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 favour, 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. Her work focuses on the transmission of medical expertise between cultures, as exemplified by the transmission of acupuncture to the west, and by the medical experiences of non-western immigrants in multicultural Britain and America. She is the author of Alternative Medicine? A History.