You’ve heard the promises before: a certain supplement, breathing technique, exercise program or diet regimen has the power to reverse a specific source of physical suffering. You’ve heard functional medicine doctors and nutritionists say that “food is medicine” at the same time that your own efforts to cure an illness with a visit to the doctors office has failed. All you want to do is get better, but you know in your heart that everyone out there pushing a cure also makes money off of treating illness.
It’s a simple fact that both Big Pharma AND Big Wellness profit off of you coming back for more treatment.
Patients feel like they’re stuck choosing between diabolical pill pushers and snake oil salesman. At the same time though, we know that sick people often do get better when they seek treatments from healing professionals. Western medicine invents miracle cures time and again. Meanwhile, speaking from my personal experience, I’ve had success treating several illnesses with visits to chiropractors, psychedelic ceremonies, breathwork, ice baths and other staples of the wide-world of wellness.
I’ve spent the last 25 years of my career trying to untie the gordian knot of what works in both western medicine and wellness—first as a cultural and medical anthropologist and then as an investigative journalist. My first book, The Red Market, exposed ethical lapses and criminal conduct in drug development and at hospitals all around the world. The next one, The Enlightenment Trap, exposed the history of grift in spiritual and wellness communities. I then wrote three books (What Doesn’t Kill Us, The Wedge and Dream) trying to bridge the gap between western and alternative medicine.
Most people who have found me on Substack or YouTube are probably most familiar with my ongoing project to expose the Liars, Cheats and Charlatans of the Griftoverse. The reports there catalogue the criminal and illicit behavior of scientists and wellness gurus who break bad. But the truth is that even the most egregious charlatans usually build their businesses on kernels of unconventional truth. Wellness sometimes works at the same time that even a criminally exploitative healthcare system saves lives. Healing not black and white. Medicine is an art, not a science. Occasionally breathwork IS better than spending a lifetime on anti-anxiety medicine.
If we set aside cases of malfeasance, negligence and deliberate fraud by bad actors, western medicine and wellness both have important lessons on human health. It’s just that they are two entirely different paradigms of knowledge. To simplify what should be an entire medical anthropology Ph.D. dissertation—western biomedicine treats symptoms and discretely identifiable diseases, while wellness aims to build the positive quality of “health” in what has historically been termed vitalism.
They might sound similar in their goals, but these two paradigms are essentially opposite approaches to health–with one aiming to increase good qualities, while the other aims to subtract bad ones.
To quote functional medicine doctor Mark Hyman form his recent appearance on the Huberman Lab podcast. “when people ask me what functional medicine is, I say it's a science of creating health as opposed to the science of treating disease. When you create health, disease goes away as a side effect.”
On the surface what Hyman is saying sounds very appealing. Like what healthcare should be. Unfortunately, the problem with being a human is that we all want vitalism, but can only objectively measure the things that cause suffering.
Everything hinges on his usage of the word “optimize.” Here’s Hyman again:
If you optimize your basic body systems, your gut, your immune system, your mitochondria, your detox system, your hormonal regulatory system, when you optimize those things, symptoms go away and you don't have to treat all the different branches of the trees and the leaves on the trees. You treat the root in the trunk, which is what functional medicine does.
While seeking optimal health seems obvious if you don’t listen too closely, it’s actually a pretty empty idea–one that the disease paradigm of western medicine already takes into account.
Take for instance, the standard measures of diabetes–if your blood sugar is below 100 you are normal, from 100-125 you are pre-diabetic and above that you are considered diabetic. Alternatively, the opposite of diabetes is hypoglycemia, or a blood sugar of 70 or lower. Being in between those two numbers is simply being normal.
There’s no extra-healthy magic number for “optimal.” There’s no other dimension here to measure. You can’t be extra non-diabetic.
This is where functional medicine – and wellness in general – makes a categorical error when they attempt to adopt scientific language. The idea of “optimal” is a fiction. Worse–it’s really just a marketing term akin to “exclusive” or “luxury” when talking about real estate or an upscale restaurant. This is because no one agrees what optimal actually means. Functional medicine is trying to have its cake and eat it too by using the language and methodology of the disease paradigm and pretending that it is measuring vitalism.
While disease can generally be quantified, and in acute cases be traced to a specific cause, there are no good metrics for what “healthy” means on its own. Take for instance the idea of “biological age.” People go through life in a single direction as a function of time. Having the same biomarkers as a 20 year old does not make you 20. Indeed, there are no biomarkers that all 20 year olds share and no single perfect standard of human health that you can use to compare to make an accurate assessment of biological age. It’s also just a simple fact of math that measuring more variables makes an equation more complex and lowers the fidelity of conclusions. Determining biological age by interpreting 100, generally poorly understood, biomarkers is akin reading tea leaves. It leads to less objectivity, not more.
And this leads to a sort of crazy outcome. If there’s no way to objectively identify ideal health, then all you can say scientifically is how far someone is from a diseased state. Since functional medicine can’t actually define optimal health, it counterintuitively has to assume that all humans are always diseased–even if they don’t have any symptoms of illness.
They convince you that you are already sick and commit you to lifelong optimization protocols that simply replace BIG PHARMA with BIG WELLNESS–only with less scientific rigor.
However, I want to remind you that this is an essay about what WORKS in wellness. Because vitalism isn’t all bad. It’s actually a cool idea that just needs to be understood as a paradigm in its own right.
Because there is a huge blind spot in the disease paradigm as well. It has a very bad time explaining the subjective sensation of “feeling good.” Just like vitalism, it doesn’t have the tools to answer the questions that vitalism is actually asking when it’s not pretending to be science.
In general people in the wellness paradigm should not talk about physiological mechanisms from a place of authority.
With a few exceptions, reductive science isn't at a place where we can conclusively say that any specific biological mechanism outside of disease leads to a subjective improvement in life experience.
Western medicine can evaluate some diseases on a population level, but is still quite limited in predicting outcomes for individuals.
Both western medicine and wellness fail when they cross their exclusive boundaries. Or maybe fail is the wrong word–it’s more like when they both generally lack credibility when they offer solutions to problems that they cannot technically address. The farther they stray into the other’s territory the more likely that are to become scams.
If we want to cure the gap between wellness and disease, we need to look at what both approaches have in common, rather than shoe-horning one idea into the language of another. To do that I’d like to put forward the idea of “Range”.
If a disease decreases the number of actions that you can comfortably take–it decreases your range. Meanwhile, if other protocols or techniques increase the actions you have available to you then you have grown your range.
Range is still an empirical measure–you can do things or you can’t do things. It’s also one that you have to evaluate subjectively on an individual basis.
Range is a particularly useful thing to consider because it connects a person to their environment. Thought of broadly enough range even accounts for what social scientists call “the social determinants of health” the the same time it considers specific disease states. A person born into a wealthy family has more range because of what social status affords–whether it’s better food, or education or anything else. Meanwhile a person with a broken leg has less range because they literally cannot walk. Thus, range allows for a total holistic view of human experience even though its limitation is that it’s generally also much less quantifiable.
Another thing that range is useful for is to explain the enduring problem of the placebo effect that many people have noticed overlaps between the domains of wellness and medicine. It’s my opinion that if someone feels better after making an intervention–whether it’s a shamanic healing or a doctor-prescribed antibiotic– the underlying mechanism doesn’t matter as much as their subjective experience. The empirical fact of increased range after the intervention is all that ultimately counts.
So this is one the places where we can build bridges between the world of science and the subjective benefits of lifestyle alterations.
I’m going to make a big statement now based on 25 years of observing successes and failures in alternative health. Here goes:
The value of a wellness intervention is proportional to the intensity of the sensations that it produces.
This is something I spent a couple hundred pages discussing in detail in my book The Wedge. It’s also the thing that is most overlooked amid the cascade of lifestyle products and wellness funnel upsells.
Sensations are both emotional and physical–and the fact of the matter is that we really don’t know exactly how sensations alter the physical substrate of the body other than that they DO alter things. If consciousness is stored in the brain, then sensations are the first step in the pathway that encodes that information from the environment into your nervous system. And those encodings have cascading effects that change the way that your body reacts to the environment.
Just like the skin is the physical barrier between your body and the outside world in terms of all the mechanisms that exist inside the body, sensations connect your psychology and your consciousness to the environment–and ultimately define your ability to act in the world.
That’s right–sensations define your range.
If you regularly experience strong sensations in order to grow accustomed to them you will and ultimately expand your range of action simply because you are comfortable doing more things.
Let me give you an example: when you first start running or lifting weights, the sensations you feel are strong and usually uncomfortable. But the more you perform those exercises the easier those actions become–thereby increasing your range.
The same goes for the trends in ice baths–uncomfortable cold quickly becomes a source of enjoyment — saunas transform oppressive heat into resilience to it. The more you expose yourself to those kinds of stresses the more range you have in experiencing them. You will also build range with adjacent sensations. For instance if you fear the ice water, immersing yourself in it and growing accustomed to it lends a general benefit towards anxiety.
You can truly do near miraculous things to expand your range–you already have just by growing up from an infant with almost zero range into the fantastic human you are today.
But I want to be very clear about the limitations to these takeaways.
We don’t really understand the mechanisms that make all the functions of the human body work together. The body is too complex for us to know how every part truly works together. Any attempt to describe the benefits of range expansion in the same terms as we try to explain medicine–through hormone cascades, receptors, and parts of the brain lighting up that correlate with specific types of emotional growth or resilience–will inevitably turn out to be categorically wrong.
Its reasonable to assume that many sensations are similar in character between people–the cold I feel is the same cold you feel, for instance. We both hurt when we stub our toes. And the overwhelming thrush of first love also shares the same character between individuals. In other words, we feel the same feelings.
But no neuroscientists or endocrinologist has ever reverse engineered a sensation. While we can be open to the possibility of that happening in the future–this is called the hard problem of consciousness– anyone claiming to understand the mechanisms based on current science is either deliberately lying to you for their own benefit, or is over confident and deluded in their understanding of human physiology.
If you hear anyone talking about heat shock or cold shock proteins as they pertain to longevity please run the other direction. Anyone who says a specific practice raises or lowers your cortisol or adrenaline and that means something deterministically about your psychological state is, again, making inaccurate assessments of causality and pretending to be a doctor when in fact they are just a charlatan.
Of course different physical actions and exposures can affect your psychological state, but we frankly have no idea how it all actually fits together. It’s just marketing jingoism.
And don’t even get me started if they mention how consciousness can affect quantum states. There are of course interesting things to say about consciousness and quantum physics in certain controlled settings, the science is not even close to talking about how that scales up to the human level. If we did there would be actual science to prove it.
Charlatans sell an image of physiological certainty by exploiting basic truths about the way we all experience sensation. It feels good to overcome challenges and expand your range. These are predictable effects of being human in the environment. That should be enough. You should exercise because of the joy it brings to you. It will make you healthier even if you can’t measure exactly what that means.
If we create a science around sensation–perhaps what used to be called phenomenology–then we would be able to foster predictable experiences through exposure that broaden people’s ranges in any number of dimensions. We don’t need to pretend that the experience of a sensation supersedes medical knowledge of physical processes.
If we do that, both science and wellness can co-exist and make human health better for everyone.
So that’s my assessment of what works in wellness. Keep doing things that make you feel good. Get good sleep, eat healthy, exercise, and develop meaningful connections with other humans. Every doctor and every wellness teacher agrees on those points. The more you do, the more you will be able to do. And, should you start to feel symptoms of an actual illness–talk to a medical doctor who specializes in it.
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