the alternative fix

the alternative philosophy of medicine
the clash

The myriad of alternative and complementary therapies all share an approach to healing that aims to harness the innate healing power of the body and emphasizes practical results rather than rational, theoretical explanations. In these excerpts from their interviews, medical historian James Whorton, alternative practitioner Andrew Weil and conventional doctor—and skeptic—Marcia Angell discuss and critique this "alternative" worldview.

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James Whorton

Professor of Medical History, University of Washington

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… 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. …

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marcia Angell, M.D.

Senior Lecturer, Harvard Medical School

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What strides has science made that you think alternative practitioners have rejected or ignored?

Well, just look at herbal remedies. It's essentially a throwback. It's saying you go to a plant and you mush it up and you stick it in the jar and you sell it and you eat it and it's going to cure what ails you. And that's the kind of stuff that people believed in the early 19th century. And you know maybe sometime something worked, but the indications were very uncertain, you didn't really know what was in that bottle, you had contaminants plus the active ingredient. You didn't know what the active ingredient was or how strong it was, and so yes, maybe occasionally, such things worked, but probably at a terrible price. Probably often did great harm.

For example, the foxglove from which digitalis was later isolated. That was a plant and people used to take it for dropsy, which is a kind of collection of fluid, edema that you can get from heart failure, and maybe taking the foxglove, the whole leaf, worked from time to time. But maybe it also kills you, which an overdose of digitalis can do. And maybe your dropsy didn't come from heart failure but it came from something else. So that's the kind of thing that happened. Then with the dawn of good pharmacology and analytic chemistry at the beginning of the 20th century, you began to be able to isolate the active compound, to purify it, and later to synthesize it. So instead of having foxglove as a plant, you had digitalis, and you could synthesize different forms of digitalis that had different speed of activity, different strengths and so forth. … It was a great advance to be able to identify the active ingredient, to isolate it, to purify it, to synthesize it. Why on earth would you want to go backwards? But that's what we see, at least [with] the dietary supplements.

But people think these things are safe because they are natural.

Oh yes, they think it's natural. You had asked me earlier about why do people go for complementary and alternative medicine; if you look at what these disparate methods have in common, I would say the most important thing they have in common is that they haven't been demonstrated. If they had been they would be incorporated into scientific medicine and there'd be nothing alternative about them. So that's the thing they have in common. Therapeutic touch, homeopathy, magnet therapy, herbal remedies, you name it. That's what they have in common: they have not been adequately tested scientifically. They also have other things in common and one is a certain ideology, a belief in things that are "natural," things that are "traditional"--as long as you don't add the words "western medicine" after traditional.

Believers in complementary and alternative medicine do have in common an ideology that celebrates the things that are natural, and things that are traditional, even though poison ivy is natural, and even though purging and bleeding are traditional. They still celebrate it in almost mindless way so when they take a bottle of something labeled "dietary supplements," they assume that there's something natural in there and therefore that that's good.

They also believe in something that is not really scientifically true, and that is that things can be simultaneously gentler and more potent. And unfortunately that's hardly ever the case. Strong medicines usually have strong side effects, and desperate illnesses often require desperate remedies. Cancer is a good example, where you might be very, very sick from the treatment. But you put up with it in hopes that it will cure your cancer. It's very seldom true that you find things that are truly potent that have no side effects at all, and yet people who take dietary supplements believe that somehow they're getting something that will cure whatever the thing is that they want to cure and do so at no cost whatsoever. …

And then the other thing about this is that the alternative medicine practitioners have to pay more attention to you. They have to be gentler, they have to be kinder, they have to be warmer, they have to at least appear to be more compassionate because that's all they have to offer. Whereas if you go to your surgeon with an appendicitis and he takes out your appendix, he may forget to be kind and compassionate. … He figures he's got some good stuff to give you and he doesn't have to give you the hearts and flowers and the frills. Now, I think he's wrong about that. I think that medicine and doctors have too often--and let me say this loud and clear--been too arrogant, too busy and too highly specialized and technologically focused. So I think there's a lot to be said for the complaints on the side of complementary and alternative medicine in that department. Nevertheless you have to say that they're offering all of these touchy-feely things because that's all they've got. Whereas you can get more if you have appendicitis or a heart attack or cancer from your standard doctor. …

Why do people assume that [acupuncture] works?

I think because a lot of people are doing it. It feeds on itself. There also a lot of mythology about China, too, that everybody uses acupuncture there for anesthesia, for just about everything, but what we're seeing is as China becomes economically more developed, it's choosing to go to what's often called western medicine. To scientific medicine. And in fact this use of the term western medicine is irritating because the Japanese practice just about the same kind of medicine that we do. What we see is that scientific medicine developed in different countries at different rates around the world. It's not particularly western, it happened to develop first, mainly in the United States, because we were economically able to do it. It's more expensive. Scientific studies are expensive. To deliver it is expensive. But as countries have developed economically, whenever they possibly can, they use scientific medicine because it works. …

You have to ask yourself about these old traditional medical treatments. Ayurveda, Chinese traditional medicine, that started thousands of years ago, what life was like for the people who relied on those therapies. Well, it was nasty, brutish and short. That's what life was like. And yet somehow they're presented now as sort of exotic chic, as traditional chic that because they're old and because they come from a different culture, there must be something to them. …

I think it's fairly random that acupuncture has become so widely accepted. And people want to make it special in some way, without seeing that it's a part and parcel of the whole phenomenon. We had talked about why do people believe in this so much now, and we talked about many reasons. One reason is that people want to have some control over sickness and death as many ways as possible. It's scary, sickness and death and so they try acupuncture plus they try whatever their doctor offers. But there's another thing about alternative medicine and that is the religious appeal, which in my view is perhaps the most important reason. People are now drawn to alternative medicine I believe because of the mysticism, because of the spirituality, because of the offer of transcendence at a time when people aren't finding conventional religion all that satisfying. So it gives them the feeling that their mind has dominion over their body. It gives them some feeling of spirituality, and in a sense, the more implausible the method, the more it appeals to this metaphysical desire, this desire for mysticism and spirituality. I think acupuncture has that.

It's totally implausible; it's like angels dancing on the head of the pin, it has a sort of fussiness, and yet at bottom it's a belief in vitalism, and energy fields, the same thing you see in therapeutic touch and some of the other more implausible mechanisms. And I think that appeals to people. I think in a sense the more implausible it is for some people, the better. It satisfies a craving for spirituality, settles some old scores with conventional medicine, it makes people think that they're rising above themselves. …

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Andrew Weil, M.D.

Founder and Director, University of Arizona's Program in Integrative Medicine

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Earlier you told me that you believed that medicine has become dangerously disconnected from nature. Can you talk about that disconnect, and how it's come about?

It's true that the vast majority of drugs in use today are of plant origin, or at least they were originally discovered from plants. But scientists today and medical doctors have no firsthand experience of the plants that they come from. There has been over a hundred years of teaching that plants were equivalent to their isolated active principles or dominant compounds. That's just not so, plants are very rich complex mixtures.

One of the great pitfalls of western science and medicine is reductionism, that is, thinking that the part equals the whole. In pharmacology that has meant isolating single compounds from plants, purifying them, making molecular variations of them, making them even stronger, and then teaching that it's better medicine to give these pure chemicals to people.

In my experience I find better results with the complex natural compounds. … I'm not completely in agreement with the herbalists who just want to use crude preparations of plants. I'm all for preparing plants in ways to make them better, more standardized and so forth. But I think there is fundamentally a different kind of medicine in presenting the body with these complex arrays of compounds that's found in plants. Often in this array there will be compounds that have opposite effects. So in Chinese medicine you find plants that raise low blood pressure and lower high pressure, that make no sense in terms of western pharmacology. We think of drugs as having unidirectional actions. But these plants clearly contain these ambivalent mixtures. When you present the body with this kind of ambivalent paradoxical array, which effect predominates I think depends on which receptors are available for binding. It's not mystical; I think there's a real biochemical mechanism to explain this. But when you do that you're allowing the body to have a choice in how it responds to a treatment.

For example one of the plants that I studied for a long time was coca leaf in South America, the source of cocaine. It's a major medicinal plant for Andean Indians, and one of its main indications is to treat all kinds of stomach disorders. Andean Indians say that coca treats both diarrhea and constipation. Again, that makes no sense in western terms, cocaine is a stimulant, it increases gut motility, so you could imagine it would treat constipation, but how possibly could it treat diarrhea? Well there's fourteen other alkaloids in coca --these are variations on the molecule of cocaine--and if you looked at the cocaine molecule, the shape of the molecule relates it to drugs like scopolamine and atropine that come from higher plants like belladonna, those have a paralyzing action on the gut and have been used to treat diarrhea, and yet isolated cocaine is a stimulant. … So you give the body this ambivalent mixture, it decides what it needs, it takes what it needs. That is a different kind of medicine from giving the body a strong unidirectional push with a powerful purified compound.

I think both kinds of medicine are probably useful. If you're dealing with a critical condition, something very fast moving, it's nice to have these purified compounds that work very dramatically in one direction and quickly. But I think for general purposes, it's a whole other way of thinking about medicines and the body, that you let the body decide what it needs, to take what it needs. …

By the way I think this is also very consistent with developments in other areas of science. Right now one of most exciting things going in mathematics and physics is the rise of complexity theory. We're finding that if you want to describe the natural world, you need complex models, that classical simplistic models don't work. Medicine has shown not the slightest interest in that. I think that medicine is at the moment firmly wedded to reductionism as a tool for dealing with the natural world. …

What do you think has to change in medical culture?

To me the major thing that has to happen is to shift the focus of medicine from disease and symptoms and treatment to health and healing. The major thrust of my writing has been about the innate mechanisms of healing in the human body, much more than about alternative medicine. That's why I don't like being called a guru of alternative medicine.

I have tried to call attention to the fact that the body--I mean it's hardly a new idea--has incredible potential for self-diagnosis, for repair, for regeneration. When I approach a patient, my first thought is always why is healing not happening in this person? What's blocking it? What can I do as a physician to facilitate healing? That's a different perspective. …

That's what I mean by this change of perspective: at best, treatment facilitates healing, it impinges on natural healing mechanisms of the body, unblocks them, it allows them to operate. … Similarly I think that looking at people as whole persons, not just physical bodies, that people are also mental, emotional beings, they're spiritual entities, they're community members, all of those other dimensions of human life are very relevant to health and healing. …

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posted november 4, 2003

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