Mind, Body, Medicine
Is revolution brewing in medical research?


Everybody assumes that because it's "alternative," it's safe and effective . . . but that's just not the case.
William McDonald, Assistant Professor of Psychiatry

Mind/body investigations at Emory
Research highlights

 

In 1994, microbiology professor Linda Gooding became the first U.S. researcher to win Food and Drug Administration approval to test Chinese herbs in humans. Preliminary results of the study, funded by the newly established Office of Alternative Medicine at the National Institutes of Health, were promising. But funding ran out before the study could offer definitive findings. The research program in alternative therapies Gooding had hoped to seed never received university support, and like-minded researchers tended not to stay long in Emory’s medical school.

Several Emory researchers observe that while programs in complementary and alternative medicine were sprouting at schools like Harvard and Hopkins in the 1990s, Emory lagged in this area. One reason, Gooding suggests, is “our self-image is that we’re a specialty center, and complementary medicine tends to address primary care issues.” At Emory and across the nation, though, more researchers are beginning to take seriously a long-held belief of millions of Americans—that the intimate kinship of body and mind calls for a more sophisticated dialogue between traditional and alternative medicine.

It’s true that the $70 million the NIH pours into research into complementary
and alternative therapies is a mere drop in its $90 billion total budget. But growth in this funding has been “logarithmic,” says Mahlon DeLong, chair of the department of neurology and director of Emory’s new Center for Research on Complementary and Alternative Medicine (CAM), which just won $5.7 million to study alternative therapies for neurodegenerative diseases. Just after DeLong and CAM co-director, Professor of Rehabilitation Medicine Steven Wolf, launched their center, another group of doctors, led by Associate Professor of Psychiatry Andrew Miller, established the Mind-Body Program in the Department of Psychiatry. While CAM researchers assess the value of alternative therapies, investigators in the Mind-Body Program focus more on the biological mechanisms that govern the marriage of mind and body.

SHIFTING BOUNDARIES

The advent of these two programs at Emory comes amid a surge of national interest in alternative medicine. Discoveries in this emerging field may shake up medical schools in some of the same ways that “alternative” literatures and methodologies shook up the humanities and social sciences in recent decades—a phenomenon commonly called “the culture wars.”

Like that movement to reshape the traditional canons of literature and history, the push for better understanding of alternative medicine reflects a growing interest in non-Western cultural traditions. For instance, to illuminate the relationship between mood disorders and the systems that regulate body temperature, Assistant Professor of Psychiatry Charles Raison and postdoctoral collaborator Guiseppe Pagnoni plan to study a Tibetan Buddhist meditation technique that raises body temperature. And Wolf has already proven that Tai Chi can reduce injuries and falls in elderly people.

“What really came into focus for me,” says Michael McQuaide, an Oxford professor of sociology who has walked with shamans in the forests of Ecuador and witnessed sacred, fiery rituals, “is the role that expectation plays in healing. From a Western point of view, it shouldn’t work. But for the supplicant, the shaman’s authority is real.”

To scientists, the authority of some practitioners of alternative therapies is becoming more real as treatments such as acupuncture are validated in rigorous, controlled studies. “Basically, once we prove a treatment effective, it’s no longer labeled ‘alternative,’“ says DeLong, indicating that the boundary between orthodox and alternative medicine is permeable and shifting.

Another shift reminiscent of the culture wars is a heightened interest in topics previously seen as marginal to the field. Neuroscientists, for example, traditionally describe areas like the immune system as “peripheral.” “The implication of that language, ‘in the periphery,’ is that it’s not central, and that we brain scientists of course study things central to the brain,” says Assistant Professor of Psychiatry and Behavioral Sciences Brad Pearce. With Miller and others, Pearce is reassessing those assumptions. “A lot of neuroscientists look at the body as a support system for the brain, but I realize now that the interface is actually more blurred.”

For instance, infections and other stressors that strike far from the brain seem to set off complex reactions that ultimately shape mood and behavioral disorders. Key
travelers between brain and body appear to be immune system molecules called cytokines. The similarity between the lethargy we feel when we battle a virus and the lethargy of depression led Miller’s team to focus on cytokines. Their research suggests that some depression may, in fact, be triggered by an overactive immune system. “In some ways,” says Miller, “our work is a reversal of that old story about the mind’s powerful influence on the body. Instead, we’re finding the brain hostage to bodily influences. The street is two-way.”

HIGH STAKES

A striking difference between the “culture wars” that raged on campuses in past decades and this shift in medicine lies in its high stakes—money and health. Ameri-cans spent $27 billion on alternative therapies in 1997 alone, according to conservative estimates published in the Journal of the American Medical Association. In the same year, visits to practitioners of alternative therapies reached 629 million, exceeding total visits to primary care doctors. An estimated one in five people takes prescription medicines along with herbal remedies, high-dose vitamins, or other alternative therapies. But about 60 percent of users of alternative therapies do not tell their medical doctors about the other therapies, thereby risking potentially harmful drug interactions.

“I think there is a good chance that many of these therapies have value, but it’s not enough to believe they work,” says DeLong. “We need to scrutinize them scientifically to ascertain safety and efficacy. Many herbal remedies, for example, are impure. What people are taking over the counter may contain toxins—heavy metals, lead, mercury.”

The simultaneous emergence of these two programs may well indicate a significant change in the culture of medical research. But whether this trend will reshape assumptions and methodologies in the school of medicine—as the “culture wars” have done across campus—remains an open question. A.B.B.