?

    and

    are we not addressing these causes in other ways?

    both essentially are addressed in the same way. we have smoking laws, seat belt laws, food and drug warnings. I am not sure what more can be done, especially from the perspective of practicing science based medicine.

    ultimately, the squishier the words get, the less effective any group of people are going to be at addressing the problem, especially when you start redefining disease and whether causes of such “disease” are psychological or spiritual etc.

    should we be treating small children who like video games for hypertension “psychologically,” since their immobile lifestyle will eventually lead to obesity? In fact, I am not 100% sure what the content of your post even aims to state.

  16. pmoran says:

    A little thought should show that doctors have very little opportunity to influence overall lifestyles, and one-on-one medical interaction would be a ridiculously costly way of approaching public health concerns.

    The relevant information can be written on the back of an envelope and taught in schools, on TV and other media, and most importantly (and hopefully), in the home.

    And the big problem, anyway, is getting people to follow through with what they are advised.

    Relying upon alternative practitioners would be the worst possible option, even more costly through its supplement-orientation.

  17. windriven says:

    @jmm

    Is it your position that physicians do not take such causality into consideration? Have I been mistaken in my belief that medical doctors first established the link between smoking and lung cancer? Was it actually a naturopath gazing into a crystal?

    All competent physicians consider lifestyle issues. They cajole their patients to quit smoking, lose weight, eat balanced meals and so forth.

    Spritzing bullshit with pseudo-psychological potpourri doesn’t make it smell any better.

  18. DevoutCatalyst says:

    “…Have I been mistaken in my belief that medical doctors first established the link between smoking and lung cancer? Was it actually a naturopath gazing into a crystal?…”

    The Three Stooges referred to cigarettes as “coffin nails” back in the 40s. Good enough for me, nyuk, nyuk.

  19. Harriet Hall says:

    King James said it first, long before the Three Stooges. He said tobacco was

    “a custom loathsome to the eye, hateful to the nose, harmful to the brain, DANGEROUS TO THE LUNGS, and in the black stinking fume thereof nearest resembling the horrible stygian smoke of the pit that is bottomless.” from his Counterblast to Tobacco in 1604
    http://www.jesus-is-lord.com/kjcounte.htm

    He had quite a way with words.

  20. tall penguin says:

    As someone who was once steeped in alt med, both as a consumer and as a practitioner, the idea of the “one true cause” never quite sat well with me. I remember doing a training in yet another alt med modality and questioning one of my instructors as to how I could best choose which modality to use when. Her response? “Everything fixes everything,” closely followed by “Energy follows intention.” So, basically, if you hold a positive intention when working with a patient (regardless of the condition they’re presenting), it doesn’t matter whether you’re using homeopathy or energy work or acupuncture, somehow everything will work out. Somehow, the mysterious energetic healing forces will find their way to the cure.

    It must sound bizarre but this is what alt med practitioners believe, sincerely believe. I know it’s often suggested that alt med practitioners are in it for the money and can’t possibly believe their own rhetoric, but they do. They sincerely believe that what they are doing is helpful. It’s not that different than the religious true believer. They are sincere but horribly misguided. These are the most dangerous of all, because no amount of logic can deter them. What’s that quote? “The road to hell is paved with good intentions.”

  21. alison says:

    Tall Penguin:

    I’d forgotten that expression “energy follows intention”; I’ve been told that too and it really does summarise what I was saying in my earlier comment.

    And yes, you are right: they do sincerely believe in the rightness, validity and usefulness of what they do, and no matter what they say about being ‘complementary’, they also believe that they are superior to medical doctors and vets not only because of their mystical knowledge about One True Causes but also because with many therapies they believe they can heal people who are unbalanced at “the energetic level”, i.e. before their imbalances manifest themselves as physical symptoms. The idea is that if you are ill enough to need real medicine you have left it too late – this is one of the reasons for promoting regular sessions of whatever for ‘maintaining wellness’.

    Training courses for practitioners include elements of real science (anatomy, physiology, etc) and metaphysics so intimately mixed that it becomes hard for the student to see where the boundaries are; apparent correlations between biological facts and metaphysical theories are presented as “evidence that modern science has validated the ideas of the ancients” and so on.

    There is also a lot of communal reinforcement behind the scenes. There are magazines and publications from the alt med societies which emphasise the party line (and encourage devotees to arm themselves against the pesky sceptics who are bent on belittling what they describe as their “wonderful therapy”), and workshops and courses in which charismatic presenters use passionate rhetoric and various new-age practices to do a sort of mass hypnosis on a group of people who are all ready and waiting to have their values and beliefs confirmed. There is an underlying acceptance of new age metaphysics in which nothing, however bizarre, is rejected as long as it reinforces the general view of how things work. Some of this is beyond weird, but the majority of alt-med consumers don’t know how weird it actually is, because almost none of this underlying stuff appears on the websites, or in leaflets, or in discussions during a treatment. If you’ve never been involved except as a consumer, you probably wouldn’t be able to imagine what some of these people get up to.

    My involvement in alt med was fortunately a brief dip rather than total immersion or even a steeping. Unlike most students, I decided to explore the evidence my teachers had mentioned … and soon discovered sites such as this one and rapidly realised that a change of opinions was required. For a while I felt cringingly embarrassed about having been led astray, but now I reckon my inside knowledge puts me in a stronger position as a sceptic. Not, of course, a stronger position with my former colleagues, who were less than delighted when I told them about my apostasy, and the reasons for it. As you say, no amount of logic will do any good, and knowing what I know, you wouldn’t expect it to.

  22. Eric Matheson says:

    Wonderful post Harriet, thank-you. The subject of cause was discussed on SomaSimple.com in a thread begun two years ago titled Cause’s Confusion. It complements Dr. Hall’s assertions precisely. You can read it by following this link; http://www.somasimple.com/forums/showthread.php?t=4642
    Specifically, the distinction between cause and origin of painful problems is discussed. Your comments are most welcome.

  23. edgar says:

    Good post, but i think it is important to understand why the alt-med community flourishes.

    1. Because medicine is woefully unequipped to ‘cure’ with many chronic illnesses. If I were in chronic pain, I might just seek out alts, out of desperation.
    2. I think medicine has historically discounted how important keeping the body health is (And more than anything, I think this is due to the rapid shift between the prevalence of infectious disease and chronic). Plaque on teeth? What difference does THAT make?

  24. jmm says:

    EricG, the point of my comment was that there is actually some truth in the accusation that the conventional medical system neglects underlying causes. For behavior, medical science does indeed study which behaviors are and are not harmful. But little to delve into what does and does not lead to compliance. When one true causes start getting into things like “imbalances” and the spiritual, they can be seen, on a good day, as attempting to address the psychology that leads to poor choices of behavior. I suspect that people in a good place spiritually, however they get there, have more self-control and are capable of more compliance.

    pmoran, this is exactly the question. What is it that will lead patients to follow through rather than essentially to self-harm? The conventional medical system does not currently have good answers to this. I think it should be looking harder.

    Eg, a friend of mine in family practice has anecdotally observed greater success on diet when she emphasises not harm to the adult individual in her clinic, but the danger to the children, and finds she makes progress only when she deals with the entire family together. That said, she left the east coast, because apparently family practice essentially no longer exists there, adults go to an internist and children to a pediatrician. Her professor at Harvard Medical School said she was “throwing her life away” going into family practice. The sort of work that deals with compliance is among the least prestigious within the medical profession.

  25. windriven says:

    @ DevoutCatalyst and Dr. Hall

    The famed philosopher Moe Howard and the King James bible may well have appreciated the loathsome nature of tobacco smoke. But I believe it was Alton Ochsner, MD who drove the nail that linked tobacco smoking with lung cancer.

  26. Harriet Hall says:

    Whoever gets the credit for discovering that tobacco could cause lung cancer, it certainly wasn’t an alternative medicine practitioner.

    Smoking is the leading preventable cause of death. Do alternative practitioners recognize this? Many of them do encourage patients to stop smoking. How do they fit that into their one cause philosophy?

  27. weing says:

    edgar,

    How about SBM being honest about what can or can’t be done to help the patient allows the hucksters, who don’t have those constraints, to flourish?

    I don’t think that medicine has historically put wellness on the back burner. That takes up a lot of my day.

  28. windriven says:

    @edgar

    I think you make a great point about people sometimes seeking alt med solutions when SBM just doesn’t have much to offer. I would be interested to know what proportion of alt med users fit that profile and what proportion are just goofs.

    It also begs the question of why institutional medicine in general and the FDA in particular have been loath (with a few exceptions) to offer investigational therapies to otherwise hopeless patients. I understand that there are ethical issues that need to be addressed. Apparently WBM is rather less constrained in that regard.

  29. BA says:

    As to jmm’s (first) comment and applicable to the last as well,

    If behavior is subject to the laws of nature and all sciences represent a continuity of inquiry at different levels of analysis we could say that the cause of the big bang is the cause of all disease. So in some sense there is a single cause to all ills but it is the same cause as is there for all non ills. That said, each level of analysis (i.e., means of scientific inquiry) has some part of the story to tell in describing causality (or explain if one is not averse to such terminology as explanation often requires crossing levels of analysis making the complete account choppy). Though medical science focuses on physiological mechanism there is still the psychological accounting for why one engages in the behavior in question. Smoking, though bad for one’s health, occurs because of a number of factors (yes, some of them are physiological, accounted for how our species has evolved and responds to this substance). Personal histories (phylogenic and ontogenic) and social contingencies (as they impact that smoker) are all relevant (spirituality and other nonsense can check their coats at the door).

    Though the MD can speak cogently of the underlying physiology and note the relevant behavior, they are not in the best position to account for the cause of the behavior. They are likely, however, (some exceptions of course) in a very good place to give a coherent synthesis of the variables related to smoking. So to say that modern medicine neglects “deeper cause” is bull pucky. Medicine stands on the basic sciences of anatomy and physiology and these sciences are beholden to the more reduced levels of analysis embodied by chemistry and physics. There are less reduced levels of analysis that need to be considered as well (i.e., psychological variables). Quacks are in no better position to talk about deeper meaning, they are in a worse place given the science be damned attitude.

  30. edgar says:

    That said, each level of analysis (i.e., means of scientific inquiry) has some part of the story to tell in describing causality (or explain if one is not averse to such terminology as explanation often requires crossing levels of analysis making the complete account choppy). Though medical science focuses on physiological mechanism there is still the psychological accounting for why one engages in the behavior in question. Smoking, though bad for one’s health, occurs because of a number of factors (yes, some of them are physiological, accounted for how our species has evolved and responds to this substance). Personal histories (phylogenic and ontogenic) and social contingencies (as they impact that smoker) are all relevant (spirituality and other nonsense can check their coats at the door).

    Interested in particular at that last part, about spirituality….Care to expand, as I have some thoughts on this, but I don’t know if I understand what you mean. If we are talking about behavior change, then spirituality does indeed play a role.

    Though the MD can speak cogently of the underlying physiology and note the relevant behavior, they are not in the best position to account for the cause of the behavior. They are likely, however, (some exceptions of course) in a very good place to give a coherent synthesis of the variables related to smoking. So to say that modern medicine neglects “deeper cause” is bull pucky. Medicine stands on the basic sciences of anatomy and physiology and these sciences are beholden to the more reduced levels of analysis embodied by chemistry and physics. There are less reduced levels of analysis that need to be considered as well (i.e., psychological variables).

    I think medicine (and science) overlooks the mechanisms between social and environmental justice and health. From my perspective, this might just be the key to chronic disease. Also, we need well as culturally relevant ways of healing generational trauma.

  31. edgar says:

    PS, Wind, I haven’t forgotten about you, it will probably be friday.

  32. BA says:

    edgar:

    “Interested in particular at that last part, about spirituality….Care to expand, as I have some thoughts on this, but I don’t know if I understand what you mean. If we are talking about behavior change, then spirituality does indeed play a role.”

    I would argue that spirituality as cause is an explanatory fiction. Not that there is any problem with the term spirituality but identifying it as a cause of action is the fiction. When one acts under the influence of social contingencies, these social contingencies are part of the ontogenic experience and are how socio-cultural influence shapes the behavior of the individual. The cause is in the history that produces behavior we refer to in the vernacular as caused by spirituality. Take as a parallel saying an emotion is a cause (I’m not arguing it can’t cause somethine but rather the way we use it in the vernacular is a fiction). If we say frustration causes aggression, we are mistaken. Frustration does not cause the aggressive act. The causal sequence is complex but a major influence is the history (ontogenic and socio-cultural) of aggressing produces tangible outcomes (escape from the “source of frustration”, “retribution”, etc.). These tangible outcomes are part and parcel of the ontogenic cause. Frustration causes heart rate change, sweating, pupillary constriction…and changes the value of aggressive acts. It is relevant variable but to identify it as the sole cause is inaccurate.

  33. windriven says:

    edgar, take your time. This is purely intellectual curiosity and I sincerely appreciate any insight you can offer.

  34. In the manual therapies, we see lots of One True Causes of All Pain.

    One of the most amusing examples I’ve ever encountered came from a Registered Massage Therapist who claimed that all chronic pain came from postural asymmetry caused by … wait for it … coriolis force! He suspected that “the pattern is probably reversed in Australia, but I haven’t been able to afford to get to Australia yet to check.” Fascinating that he regarded his hypothesis as testable … just too expensive to test. (And you can’t trust the Australians to check this sort of thing.)

    Another massage therapist introduced himself to me with the grandiose declaration, “I have been at this for twenty years and have the answers that we all search for.” In a weird twist on the I-can-cure-everything-by-touching-only-one-bone theme (see also NUCCA), he picked the … wait for it … the cuboid bone!

    That’s right, the weensy tarsal bone, about the size of a sugar cube. Cuboid joint dysfunction = one true cause of all pain. Can you BELIEVE that mainstream medicine has been missing this? Facepalm!

  35. jmm says:

    This discussion on the deeper causes of behavior, spiritual or otherwise, contains way too much certainty than my skeptical and scientific mind thinks is justified by the evidence. I can only quote one of my favorite scientists here, JBS Haldane:

    “I have come to the conclusion that my subjective account of my motivation is largely mythical on almost all occasions. I don’t know why I do things.”

  36. mxwalker says:

    For article espousing the benefits of science-based medicine, it sure is full of a lot of its own conjecture, opinion, and unfounded criticisms. You sound just like the alternatives who whine about mainstream.

    My experience has led me to different conclusions than yours. After some years of increasingly debilitating health problems, the AMA\-style practitioners finally gave me a blank stare and another bottle of narcotic pain killers. I’d been raised with a suspicion of alternative medicine, but I went shopping in that camp for help. It took some time, but I eventually found the talented healers who got me back to a functionable level of health. I now use a fair amount of alternative health techniques with my family along with a fair amount of traditional techniques. That balance is further supported by my wife, an R.N.

    For a few years, I espoused the “mainstream are idiots” viewpoint, but eventually have landed in the middle, using each kind of medicine for what it’s good at. I’ve seen talented, sincere healers in both camps, and I’ve seen the best of quacks in both camps. It’s no more valid to claim that chiropractors are one-trick, back-adjustment ponies than it is to claim that the AMA types are fully enlightened and use all manner of treatments. Each of those views is an utter and dishonest deception.

    Seems to me any absolutist view in this space is foolish. And it’s worth questioning the talent and sincerity of any practitioner on either side of the argument who can’t see any benefits of the other camp’s approaches.

  37. circleh says:

    One thing that gives the alt.med. club some traction has been the general ineffectiveness of primary care physicians in the treatment of minor musculoskeletal disorders. This is indeed one case in which typical treatments often only treat symptoms without attempting to get at root causes. This gateway is the door that many questionable therapies use to build their cases on an unsuspecting public.

  38. EricG says:

    @ mxwalker

    yea, understood, but I think a few things need to be reiterated here.

    science is a process, not a thing. doctors, researchers etc. use that process to find information. there remains information to be found. your post smacks of “science doesn’t know everything.” but i dont want to put words in your mouth…

    perhaps it is easy to misinterpret that the writers of these blog posts are being “absolutely certain” in their position. They would all be likely to recite the pc science phrase of something like, “we see no evidence for the claims, this does not mean they do not exist, the burden of proof is on the claimant” for the 1000th time. Should I pray to the pink fairy goblins in my mother’s teapot when doctors have no sound recourse? I’m sure you would disagree.

    We are all blissfully happy that you found relief. we all agree, quacks are quacks and so on. that is not the point. the point is…evidence.based.medicine.

  39. Suraky says:

    So that’s why the alt-med crowd won’t follow science!

    Because them doctors are trying to treat the underlying cause … the Big Bang!

    hehe, great article :)

  40. daijiyobu says:

    I thought this may be of interest, per naturopathy’s idea of ‘one true cause’, according to ND Walsh:

    “inflammation is now considered a source of all disease [...] our rate is $250/hour [or "$6,000 for three months" if you browse his site].”

    (see http://www.drbryanpwalsh.com/faq.html ).

    -r.c.

  41. Nescio says:

    Chronic metabolic acidosis causes all diseases, according to many alties. This is caused not just by acid foods, but by negative thinking, stress and toxins. ND Robert Young claims that “there is only one sickness and one disease which is caused by an over acidification of the blood and then tissues due to an inverted way of living, eating and thinking” If you remain alkaline you will never get ill (I know, I know…). I suggest that sceptics avoid his blog if they have high blood pressure: http://articlesofhealth.blogspot.com/

    It seems there is some mysterious part of the body that is not constantly perfused by alkaline blood and harbors ‘acid residues’ that cannot be detected by measuring arterial blood pH or even tissue pH, but only by salivary and urine pH, which are far more effective at assessing acid-base status, apparently.

    Young even claims that acidity is so bad that healthy people do not have acid stomachs. But he also claims our brains run on electrons, not glucose, that having any kind of sugar in your body is bad, that antibiotics don’t kill bacteria, that our primary brain is our gut brain, and that darkfield live blood analysis is an effective diagnostic tool. Darkfield live blood analysis, for those who don’t know, is a fantastic way of actually watching all the candida in people’s blood pleomorphising into viruses, bacteria, parasites, maybe even small furry mammals (no more unlikely, surely!).

    The only way to combat this acidosis is to eat nothing but green vegetables, alkaline lemon juice and Young’s magic alkalising powders, that definitely work because your urine turns alkaline when you eat them.

    I once spent a great deal of time and trouble arguing about this BS on an altie forum, but I had to stop because my eyeballs started to bleed. I did collect enough material for a small book on the subject, which I intend to title “Alkalise and Die”.

  42. stanfr says:

    IMO, one of the main reasons alt med has thrived is that modern medicine still is woefully unaware of the importance of mindbody. Physicians treat every non-traumatic, non-pathologic disorder with: surgery, pain pills, steroids, and other assorted symptom-treating drugs. No acknowlegement of the role of the psyche. From personal experience (I have no objective proof, but I am convinced), stress and anxiety are the primary underlying cause of most of these disorders. I became convinced after being cured of various misdiagnosed problems by familiarizing myself with psychosomatic medicine (originally through the work of John Sarno, MD). I am convinced that this is one reason the anecdotal evidence for alt med claims is so convincing to the public–it is because placebo is a major factor im most of these anectdotal recoveries. A psychosomatic disorder is very receptive to the power of suggestion–if you believe a certain treatment will help you, there is a good chance it will, if the underlying problem is psychosomatic. That is why so many alt med treatments are “equally” effective–they are all acting as placebo! Take one alt med treatment–drinking urine (!). Now, if you drank your own urine–you would certainly have a strong psychological incentive to get better, now wouldn’t you? Otherwise, you just drank urine for nothing! Problem is, Modern medicine won’t acknowlege that these placebo ‘cures’ can be actual improvements–it insists that placebo itself cannot at least temporarily affect one’s body, even when the true underlying cause (stress, anxiety) is not addressed. That is where the problem lies.

  43. Lenoxus says:

    Problem is, Modern medicine won’t acknowlege that these placebo ‘cures’ can be actual improvements–it insists that placebo itself cannot at least temporarily affect one’s body, even when the true underlying cause (stress, anxiety) is not addressed. That is where the problem lies.

    I don’t get this strange notion that science underestimates the placebo effect. Um, if that were the case, why would trials bother to compare drugs to placebo? I’ve never seen any peer reviewed literature or meta-analysis to the effect that the placebo effect is fully understood and can just be tossed in the bin. It’s an area of much active study.

  44. squirrelelite says:

    @stanfr and Lenoxus

    Lenoxus,

    When you quoted stanfr, I thought your first paragraph represented your own thoughts until I read the second paragraph and realized they didn’t really agree. Sometimes, quotation marks can help.

    I don’t think modern medical researchers (at least the good ones) really “won’t acknowledge that these placebo ‘cures’ can be actual improvements”. However, good researchers will measure this improvement in some way that can be documented and compared to the improvement other patients receive from the same or different medicine/treatments.

    However, when we start looking at the situation as “I got better so the placebo must have done something real even if we don’t know what it was”, we drift toward seeing the placebo as some sort of magical cure. We see this in lots of the writing about placebo-controlled acupuncture.

    Scientifically at least, it is more useful to think of the placebo as a careful system of controls to help the researcher sort out the statistical wheat from the chaff and see if the tested medicine/treatment has a real beneficial effect (unlike the Gonzales protocol!).

    Thus, it is important to keep in mind some of the several things that can happen to a patient being studied that can confuse or obscure the result.

    1. Some patients recover and get well by themselves, whether you give them any treatment or not. This is especially true for mild infectious diseases such as the common cold or an upset stomach. It is much less so for really nasty conditions like stage IV cancer or a gangrenous leg.

    2. Many conditions which are difficult to completely cure like chronic pain tend to wax and wane (get better or worse) over time. Some days you hurt a lot and other days not so much. If you go see the doctor when you hurt a lot and a few days later you feel better, you are likely to credit whatever the doctor did for your improvement, whether it really helped or not.

    3. Some patients take better care of themselves when they are participating in a study.

    4. Just going in to see a doctor and have someone listen sympathetically to your problem and “get it off your chest” may make you feel better even if you don’t really.

    Et cetera, et cetera.

    For further information, I suggest the following three blogs on the placebo effect:

    http://www.sciencebasedmedicine.org/?p=1248#more-1248

    http://www.sciencebasedmedicine.org/?p=672#more-672

    http://www.sciencebasedmedicine.org/?p=24

  45. Artour says:

    If we look at scientific evidence regarding respiratory parameters in the sick, then we can realize that chronic diseases have one feature in common: 100% prevalence of chronic hyperventilation. This table is a summary of 34 published articles on heart disease, asthma, cancer, diabetes, ….
    http://www.normalbreathing.com/index-Table1.php

    It points to THE CAUSE of diseases, as well as to modern fantasy-myth that breathing more increases tissue oxygenation (in reality vice versa).

    “All chronic pain, suffering and diseases are caused from a lack of oxygen at the cell level.” Arthur C. Guyton, The Textbook of Medical Physiology, Fifth Edition.
    - Most widely used medical textbook of any kind
    - World’s best-selling physiology book

  46. Lenoxus says:

    Huh, so my earlier comment didn’t come out right — I blame the

    lack of preview. (Or maybe HTML doesn’t work here as I expect.)

    Thanks for the info, squirrelelite. I can’t yet get a fix on medicine’s “official” stance regarding placebo — whether it’s all or mostly tincture-of-time and subjective inference, or health management system, or what. So that’s why I take it to be an area of active study.

    Here’s an interesting paragraph from the Wikipedia Journal of Science:

    A placebo described as a muscle relaxant will cause muscle relaxation and if described as the opposite, muscle tension.[35] A placebo presented as a stimulant will have this effect on heart rhythm, and blood pressure, but when administered as a depressant, the opposite effect.[36] The consumption of caffeine has been reported to cause similar effects even when decaffeinated coffee is consumed, although a 2003 study found only limited support for this.[37] Alcohol placebos can cause intoxication[38] and sensimotor impairment.[39] Perceived ergogenic substances can increase endurance[40] and weight-lifting ability,[41] leading to the question of whether placebos should be allowed in sport competition.[42] Placebos can help smokers quit.[43] Perceived allergens which are not truly allergenic can cause allergies.[44] Inventions such as psychotherapy can have placebo effects.[45]pp 164–173 Swimsuits have even been thought to increase swimmer speed.[46]

    God, just by pasting a block like that, I feel like a crank. Well, I don’t have anything to push except that Science Is a Neat and Ongoing Process and All of the Above Could Very Well Be Bullshit.

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