Fear and trembling in the medical-industrial complex

I’m tempted to exclaim, “Take that, medical-industrial complex! ” On the heels of a recent Atlantic article about the growing mainstream acceptance of “New Age” or alternative medical treatments comes one from The Wall Street Journal about the verifiable benefits of meditation, cognitive therapy, and other psychological interventions for chronic pain. The establishment, naturally, is quaking in its boots, especially since this trend is both arising from and contributing to the underscoring and highlighting of its fundamentally flawed (and evil) system that financially incentivizes “productivity” at the expense of authentic patient care.

Of course, my thoughts and feelings are strongly impacted by the many years I’ve spent in deep personal involvement with somebody who suffers from chronic health problems, including chronic pain, and who has been helped more by alternative treatment methods and modalities than mainstream ones. These methods and modalities are generally branded “quackery” by the mainstream medical mindset — even though several years of intensive treatments of the mainstream variety not only utterly failed to help but actively exacerbated the problems.

It doesn’t take a genius to see that the dawning new age of American medicine is part and parcel  of the gathering cultural-philosophical-scientific tide that promises to deal a death blow to physicalism, materialism, and scientism. Bob Dylan was right. The times, they are a-changin’.

“The Triumph of New Age Medicine” — David H. Freedman, The Atlantic, July/August 2011

Medicine has long decried acupuncture, homeopathy, and the like as dangerous nonsense that preys on the gullible. Again and again, carefully controlled studies have shown alternative medicine to work no better than a placebo. But now many doctors admit that alternative medicine often seems to do a better job of making patients well, and at a much lower cost, than mainstream care — and they’re trying to learn from it.

[…] Every single physician I spoke with agreed: the current system makes it nearly impossible for most doctors to have the sort of relationship with patients that would best promote health. The biggest culprit, they say, is the way doctors are reimbursed. “Doctors are paid for providing treatments, not for spending time talking to patients,” says Victor Montori, an endocrinologist at the Mayo Clinic. A medical system that successfully guided patients toward healthier lifestyles would almost certainly see its cash flow diminish dramatically. “Last year, 75 percent of the $2.6 trillion the U.S. spent on health care was for treating chronic diseases that, to a large degree, can be prevented or reversed through lifestyle change,” says Dean Ornish of UCSF. Who (besides patients) has an incentive to make changes that would remove that money from the system?

[…] [A] more open-minded consideration of alternative-medicine practices has become par for the course at medical schools. In recent years, the American Medical Student Association has co-sponsored an annual International Integrative Medicine Day, which, according to this year’s press release, “will increase awareness and availability of integrative medicine, promote inter-professional collaboration, encourage self-care, foster cultural awareness and enhance patient-physician communication” (an “infiltration of quackademic medicine,” blogged David Gorski, a surgical oncologist at Wayne State University and one of the more prickly anti-alternative-medicine warriors, in despair).

“Thinking Away the Pain” — Jonah Lehrer, The Wall Street Journal, July 9, 2011

Despite the increasing prevalence of chronic pain — nearly one in three Americans suffers from it — medical progress has been slow and halting. This is an epidemic we don’t know how to treat. For the most part, doctors still rely on over-the-counter medications and opioid drugs, such as OxyContin and Vicodin. While opioids can provide effective relief, they’re also prone to abuse, which is why overdoses from prescription painkillers are now a leading cause of accidental death.

But there are glimmers of progress in the war against pain. New therapeutic approaches don’t target body parts or nerves close to the source of the problem. They don’t involve highly technical surgeries or expensive new drugs. Instead, they focus on the mind, on altering the ways in which we perceive the pain itself.

[…]A brain scanner showed how the intervention worked. Learning to meditate altered brain activity in the very same regions, such as the insula and anterior cingulate cortex, that are targeted by next-generation pain medications. It’s as if the subjects were administering their own painkillers.

[…]But meditation isn’t the only mind-based approach that has gotten impressive results. Researchers at Duke University recently looked at a wide variety of psychological interventions for chronic lower back pain, including cognitive behavioral therapy, biofeedback and hypnosis. In almost every case, these treatments proved effective, leading to improved health outcomes at a fraction of the cost of conventional medical approaches.

The larger lesson is that, for far too long, we’ve been treating pain as a purely physical problem, a sensation rooted in the breakdown of the flesh. As a result, we’ve invested in costly and often ineffective surgeries, such as spinal fusion, that attempt to fix the mechanical failure.

But this approach oversimplifies an extremely complex condition. It’s now clear that pain is best understood as a mental state concerning the body, an objective sensation terribly twisted by the brain. And that’s why these psychological interventions sometimes work better than scalpels: They help us to untwist our thoughts.

Photo credit: Nina Aldin Thune [GFDL (www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (www.creativecommons.org/licenses/by-sa/3.0/)], via Wikimedia Commons