James Gordon MDThere is so much in the news now about alternative medicine — the cover story in our local city magazine, The Washingtonian, articles in almost every issue of every womens’ magazine, features and notes and comment in the health sections of the newspapers. Practices that a few years ago were regarded as truly strange — acupuncture, homeopathy, guided imagery and laying on of hands, among them — are now treated with real respect, if not deference. Increasingly, insurance companies and HMOs are willing to cover some of these techniques and medical schools are offering elective courses and continuing medical education credit for them.
We are in the process of a profound change in our model of medicine. The change is, or seems to be, taking place so fast that it may be useful now to take a step back to look at some of the reasons why medicine resists change and some of the forces that may now be compelling it.
Medicine is based on science — on the biology, chemistry, and physics that every pre-medical student has to pass — and is embedded in its world view, constricted by its conventions, reinforced by the kinds of social structures and economic interests which sustain and shape science. But it is also quite different and special. The successes, limitations, and failures of medicine have a felt immediacy that is simply missing from geology, astronomy, or physics. Doctor’s decisions, procedures, and medications are, literally, a matter of life and death — for all of us. And so too, by extension, are the theories they are based on.
We have a passionate attachment to the achievements of our medicine and a desperate fear of its failures. On the one hand, we are terribly eager to believe in the science that promises to save our lives or relieve our misery, and in the health care professionals who bring us its benefits. On the other hand, when that science and those who serve it fail us, we have the most powerful incentive to look for help from alternatives which may call every aspect of that “conventional medicine” into question. As more and more of us gain more and more access to information about the latest developments in medicine both the possibilities for reinforcing the power of the existing system and the potential for challenging it increase.
During the last century the extraordinary benefits of biomedicine gave us both concrete help and an almost indomitable hope. Can’t vaccines and antibiotics prevent and conquer once deadly infections — smallpox and polio, meningitis, and rheumatic fever? Didn’t our medical scientists isolate and synthesize the insulin that enables diabetics, once among the early dead, to live long and productive lives? Surgery and chemotherapy shrink and obliterate some tumors. Premature infants who would never have survived live. And now we wonder if inherited diseases that were thought years, or even months, ago to be beyond our therapeutic reach, might be cured by microsurgical genetic splices. At moments I suspect that even the most skeptical of us secretly hopes and feels that all illness may eventually yield to our relentless research effort.
For all their promise, however, our successes have had a conservative character. As a society we want innovation and progress, but for years the only change that most of us conceived of was that which took place within the bounds of the present scientific model: a new drug or procedure. We worried that if we changed our ways of research, or decreased its budget, or refused to go the extra investigational or therapeutic mile, something terrible might happen. Chemotherapy is not nearly so successful in treating cancer as we once hoped and anti-inflammatory drugs address symptoms, not causes, yet we have continued to invest billions in them and have kept on hoping. The terrible fear was that if we did not, we might omit that drug or fail to make that advance which could save our life or the life of someone we love.
When we are sick and do question a respected physician’s advice, we feel ourselves standing not only beyond his protective embrace, but against the weight of an enormous establishment of people far more expert than we. If we choose to disregard the choices that thousands or millions of other equally sensible people have made — people who have considered the same decisions as carefully and value their lives no less than we do — we have to doubt our motives, and even our sanity. “What makes me think I know so much? Is this wishful thinking or a plausible choice? Am I being intelligent or masochistic? Am I pitching my life or my child’s life in some petulant ideological quarrel with the medical establishment?” And if we voice our doubts, the cautionary chorus of family and friends inevitably weighs in.
The pressure against physicians who question accepted practice or make use of unconventional therapies is, if anything, greater. We risk the derision of teachers and colleagues, and, in a professional world finely tuned to nuances of pathology, we expose ourselves to questions about our competence and, indeed, our mental health. And should a therapeutic experiment fail, should the patient who follows advice which goes against accepted practice do poorly, the physician is horribly vulnerable, not only to doubt and self-doubt, but to accusations and ostracism and exhausting, costly, and humiliating malpractice suits. “Doctor,” one imagines the lawyer for the plaintiff intoning, “did you really think that mental imagery — or acupuncture or herbs or homeopathic remedies — could really cure uterine cancer?”
On the other hand, because the personal stakes are higher, the pressure against the dam of perceived authority can also be far stronger than it is in the pure sciences. A man who has reached the end of the establishment’s capacity to offer help for a metastatic cancer, a woman with migraines intractable to conventional treatment, may well be willing to accept any therapy that promises to relieve suffering or prolong life. At a certain point, fear of death or disability overwhelms our fear of questioning those who are scientifically credentialed and socially sanctioned to care for us. Drowning people do grasp any hands that are extended.
And if some of those who reach out are pulled out, if, against all the odds of authoritative precedent and fear, derision and self-doubt, someone gets well, then the rules of the game are irrevocably altered. In science an anomaly raises a small doubt in the minds of the initiated. In medicine an anomalous recovery is a truth seared into the body and mind of the one who is now well.
Someone so helped knows in his bones the limits of received medical truth. He will never again listen uncritically to solemn pronouncements about what works and what doesn’t. And, inevitably, he will share the good news with others who are suffering in similar ways. One of my patients says he just can’t help himself. “It really troubles me,” he told me not long ago, “to see people suffering the way I did from arthritis, crippled up and popping non-steroidals or puffed up from Prednisone. And listen, most of the time I don’t have to say a thing to get them interested in alternative medicine. They just take one look at me and say, `What have you done? You look fifteen years younger,’ and then I have to tell them.”
If the person who is helped is a health professional, the process is both more complex and far reaching. It probably requires more energy, pain and frustration to prompt those of us who are health professionals to turn from conventional biomedicine and its theories to other healing practices, to allow ourselves to mistrust received medical authority. We risk a loss of certainty about our own profession and the ridicule of our colleagues. But once we’ve stepped outside the bounds of conventional medicine and found help, there is no going back, for ourselves, or our patients.
This happened to me twenty-two years ago when a combination of fasting and osteopathic manipulation cured a back problem which was forcing me toward surgery. On the most superficial level, I could no longer insist that everyone with back pain immediately see the orthopedist, or share my colleagues’ scorn for chiropractors (at the time M.D.s who referred patients to chiropractors were deemed unethical by the AMA) who, like osteopaths, manipulated the back. I couldn’t continue to reflexively scoff at the dietary therapies that people said helped them, or for that matter any therapy that someone — practitioner or patient — found of value. Indeed, I reminded myself, I would have to listen far more closely and respectfully to everything that all of my patients said and all the avenues for help they wanted to explore.
The same process is now being repeated on a vast scale. Thousands of health professionals and millions of others are experiencing the beneficial effects of a new more democratic and collegial approach to health care, of mind-body approaches and alternative therapies that work. They are telling others in person, in print, on television, and over the Internet that they feel better. They are sharing what they know with those who come to them for help and this sharing is changing how we as a society define medicine and what we expect from it. The many voices of personal experience have an authority which is compelling all of us to question all received medical truths and to search for and demand new techniques and new models of care.
Maryon Stewart
Tom Ferguson MD
Daniel Redwood DC