Mainstream Medicine and the Oprah Factor

If people still trusted the health care industry, then it would be unnecessary to brand Oprah for "crazy talk" simply because she provides a forum for ideas outside of mainstream medicine.
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A recent cover story in a struggling news magazine, under the title "Crazy Talk:" accuses Oprah Winfrey of spreading "dubious advice" in a wide range of health issues from menopause and hormone replacement therapy to autism, cancer, aging, and weight loss. The tone of the article was the same tiresome blend of gotcha journalism and selective fact-reporting that fills tabloid coffers. The story failed to gain traction for obvious reasons. Oprah has aired innumerable shows on health, of which the controversial ones are a tiny minority. Her intention to improve women's lives on all fronts is so obvious as to be almost above criticism. The credibility for women's well-being and welfare she has earned day after day over the past two decades will not be undone with a story that cherry-picks the guests who can be made easy targets of ridicule by the medical establishment. And the fact that she has celebrity guests who have causes and crusades in the area of health, such as Jenny McCarthy or Suzanne Somers, is not the same as Oprah herself endorsing what they say. The criticism the medical establishment is directing at Oprah through this article only exposes their own frustration in having squandered their credibility with the public. They hope that if they can successfully attack the Oprah's immense credibility, then they can magically get some of that credibility back for themselves. However, if people still trusted the health care industry to act in their best interest the way they did decades ago, then it would be unnecessary to brand Oprah for "crazy talk" simply because she occasionally provides a forum for ideas outside of mainstream medicine. The medical profession is burdened with a host of problems that Oprah addresses with more candor and force than the AMA. She promotes wellness and prevention, two areas that drastically need improvement. She brings up creative solutions to problems that medical science is baffled by, such as the healing response itself and the role of subjectivity in patient response. These are issues that few M.D.s are willing to explore, yet she has done so for decades. Instead, we got a response from an oncologist in Canada repeating the establishment position: alternative treatments of cancer are bogus, subjectivity has no place in science, "soul talk" about illness is rubbish. This is exactly the kind of dismissive arrogance that drives millions of people away from conventional doctors. Every illness has a subjective component -- after all, to be sick is to change your moods and emotions, and severe illness causes one to examine primal issues like life and death and the meaning of existence. Do these subjective changes affect healing? Obviously they do, or we wouldn't have the placebo effect, which comes into play at least 30% of the time in illness. Scientific medicine by and large ignores wellness, prevention, and alternative medicine in general. On a daily basis doctors don't deal in these things; few take courses in medical school centered on them. That's why a massive movement has arisen driven by patients themselves. Oprah serves as a public outlet for a conversation that needs to be ongoing. As long as official medicine, backed by huge pharmaceutical companies, denies the existence of the problem, much less alternative solutions, the movement will remain patient-centered and the attitude toward alternative medicine will be one of unfounded disdain, suspicion, and ignorance on the part of physicians. Denial also plays a huge part in this story. Mainstream medicine continues to downplay the enormous drawbacks of a health-care system that is addicted to drugs and surgery as the two constant drumbeats of treatment. This lopsided emphasis has created dilemmas that official medicine hasn't remotely solved: * In Seattle a recent study of 638 patients with chronic lower back pain were given either some sort of acupuncture or standard treatment with anti-inflammatory drugs and massage. On average, the acupuncture patients received twice as much benefit as those on standard treatment. The kicker is that some of the patients received fake acupuncture -- they were pricked superficially with toothpicks -- and received the same relief. * Iatrogenic disease, roughly defined as illness that results as a complication from a doctor's care, leads to between 230,000 to 284,000 deaths every year, making it the third leading cause of fatality in the country. * A survey of 1,249 health care professionals found that 81% had taken dietary supplements like vitamins and minerals. This, despite the fact that mainstream doctors frequently tell their patients that the only benefit of such supplements is "expensive urine." * Two of the most frequently performed surgeries, heart bypass grafts and balloon angioplasty, became fashionable without serious testing (the government approves drugs but not surgical procedures). They continue to be used in the face of perennial findings that neither procedure increases life expectancy. Besides relieving symptoms, which of course can be very troubling to the patient, both procedures carry serious risks. (The most recent finding showed that diabetics with stable heart disease do not survive longer if given heart surgery.) * In the past, such common procedures as hysterectomies and radical mastectomies were widely performed without testing their efficacy. Not until European results revealed that lumpectomies were often just as effective did American surgeons question the staunch support of mastectomies. One might also consider that surgeons were very slow to perform cosmetic breast replacement for women who faced devastating psychological fallout from their mastectomies -- a typical neglect of any patient's subjective response to illness. * The benefit of lifestyle changes has been grossly underestimated and underused. Coronary heart disease, prostate cancer/breast cancer, diabetes, and obesity account for 75% of health care costs, yet the progression of these diseases may often be stopped or even reversed by making intensive lifestyle changes. The most recent findings show that such changes actually cause beneficial alterations at the genetic level, affecting up to 400 genes through such measures as improved diet, exercise, and meditation. * Overall, this country's health care system is actually a "sick care" system. In 2006, $2.1 trillion were spent in the U.S. on medical care, 95% of which was spent to treat disease after it had already occurred. We're just scratching the surface here. Yet even if these massive problems didn't exist, the Oprah affair raises the question of sins by omission. It's one thing for official medicine to decry alternative medicine and hurl accusations of quackery, not just at the non-M.D.s who work as health practitioners but at licensed, highly educated and qualified physicians who are creative enough to explore new avenues of treatment. Their own lack of curiosity and creative thinking is disturbing. Does the most brilliant researcher in the world know why cancer sometimes spontaneously disappears? Why a patient with obsessive-compulsive disorder or depression can respond equally well to talk therapy and drugs -- that is, why talk is as effective as chemicals in altering the brain? Or how the body's healing system is influenced by outside forces? The answer is no. Which means that mysteries remain to be solved, and creative solutions have every chance of arising from unexpected quarters. Scientific medicine is leery of so-called anecdotal evidence, that is, individual stories of disease and cure. Their skepticism is rational and well-founded. We all agree that without impartial studies, the advance of knowledge becomes chaotic and untrustworthy. But Oprah is letting individuals tell their stories for other, positive reasons: to share their pain, to reach out to others in the same circumstance, to provide hope. Official medicine falls short on these fronts far too often. It would be laughable if it weren't so sad that the typical TV ad for drugs paints glossy pictures of happy patients running through flowery meadows, ending with a list of every imaginable side effect, including death. The article sneers at the popular movement linking autism with childhood vaccination, yet current understanding looks at autism as a complex, multi-factorial condition in which some cases could be influenced by an outside factor like a vaccine. It's all too easy for medicine to disdain that possibility and cry foul against guests on Oprah's show, raising a smokescreen for the countless irresponsible prescriptions written, especially for elderly patients, by doctors every day. One fears that all of these arguments will fall on deaf ears, because the schism between official and alternative medicine runs deep -- deep enough that the average physician doesn't bother even to skim the thousands of studies that bolster alternative claims. So let me offer a typical finding that comes from the Centers for Disease Control and Prevention, among other official sources. It concerns the effect of child abuse and other adverse circumstances on later health. Is it "soul talk" to believe that a child raised around parents who abuse substances, who suffer from mental illness, or who outright abuse the child will suffer health risks later in life? According to the CDC study, covering 15,000 HMO members in San Diego between 1995-97, the risk of contracting an autoimmune disease as an adult is increased from 70% to 100% if you happened to be abused as a child or grow up with adverse home conditions. This finding isn't isolated. Autoimmune diseases are one in which the body's immune system attacks the body itself. There are few known causes; it is baffling to grasp why the body's chief defender against illness should turn around and become the cause of illness. This study suggests a human connection rather than a biological one. Or rather, human distress leads to biological distress. Doctors don't officially believe that; millions of ordinary citizens do. Earlier studies had already correlated adverse childhood conditions with the risk of inflammatory conditions. In the little picture, a new finding has been added to the long list of mind-body links for illness and aging. In the bigger picture, the fact that we don't fully understand the mind-body connection, much less use it for healing in official medicine, comes into glaring relief. What this tells me is that medicine needs Oprah and other patient advocates who are demanding that official medicine heal itself. To accuse them of lacking medial credibility is a red herring. Patients aren't supposed to know more than their physicians. The fact that they often do, at least insofar as alternative treatment goes, is both a sign of hope and cause for distress.

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