I think there are 3 barriers to hormesis really taking off in the medical field.
1. Reimbursement doesn't support it (meaning it doesn't fit the current business model of medicine-and I don't expect that to change as medicine becomes more socialized.
2. Patients don't expect it.
3. Patients often times don't want it. … very few of my patients would actually do it. … Most say that they just aren't disciplined enough.
These all sound to me like great observations. Here are two more:
1. I'm thinking that hormesis is actually very popular outside of a "scientific" context. Pretty much everyone thinks that facing adversity, exerting yourself, practice, willpower, self-discipline, overcoming progressively more-difficult obstacles, etc. build skill, character, and toughness. Pretty much everyone thinks that too much comfort makes you lazy and soft. It's really not controversial. Whether it's jogging, weightlifting, learning math, practicing piano, or getting good at a video game, hormesis is pretty much the default way that people think about improvement. The word "hormesis" is not widely known, but the idea is.
2. In grad school, I've had an up-close look at how scientists usually study things. They're looking for independently measurable input factors to correlate against independently measurable output factors. They don't want to deal with complicated interactions between many simultaneous factors, because the statistics are much harder to deal with. And, no matter what they say about statistics trumping everything, they tend not to take an idea seriously unless there is a known mechanism involving a very specific chain of events, one part of the system affecting the next, through which a cause produces its effect. They prefer to look at first-order effects; second-order effects are much harder to research and understand.
Eyeglass prescriptions give instant results that are easy to measure and prove. It's fairly easy to measure and prove the short-term effects of drugs. The effects of long-term medication are actually very hard to measure, but at least there are only a few input factors to control (drug, diagnosis, and maybe a couple other easily specified factors, like weight, age, and gender).
The mechanism of eyeglasses is straightforward optics—that they produce their effect and how they produce their effect are known with utter certainty. Most drugs actually don't have well-understood mechanisms of action, but at least there's a story to explain how they work in terms of very simple factors: "cholesterol clogs your arteries, therefore don't eat as much cholesterol (or take a drug that interrupts the metabolic pathway that produces cholesterol)"; "schizophrenia is caused by too much dopamine, therefore take a drug that clogs up your dopamine receptors"; "depression is caused by not enough serotonin in your synapses, therefore take a drug that clogs the re-uptake of serotonin"; "you don't have enough vitamin D, therefore take supplements"; etc.
Hormesis seems like a "whole-body" phenomenon. It's hard to figure out the mechanism by which hormesis works. It involves perturbing a vast network of feedback loops all at once. Hormesis is by definition a second-order effect. The first-order effects of acute stresses are obvious, easily measurable, and always bad. So, hormetic effects live in a blind spot of most scientific research.
Still, all the different forms of hormesis do seem extremely amenable to straightforward empirical tests and measurements. This "blind spot in science" sure looks like a surmountable obstacle.
