A historical perspective of alternative medicine

by Roberta Bivins

As a historian who writes about the controversial topic of ‘alternative medicine’, I get a lot of questions about whether this or that therapy ‘works’. Sometimes, these questions are a test of my objectivity as a researcher. My questioners want to know whether I am ‘believer’, or a fan of alternative medicine, or have any stake in promoting or disdaining a given medical system. Other people are asking simply for advice: is it worth trying acupuncture, say, or homeopathy for a particular condition? From either angle, such questions ask me to take a stand on whether homeopathy is quackery, or whether I believe in acupuncture channels, or chiropractic manipulation.

My instinctive – if perhaps unhelpful – response to such questions is, more or less, to shrug my shoulders and reply that I don’t really care: the issue of therapeutic efficacy isn’t at the heart of my research on this fascinating subject. Instead, I want to know what lies behind the enduring popularity of alternative medicine, what is (or is not) really ‘alternative’ about it, and why so many of biomedicine’s current crop of ‘alternatives’ have been imported from very different global medical cultures. These are questions that a historian can answer. They are also questions that shed more light on the persistence of alternative medicine than would a yes or no answer about the efficacy of any given technique. After all, we know that once-respected mainstream therapies like bloodletting and purging enjoyed centuries of popularity despite being uncomfortable, potentially dangerous and (in light of today’s medical knowledge) ineffective. Even today, patients prescribed antibiotics for a nasty cold often report feeling better after taking them – despite knowing that most colds are actually caused by viruses, and thus immune to antibiotic therapy.

My position has not always been popular with my fellow authors writing on the topic. They are often passionately committed supporters or opponents of alternative therapies, and demand that I become one or the other as well. But history studies the interplay of light and shadow, not the boundaries between black and white. So I am happy to let the healers fight it out in the battle to prove or disprove the efficacy of their chosen treatments. My job as a historian is to remind them — and to remind us all as consumers — that even the most objective evidence remains historically contingent: no medical experiment can escape from its social milieu, since both its designers and its subjects are shaped by their own historical and cultural context and beliefs.

For example, in contemporary biomedicine, it is conventional to separate the mind and the body when designing a medical experiment: hence the rise of the double-blinded random controlled trial as medicine’s ‘gold-standard’ of proof. Yet physicians and researchers simultaneously acknowledge the impact of the mind on bodily processes. They call it the ‘placebo effect’. As understandings of the mind-body relationship become more sophisticated, it is possible that the blinded RCT will fall from favor, as a limited test of therapeutic activity which obscures an important variable. Such changes have happened in the past, as evidenced by the shifting balance between deductive and inductive reasoning in scientific experimentation since the Scientific Revolution, or the changing status of ‘empiricism’ in western medicine since the 18th century. Then again, it may not: history is not a predictive science! My point is that today’s objective truths are neither value-free nor future-proof.

More practically, it is also my task to point out that the arguments used on either side — for instance, ‘homeopathy is bunk; no trace of the medicinal substance remains in a homeopathic dilution’, or ‘biomedicine reduces humans to objects, and ignores individuality’ – are by now over a century old. Most of them, virtually word for word, can be found in any nineteenth century medical journal. Medical consumers were not persuaded to renounce their alternative therapies (or biomedicine) then, and they show little sign of doing so now.

Alternative medicines remain the bane of medical scientists who despair of consumers’ collective ‘flight from reason’. Such medicines remain popular, widely used, and almost universally available. If researchers and scientists are convinced that alternative medicines threaten the public health and purse, they must move beyond simple denunciation, and seek the source of alternative medicine’s enduring appeal. What are contemporary medical consumers dissatisfied with, or rebelling against? How must biomedicine change if it wishes to establish therapeutic monopoly? My research suggests that medical consumers seek a medicine that reflects and responds to their experiences of health and illness, as well as observable anatomical, physiological, biochemical and even genetic data. Biomedicine’s nineteenth century step away from the experiential and towards the externally observable coincides with an enormous growth in the power of clinicians to treat and to heal – and with a parallel growth in consumer demand for more inclusive medical visions of their bodies in sickness and in health.

Roberta Bivins is Associate Professor in the Department of History at the University of Warwick, United Kingdom. This post originally appeared in the Oxford University Press blog.

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  • Brian

    As understandings of the mind-body relationship become more sophisticated, it is possible that the blinded RCT will fall from favor, as a limited test of therapeutic activity which obscures an important variable.

    But that’s exactly what RCTs are meant to do: Eliminate extraneous variables in order to determine to what degree the specific variable being tested is responsible for the results. If anything, increased awareness of the fact that mind has an influence over matter is a reason to continue RCTs as the “gold standard”.

    As such, you’re not likely to see RCTs disappear any time soon.

    • gzuckier

      the standard reply in fields such as ESP research or even audiophile product marketing is that the analytical/quantitative/comparative mindset necessary for double blind testing is not conducive to the more openly receptive state of mind necessary for the effect in question to be detected by the subject.

      boy, there’s a catch for you.

  • ninguem

    Look up the author “Norman Gevitz”.

    “The DO’s: Osteopathic Medicine in America”

    He writes about osteopathic medicine, and the matrix from which it emerged in the 19th century, and growth and change in the early 20th century.

    Reading about the DO’s, you learn a lot about the various movements and sects in medicine at the time.

  • http://brileyvirtualmedia.com brenda

    The writer says that traditional medicine needs to discover why people pursue alternative medicine.

    I was a firm believer in traditional medicine until I had a daughter that was chronically ill. Between Dec 2005 and Sept 2008, my teen daugher was put through tests and meds by a pediatrician, endocronologist, rheumatoidand arthritis, and gastroenterologist specialists. It costs thousands of dollars and she was sick for almost 3 years. A friend suggested I take her to a chiropractor. Within 10 minutes he muscle tested her for allergies and said “you are gluten intolerant, give up gluten and you are cured”. Within 24 hours she no longer had nausea and vomiting. Any introduction of gluten will make her ill.

    This past year my 21 year old daughter complained of constant sore throats. She’d go to the doctor, be given antibiotics and sent home. At one point a surgeon suggested she have a tonsillectomy. We took her to a local alternative medicine pharmacy and the customer service person told her she was likely gluten and/or dairy intolerant. She came off gluten and was cured. No more drainage or sore throats.

    This is why my first response from now on will be to explore alternative medicine in the event myself or one of my family is ill. I was totally disilllusioned by the fact that specialists are so singularly focused and prescribe meds when they have no idea what is wrong. I know that our culture has grown to expect a magic pill when they go to the doctor. My daughter suffered terribly, her nausea and vomiting had a huge impact on the quality of her life. I just hope that the tests and medicines do not have any long term health consequences for her.

    • Brian

      It will be interesting to hear about the “alternative medicine” emergency room to which I infer you would take your family members in the event of a car accident or heart attack.

      Look, medicine in the day-to-day can be very complex, and very difficult. For patients, this generally results in a great deal of frustration, concern, fear, anger, etc. I don’t mean to discount your experience, but the fact that alternative medicine practitioners (or a customer-service representative, apparently) “cured” your daughters by recommending they come off gluten is certainly not to say that, in general, the health of your family would best be served by avoiding medicine altogether.

    • pj

      Sorry to hear of your bad experiences, but I must point out, gluten sensitivity is a real, known, documented disease (or health issue if you prefer) and a gluten free diet is a mainstream, traditional accepted medical treatment. So please don’t give up on “traditional medicine” simply because the physicians you initially consulted didn’t advise gluten free diets.

      Re- the “muscle test” for allergies, there is no reliable such test that I know of, but would like to know the name of the one that worked for you. Serum antibody tests seem to be the gold standard, though I’m not an allergist/immunologist.

      Honestly, every time I mention a gluten free diet to a suffering patient, once they find out how tough it is to avoid gluten, they don’t make the change….

  • http://skeptvet.com/Blog SkeptVet

    I wholeheartedly agree that the social, psychological, and cultural factors that contribute to the forms alternative medicine takes and to its popularity are crucial in understanding people’s attitudes towards it. The factual data about safety and efficacy are far less cogent to most people than the ethos of these therapies.

    However,that doesn’t change the fact that there are answers to factual questions about safety and efficacy that are not contingent on human perceptions. Gravity has always worked the same when, even when people believed the Earth stood on the back of a turtle. Similarly, antibiotics cure bacterial infections whether you believe in them or not, and homeopathy cures nothing no matter what you believe about it.

    Our understanding and our models of reality may be trapped in a cultural and historical mileu, but reality is unmoved by how we view it. And the reason that the scientific methods of inquiry have changed human life more dramatically in a couple hundreds of years than in all the preceding millenia is because they allow us to compensate for our biases and approximate reality more effectively. Not instantly and not perfectly, but undeniably more effectively.

    Also, you seem to have accepted a common misperception of the placebo effect–that it is a case of our minds making our bodies better. Actually, it is a collection of effects that make us feel better, and that make us look better in clinical trials, without actually changing our bodies at all. The effect is dramatic in studies with poor controls and subjective outcome measures, and essentially disappears in studies with objective endpoints and proper controls. It is not mind-over-matter, so while it may be useful in managing how we feel (pain, nausea, etc), it is not a data point against the naturalistic paradigm or the RCT.

  • ninguem

    I didn’t know that gluten sensitivity was considered “alternative” medicine.

    What you had was a conventional diagnosis that was missed, or not considered.

    • http://brileyvirtualmedia.com brenda

      “What you had was a conventional diagnosis that was missed, or not considered”

      This is exactly my point. I had to decide if I was going to passively fill her prescription for anti inflammatories or seek alternative care. When the doctor told me that these powerful drugs were known to cause liver damage over long term use, I had to try something outside mainstream medicine.

      Secondly, when I discovered that the fibromyalgia diagnosis the doctors had given her was basically a catchall for a group of symptoms, I made the appointment with the chiropractor.

      He used muscle testing while my daughter held bottles of known allergens. He not only correctly diagnosed but he relieved many of her “fibromyalgia” symptoms through chiropractic care and educated her to do better self care. .

      I am not against all doctors and all medical care. In my opinion, I learned the hard way that medicine relies too heavily on expensive tests and drugs to chemically diagnose and cure ailments. I think the reason things are done this way is that the system has narrow vision, lack of time to treat the whole person, insurance mandates, and fear of lawsuits.

      I would like to see doctors exposed to these alternative treatments and judge for themselves. Rather than giving a blanket judgment about alternative care, how about scientifically inquiring about these methods others use?

      I understand why doctors do this because I did it too. I thought all chiropractors did more harm than good and they were probably quacks. Investigation changed my mind.
      brenda

  • imdoc

    Well, our tax dollars are paying for the answers…
    Search “NIH alternative medicine research”

    This is the pet project of a senator who was a “believer” and got the NIH to fund a lot of studies. Peruse them and you will see anecdotes put to a controlled study. They are not controlled by pharmacists, drug companies, or physicians. Never heard of this institution? That is likely because nothing greatly newsworthy has emerged.

    • ninguem

      imdoc, it’s been my understanding that the NIH alternative medicine studies that have come out, all show the alternative treatment studied, did not work.

      At least the ones I’ve seen. If there are exceptions, I’s like to know about them.

      • Brian

        I think that’s what imdoc was getting at.

        That is likely because nothing greatly newsworthy has emerged.

        i.e., “alternative medicine” has been measured and largely found wanting.

        • pj

          Not sure if it was an NIH study, but acupuncture was found to be helpful for lumbar pain in a pretty good study, if I recall.

          • gzuckier

            which puts it one up on spinal surgery.