Marketplace of the Marvelous (43 page)

Even so, irregular medicine did not disappear. Its story is not of a comeback but of persistence. Part of that persistence must certainly come down to the story itself. Irregular healers told accessible and believable stories to win followers in the nineteenth century. People went to these healers because what they said made sense. Every symptom had a cause and a cure. Humans impose narratives on life because uncertainty is hard to accept. Irregular medicine today has in many ways a better story than regular medicine does. The very complexity of the body and scientific medicine doesn't make for the same neat linear narrative of cause and effect that humoral medicine once provided. There are many things that regular doctors just don't know or can't explain. Irregular medicine, on the other hand, tends to still tell a coherent story and offer a remedy and health program that is believable and easy to understand. This may in fact go a long way toward explaining irregular medicine's popularity and efficacy. Understanding the cause of your disease and your path to improvement goes a long way to healing. Belief is powerful medicine.

Our same desire for a story to make sense of the world may also explain the popular myth that obscures the history of irregular medicine. Regular medicine's rise to dominance by vanquishing irregular quacks with science makes for a simple and engaging narrative but also one that is deeply flawed. All of the evidence to the contrary is around us, in the countless ads for acupuncturists, storefront homeopaths, and in integrative medical clinics. If regular medicine won, why are there are still so many irregular healers?

That many types of irregular medicine have survived and even expanded in recent years can obviously not be explained by the usual story of deviance and public danger. Regular medicine's authority over healing remains far from complete. More than a third of Americans
with chronic back pain, for instance, seek chiropractic rather than regular medical treatment, while between a quarter and half of all people suffering terminal illnesses seek alternative care at some point. Domestic medicine and home health manuals did not disappear with the rise of scientific medicine. Self-help, diet, and exercise books line store shelves and top best-seller lists. Even greater numbers of Americans turn to a proliferation of web-based medical advice and educational sites. Most people continue to treat and prevent illnesses themselves, without the help of doctors.
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American attitudes toward medicine have long been somewhat ambivalent. People tend to trust individuals—their doctor, whether regular or irregular—and scientific medicine to a degree, but they remain skeptical of the profession as a whole. More than a third of Americans report using alternative medicine regularly despite scientific studies that show again and again that most alternative therapies help patients no more than placebos.
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But as medical historian James Whorton has said of homeopathy, “Whether or not homeopathy works, it fulfills a need in a lot of people.”
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The same could be said of nearly all healing systems.

Regular and irregular medicine today have reached a partial truce. Many regulars have abandoned their hostile attitude and seem more open to a variety of approaches to health and wellness. Irregulars, too, have mellowed, showing more interest in integrating rather than pursuing the overthrow of the regular system that had motivated them for most of the last two centuries. Perhaps both are listening more to their patients and following their lead. Most followers of irregular medicine today, as they did in the past, use a combination of regular and irregular therapies, forging their own individual integrative practices.

Irregular medicine has demonstrated considerable strength in some areas where regular medicine continues to falter. The twentieth-century scientific medical model trained doctors for quick and decisive action but left them less prepared for the long-term management and personal attention people often require. The constraints and pressures on a regular doctor's schedule can make patients feel that their doctor has no time for them or that they may be wasting their doctor's time if they talk too much. Irregulars, in comparison, tend to be more numerous and easier to access, and they often encourage long appointments. Most also work in more pleasant office
spaces that help to put their patients at ease and lead to more positive medical encounters. Few people are likely to cite their doctor's office or local hospital as an inspiring, well-designed, comfortable place.

Scientific medicine tends to work best on easily pinpointed diseases and less well on illnesses lacking obvious physical causes, particularly those of psychological origin. Many people go to irregular healers for anxiety, chronic pain, and back problems, issues for which regular medicine currently has few easy answers.
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Other patients, after an examination by a regular doctor, are told that nothing can be found wrong with them, but they continue to feel sick. These conditions are some of the most frustrating to deal with for both patients and their doctors. No patient wants to hear that his doctor does not know everything and no doctor wants to tell her patient that there's not much that can be done. Yet that's often what happens. Not surprisingly, patients are unhappy with this answer. They are suffering and want relief, so they are willing to try other therapies and other healers. Irregulars are often more willing to diagnose and treat symptoms and provide a more satisfactory explanation to the patient to address concerns and complaints.
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The placebo effect may play some role. The effects of placebo have been recognized for centuries. One of the first to describe its power was sixteenth-century philosopher Michel de Montaigne, who wrote, “[T]here are men on whom the mere sight of medicine is operative.”
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Oliver Wendell Holmes declared that patents receive the best medical benefit “through the influence exerted on their imaginations.”
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Nearly everyone, regular and irregular alike, understands that the placebo effect is real even if no one understands how it works. Studies have confirmed the efficacy of placebos in nearly every area of medicine, from pain alleviation and depression to inflammatory disorders and cancer. The effects can come from belief or expectations as well as subconscious associations between recovery and the treatment experience: a white coat, a doctor's office, and a handful of pills can convey tremendous healing power.
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Placebo has a bad reputation, though. When a treatment or drug is said to be “no better than placebo,” the underlying message is that the benefits are all in your mind and not worth pursuing. And those patients that respond to it are often assumed, like followers of irregular medicine more generally, to be gullible and weak. But the placebo effect is far more than patients merely thinking they are better. It
triggers something in the patient's brain that causes real physiological change and is influenced by multiple factors.
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The sights, smells, touch, and sounds all tell a patient that a therapy is being performed. When a patient expects a treatment and then expects to feel better afterward, neurotransmitters are released that can help him or her feel better. Scientists are still not sure how that works. Perhaps placebo is one form of the ancient idea of the healing power of nature,
vis medicatrix naturae
.
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Its effects are fickle, though, operating in different ways with large individual and cultural variations.
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Nonetheless, placebo appears to have real therapeutic value.

But even so, many doctors, pledged to the health and well-being of the patient, are leery of using it because it may require some deception. Can it ever be right to prescribe placebo without telling the patient?

Many opponents of irregular medicine also argue that its reported benefits are nothing but placebo. If so, and that question remains open to debate, irregular therapies may excel at activating and deploying the placebo effect, even if that's not what the healer intended or believes about the treatment himself. Many aspects of irregular medicine correlate to effects associated with inducing placebo. A doctor who takes the time to listen, asks questions, and pays attention provides the good bedside manner that is often lacking for a variety of reasons in the modern medical system but has been shown to improve patient outcomes. Like regulars, irregulars also believe strongly in their treatments and administer them with confidence and reassurance. That alone can perhaps be enough to do a patient good.
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It may even be possible that treatment by persuasive irregular healers may realize the full potential of the placebo effect in ways not possible in regular medical settings, making them an effective option for conditions that appear to respond best to placebo.

Placebo is alive and well in regular medicine, too. In 2002, patients suffering osteoarthritis who underwent a sham arthroscopic surgery reported just as much relief and improved mobility as those who had actually had their bony spurs and degenerated cartilage removed.
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Pharmaceutical companies have struggled to develop new drugs that best placebo. Half of all new drugs developed today fail in late-stage clinical trials, unable to beat sugar pills.
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The placebo response itself, however, does not distinguish between
regular and irregular medicine as its practitioners do. It may be triggered by a benign drug, a compassionate caregiver, a sugar pill, or a magnet. All that is required is that the patient have a realistic expectation of getting better.

Irregular health is not the province of hippies and hipsters either. Its politics are far more complex. Look only to the two senators who endorsed the study of alternative medicine at the National Institutes of Health: a Democrat from Iowa and a Republican from Utah. Sociologist Michael Goldstein believes that alternative medicine transcends the expected political divisions by drawing on ideologies from both ends of the spectrum. From the left, alternative medicine “opposes the dominance of professionals as well as excess profit-making in medicine,” writes Goldstein, while also encompassing “a strong countercultural component whose roots are on the left. Yet, the strong focus on enhanced individual responsibility for health, along with an emphasis on nongovernmental solutions to health problems, often gives alternative medicine a distinctly rightward cast.”
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In other words, followers of alternative health systems don't fall neatly into categories, political or otherwise.

Alternative health care has long offered followers multiple strands of meaning by which individuals can understand themselves and their world. Every discipline, from history and political science to sociology, biology, and psychology, has its own preferred method of explaining human behavior and belief, and each of these theories may be right or offer some hope for at least some segment of irregular health's believers. We tend to look to individuals, not systems, for help and to put our trust in those who have demonstrated their facility in healing no matter the method. That's how irregulars gained power and adherents and a primary reason they have survived for centuries. People seek, and often find, in alternative medicine a more personalized, holistic, and less aggressive approach to healing that appreciates the relationships between mind, body, and spirit.

The truth is that Americans have used and sought out many forms of medical care for centuries. We don't want one rigid system with only one model of care. In medicine, as in everything else, choice is what we want and what we've always wanted, so the sense of novelty and “newness” attached to alternative health is far greater than deserved given its long history. But choice from the perspective of regular medicine is
often seen as illegitimate, ignorant, and misguided, even though a true accounting of our nation's medical history shows that the dominance of one form of care is the historical anomaly.

Attacks on alternative medicine tend to focus exclusively on whether alternative medicine works according to the criteria of efficacy of modern scientific medicine. And while it's an important question, as regular doctors have significant safety concerns about many irregular therapies, it isn't the only question. Perhaps serious consideration should also be given to why these alternatives persist and what that says about medicine and what it can and cannot do. Medicine has made great strides in the last century, vastly improving public health and increasing life expectancy. But holes remain. When people have so little faith in scientific evidence that they go with their gut, then something is wrong. Irregular healers have demonstrated significant abilities to help people feel better whatever the mechanism—and it may be nothing more than a highly potent placebo. Reports and anecdotes of irregular success offer a tremendous database that may be low on scientific precision but is rich with ideas and possibilities to improve all aspects of medical care. As medical historian Owsei Temkin has noted, “Medicine is healing based on such knowledge as is deemed requisite. The fact that medicine in our days is largely based on science does not make other forms less medical.”
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The scientific case for the efficacy of irregular health may perhaps lie in the millions of people over hundreds of years who have found some measure of relief and comfort in its care.

There will likely always be boundaries between different types of healers, but those lines will shift and transform with new technology, new scientific discoveries, and cultural trends. Medicine, even in its modern form, is not a rigid structure but a culture in continual redefinition and negotiation. Even so, the chaos and contentiousness, not to mention unbridled enthusiasm and hopeful thinking, that characterized nineteenth-century medicine seems unlikely to surface again. But medicine will continue to change and evolve with human needs both existing and emerging. Simply disregarding irregular health and its believers rather than trying to understand them does nothing to advance what we all are seeking: a way to feel better.