Nature Cures is an incredible exploration of the history of alternative medicine in the US, exploring each major alternative’s approach, philosophy and historical development. While I won’t examine each approach, below I summarise some of the major takeaways from reading the book.
Fundamental differences between alternative medicine and allopathic (mainstream) medicine
Holistic vs specialisation
Alternative medicine generally claims to treat the whole body, whereas allopathic doctors specialise and treat a part of the body.
Nature as therapy vs heroic therapy (interventionist)
Alternative medicine attempts to use nature or natural remedies to treat patients, whereas mainstream medicine uses pharmaceutical interventions.
Empiricism vs theory
Alternative medicine takes an experimental, trial and error approach (although is often underpinned by a theory or philosophy), whereas mainstream medicine is theoretically-based.
Historically (mainly 19th Century in this book), both alternative and mainstream medicine involved, at times, incurring harm to patients. While mainstream medicine typically had greater claims to a scientific basis, it did use treatments and approaches that were harmful to patients, such as calomel. Alternative treatments were often not effective in the way they claimed, but often did less harm and included beneficial lifestyle changes. Often, the harm was in the form of opportunity cost – patients were having unproven treatments at the expense of receiving proper care from a qualified mainstream practitioner. (This was truer as mainstream medicine improved.)
Alternative medicine involved longer, more patient-focused consults than mainstream medicine, where a holistic approach was taken to understanding the illness.
Lifestyle factors were emphasised by alternative practitioners much more frequently than mainstream doctors.
Development and change in alternative and mainstream medicine
Alternative approaches were pioneered by a driven, obsessed, hard-working individual. The approach catches on in the public, causing an influx of new practitioners, some good, some not so. It rises and threatens the mainstream and other existing alternatives, whereupon criticism and lobbying ensue in an attempt to combat the competitor and elevate their own approach against the less reputable challenger. Alternatives claimed that mainstreamers did harm, while the latter claimed alternatives were quacks.
The founders were often tunnel-visioned visionaries, often working without science but utterly convinced of their approach. They were described as medical cultists, because they claimed to have cure-alls through their new approach, while the mainstream was the Devil, involving toxic, harmful, interventionist treatments that hurt patients. Followers could be slavish to the founders in a cult of personality.
Regulatory battles are a key aspect of the history of the development of medicine in the US. Was regulation used as a barrier to competition, or to protect people from harm? Was licensing a threat, or was it the making of some approaches? How did regulations affect the trajectory of these alternatives?
At times, efforts to ban or quash a new approach were overturned by courts, typically on the basis of freedom to choose or freedom to practice. Bans and regulations became more effective in the late 1800s and early 1900s, and eventually, different approaches were forced to adopt a more scientific approach to gain the approval of government through state licensing. In this way, licensing could be the making of a profession, and actually helped move each approach forward in their development. State licensing authorities were not going to give their imprimatur to a disorganised, unscientific approach, so licensing often led different approaches to enhancing their educational requirements and offerings, and formalising and homogenising their approaches. Schools for the teaching of the various approaches proliferated as popularity and recognition of the approach grew. Journals were created and professional associations were formed to organise the profession and lobby the government.
Alternative medicine was popular in the 1800s and remains popular today. During the growth phase of a particular approach, many people flocked to try it out. Approaches rose and fell, with new ones emerging as thinking and society progressed. The popularity of these approaches came from a distrust of or dissatisfaction with mainstream medicine (which faced its own scientific issues and provided a fairly narrow approach to medicine), being suckered in by charisma or marketing materials, or sympathy with the philosophy of the new approach. Medicine in the 1700s and 1800s was done substantially in the home with natural remedies, so there may have been some intuitive of these alternative approaches.
Mainstream medicine ascended in the eyes of the public and government in the late 1800s, through taking a more scientific approach and finding solutions to acute illnesses.
Some alternative approaches rose while others fell. Osteopathy was a more successful field in the twentieth century, by increasing rigour, adopting science and organising well. Holistic, alternative medicine as a whole really started to make major gains in reputability from the 1970s, for a number of reasons:
- The honeymoon period for mainstream medicine was over, with concerns over the overuse of drugs and their side effects.
- The defeat of acute illness and the rise of chronic illness, which mainstream medicine struggled to address. Alternative medicine’s whole body and often environmental approach became more relevant, whereas mainstream medicine’s increasing specialisation left it struggling to address some chronic health conditions.
- Medical holism was a repudiation of Cartesian dualism, holding that the mind and the body were connected, not separate as was so often the approach of mainstream medicine. Alternative medicine was more open to taking an approach that incorporated body, mind, spirit, and environment, integrating it with mainstream approaches as alternative medicine became more scientific. Integrative medicine has been an important force in recent years as medicine has become more individualised, holistic, and environmentally- and genetically-focused.
- The rise of the counterculture, including natural living. A collaborative approach to medicine was becoming culturally appropriate.
The subtle shift in label to ‘Complementary Medicine’ was indicative of growing acceptance by mainstream practitioners of alternative approaches. As alternative approaches began to incorporate more science into their education, approach and body of knowledge, they were becoming more reputable and able to be embraced by more alternate and open-minded mainstream practitioners, as well as the government. However, there were many mainstream practitioners that were still very skeptical or openly hostile to alternatives.
Resistance to alternative medicine continued for several reasons. Despite the increased use of science in alternatives, many alternative practitioners were not trained to conduct research. Many of the approaches were not amenable to being researched to the scientific standard required because they used a holistic approach including several or many different treatments, which renders it difficult to discern the effect of a single intervention. Research funding was also harder to come by for alternative medicine. Therefore, it was quite easy to claim that there was no evidence to support alternative medicine.
With the establishment of the Office of Alternative Medicine, which provides funding for research into the most promising approaches, and the establishment of the National Centre for Complementary and Alternative Medicine in 1998, alternative medicine has been accepted as a legitimate field of inquiry.
- Naturopathy developed out of hygieotheraphy (water therapy). Hygieotheraphy morphed into an ultra-wellness movement involving whole living and lifestyle improvements in addition to water therapy. The temperance movement piggy-backed off this approach.
- Magnetism and mesmerism involved healing energy from earth’s magnetic forces. This field morphed into hypnosis, and then into Christian Science, which held that evil and immorality caused illness and religion was the cleansing antidote.
- Thomsonianism was an important, botanical approach in the earlier alternative medicine movement. It used vomiting or heat in a trial and error approach.
- Thomsonianism and homeopathy were two of the biggest alternative approaches in the 1800s.
Alternative medicine still faces hurdles relating to a lack of scientific evidence to support their practices, with the Australian government removing naturopathy from eligibility for private health insurance rebates due to a claimed lack of scientific support for their practices, despite the presence of many studies finding positive naturopathic approaches. These approaches often involve holistic treatments containing several or many approaches. This scientific approach does not isolate specific effects and therefore is not reputable in the eyes of mainstream scientists. The lack of funding causing a lack of evidence causing a lack of funding is a chicken-and-egg situation and is seen in many alternatives to mainstream perspectives. Incumbents control the funding bodies and journals, and yet claim there’s a lack of evidence to support alternative ideas. The standard approach taken by incumbent interests in highlighting the lack of evidence for competitor approaches is a classic anti-competitive play.
I found it interesting that becoming established as a reputable medical approach came from being recognised by government. I was surprised by this. State governments tended to require each field to show scientific bona fides to become established as a licensed and therefore legitimate field of practice. Government also played inhibitory roles at times. Of course, this may have been because some of the approaches were not scientific and possibly dangerous, and therefore government played a protective role for consumers. Self-interested rent-seeking remains another explanation. I’ll look into this issue more in the future.
It was uncanny to read how each approach developed. They followed the same trajectory – charismatic and determined leader, enthusiasm in the public grew and practitioners entered, criticism and pressure from competitors, becoming more legitimate/organised, establishment of schools, journals etc. The death of the founder led to its demise, infighting or reconfiguration. It grew to reputability through adopting science and gaining the support of government. It certainly required fortitude and determination to build itself, withstand attack, and organise institutionally. The development of a new approach is a multi-skilled endeavour, requiring a talented and special individual. Reading this book supported my view that history is substantially affected by special individuals that others follow. Literally each of the approaches examined in this book were founded by a very unique and determined individual.
Overall, this was a well-research, clear and enjoyable book, that balanced story, science, issues, industry dynamics, the role of government, and the competition between incumbents and competitors. It provided a great summary of each approach, allowing me to understand their founding philosophies and assumptions. It gave a strong boost to my perspective on history – that individuals really matter. It reiterated to me the uniqueness of the American culture – the innovation and entrepreneurship, the experimentation, etc. And it provided incredible historical context to the medical landscape that we move in today.