Review by Joel Daniels, 2009
The Scientific Basis of Integrative Medicine, 2nd edition. By Leonard A. Wisneski and Lucy Anderson. CRC Press, 2009. 401 pages. $99.95.
Unless you’ve been living in a cave for the last six months, you know that the young Obama administration has taken on that largest and riskiest of all possible governmental reforms: health care. It has pitched reform as a moral obligation, along the lines of Medicare, and as a financial obligation, mostly as a result of Medicare.
It is a gambit that is politically risky for a number of reasons, but especially because health care is such an emotional issue. The health care industry has the terrible combination of being massive, complicated, impersonal, and absolutely essential for individuals’ sense of security and well-being. There is something fundamentally unfair, the reasoning goes, for an individual to die, or a family to go bankrupt, over the random misfortune of acquiring some catastrophic illness when insurance coverage was lapsed, or inadequate. The fear of being denied life-giving care for financial reasons is one shared beyond disadvantaged populations and well into the middle class. It doesn’t help that the industry engages in practices like rescission, the term for a company’s retroactively cancelling insurance coverage precisely when a crisis moment is about to consume a large amount of resources. In June of this year, industry executives appeared before a committee of the House of Representatives investigating rescission; a rare moment of political bipartisanship followed when, after hearing from executives and patients, both liberals and conservatives were dumbfounded by the indefensibility of the practice. When insurance companies are collectively making a profit of around $15 billion annually, and average medical costs for a family are approaching $17,000 a year, the fear that coverage still may not be adequate leads to public outrage.
For all that money sloshing around in the health care system, however, it’s not a terribly profitable industry. $15 billion in profits is a lot of money, granted, but the average profit margin health insurance companies is only between 3-5%. For the sake of comparison, the average profit margin for oil companies is about 10%; cell phone companies about 11%; Google and Microsoft boasted 21% and 26% respectively. So where is all that money going?
The answer is complicated. Overuse of medical tests, out of a fear of malpractice lawsuits, is likely a factor, as is simple fraud. Federal disclosure reports show that the health-care lobby spends $1.4 million a day to influence legislation; Aetna’s CEO received $24 million in compensation in 2008. There’s no doubt, however, that costs of pharmaceuticals constitute a large chunk of the expenses. Americans spend over $220 billion a year on prescription medication, and the percentage of health care expenses spent on medication is expected to rise. It has put pharmaceutical companies in an enviable financial position: their profit margin is around 20%, or five times that of health insurance companies. An effort to reduce the costs of health care, therefore, is going to target medical interventions in general, and pharmaceuticals in particular.
This cost-conscious environment may lead to a different reception to the recently-published second edition of The Scientific Basis of Integrative Medicine, by Leonard A. Wisneski and Lucy Anderson, than might otherwise be the case. Over the course of the eleven chapters, the book accomplishes four, somewhat overlapping, purposes. The first purpose is to discuss the physiology of everyday experience, the anatomical structures and pathways by which environmental factors affect health. These sections explain the causal links that make integrative medicine effective physiologically. It is essentially a primer on anatomy and physiology, describing the basics of the nervous, endocrine, stress and immune systems, plus the proposal of a “relaxation system” that can effect healing. Most unusual is a reassessment of the pineal gland in the penultimate chapter; the authors hold that the photosensitive pineal gland is the “master gland,” “arguably both the most misunderstood and underrated endocrine gland in the human body” (345). They posit that melatonin, of which the pineal gland is the source, is the essential factor in the relaxation response, and the human being’s “biochemical interface” with the world.
The second purpose the authors undertake is to describe existing practices and technologies of complementary and alternative medicine (CAM) that take these integrated systems into account. It must be an exhaustive list; over the course of 150 pages, it covers everything from more established practices like acupuncture and chiropractic medicine to practices that sound more like snake oil than science. (Electricity and magnetism play large roles.) Admirably, however, the authors provide caveats when the evidence moves beyond the empirical to the speculative, and are forthcoming about the problems with some of the research.
The third purpose is to provide a philosophical perspective on these issues. The authors propose ways in which medical education and practice should be changed in order to coordinate with this integrative medicine. Along these lines, Wisneski and Anderson formally lay out “Four Pillars and Two Guideposts for the Healing Professions” (a phrase the authors have trademarked). The four “pillars” are actions that individual practitioners can take: collaborating across specializations; being culturally aware; being personally sensitive; and utilizing technology. The two “guideposts” are policy recommendations: increasing access to medical care by disadvantaged populations, and reducing inequality in medical care across continents by decreasing the “brain drain” of newly-trained doctors from developing to developed countries.
The fourth purpose of the book, primarily but not wholly limited to the final chapter, involves Wisneski and Anderson moving from discussions of physiology, research, and practice, to discuss the more controversial concept of “subtle energy.” They hold that at certain frequencies of oscillation matter stops being perceptible to the senses, but does remain able to affect the human body in the form of subtle energy, which they also refer to as “nonphysical matter.” Subtle energy travels at velocities greater than the speed of light, and is therefore not bounded by the dimension of time. In this they follow the work of scientist William Tiller, emeritus professor of Materials Science and Engineering at Stanford University, and controversial figure in the field of “psychoenergetics.” Tiller postulates that particles called deltrons can travel back and forth between the subtle energy itself and the physical structures, especially the pineal gland, that are then affected. Subtle energy, which the authors identify with qi, can facilitate the healing process through the mediation of the chakras. Subtle energy is also the source of the documented brain activity that corresponds with feelings of transcendence.
While the tone of the discussion of subtle energy, and its placement at the conclusion of the book, show that it is the topic closest to the authors’ hearts, it is not a required element of their advocacy for integrative medicine more generally. For the purposes of the book’s reception in scholarly circles, however, if the authors’ physiology is wholly uncontroversial, and the proposal of a stress response only a bit more so, with the concept of “subtle energy” they have moved fully off the scientific reservation. Whether the topic’s presence voids the credibility of the book as a whole remains to be seen. If it does not, however, The Scientific Basis of Integrative Medicine could be a significant contribution to the adoption of CAM. The physiology about which the authors write will probably be uninteresting for consumers, and unnecessary for practitioners of Western medicine, but its inclusion will show the latter group how what is already known and uncontroversial about the human body supports the case for integrative medicine. If Wisneski and Anderson are successful in achieving that goal, their book could serve as the Rosetta Stone (a metaphor they frequently employ), translating between Eastern and Western theories of medicine.
If integrative medicine could be shown effective in the way Wisneski and Anderson advocate, I imagine that adoption by insurance companies would soon follow, especially given the relatively low cost of the Eastern therapies. If insurance companies can determine that Echinacea or garlic pills (6-7 cents a pill, at your local drugstore) can have an effect consonant with Lipitor or Wellbutrin ($3-$4 a pill), which one should we expect insurance companies to cover? If meditation is as effective in improving mental health as Prozac ($6 a pill)? If acupuncture (around $75 a session) relieves the pain of arthritis as much as cortisone shots do (around $300 per injection)? I speculate that this growth market in integrative medicine is something that Wisneski is aware of as well; he mentions that he was responsible for corporate health care at the hotel chain Marriott for several years, a position in which it is hard to imagine that his responsibilities for patients didn’t overlap with his responsibility to the bottom line.
I doubt that the authors’ enthusiasm for subtle energy will come to be shared with their colleagues, but I wouldn’t be surprised if their integrative view of the human body becomes mainstream. While the resistance of doctors to CAM, including its spiritual components, may not be overcome by Wisneski and Anderson, Dossey, or Koenig, it will disappear with nary a whisper when adopted by insurance companies and their reimbursement policies. In the realm of medicine, it is the insurance company, not the doctor, that is sovereign, and there’s no reason to believe that any future conflict will change that. The fate of CAM lies in the cost-benefit calculations performed by medical directors at insurance companies.
The popularity of millennia-old Ayurvedic and Chinese medicine shows that, as in fashion, everything old is new again. Its eventual adoption into the mainstream of health care, however, will support a much more fundamental maxim: money talks. Loudly.