The "Coals to Newcastle" Model of Health and Medicine

The fount of vernacular springs eternal. Even in America, where most people don’t know where or what a “Newcastle” is (outside of amber lager in a yellow-labeled bottle), the term “coals to Newcastle” is still well-warn in many circles, particular collegiate ones. For those who don’t already know: Newcastle on Tyne was England’s coal exporting port and well-known coalmining town since deep into the Middle Ages. To carry coals to Newcastle, then, is to do something that is rendered totally pointless by scale – similar to a drop of rain in the ocean, a grain of sand in a desert, or, for that matter, a vote in a presidential election (yes I said it). There are two ways to employ this phrase: to say directly that something is superfluous because it is already vastly outweighed by an overabundance of the same thing, e.g., Newcastle already has enough damn coal; and to say indirectly that a small gesture is pointless because it is vastly outweighed by other, more powerful factors, e.g., drinking a “Diet” Coke with your extra large lardburger and grease-sticks. It is with the second one that I am concerned in this essay.   

Like most people of a scientific bent, I have long suspected that herbal medicines, alternative remedies, and so-called healing foods – their very concepts, in fact – were nearly, if not actually, completely hogwash. I have never taken a dose of ginseng, echinacea, kava kava, rhodiola, ashwaghanda, cat’s claw, St. John’s wort, or chamomile and had it do anything other than imparting a nasty taste (except that last one, which can be pretty tasty). Nor have I ever experienced any surges in immunological function from mega-doses of vitamin C, any calming effects from magnesium, any beautifying effects from bio-available silicone, or any noticeable healing acceleration from colloidal silver. And as for the currently insanely popular fermented teas, I stand alongside the growing body of researchers who believe those things are potentially less beneficial than harmful.

And yet – and yet… Until recently, and exclusively in the West, nearly all medicines were taken straight out of the gardens, fields, and forests in which people dwelled. Practitioners in the field of ethnobotany have done a terrific job of tallying and studying the use of plant- and animal-derived medicines and entheogens that continue in some cultures to this very day, and to them and their cultural informants we owe – with allowances for ethical slipperiness in a lot of early cases – a considerable debt for a whole host of modern medicines. According to a 2007 article by the U.S. Cancer Institute’s David Newman and others, around 70 percent of all new medicines introduced in the United States in the last 25 years were derived from “natural products.”  Among the most widely-known and beloved examples are aspirin and quinine, which both come from tree bark; novocaine and cocaine, which come from South American bushes; opiate painkillers like codeine and morphine, which come from poppies; and birth control, the main biochemical source of which is wild yams from Central America.

Granted, in cases of nature-derived cures such as these, the emphasis is on the word derived. The name of the game in modern medicine is to identify, isolate, synthesize, and amplify the specific molecule or molecules in the host sample in order to make it stronger, more chemically durable, more easily manufactured and marketed, and more easily regulated. While there’s no telling how much willow tree bark it would take to clear up a headache – well, I assume someone has done the experiment, but I certainly haven’t – it usually only takes a pair of Aspirin to do the trick, each of which is no larger than the nail on my pinky. And therein lies the root of my total lack of faith in alternative medicine, for most Americans, most of the time.

To reiterate: I have never experienced a noticeable effect from any of the alternative remedies and supplements mentioned above, nor any others to speak of. Bear that word “noticeable” in mind. Meanwhile I, like most people in this country, smoked cigarettes for many years, drank and continue to occasionally drink alcohol, wake up in the morning with a fishbowl-sized mug of coffee, and, while I eat as cleanly and healthfully as I can manage, as a matter of course I regularly ingest immeasurable amounts of preservatives, nutrient additives, chemical flavor enhancers, industrial food-like substances, pesticides, herbicides, and so on. I also breathe city air and drink city water, and God only knows what dark forces lurk therein. And that’s me, somebody who eats what most Americans would consider a positively Spartan diet and exercises nearly every day; I can scarcely imagine the total amounts of who-knows-what that makes its way into the bodies of average Americans. Against such odds, how could something as subtle as an active compound in its organic, non-isolated, non-magnified form possibly have any noticeable effects?

Note again the first three complicating factors on my list: smoking, booze, and coffee; the primary vehicles for, respectively, nicotine, alcohol, and caffeine. Smoking is falling out of fashion in the US, thankfully, and while alcohol is still very much in fashion that doesn’t mean everyone drinks it regularly and/or to the point of intoxication. But coffee is pretty ubiquitous. Tobacco, by the way, is a plant, as are the bushes from which we get coffee “beans” (actually dried berries), and alcohol is produced by yeast in an oxygenated atmosphere full of cereal or grain sugars. Moreover, all three of them were originally employed for either ritual or very occasional use, at least in most cases, and were neither manufactured nor consumed in anywhere near the industrially titanic concentrations in which they’re now available (with the one exception of South American tobacco variants which were, at one time, way stronger than what we grow in Virginia). Add into that refined sugars, saturated fats, preservatives and additives and enhancers and whatever else, and you’ve got the Newcastle to which ginseng is a bucket of coals.

While I’ve mused on this line for many years, I’ve never seen it experimentally tested, until now. The point was driven home with some force in a recent federal study headed up by Brown University’s Rena Wing and including a remarkable supporting cast. The study was intended to measure the effects of a change of diet and exercise in obese adults with type 2 diabetes. Which seems like a foregone conclusion, when you think of it; and for that reason little more than an expensive and totally pointless waste of federal dollars – of course diet and exercise will help! Earlier studies had already shown that proper diet and exercise significantly lower blood sugar levels, blood pressure, and cholesterol. At this point I pass the mic to Gina Kolata of The New York Times:

The study randomly assigned 5,145 overweight or obese people with Type 2 diabetes to either a rigorous diet and exercise regimen or to sessions in which they got general health information. The diet involved 1,200 to 1,500 calories a day for those weighing less than 250 pounds and 1,500 to 1,800 calories a day for those weighing more. The exercise program was at least 175 minutes a week of moderate exercise.

But 11 years after the study began, researchers concluded it was futile to continue [because] the two groups had nearly identical rates of heart attacks, strokes and cardiovascular deaths.   

Www... whuh?

Noted blogger and paleoanthropologist John Hawks appended this in an online commentary by saying, “One expert quoted in the article thinks that the large effects of smoking cessation, statin drugs and blood pressure medications may swamp the small effect of diet and exercise.” To which he added this piquant reaction: “Swamp the small effect of diet and exercise on type 2 diabetes in obese patients? Wow.” (Original italics)

So there you have it. None of the researchers interviewed for the Times article had anything to say about the daily intake of [use your imagination] by Americans, particularly obese ones, throughout their entire lives, although that may come up in the subsequent research articles the team is readying to publish. But they don’t have to. The study involved limiting patients to either 1,200-1,500 or 1,500-1,800 calories a day, but I can find no information about the sources of those calories. Contrary to popular belief – for some reason – a calorie is not a discrete thing, like a vitamin or a nutrient; a calorie is a unit of energy, like a watt or a joule, specifically the amount of energy required to raise one gram of water by one degree Celsius in a normal atmosphere. Focusing on calories is a handy dietary starting-point but it leaves out quite a lot, not least of which being the fact that literally anything from which your body can derive energy therefore consists of calories, including toothpaste, cardboard, and candle wax. Exactly what does that have to say about the quality of one’s diet?

Very little, I’m afraid. Author and dietary guru Michael Pollan likes to lament over our nutrient-oriented view of diet, as if getting the Recommended Daily Intake of this and that is the best way to achieve optimal health. (It isn’t – the Inuit eat almost nothing but animal fats, the San eat mostly vegetables and tubers, and the French drink wine and olive oil in almost equal measure, and all three populations boast considerably better average health than even those Americans who only shop at Whole Foods.) If there is any general rule of dietary health, it is derived not from consideration of diets as constellations of nutrients but as behavioral adaptations, and it would sound approximately like this: eat what you, by your specifically ethnic as well as generally human background, have evolved to require for maximum nutritional efficiency, whatever the hell that happens to be. It probably involves fresh vegetables. It probably doesn’t involve drugs like caffeine and alcohol. It definitely doesn’t involve high-fructose corn syrup, monosodium glutamate, potassium benzoate, Yellow #5, or DDT. And it surely isn’t helpful to augment that by breathing carbon monoxide every time you step outside or drinking chlorine every time you pour yourself a glass of water.

All of which converges on one central point: there are simply too many elements going into our bodies every hour of every day to even keep track of, no matter how healthfully we try to live, and the bulk of them speak with much louder voices than do the dried leaves in a small bag of Yogi Tea. This is America, where subtlety is simply not an option. We live large, work large, play large, drive large cars and trucks, create and endure large amounts of stress, eat large and drink large and swallow large handfuls of magnified large-molecule drugs every time we get so much as a hangnail. And we are all sick, tired, and dying, in a very large way, in the face of which herbal and other "traditional" remedies are indeed as useless as carrying coals to Newcastle. You're better off carrying a backpack away from all this.