the alternative fix

james whorton
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James Whorton is a Professor of Medical History at the University of Washington School of Medicine in Seattle and the author of several books, including Nature Cures: The History of Alternative Medicine in America. He has studied and written extensively about the history of alternative medicine, chronicling the field's ebbs and flows since the 1700s. In this interview, Whorton describes some remarkable similarities between other periods where alternative medicine was very popular and today, and looks at some of the economic and social forces fueling the current boom.

Why do you think so many people are seeking alternative treatments today?

I think there are a whole host of reasons why patients have turned increasingly to alternative medicine in recent years. Part of it is that the allopathic doctors [conventional MDs] have been allotted fewer and fewer minutes per patient visit over the last twenty years and people do want to have more time seeing their practitioners. And alternative doctors do typically give patients quite a bit more time.

They also [tend to] pay more interest to the patient's personal subjective experience of the illness and not be quite so fixated on what the organic pathology is. I think there has been a reaction against science among the baby boomers, growing up with the bomb, seeing the negative things that science can do. We've become very distrustful of science. Especially since the 1960s as the baby boomers came of age and the counterculture movement swept through the country, we became very distrustful of people who claimed to be authorities and the way they might mislead us, whether it was Lyndon Johnson leading us into Vietnam or allopathic doctors saying we're the only people who know how to treat disease. There has been a reaction against the allopathic denial--I don't think it's too strong a word--of the importance of emotional and spiritual factors in illness and in the way people experience their illness. People wanted to go to someone who told them it wasn't just in their head.

I think another big factor has been that in a way allopathic medicine has been spoiled by its success in that most of the doctors trained during the 20th century were trained to deal with trauma and acute infectious disease, and historically acute infections were the big disease problem. If you go back to the beginning of the 20th century the leading causes of death were infectious diseases, pneumonia, tuberculosis, diphtheria, intestinal infections. They succeeded very well; by the middle of the 20th century most infectious diseases were pretty much under control, not so much through the actions of physicians, it was really more through preventive medicine and public health, but certainly with first the sulfa drugs of the 1930s, then the antibiotics in the 1940s … Infections faded into the background as the major type of health problem. And certainly mainstream medicine should be congratulated for that role.

Whether or not homeopathy works, it fulfills a need in a lot of people to not be reduced to physiochemical machines.

The problem was that when that happened, a new disease pattern emerged, one that's dominated by chronic diseases that aren't necessarily curable, that have to be dealt with over a long period of time, have to be managed and that present a lot of difficult emotional challenges to patients. Doctors who were trained to diagnose an infection and select the right antibiotic for it were not as well equipped to deal with patients who were suffering from cancer or diabetes or heart disease and having to deal with these chronic problems for the rest of their lives, and so people became dissatisfied with physicians. …

[Another] one of the major forces supporting alternative medicine historically and I think down to the present is the harshness of some of the allopathic therapies. In the 19th century there was a great deal of uneasiness with the drugs that were prescribed by physicians. One in particular, calomel, a mercury compound that is a very powerful purgative, flushes the bowels very efficiently, and according to allopathic theory at the time, it made sense to give it. Calomel was given to just about everyone and many of the people who took it suffered mercury poisoning as a result. … There were other elements of allopathic therapy that were criticized as well, the dependence on drawing blood, a pint or more at a time, giving drugs to produce vomiting, treating the skin with blistering agents, applying leeches to draw blood, a whole range of therapies that appeared to alternative doctors to be going against the healing efforts of nature.

Calomel in particularly was justified by allopaths in the 19th century as a treatment that yes, did injure the patient, weaken the patient, but nevertheless was needed because its beneficial effects were greater. When we look at that today, I suspect our first reaction is, well, that seems a little questionable. But of course the same thing is done today with chemotherapy. Oncologists rationalize the use of chemotherapeutic drugs, the hair loss, the nausea, all the other things that come with it, with the argument that nevertheless it does more good than harm. Alternative practitioners will maintain that this has been a theme throughout the history of allopathic medicine, that there has never been adequate attention paid to the side effects of drugs and that the benefit of naturopathy or acupuncture or whatever other system you might consider is that there are no injurious side effects. …

Can you put the surge in interest in alternative medicine that seemed to start in the 1990s in historical perspective? Are the levels of interest we see in America today unprecedented?

I think actually alternative medicine [has] been gathering momentum since the seventies. If you look at the health of the various alternative systems in terms of the number of practitioners, the number of schools and so forth, they really were at an all-time low in the 1960s. Homeopathy had just about disappeared in the United States. They started to make a come back with the holistic medicine outbreak, or the holistic health explosion as Norman Cousins called it, in which the American public became much more interested in finding approaches to healing that dealt with the whole person, mind and spirit and so forth as well as body, and that took a more humane approach to patients, and that used less aggressive therapies. All of the alternative systems were able to capitalize on that and they did it very effectively I think. …

There also was a reaction within the public I think against the tendency of mainstream medicine to reduce everything down to physical chemical explanation and to disregard not just emotion, but spirit and energy and things that couldn't be easily measured and quantified. And the alternative systems all emphasized those elements in their philosophies and in their therapies. So I think there was a coming together of the public outlook toward health and the approach that alternative practitioners had always taken.

At the same time there was a great deal of concern over the growing costs of medicine as the costs spiraled well above ten percent of the gross domestic product. Then we became very concerned politically to try to control costs, and alternative systems presented themselves as low cost options that did not take such aggressive high tech interventions. And so there was hope that within alternative medicine we might be able to find therapies that worked and cost much less than what was being made available through conventional medicine. That was a major factor in the establishment of the Office of Alternative Medicine in 1991. …

Was the establishment of the Office of Alternative Medicine at the National Institutes of Health contoversial?

Well, I think it's what you would have expected, given the long history of conflict between allopathic medicine and alternative medicine. Alternative medicine had always been looked down upon as quackery in the sense of being ineffective therapy and sometimes dangerous therapy… so it certainly was no surprise to me that there was this reaction that somehow witchcraft and sorcery and alchemy and voodoo were being introduced into the National Institutes of Health and it had no place there, and that this was purely a political ploy. But by then also there were a number of allopathic doctors who had come to recognize or at least to accept that perhaps there was something worth investigating there … so it was not a unanimous condemnation of what Congress were doing, but I'm sure the people at the NIH who are research scientists, and I think are much less inclined toward the kind of worldview that alternative medicine has, I'm sure that they were very upset by it.

What sort of progress was made in the early years of the Office of Alternative Medicine?

Well, the original budget for the Office of Alternative Medicine at the NIH was only two million dollars, which was a very small amount compared to the overall funding of NIH, which was several billion dollars, I think nine billion dollars at the time. It was so small that the original director of the office, Joe Jacobs, made the comment that it was a homeopathic level of funding. ….

The people who were doing research under these early grants that were given out were put under very close scrutiny to begin with because there was so much skepticism about how effective they could be. I think there probably was more pressure put on them to come up with results than they were able to deal with. They were expected to get good results in less time than perhaps it was possible to do, given the budgets they were working with. My impression is that still not a lot has come of these studies to justify in many physicians' minds, certainly many of the people at NIH, the expenditures that have been made. …

I'm guessing that in the early years there was there was more pressure to be sympathetic toward alternative medicine. The Office of Alternative Medicine was a political creation and my guess is there was political pressure to be more open-minded, less hardheaded allopathic in orientation. Since then I think there's been a softening of that attitude because alternative practitioners have come to appreciate that if they are going to be accepted and integrated they are going to have to demonstrate somehow that their therapies are effective and that they are going to have to meet certain scientific standards. I think they even welcome somebody now who would impose that because they feel that they can do it.

Where the problem lies I think is that within allopathic medicine there is a very strict gold standard of what constitutes proof: the double blind, randomized controlled trial. That doesn't necessarily work well for alternative therapies. There are a range of reasons that alternative practitioners will point to that say "this is not a model that works that well for us." For example, that it applies to populations and it tells you that a certain drug will be of benefit to most people within a population, but it doesn't tell you how it's going to affect an individual, and all of our treatments historically from the beginning have been oriented toward finding the best therapy for this individual patient.

To take naturopathic medicine as an example, naturopaths, if they treat an inner ear infection, they would treat it very differently in one patient from the way they'd treat it in another depending on the patient's age, the patient's diet, other aspects that that I can't really comment on because I'm not a naturopathic practitioner. But they could have thirty or forty different therapies that they might use depending on the patient, and they would use those therapies in different combinations, whereas in most cases if you've got an ear infection or your kid's got an ear infection you take him to an MD, he's going to give him amoxicillin. There are these wonderful randomized double blind studies that show amoxicillin works against infections, so everybody gets the same treatment. A naturopath would argue, "Our approach can't be crammed into that box. It just doesn't apply because we individualize our therapies and you would have to have so many different trials that you wouldn't have enough people within each category to feel you had a statistically significant population you were working with."

But a research scientists would say that's a cop-out.

Well, I understand their position and I can see why to them it would appear to be a copout. And I think many, many allopathic doctors would maintain that saying that the double blind study doesn't apply to alternative therapies is a copout. It allows alternative doctors to escape from being subjected to this scientific method of evaluating therapy. Most allopathic therapies can be studied that way. Whether or not it is a copout I'm unable to say, I'm not an epidemiologist. These are questions that are beyond my area of expertise.

I can say that alternative practitioners do not see it as a copout, they sincerely believe that because therapy's individualized, because the style of the practitioner and interacting with the patient contributes to the healing that you can't apply these other methods. They claim to be very open to developing other evaluation techniques that will be accepted by allopathic medicine, and there's a lot of thought being given to that among alternative practitioners. But at this point I don't think anyone's come up with an alternative to the randomized double blind trial that is acceptable to allopathic practitioners. But there have been studies done of different alternative therapies using that method that indicate efficacy. The trial of homeopathy against childhood diarrhea that was done in the early 1990s appears to be a very well designed study and it shows a definite benefit from with homeopathy over just basic nursing care.

But there aren't a lot of randomized double blind trials that show alternative treatments work.

The Office of Alternative Medicine, now the National Center for Complementary and Alternative Medicine has been doing research, or funding research, for ten years to try to demonstrate efficacy with alternative therapies and there's not a great deal positive that's come out of that yet. There have been some benefits shown from acupuncture. I think a couple of herbs have had some benefits shown, but there's nothing really I guess path breaking in the research that's been carried out so far.

What does that say, about the studies or about the treatments themselves?

I think all it says to me is that we, we still don't know. I'm skeptical of a lot of alternative therapies. I suspect that we may never get solid convincing evidence that a lot of things work. I suspect we'll find that some things do. Allopathic medicine has discarded a lot of therapies over the years that for a while they believed worked. I think this is just the natural process of medical evolution no matter what kind of therapies you're using. …

What would you say is the state of relations between traditional "allopathic" medical practioners and alternative practioners today?

I think there is genuinely a period of peace and an attempt to establish a truce--maybe more than a truce, an actual alliance--between the two which has resulted from at least a couple of developments. One is that the alternative professions have carried out a remarkable program of bootstrapping over the last half a century, raising their standards of education, of training, raising the bar for licensing their practitioners, policing themselves more effectively to keep incompetent practitioners out. And perhaps as important as anything, cutting back on the extravagance of their therapeutic claims. Historically the alternative systems claimed to be able to cure everything. They all began that way, claiming that they could cure any condition allopathic medicine couldn't cure, anything except the occasional surgical problem. … At least most of the major alternative systems now are happy to concede that allopathic medicine is very good at certain things, dealing with trauma particularly, acute infections, managing some of the symptoms associated with terminal illness.

On the other side what's happened within allopathic medicine is that since the 1960s there's been a steady realization within the that the old style of medicine that had prevailed from the beginning of the 20th century through the first half of this century had become too focused on pathophysiology, on dealing with the disease, had lost sight of the patient as a person and of the emotional and psychic components of health that influence the way an individual experiences disease. …

I think one of the things that's most striking to an historian looking at the current situation is that we are, even though there still is a lot of skepticism on both sides about the others, there is a willingness, an openness to talk with one another, a degree of tolerance that you'd never see before the 1990s or so. Historically the two sides have despised one another. As an example I can think of an allopath in the 1840s who commented on how his colleagues should think about homeopaths and he said, "You should consider them the unclean thing, something fit only to wipe your feet on, a prostitution of our noble profession," and so forth. About the same time a homeopath commented on how his colleagues should feel about allopaths and he said, "You should consider them foul and slimy reptiles. Dogs may eat their vomit and pigs return to wallowing in the mud, but we should never return to the allopathic medicine that we have broken away from." And those are just two examples of literally thousands of comments made from both sides about how revolting the other side was. …

Things are more civil today, but isn't there still some rancor between allopathic and alternative practioners?

Even though we're seeing a great deal of openness, cooperation and even collaboration between allopaths and alternative providers today, there are plenty of people on both sides who do not trust the other side, who believe the other side is inept, incapable of providing effective care for people, and very suspicious of the motives of the people on the other side. This I think is the result of a very long history of conflict and rancor between the two groups. There are very deep wounds that have been formed over these two centuries of conflict. And even though for many people they've closed they're still pretty shallow, it doesn't take a lot to reopen them….

What is homeopathy?

Homeopathy is an approach to medicine that is very popular worldwide. It has become more popular in America in recent years, but it's still not as common here as it is in Europe and in Asia, especially in India. But the word "homeopathy" is derived from Greek root words meaning "like the disease," and it's an approach to healing that involves treating patients with drugs that duplicate the symptoms of the illness. So that if a patient finds himself complaining of headache and nausea and restlessness, the homeopath will find a drug that through experiments done by homeopathic practitioners has been found to produce those symptoms in healthy people. It's a form of like curing like.

Homeopathy is an interesting alternative system because for most of American history alternative medical history it was the most popular system; from the 1840s into the early 1900s homeopathy attracted more patients than any other alternative system. As recently as 1900 roughly ten percent of all the practitioners in America were homeopaths. That was maddening to allopathic doctors because homeopathy seemed to them to be the most impossible system of all, because its system of practice involved first of all administering drugs that were supposed to duplicate the symptoms of the disease and that didn't make any sense to allopathic doctors. But more than that, it seemed to be absolutely impossible because homeopaths insisted that for their drugs to be made effective they had to be carried through a special process, a preparation that involved passing them through serial dilutions of the order of one to a hundred.

The classic way of preparation of a homeopathic drug was to take one grain of the remedy, to grind it up with ninety-nine grains of milk sugar, lactose, and mix that very thoroughly to get a medicine to the first dilution and then of course if you took one grain of that mixture and you had mixed it thoroughly, you would have one one-hundredth of a grain of the starting drug. They would take one grain of the mixture, add it to another ninety-nine grains of lactose, grind that up, mix it to get a medicine to the second dilution, which means now if you take one grain of that you're going to have one ten-thousandth of a grain of the homeopathic drug. But they would then take a grain, carry it through a third dilution and ultimately this would be done until the thirtieth dilution was reached, which means you would have, I'm not sure what the word for this is but you would have one over ten to the sixtieth grains of the drug. And if you took a random grain from that thirtieth dilution you would not have a single molecule of the starting material. And so certainly from the allopathic perspective it couldn't exert any effect.

Homeopaths were convinced it did because the method had been discovered through experience by the system's founder, Samuel Hahnemann. He had found that, first of all, that giving drugs that simulated the systems of the disease cured people. And then secondly he had found that the more he diluted those drugs, the more he broke them up through this preparation, the more effective they were and the fewer side effects there were. He couldn't explain it. He made some general suggestions about freeing the spiritual or the "dynamism" was the word he used to indicate some sort of spiritual power, or an energy perhaps we might say today from the drug; he believed you stripped it away as you ground it down and kept diluting it. But he would not have made a strong stand on that as his theory, he really wasn't that concerned about what was going on, it was simply the fact that clinical experience indicated to him that it worked, and it worked much more effectively than anything allopathic doctors were doing. So while allopathic medicine has been critical of all alternative systems historically, it's been more critical of homeopathy than any other because it's impossible to explain it in terms of conventional scientific theory.

But for much of American history it was the most popular system. It took away more patients than any other system and it was maddening in the 19th century in that homeopathy appealed particularly to the upper classes. It was disturbing to allopaths to see the more educated people in American society falling for homeopathy. And secondly, people with more money to pay higher fees were going to homeopaths. …

But the people who went to homeopaths were attracted to it for the same reason people are attracted to many alternative systems today, in that it gave spirit or some non-material entity, some vital force, some vital energy in the human body a place. Whereas allopathic medicine was already in the early 1800s walking down that path of reductionism, of accounting for everything in terms of chemistry and physics and essentially denying anything that couldn't be explained that way. So I think whether or not homeopathy works it fulfills a need in a lot of people to not be reduced to physiochemical machines and to feel that they there is some sort of healing power in their bodies that can be tapped into by a similar force. …

Has there been any conclusive evidence on whether homeopathy works?

… In 1994 there was an article published by Pediatrics, which is a mainstream medical journal, reporting a study done on childhood diarrhea in Nicaragua by a homeopath which demonstrated that children with diarrhea treated homeopathically fared better than those who were given the basic supportive nursing treatment. That article was initially turned down by the journal because one of the reviewers responded that even though it appeared to be a well designed study, he refused to believe that homeopathy could work until he could be provided with an adequate explanation of how it worked, something that made sense in terms of biomedical science. The other two reviewers were favorably impressed by it, but initially it was turned down on the grounds that homeopathy couldn't work, therefore it didn't. Eventually it was accepted, it was the first and I think still only homeopathic article to be accepted and published in an allopathic journal.

How many alternative practioners are there today, compared to the beginning of the 20th century?

At the beginning of the 20th century, there were close to ten thousand homeopaths. We don't have solid figures for any of this, but there were several hundred "eclectic" practitioners. There would have been a couple of hundred "physio-medicals," this was another alternative school of practice. … I would estimate somewhere between ten and fifteen percent of all practitioners in the country were alternative practitioners.

I think that number is comparable to what we have now at the beginning of the 21st century. Again, I don't have solid figures for this, but roughly we have somewhere between 550,000 and 600,000 MDs actually involved in clinical practice. We've got about fifty thousand chiropractors; chiropractic is the largest alternative group. There [are] somewhere around forty thousand osteopaths--whether or not osteopaths should be considered alternative is a bit problematic, because they do many of the things that MD's do, as well as the musculoskeletal manipulation. Some people see them as being part of the establishment, being much the same as allopaths. Others see them as alternative practitioners. But if we count them as alternative that puts us up to ninety thousand. Then there are a couple of thousand people doing acupuncture. There are a thousand to 1500 doing naturopathic medicine, probably 1500 practicing homeopathy. And then boy, I'm not sure what the numbers are for others but there are a lot of others. I've seen estimates of as many as three hundred different alternative approaches to healing being offered to the American public right now. But I think it's safe to say that probably fifteen percent of the practitioners in America now are offering one or another alternative approach, particularly if you include osteopathic medicine.

It's interesting that we have similar numbers, or similar percentages of alternative practitioners today to what we had a hundred years ago. But that doesn't mean that there was some flat line relationship that ran through the 20th century. Alternative medicine remained very popular in America through the first thirty years or so of the 20th century. … But then all of the alternative approaches went into a decline that for some became almost a tailspin by the 1960s, during the middle third of the century, largely because of the advent of the so-called wonder drugs, the sulfa drugs in the thirties, the antibiotics in the forties. Suddenly allopathic doctors actually were able to very effectively treat some of the major disease threats to people. … People were won over to allopathic medicine to an extent they hadn't been before. They largely abandoned alternative providers, except perhaps for chiropractors who were providing care for a condition that MDs were not very effective at treating, low back pain. Except for chiropractic, the alternative systems all slowly faded away into the 1960s. But then began a resurgence in the 70s with this explosion of interest in an holistic approach to healing. …

Can you explain what "allopathy" means, and how mainstream doctors came to be referred to as "allopaths"?

Another thing that's very interesting historically I think is that we've seen a new term applied to mainstream medicine in recent years, or at least I think MDs consider it a new term, "allopathic medicine" or "allopathy" to describe what MDs do, conventional medicine. That term is not a new term at all, it actually comes from the late 1700s, it was coined by Samuel Hahnemann who was the founder of homeopathy. Hahnemann coined that to distinguish between his approach to medicine, homeopathy, which treated disease with drugs that were like the disease, that duplicated the symptoms of the disease, whereas conventional practitioners used treatment that worked against the disease, that countered the disease. They would try to lower a fever, they would try to flush out the poison that was causing disease. They were attacking the disease. And so he coined the term "allopathy" from Greek roots meaning "other than the disease," to suggest that indeed allopaths were acting in a way contrary to the proper way to treat disease to the natural way which is the way used by homeopaths.

And so allopathic initially meant working against nature in essence, doing the opposite of what needed to be done. It was very quickly adopted by the other alternative systems of the early 19th century. It spread from homeopathy into hydropathy and into mesmerism, magnetic healing, all the other alternative systems. Everybody was calling the mainstream practitioner an allopath by the 1840s. And the allopaths found that very offensive because they felt it reduced them to the same level as these other systems. They saw themselves as scientific medicine, the only true medicine and all these other systems as misguided approaches to treatment. And so if they were called allopathy, that indicated they were just another "pathy" like homeopathy and hydropathy and these other systems. …

The terms, allopath and allopathic medicine fell out of use during the period when alternative medicine underwent its mid-20th century decline. It wasn't until alternative medicine underwent that revival in the 1970s that "allopathic medicine" came to be used commonly again by alternative practitioners, and also still used in a derogatory way. But allopaths didn't realize that it was an offensive term anymore; it's just amazing to me now to see medical students accept being called allopaths without any problems at all. …

Do the disparate alternative medical systems have anything in common with each other, in opposition to conventional allopathic medicine?

… If you look at the various alternative systems you see each one has its own distinctive therapies and its own individual theories to rationalize the therapies; they're all quite different from one another, but at the level of philosophy, their medical worldview if you will, they're all the same. They share a common philosophy and it's the same philosophy they've had since their origins in the early 19th century. It emphasizes first of all, relying on nature to heal. Their conviction is that allopathic medicine attacks nature, the doctor tries to cure without taking any account of the body's own innate healing ability and often interferes with the natural restorative process, whereas each of their therapies supports and stimulates the efforts that the body is making to restore the person to health. They have a great deal of faith in an innate restorative power, the vis medicatrix naturae the Latin formulation that's been used for centuries, "the healing power of nature."

Secondly, they claim to develop their therapies through clinical experience entirely. They do not allow theory to dictate treatments to them and they maintain that allopathic medicine does. Historically there's a lot of truth to that; in the 19th century, early 19th century particularly, allopathic medicine did use the bleeding and the purging and the vomiting that other therapies it did because theory indicated it was supposed to work. Alternative practitioners claim their treatments are all confirmed by clinical experience. They don't try to justify the treatments theoretically until they're certain that they work, and then they may or may not try to come up with some theoretical rationalization of it, but it's not important particularly to have a theory.

They make another point that I think has a lot of validity, that to a great extent they've been rejected by allopathic medicine historically and still are because their methods that they believe are confirmed by experience cannot be explained in terms of allopathic theory. And if it doesn't make any sense then allopaths aren't going to pay any attention to it. They have to be able to understand it according to some patho-physiological mechanism that fits within the allopathic scientific model, otherwise they can't take it seriously.

My favorite example of that is a talk I heard a few years ago by an MD who has become very active in the complementary medicine movement and is particularly interested in the effects of prayer on healing. And in a talk he gave that I attended he said that in a previous talk he was interrupted, after having cited literature indicating that prayer does have beneficial effects on healing, by a faculty member at the medical school where he was speaking, who said, "That's the kind of crap I wouldn't believe even if it was true." And alternative practitioners believe that's the way they've been treated and continue to be treated by the establishment; that even if what they use has been demonstrated to be true, it won't be believed unless they can somehow come up with an acceptable patho-physiological mechanism that allopaths will recognize.

Another element of the alternative medical worldview has been to maintain a holistic orientation toward treating patients. "Holistic" is a term that came in in the 1970s and it became a big buzz word, but all of the alternative systems have been holistic from the very beginning. They didn't know it because they didn't have the term, but they all, as early as the 1830s and 40s, are emphasizing that every patient has to be treated as an individual. His or her emotional and spiritual and other psychic factors have to be taken into account, and they have to be treated humanely. Whereas allopathic medicine, it was being charged from the beginning, treats people as containers of organs that have to have the disease beaten out of them, but don't deal with them as whole people. That's been there from the beginning.

It's part of what I call the "Hippocratic heresy" which is a term I've suggested for the philosophy of alternative medicine because they have been treated as heretics, they've presented heretical ideas about healing. But those ideas can all be traced back to Hippocrates. Allopathic medicine speaks of Hippocrates as the father of medicine, and they look to Hippocrates as the originator of the western medical tradition, which he is. But for allopaths, Hippocrates stands out so because it's in Hippocratic thought that for the first time we see a consistently naturalistic approach to interpreting disease and to treating it. No supernatural elements are allowed in, so we don't think in terms of disease demons or punishments by gods or relying on prayer or magic ritual or anything of that sort to treat disease.

Alternative practitioners revere Hippocrates for that same reason but also because in Hippocratic medicine there is very heavy emphasis on trusting in nature to restore people to health. Hippocrates is the first person to call attention to the fact that people do get better spontaneously. Most people recover with or without any medical treatment. In the Hippocratic literature, there's a heavy emphasis on relying on experience to discover effective therapies, not being directed by theory as allopaths work, and there is a very pronounced holism in Hippocratic medicine. The Hippocratic approach involved taking account of each individual patient's not just physical history but emotional history, lifestyle, environment in which the person lived. All of the components of the basic philosophy that all alternative systems share can be found in Hippocratic medicine, so they see Hippocrates as their father as well. So poor Hippocrates is caught in the middle with the allopaths tugging from one side and the alternative practitioners on the other. …

How do alternative practioners understand the "placebo effect" as compared to allopathic doctors?

One of the really interesting elements of the debate historically, but which I think is really coming to a head today, is over the significance and the importance of the placebo. Historically alternative medicine has been dismissed as nothing more than placebo effect. It gives the patient attention, the patient's given something that he hopes will be effective and the placebo response follows. Allopathic doctors have tended to see the placebo as something that is useless in their practice, and believe, in fact, that is unethical to give because it's a kind of deception. You shouldn't give a patient something that's not a drug without telling him it's not a drug--but then of course you won't get the placebo effect.

Alternative practitioners argue that the placebo should be regarded as just as valuable as a drug. It is in a sense a drug. It's a therapy. It produces an indirect effect, perhaps, rather than the direct effect of a drug, but still it does provide benefits for patients and so it should be incorporated into therapy and utilized rather than disdained.

What do you think about the institutional integration between conventional and alternative medicine that's taking place in hospitals and medical schools today?

Well it's another interesting thing that has developed over the last decade is the growth of instruction in alternative medicine in allopathic medical schools. … More than half the medical schools in the country have adopted at least some instruction in alternative medicine into their curriculum. In some cases it's part of their required curriculum, in other cases it's an elective for the medical students. But still at most medical schools now there is an opportunity for the allopathic students to learn something about alternative medicine.

There's money involved now.

My guess is that there's more incentive of that sort for the hospitals than for the students, because the kind of instruction that's being given so far is pretty limited. I don't think they would be able to learn enough to feel that they knew what they were doing with acupuncture or naturopathy. Certainly the alternative practitioners are insulted by the suggestion that this stuff can be taught as part of a medical school curriculum. But certainly there's a great financial incentive for hospitals to provide this [kind of care].

The Eisenberg study showed that enormous sums of money were being spent on alternative medical services, that there was a great consumer demand for it. I think that encouraged hospitals and health care plans to provide those services--partly to meet the desires of their clientele, partly for the money that was involved. …

One of the most striking things for me when I look at the situation today is to see how rapidly the system has accommodated alternative medicine. We've seen two hundred years of bitter conflict between the two, allopaths denouncing all alternative systems as quackery as a danger to the public health, and now in the last few years in some institutions we're seeing a range of alternative treatments provided, in some cases before we have very solid evidence that these are effective. It is strange to a historian to see how rapidly we've made that transition. I can't see that it's been made purely for scientific reasons because we don't have as solid evidence as we'd like for the efficacy of some of the treatments. I hate to have to suspect it's made for economic reasons because there is so much consumer demand for it, but I'm not sure how else to account for it. …

It's got to be economic.

I think so, but I think also the physicians who have been trained in the last twenty to thirty years have been educated, especially doctors in family medicine, in the same kind of philosophy that the alternative doctors have been espousing for a couple of centuries. They're finding some common ground that makes them open to what they're claiming, perhaps to a degree they shouldn't be. Perhaps they've gone from being too critical perhaps to being not critical enough. It's the sort of thing that only time will tell. Once we get more data on the efficacy of these therapies we may see that this was a major turning point in the history of medicine or we may see this was a phase that was a little bit crazy.

What do you predict for the future of alternative medicine?

I think it's still up in the air what's going to happen. The Journal of the American Medical Association four or five years ago had an entire issue devoted to alternative medicine, and two of the items in that issue were editorials. In one a physician predicted that this was all just a fad and it would be gone in a few years. In the other, another physician predicted that alternative medicine's here to stay. Historians make lousy fortune tellers but my guess is it is here to stay at least in the sense of imposing its philosophy on allopathic medicine. This holistic approach, reliance on nature, avoidance of extremely aggressive, invasive measures, and so forth, these are all principles that allopathic medicine has been developing since the 1960s, but it's been given a big boost I think by alternative medicine and now that there is so much more interaction between allopathic practitioners and alternative providers, this is being strengthened, and I don't think we're going to turn away from that.

Conceivably many of the alternative medical practices will be confirmed by research to be effective and we could have a truly integrated system in twenty or thirty years in which chiropractors and MDs and naturopaths and homeopaths and acupuncturists all work happily together, collaborating to provide each what he does best for the patient. But I think it's a bit early to predict that.

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posted november 4, 2003

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