|The failings of contemporary medical practice are best confronted from the rational basis of scientific medicine, not by a retreat into the mystical traditions of alternative health.|
|The inadequacies of modern medicine are all too readily apparent. A patient with multiple sclerosis recently told me that, though she had been attending neurology clinics for nearly 20 years, she had yet to receive an effective treatment for any of her symptoms. Another patient, who has had a recurrence of cancer only shortly after completing an arduous programme of surgery and radiotherapy, wondered whether he might have been better off if he had opted to forgo treatment from the outset.|
|Both also described encounters with doctors who were brusque and unsympathetic, as well as with hospital systems that were bureaucratic and incompetent.|
|Yet both these patients have also rejected alternative medical treatments, despite receiving numerous recommendations to try acupuncture, homeopathy or herbal remedies as well as more exotic therapies. As one put it, 'just because orthodox medicine doesn't work is no reason to resort to witchcraft'.
This - increasingly uncommon - antipathy to alternative therapies brought to mind the journalist John Diamond, who died last year of cancer of the tongue at the age of 48. Though four years of surgery and radiotherapy robbed him of his voice and much else, he remained to the end an implacable enemy of alternative medicine.
- 'A rationalist cancer patient'
|As he put it, with characteristic brio, in his memoir C: Because Cowards Get Cancer Too, 'where I stand on alternative medicine is roughly where the Pope stands on getting drunk on communion wine and pulling a couple of nuns' (1). (His last, and sadly uncompleted, book Snake Oil and Other Preoccupations, a polemical attack on a range of alternative treatments and their advocates, was published posthumously.)|
|Oxford don and cancer patient Michael Gearin-Tosh's recent book from the alternative perspective characterises Diamond as 'a rationalist cancer patient', and advocates a non-rationalist approach (2). Writing in 1995, leading medical scientist and clinician David Weatherall commented that 'a visitor from another planet, landing at a modern airport and perusing the shelves of its bookshop, might wonder at the sanity of a society that extols the virtues of activities ranging from transcendental meditation to the administration of coffee enemas to sustain a feeling of wellbeing' (3).|
|Yet these are the very therapies that Gearin-Tosh has used - and implicitly recommends - not merely to sustain a feeling of wellbeing, but as treatment for cancer.|
|Though John Diamond's poignant account of his personal tragedy won universal sympathy, his campaign against alternative medicine has had little impact. In his own medium of broadsheet journalism, most newspapers now carry at least a weekly alternative health column. In the High Street, alternative products have long made the transition from the hippy-dippy health food shops to the big chain pharmacists. Most significantly, the mainstream medical profession has opted for peaceful coexistence with 'complementary' therapies; some prominent doctors even favour the concept 'integrated medicine'.|
|The great legacy of the Enlightenment is the spirit of rational inquiry|
|Have we all, as Professor Weatherall suggests, lost our marbles? Before looking in more detail at the relationship between scientific and alternative medicine, it is first worth considering the tendency in contemporary society to disparage rationality.
The 'Barefoot Doctor', who writes a weekly alternative health column in the Observer, provides a comprehensive statement of his philosophy in a special supplement of the New Statesman on 24 June (4). He outlines a familiar list of environmental concerns - global warming, intensive farming, pollution, HIV, etc - and identifies an 'untenable void' resulting from the demise of 'our Judaeo-Christian spiritual life models'. This combination 'engenders extreme insecurity at the most profound existential level'. But 'darkness never comes without light', and illumination is at hand in the form of 'self-help systems' rooted in Taoist, Buddhist and Hindu traditions which offer 'a cultural base for alternative approaches to personal and social health'.|
|The elevation of intuition and instinct over reason, and the revival of ancient forms of mysticism, do indeed indicate a profound existential crisis in contemporary society. At a moment when there is little optimism about the prospects for social progress, even the past achievements of humanity are put in question.|
|Not the least of these achievements was the rising status of reason as a governing principle in the life of society. For Aristotle, man was distinguished as the rational animal, and the advance of human civilisation can be measured by the extent to which reason has prevailed against rulers who claimed power and privilege on the basis of wisdom acquired by intuition or divine inspiration. In pre-modern societies, elites made up of monarchs, aristocrats, prelates, patriarchs and shamans used their intuited wisdom to subjugate and exploit the masses. (The mystical religions of the East, now fashionable in the West, for centuries legitimised stagnant and oppressive societies.)|
|The great legacy of the Enlightenment is the spirit of rational inquiry, a spirit that inspired revolt against the divine right of kings and the secular power of bishops. The establishment of scientific criteria of truth challenged mystical claims to insight into the laws of nature and opened the way for the development of science and technology. The pursuit of rational and creative intervention in both the natural and the social worlds has allowed humanity both to transform its relationship to nature and to transcend some of the limits of biology.|
|The conservative tradition that emerged in response to the French Revolution has never come to terms with the political and social consequences of a society ordered according to the principles of reason, with individual liberty and democracy. Reactionaries who wanted to turn back the wheel of history upheld tradition, divine and ecclesiastical authority, hierarchy, monarchy and aristocracy. They readily invoked metaphysical principles of God and nation, blood and soil.|
|In the twentieth century, upper-class reactionaries and their followers provided the natural base for conservationist and environmentalist causes. They also patronised mystical cults such as theosophy and alternative healing systems such as homeopathy. One of the curiosities of the past 30 years is that many of these views have been taken up by middle-class activists, often disillusioned radicals, who have played a key role in giving them the mainstream popularity they have recently come to enjoy.|
|Given the centrality of reason to the advance of human civilisation, the conservative hostility to reason has an inherently anti-humanist character. This is expressed in the tendencies to demean notions of progress, science and technological innovation and in the parallel trends to elevate mystical conceptions of nature, the cosmos and personal spirituality. Such views are, of course, now more commonly expressed by post-modernist cynics than by traditional conservatives. As the anarchist critic Murray Bookchin observes, the common feature of contemporary anti-humanisms is their 'devotion to primality', their emphasis on immediate thoughts, feelings and sensations, and their neglect of reflection, theory and the development of ideas (5).|
|Anti-humanists collapse the dialectical interactions between humanity and the natural world, between the individual and society, into unmediated unities: from their perspective, humans are at one with nature and with one another. This approach results in the degradation of individuality, selfhood and rationality. Further consequences are the abolition of history (or its replacement with a mythical descent from a Palaeolithic golden age) and the repudiation of progress (in favour of a series of chronicles of regress).
One illustration of the trend for proclaiming metaphysical unities is the recent resolution in the world of alternative health of the historic problem of Cartesian dualism (the radical separation of mind and body declared by the French philosopher Rene Descartes in the seventeenth century).
- Body and mind - or 'bodymind'
|Pert's notion of the 'mobile brain' recalls the nineteenth-century notion of the mobile uterus|
|According to Deepak Chopra MD, renegade endocrinologist and leading New Age/alternative health guru, 'the body is not a mindless machine; the body and mind are one' (6). Candace Pert, a neuroscientist who has embraced what she characterises as the 'new paradigm', favours the term 'bodymind' to express the way that 'the brain is integrated into the body at a molecular level' (7).|
|For Pert, the 'bodymind' is part of the 'unity of life' resulting from the ubiquitous polypeptides that act as transmitters in all forms of animal life: 'humans share a common heritage, the molecules of emotion with the most modest of microscopic creatures.'|
|But what is achieved by replacing Descartes' mechanically opposed mind and body with a metaphysically (and terminologically) unified bodymind? The central problem, which is to discover the mediations between mind and body, is effaced by proclaiming a vacuous holism. Whereas Descartes' mechanistic approach was a historic innovation which provided the basis for modern medical science, the concept of 'bodymind' marks a retreat from science into mysticism.|
|Pert's notion of the 'mobile brain' - what she characterises as 'an apt description of the psychosomatic network through which intelligent information travels from one system to another' - recalls the nineteenth-century notion of the mobile uterus, which was believed to travel around the female body producing hysterical symptoms. It is no surprise to discover that, having turned her back on science, Pert has become an advocate of diverse forms of New Age mysticism and alternative healing (not to mention of the thesis that MMR immunisation causes autism).|
|'What type of weapon is reason against the imperfectly understood?' This is the alternative challenge to John Diamond, the rational patient killed by a cancer that was indeed imperfectly understood and against which the treatments of scientific medicine proved of limited benefit. To answer this question, let's look at two aspects of the challenge of the 'imperfectly understood': first the pathological processes of disease, and second, the experience of illness.
In dealing with the objective reality of human disease, we can readily reply, reason, despite all its limitations, is the best weapon we've got. Medical science has proven dramatically effective in the treatment of a wide range of diseases, from infections to endocrine disorders, in which the pathological processes are fairly well understood. This success of modern scientific medicine is the key reason why it prevailed over diverse ancient competitors (many of which have now re-emerged under the alternative health umbrella).|
|In other conditions, such as coronary heart disease and cancer, major killers of our time, medical understanding is more imperfect and therapy less effective. However, it is possible to measure the benefits of different treatments and their adverse effects. The judgement of the value of any particular treatment is made with reference to a body of scientific knowledge which is, at least in theory and increasingly in practice, available to the patient as well as to the doctor. (By contrast, the client of the alternative practitioner relies on faith alone in an inherently unequal and undemocratic relationship.)|
|In some conditions - such as multiple sclerosis (MS) or motor neurone disease - medical understanding remains limited and treatment virtually non-existent. In relation to such conditions patients are in a situation similar to that which prevailed in relation to most diseases 100 years ago.|
|Yet, just as most patients with MS today opt for conventional rather than alternative medicine, so patients in the past put their trust in scientific medicine. Why they chose orthodox medicine rather than diverse alternatives decades before medical science first began to yield effective treatments has long been a matter of controversy among historians. Some have attributed the success of orthodox medicine to the political and organisational skills of the early medical profession. A more likely explanation is the common commitment of doctors and patients to the advance of medical science.|
|Before medicine was effective, doctors' zeal won patients' respect and trust|
|Writing in 1859, the German physician Bernhard Naunyn observed that doctors' zeal won patients' respect and trust: 'it never occurred to them to inquire whether this zeal was in the interest of treatment or in the interest of science.' At a time when all treatment was experimental, patients and doctors joined in a collective endeavour against disease. Even in our cynical times, many patients still uphold this rational spirit - only to find some doctors retreating from it.|
|There has been much greater criticism of the record of scientific medicine and the medical profession in dealing with the subjective experience of illness. Yet much of this criticism neglects the major changes that have taken place in medical practice in recent years.
It is true that in the heyday of scientific medicine, from the 1940s to the 1960s, doctors seemed to take little interest in the emotional and psychological aspects of their patients' illnesses. Given the emergence of scientific medicine out of traditional healing systems, its modern practitioners were keen to distance themselves from an evangelical and charismatic style.|
|The quest for rational therapeutics was associated with a self-conscious drive to eschew the non-rational aspects of medical practice. Once doctors were in a position to prescribe effective drugs - and to replace hips and carry out kidney transplants and open heart surgery - they came to rely less on a good bedside manner and traditional 'physicianly' skills were allowed to lapse. Indeed, some doctors, especially in surgical specialities, seemed inclined to dispense even with elementary civilities.|
|The bureaucratisation of medical practice, whether through systems of insurance or state welfare, helped to make doctors more remote from the pain and suffering of their patients. The persistence of these trends towards a more aloof and instrumental medical practice, conducted through formal - and brief - encounters, has proved a key factor in the growing popularity of alternative practitioners, who offer more empathetic, informal and lengthy consultations.|
|Over the past two decades, however, a number of factors have encouraged orthodox doctors to take a greater interest in patients' attitudes towards health and illness. One is a loss of confidence in scientific medicine's capacity to overcome modern epidemics of heart disease and cancer, which has encouraged greater medical intervention in lifestyle aimed at preventing these diseases.|
|Another is the paradox of 'doing better, feeling worse': though objective indicators of health register steady improvement, people go to see doctors complaining of a wider range of physical symptoms, which are often inexplicable in terms of recognised disease categories. The dominant response to the problem of unexplained physical symptoms has been to expand the range of medical diagnosis, re-labelling illnesses as diseases, such as ME/chronic fatigue syndrome, repetitive strain injury, fibromyalgia and numerous psychiatric syndromes and disorders.|
|Unfortunately, medicine's turn towards the subjective has not been accompanied by a major expansion in the scientific study of the experience of illness and the interactions of mind and body in the genesis of symptoms. Earlier researches into the links between the nervous, endocrine and immune systems and their role in health and illness - in the new discipline dubbed psychoneuroimmunology (PNI) in the 1980s - have been little developed in mainstream medicine. However, transformed into junk science and given a mystical interpretation, PNI has been enthusiastically received by alternative practitioners (8).|
|The shift of medicine away from the treatment of disease to the alleviation of symptoms of illness in people in whom no disease can be found has important consequences. It reinforces the wider trend towards the emergence of a therapeutic society in which the state relates to its subjects through a range of therapeutic modes, including those of psychotherapy and counselling, orthodox and alternative medicine. It legitimises the expansion of medical practice into wider areas of the life of the individual and of society.|
|Astronomy and astrology are incompatible ways of studying the stars|
|Instead of - or at least 'as well as ' - practising medicine, modern doctors are expected to take on some of the tasks of social workers, teachers and the police, assuming a coercive role that can only prove detrimental to doctor-patient relationships.
Just as reason cannot be reconciled with irrationality, so orthodox medicine cannot be integrated with alternative medicine. Astronomy and astrology are incompatible ways of studying the stars; alchemy and chemistry fundamentally different concepts of the elements. As clinical psychologist Bruce Charlton has argued, 'fringe therapies are in fact a kind of cultural fossil, preserving a pre-scientific and pre-critical mode of reasoning about medicine' (9). Furthermore, 'their survival depends upon either ignorance or double-think (a deliberate bracketing-off of scepticism) - which explains why such practices can never be disproved, it being impossible to disprove a religion'.
- The absurdity of 'integrated medicine'
|Indeed, this is why the project of subjecting alternative therapies to randomised controlled trials and other scientific methods, now underway on both sides of the Atlantic, is doomed. Though numerous trials have already revealed that such treatments do not work, these results are simply denied or ignored: faith in alternatives cannot be challenged by such methods. These researches lead only to the demand for more researches.|
|Though the trend towards integration has provoked remarkably little criticism from the world of orthodox medicine, it has caused significant tensions among alternative practitioners. Some celebrate the pre-scientific and non-rational character of their disciplines and reject attempts to incorporate them into what they regard as an alien tradition. Others welcome the legitimacy conferred by association with orthodox medicine and also welcome steps towards public recognition of their professional status. Whereas the former group expresses an honourable consistency, the latter appears narrowly pragmatic, self-abasing and self-serving.|
|How can modern medicine begin to overcome its current predicament? My argument is that we should cleave to the rational principles that have made scientific medicine so successful and establish a clear boundary between this approach and that of non-rational and pre-scientific approaches to healing. Doctors should resist the tendency to extend medical intervention over wider areas of personal and social life, and confine their efforts to their real sphere of expertise - the diagnosis and treatment of disease.|
|Research into the subjective aspects of illness and into mind/body interactions should be pursued scientifically. As the great nineteenth-century medical scientist Rudolph Virchow argued, 'one must learn and become accustomed to explain the unknown from the known, rather than conversely, to choose the dark and unknown, as if it were a new truth, as a starting point in a search for fantastic conclusions' (10).|
|Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).|
The rise and rise of CAM, by Bríd Hehir
Watered-down science, by Howard Fienberg
Touching a nerve, by Sarah Glazer
Head cases, by Bríd Hehir
(1) C: Because Cowards Get Cancer Too, John Diamond, Vermilion, 1999, p98. Buy this book from Amazon (UK)
(2) Living Proof, Michael Gearin-Tosh, Scribner, 2002, p229. Buy this book from Amazon (UK)
(3) Medicine and the Quiet Art, David Weatherall, 1995, p18-19
(4) New Statesman, 24 June 2002
(5) Re-enchanting Humanity: A Defence of the Human Spirit Against Anti-Humanism, Misanthropy, Mysticism and Primitivism, Murray Bookchin, 1995
(6) Foreword to Molecules of Emotion, Candace Pert PhD, 1997, p9
(7) Molecules of Emotion, Candace Pert PhD, 1997, p187
(8) See, for example, Molecules of Emotion, Candace Pert PhD, 1997
(9) 'Philosophy of medicine: alternative or scientific', Journal of the Royal Society of Medicine, 1992; 85: 436-438
(10) Disease, Life and Man: Selected Essays, Rudolph Virchow, 1959, p23