Commonweal

Publications: Articles, Lectures, and Interviews with Michael Lerner

Curing What Ails Medicine

Researcher Michael Lerner says our medical model ignores the devastating effects of environmental toxins. Until that issue is faced, our bodies will continue as "low-rent storage facilities for untested chemicals."

A Conversation with Keith Thompson from the Pacific Sun, October 2, 2002

Michael Lerner has a knack for tracking clues that take him in unexpected and sometimes troubling directions. Thirty years ago, as an assistant professor of political science at Yale, Lerner came to Bolinas for a year-long sabbatical to reflect on "the future of children" as part of the prestigious Carnegie Council on Children. He met a young girl who had been diagnosed as retarded until a Hungarian psychoanalyst named Magdallena Pallos took her off wheat and dairy products. It turned out the girl was mildly learning disabled but not retarded.

"I had studied child development at Yale for many years," Lerner says, "but I had never had anyone suggest that nutrition could play a role in human consciousness." He was so shocked by the discovery that he ended up resigning from his tenure track position at Yale to start a school for troubled children called Full Circle. A few years later, while walking on the Bolinas mesa, Lerner looked out at an old piece of property, and had "what I can only describe as a very powerful intuition that it might be possible to create a health and environmental research institute, a place that would look at the interface between personal and planetary healing. That's what came through my mind, which is what I now see the essence of ecological medicine."

The property is today called Commonweal, a 27-year-old health and environmental research institute that Lerner co-founded, and of which he is president. Commonweal works with at-risk children, adults with cancer, health professionals in search of the heart of medical practice, and critical environment and environmental health issues. Senior staff include such Marin residents as children's advocates Carolyn Brown and David Steinhart, environmentalist Burr Heneman, and physician Rachel Naomi Remen, M.D. Other Commonweal senior staff are located in Oakland, San Jose, and Washington, D.C.

Lerner describes Commonweal as a collaborative, an "instrument of service" rather than an institution, and he clearly delights in the accomplishments of his gifted colleagues. Lerner's personal focus within Commonweal has been on the Commonweal Cancer Help Program, a week-long residential support program for people with cancer that he has co-lead for seventeen years, and on Commonweal's initiatives in environmental health. A former member of the faculty at Yale University in the 1970s, Lerner received a MacArthur Prize Fellowship for contributions to public health in 1983. His widely acclaimed book Choices in Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer, from MIT Press, is considered a classic in the field.

There's a strong consensus among Lerner's colleagues that he's highly skilled at making connections across seemingly disparate fields of research and practice. "Michael's instincts as an activist and his moral clarity reminds me ever so much of Martin Luther King, Jr., back in 1966," says Sukie Miller, a Sonoma County author and therapist who works with cancer patients. "King had established himself as the preeminent voice on civil rights, and felt he had to speak up against the Vietnam war. Many of his advisors urged him not to, but King saw the human rights issues at the center of both movements. Likewise, Michael could have chosen to work within the boundaries of the established mind-body health movement, but he saw that the issues were bigger than the usual practitioner-client relationship. Once he got the critical importance of poverty and environmental issues, Michael was determined to speak publicly about the linkages between mind-body health and environmental public health, even though this would ruffle some territorial feathers."

I talked with Lerner in his Commonweal office. There's a gentleness to his voice that leaves you unprepared for the moral authority at the heart of his message: We've got to start paying serious attention to the environmental causes of so many of the pandemic health conditions of our time.

Interview

Keith Thompson (KT): You've been critical of the holistic health movement for, in effect, not practicing what it preaches. What's missing?

Michael Lerner (ML): Let me begin by stipulating that I myself have been deeply involved in holistic health, in complementary and alternative medicine movement, or in integrative medicine ­ the terms are overlapping ­ for over 25 years. My criticism of what the movement has neglected is really inseparable from my appreciation for what's been accomplished. The mind-body health movement has greatly increased the number of therapeutic options that a patient and health professional can consider. And it has brought the psychological and the spiritual dimensions of healing very much to the forefront.

But what the movement has profoundly failed to do is to ground personal healing in the economic, social and environmental determinants of health. That failure is remarkable, because the mind-body health movement presents itself as having a holistic vision of health. Yet instead of a truly holistic vision of health, grounded in the well documented social, economic and environmental determinants of health, what the mind-body health movement really has done is to create a new set of boutique health services, focused on the individual health instead of on public health, targeted largely for middle and upper middle income clients.

KT: Holistic health practitioners typically say their methods are personal, in contrast to the impersonal context they say typifies mainstream medicine. Isn't that progress?

ML: Yes; complementary and alternative medicine (CAM), which is the term of art these days, has brought enormous progress to health care. When you go to a good CAM professional conference, you will hear a great deal about spiritual approaches to life and death, about transpersonal psychological therapies, about a whole range of nutritional therapies, and about physical approaches from yoga to osteopathy. You will hear about traditional medicines from China and India, alternative pharmacology, electromagnetic therapies, and intentional healing through prayer. Yet at the same conference, the term "public health" is likely not to be mentioned even once. Presenters will talk about death and dying but they never talk about the health effects of job loss, or poverty, or living next to a chemical plant, or even about living in Marin County with the highest breast cancer rate in the country. The closest reference to societal issues might be a call for the insurance policies to reimburse alternative and complementary healing modalities.

KT: You're saying mind-body medicine in practice has become privatized ­ even though the movement's rhetoric stresses holism, which should include public or collective health?

ML: Precisely so. Mind-body health, or complementary and alternative medicine, which should be defined more than anything else by its commitment to holism, has largely given in to the commodification of health care services offered primarily to people who can afford both conventional and alternative health care. It has become increasingly clear that conventional medicine has something important in common with mind-body medicine ­ both are good for business. Complementary and alternative medicine practitioners, struggling to get inside the medical establishment, have had little to gain by taking up the public health issues that concern communities of color, environmental justice advocates, poor people, and workers who are heavily exposed to dangerous workplaces.

But I want to be clear that I'm not saying it's a personal moral failing of mind-body medicine practitioners that they have largely ignored the social and environmental determinants of health. They are trying to change health care in America, which is a profoundly important agenda in itself. But in focusing on changing health care, we have largely ignored the reality that historically public health measures have been far more cost-effective in preventing disease and improving the health of communities than medical treatments of individuals after the epidemics of environmentally related illness have struck.

KT: You've written that we've got a long way to go ­ that medicine has barely scratched the surface regarding the environment.

ML: The truth, which some scientists know but the public has not yet fully grasped, is that we live in an Age of Extinctions. We are driving the tree of life, biodiversity, back to its lowest levels of fruitfulness in 65 million years, since the end of the Age of Dinosaurs. We are exterminating species at somewhere between a thousand and ten thousand times the background level of extinctions that normally goes on. This is the sixth great spasm of extinctions in the history of the planet. And the five horsemen of our apocalypse are climate change, ozone depletion, habitat destruction, toxic chemicals, and invasive species that move in when ecosystems are destroyed. We sometimes have the illusion that we can securely destroy much of the rest of life on earth without doing much to human health. But of course these horsemen of the apocalypse do not distinguish between humans and other species.

I have argued that the best hope from moving from this Age of Extinctions to a new Ecological Age is what I believe we can call the emerging environmental health movement. I know for a fact that a growing number of health-affected groups ­ people with cancer, learning disabilities, infertility, endometriosis, immune disorders, asthma, birth defects ­ are becoming aware that they are the canaries of the mine shaft. They are the early victims of this holocaust of life in which we are presently engaged. I believe that as people everywhere increasingly link their health and the health of their families to these horsemen of the environmental apocalypse, sensible people all over the world will rise up in a peaceful global movement -- a movement larger than the environmental health movement, a movement that has no name -- and make the changes we need to begin to move toward a more sustainable world.

KT: A boutique approach to health care doesn't make for a very sturdy port in a holocaust.

ML: Spend a month in India, Thailand, Malaysia, and the Philippines, as I did two years ago, and the ruinous effects of a degraded environment are so obvious as to make any counter argument pure folly. Complementary and alternative medicine, for all its benefits, cannot address the degraded environment any more than mainstream clinical medicine can. The degraded environment is a public health issue. The U.S. is not an island exempt from these trends. People are waking up to the reality that the struggle for a sustainable world is not just a struggle for the snail darter or the spotted owl. It is a struggle for the health of our own families ­ for our personal health in powerfully direct ways.

KT: As America looks to oil-rich Iraq, it seems relevant to note that three of the five principal causes of the Age of Extinctions you named result from the abuse of the hydrocarbon assets that lie below the surface of the Earth.

ML: True. Climate change, ozone depletion and toxic chemicals, three of the greatest drivers of this Age of Extinctions, are all linked to our misuse of hydrocarbon resources. This has been the Hydrocarbon Century. Both World Wars were determined by oil and of course the Middle East Wars are all about preserving access to oil. Daniel Yergin's The Prize is the classic on this. We extract hydrocarbons from below the surface of the Earth, we transmute them into environmentally undigestible and therefore bioaccumulative substances, and then we distribute them in the biosphere where they cycle back into our bodies at ever increasing levels. The oncologist Karl Henrik-Robert has written beautifully about this and inspired the whole Natural Step approach that recognizes we cannot allow bioaccumulative toxins to continue to accumulate in our bodies.

KT: The 19th century crusade for public hygiene didn't pick up serious steam until it won the physicians and health practitioners over to its cause. By analogy, the medical community's awareness of the dangers of toxic chemicals seems to be growing.

ML: Yes, health professionals and patient or health affected groups have been critical to every successful public health movement. And both patients and health professionals are becoming aware of the chemical threat to health. Poll data repeatedly shows that North Americans have a low awareness of climate change as a major issue, but a high awareness of the role of toxic chemicals as a threat to human health.

There is an explosion of science on some of these chemicals, which are called "developmental toxicants." The new evidence indicates that the developing fetus is affected by some chemical and heavy metal exposures at levels orders of magnitude lower than the level at which these toxics cause cancer by traditional toxicological mechanisms. These endocrine disrupters send false signals to the developing fetus, as though they were signals from the mother's endocrine system, which guide fetal development. These endocrine disrupters can affect intelligence, health, fertility and the whole spectrum of human consciousness: intelligence and behavioral responses and so forth. The best book on this is Theo Colborn and Pete Myer's Our Stolen Future.

When I'm speaking before an audience, I sometimes run down the list of health conditions where chemicals and heavy metals are either known or suspected of playing a contributing role. The current list includes Asperger's Syndrome, autism, asthma, birth defects, brain cancers, breast cancer, bladder cancer, childhood cancers, esophageal cancer, liver cancer, leukemia, lung cancer, lymphoma, melanoma, testicular cancer, chronic fatigue syndrome, depression, reproductive cancers in DES daughters, developmental disabilities, juvenile diabetes, Down's syndrome, eczema, fibroids, fibromyalgia, infertility, increased time to conception, lower sperm counts , lower birth weight, miscarriages, premature birth, premature puberty, declining age at menarche, immune disorders, rheumatoid arthritis, Systemic Lupus Erythematosus, learning disabilities, multiple sclerosis, Parkinson's disease, and so forth. Gina Solomon at the Natural Resources Defense Council and Ted Schettler at the Science and Environmental Health Network are two of the physician-scientists researching this whole set of relationships.

When I have gone down the list, I ask for a show of hands: How many people in this audience have a family member or somebody close to you that's been touched by one of those conditions? Then I ask a second question: How many of you have made the connection that leads you to understand that such a wide range of diseases and disorders have this potential environmental toxicant link? Then a much smaller number of hands are raised.

KT: A certain threshold of consciousness hasn't been achieved.

ML: The recognition that the pandemic of environmentally related health conditions are linked, that they form a pattern, and that the environment is affecting our health and that of those we love right now, is the kind of shift in consciousness that I think we need to think about. It's a big advance for breast cancer patients to enjoy a sense of community with other breast cancer patients. But the linkage between breast cancer, asthma, learning disabilities, birth defects, infertility and all these other diseases and conditions, is the thing that still escapes most of us. We haven't learned to think holistically about those linkages. Having said that, I should add that a new generation of breast cancer advocacy groups are in the vanguard of this emerging environmental health movement. They get it.

KT: Present action is invariably connected to a possible future. How can policy be shaped when there are several future scenarios simultaneously in play ­ ranging from stark pessimism about the degradation of life on Earth, to hopes of achieving a sustainable society?

ML: James McNeill, direction of the Brundtland Commission, which introduced the concept of sustainable development, once told me at a Commonweal conference that he found it constructive to imagine four possible futures for humanity:

I like this formulation because it indicates that the real future will not be one of these four ideal types, but will inevitably be a mixture of all four. What those of us who cherish the Creation and wish to preserve it are fighting for is a world in which we retain as much of our natural heritage as possible. But the most interesting thing about this formulation is that achieving a sustainable future is in one sense the most artificial of all four possibilities. To move toward sustainability we must learn, as the great French scientist Rene Dubos proposed, to cultivate the Earth as a garden, to be gardeners of the Earth. A garden is by its nature an intimate mixture of nature and artifice.

KT: What are you working on right now?

ML: I'm completely focused on a new Collaborative on Health and the Environment (CHE) that Commonweal helped launch, along with about 100 colleagues from California and across the country, on March 21st at the San Francisco Medical Society. The goal of CHE (www.healthandenvironment.org) is very simply to bring patient groups, health professional groups, scientists, environmentalists and other concerned people together in support of the emerging environmental health movement. Remember we said these public health movements don't gain traction till the doctors and nurses and patients come together and demand change? Well, that is what we are trying to contribute to. We welcome new partners who are committed to working together within a framework of good science in a civil and collaborative way.

Six months out CHE has over 200 organizational and individual partners, dedicated and able people who want to find new ways to work together for clean air, clean water, safe foods and a world where breast milk is free of toxic chemicals and where all the suffering from diseases caused in part by toxic exposures is as much a thing of the past as polio or smallpox.

This is one of the very great struggles of our time. We can't know whether we will win or not. But it feels a lot better to me to be part of the global movement that just says no to toxics in breast milk, and no to the pandemics of cancer, learning disabilities, infertility and all the other fifty conditions we know or believe are partially caused by chemical exposures.

KT: The data are extremely disturbing. What keeps you going?

ML: This is personal for me. I have spent too many years in Cancer Help Programs with young women who have young children and are dying of metastatic breast cancer. I know too many learning disabled children, autistic children, Asperger's Syndrome children. I know too many young women and their husbands dealing with the agony of infertility. And as more people come to understand the science, finally we will come to realize that this is not just personal for some of us -- it is personal for all of us.

At that point, I believe we just won't sign up any more for having our bodies and breast milk and babies used as low-rent chemical storage facilities for untested chemicals. It just doesn't make sense any more. It is certainly not necessary. The Europeans are far ahead of us in thinking about the need to phase out of bioaccumulative chemicals and to take a precautionary approach that requires testing of all chemicals before they are allowed to be put into use. Why should we accept lower health and safety standards than the Europeans for chemicals? I can't think of a single good reason.

On October 17, 2002 Michael Lerner will be the keynote speaker at a day-long pre-conference workshop "The Greening of Medicine" in San Rafael, part of the Bioneers 2002 conference. The workshop will explore medicine's relationship and responsibilities toward maintaining a healthy ecosystem, the principles of ecological medicine, and what a "green" clinic or hospital might look like. For information, call (877) 2466-6337 or visit www.bioneers.org.

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