From the Editor

It’s been a rough season for Big Pharma. No sooner does Marcia Angell, former editor of the New England Journal of Medicine publish The Truth About the Drug Companies: How They Deceive Us and What to Do About It, her scathing book detailing the drug industry’s lockhold on academic and clinical medicine, then Merck recalls Vioxx, its superstar $2.5 billion a year anti-inflammatory.

Adding salt to the wound, in October, Dutch researchers published a study in JAMA showing a doubling of pneumonia incidence in people on proton-pump inhibitors and other anti-ulcer drugs. And of course there’s that flu vaccine shortage, as we enter what public health experts predict will be a bad flu season.

It is easy to blame corporate greed for many of these problems, and there’s no doubt the profit motive, taken to extremes, plays a big part in the current state of affairs. The “greedy drug industry” etiology is a strangely comforting explanation, and it is easy enough to support. But there’s something deeper, and more disturbing at work: something connected with core assumptions about health and illness; something related to how we, as a society interact with the natural world.

The drug development model holds specificity of action as its ideal: the more specific a drug’s mode of action, the more controllable and predictable it appears to be, the more confident the therapeutic claim. But nature doesn’t seem to work that way. Vioxx was a very specific drug. It preferentially inhibited COX-2 versus COX-1 by a factor of 35. But that very specificity may be what put Merck between a COX and a hard place, if you’ll excuse the pun.

A key principle in herbal medicine, whether from Euro-American or Asian traditions, is that the inherent biochemical complexity of plants is essential to their healing properties. Plant medicines do not work as fast as pharmaceuticals, and they often have polyvalent actions. But they provide an array of biochemical checks and balances, which, assuming one is not over-dosing with a particular herb, bring about the desired effect without extreme physiological swings.

The ulcer drug-pneumonia connection, which still needs confirmation from prospective studies, points to another disjunct between the ideals of pharmaceutical-based medicine and the processes of nature. The proposed mechanism for the observed increase in pneumonia is the prolonged down-regulation of stomach acid, one of the body’s primary defenses against ingested pathogens. Long-term suppression of any natural process inevitably leads to unwanted consequences.

Yes, we do need effective medications, and innovative drug developments. Targeted suppressive therapies are sometimes life-saving. But the notion that chronic diseases are immutable and that the best we can do is block symptoms with an array of pharmaceuticals absolves practitioners and patients alike from undertaking a search for therapies and lifestyle changes that can engender true healing. The current situation is a challenge to natural medicine as well. As they move into the mainstream, herbs and nutritional products are being used increasingly like “green” drugs. Prolonged use of herbs or nutrients, especially in high doses, may be as questionable as prolonged use of suppressive drugs. And of course, the natural products industry is not without its own profit drives.

How do we move toward a comprehensive system of medicine that encourages innovation yet is in accord with the intrinsic processes and properties of nature? How do we develop products and practices that serve our health needs, and provide solid recompense to practitioners and manufacturers, but in an economically and ecologically sustainable way? These are challenging questions, but ones well worth pondering.

Meg and I wish you a happy, healthy, and fulfilling holiday season. May we yet find our way to Peace on Earth.

As always, I welcome your input on how we can improve Holistic Primary Care—News for Health & Healing, and our new website, Reach me at: or 212-406-8957.

Subscribe to Holistic Primary Care