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 medical 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.
When Michael Steele, the hapless chairman of the Republican Party, lost his bearings and called Rush Limbaugh's style ugly and incendiary, everyone knew it was the truth. But it was a perfect example of an inconvenient truth. The right wing has long used ugly, incendiary speech the way baseball players use steroids: to artificially pump themselves up. Limbaugh has taken to saying that he wants Obama's policies to fail because they spell the end of an America based on personal freedom. This isn't just a grotesque exaggeration; it disguises the very thing the right wing has been doing when it curtailed civil liberties in the name of national security.
Yet I know people who listen to Limbaugh every morning. They don't believe a word he says. They deplore his rhetorical sins. They detect the whiff of hypocrisy. Basically, they tune in out of sheer incredulity.
Limbaugh has been plowing the field of moral outrage for decades, but unlike Billy Sunday and the other hot-headed radio preachers who cashed in on social resentment in the Great Depression, Limbaugh threw out God. With no religious tradition to anchor himself, he can swing wider. Anything Limbaugh judges against is condemned, not by scripture, but simply by him being pissed off. Whatever Limbaugh hates -- however petty, personal, and arbitrary his animus -- is ipso facto wrong.
This represents a huge social shift in American values. Before the '80s there were a handful of right-wing outlets on the air; now there are well over a thousand. They exist purely as steam vents. The common citizen gets to be pissed off by the millions, unrelentingly, without cease or solution, and in return, he is praised. To be outraged is to be morally superior.
The Limbaugh effect fueled the anti-morality of the Bush years. Under ordinary morality, the wretched plight of illegal immigrants, for example, must be considered along with the fact that they are breaking the law. Being poor, illiterate, and desperate, their human condition makes them more sympathetic than ruthless lawbreakers would be. But under anti-morality, if you hate immigrants because they are foreigners who don't look American enough, the argument is over. Your anger strips away tolerance, sympathy, and regard for "the other." Hence the almost imperial bearing of Limbaugh, the bland certainty that because he never stops being angry, he never stops being right.
The same goes for a wide range of "others" who mightily tick off Limbaugh's listeners: Muslims, feminists, people of color, gays, and environmentalists. There's no need to understand them or try and accommodate their views. Just put them through the wringer of Limbaugh's perpetual judgment and, poof, there's no problem anymore. Of course, the whole scheme is delusional. Problems aren't solved by remaining perpetually ticked off. Accords can't be reached when you demonize the other side.
By any sane account, Rush Limbaugh is dead weight when it comes to finding a solution to anything. Like Sarah Palin, his spiritual bride, he lurks in the shadow of the human psyche, expressing the dark anger, resentment, jealousy, and vindictiveness that society can never escape. And yet, the next time you tune into Limbaugh's censorious circus of insensitive scurrility, give him a kind thought. As far back as Mark Twain, the American character has been ornery. We secretly love rascals, bank robbers, tricksters, swindlers, hell raisers, and outlaws. And when we feel so inclined, we laugh at them. Rush Limbaugh may represent a toxic form of entertainment -- and the bile he spews bears no resemblance to true morality -- but the fact that America makes room for him is something to be proud of. I don't pray that he goes away. I pray that we can keep laughing, even if our grin is crooked, at the pranks of the eternal shadow who is our companion for life, whether we want him or not.
This piece originally appeared in the San Francisco Chronicle.
It's a sore temptation to hunt down Osama bin Laden -- one of the most consistent campaign promises made by President Obama -- and yet there are strong arguments against it. U.S. forces would have to penetrate deep into provincial Pakistan and perhaps even conduct house-to-house searches. Such incursions would destabilize Pakistan's already shaky regime and inflame the extremist element. More troops would have to be committed to the Afghanistan war zone, with no positive outcome in sight. And making a martyr of bin Laden would probably incite a crop of new terrorists as deadly as he and his cohorts.
But the most compelling reason is that any solely military solution to terrorism is doomed to fail. Right now, U.S. intelligence knows that the jihadist movement is endemic in the extremist sects of Islam. It exists from neighborhood to neighborhood, dinner table to dinner table, across a vast swath of the globe. Although terrorism is a tactic, what lies behind it is an idea, and once an idea seeps into people's brains, bombs and mortar attacks won't defeat it. That's why Israel's overwhelming military superiority to Hezbollah and Hamas hasn't defeated those movements and never will -- this is an enemy for whom death is a victory of the spirit.
Our only hope against Islamic terrorism is to police it in the short run, and offer a more enticing idea in the long run. Peace and social reform are both enticing ideas. Changing our strategic relationship with corrupt regimes that receive significant foreign assistance from the United States is a second important step. The United States must shift its anti-terrorism policy in those directions. Because the United States kept pursuing a military solution, the 2004 presidential election was a poisoned chalice. Whoever won it would be plunged into the quagmires of Afghanistan and Iraq. The 2008 election was better. Both candidates pledged to leave Iraq, Republican Sen. John McCain under the face-saving banner of "victory;" Democratic Sen. Obama under the more realistic banner of ending an unjust war that should never have been started.
There is a military difference between "deploying" more soldiers to Afghanistan and "employing" them within the country -- in an effective way. If President Obama insists on troop buildups in Afghanistan and a promise to hunt down bin Laden, we must all recognize that a country should not pursue two contradictory ideas at the same time: one, that terrorism is stateless, and two, that military forays into foreign states are productive. The chief reason to remain in Iraq and Afghanistan, once we entered and found chaos, is humanitarian, as it has been for at least five years. Both are failed states; both are rife with violent extremists. Age-old hatreds won't die easily in either region, and yet the United States can't stand by and let those hatreds turn into genocide and endless combat.
The United Nations and NATO must rally to carry out the humanitarian goals that need to be pursued. But that's not the same as deluding ourselves into believing that we are defeating terrorism. Bush's war on terror was a horrendous mistake, an ideological delusion and a failed tactic. It alienated most of the world and created as many extremists as it defeated. Obama knows all this. Now it's time for him to lead us out of a self-created quagmire. The United States can't have it both ways, talking peace but maintaining a hostile military presence in the region, neither Pakistan, nor Afghanistan has a government seen as legitimate by its population. Neither has the ability, or the national will to police its borders, or seriously confront extremism, or foreign fighters. History has already taught us how these endeavors end, and they do not end well. No matter how just our cause, we are seen as aggressors, and may just as likely suffer the death of a thousand cuts, just like Genghis Khan, Alexander the Great, the British Empire and the Soviet Union. Without establishing a foundation of legitimacy, and hope, or any semblance of the rule of law, a purely military strategy will likely be defeated in the end.
The following is a memo to Barack Obama from Deepak Chopra
You have been elected by the first anti-war constituency since 1952, when Dwight D. Eisenhower was elected after promising to end the Korean War. But ending a war isn't the same as bringing peace. America has been on a war footing since the day after Pearl Harbor, 67 years ago. We spend more on our military than the next 16 countries combined. If you have a vision of change that goes to the heart of this country's deep problems, ending our dependence on war is far more important than ending our dependency on foreign oil.
The most immediate changes are economic. Unless it can make as much money as war, peace doesn't stand a chance. Since aerospace and military technologies remain the United States' most destructive export, fostering wars around the world, what steps can we take to reverse that trend and build a peace-based economy?
1. Scale out arms dealing and make it illegal by the year 2020.
2. Write into every defense contract a requirement for a peacetime project.
3. Subsidize conversion of military companies to peaceful uses with tax incentives and direct funding.
4. Convert military bases to housing for the poor.
5. Phase out all foreign military bases.
6. Require military personnel to devote part of their time to rebuilding infrastructure.
7. Call a moratorium on future weapons technologies.
8. Reduce armaments like destroyers and submarines that have no use against terrorism and were intended to defend against a superpower enemy that no longer exists.
9. Fully fund social services and take the balance out of the defense and homeland security budgets.
These are just the beginning. We don't lack creativity in coping with change. Without a conversion of our present war economy to a peace economy, the high profits of the military-industrial complex ensures that it will never end.
Do these nine steps seem unrealistic or fanciful? In various ways, other countries have adopted similar measures. The former Soviet army is occupied with farming and other peaceful work, for example. But comparisons are rather pointless, since only the United States is burdened with such a massive reliance on defense spending. Ultimately, empire follows the dollar. As a society, we want peace, and we want to be seen as a nation that promotes peace. For either ideal to come true, you as president must back up your vision of change with economic reality. So far, that hasn't happened under any of your predecessors. All hopes are pinned on you.