Placebo: the lie that heals. – Howard Brody, 1982.
These basic tenets are not new, contrary to some claims. They have been fundamental to the practice of what is often called "conventional" medicine from the time of the great Greek physician Hippocrates, the "Father of Medicine". They were clearly stated in his writings 2 000 years ago, and have been handed down through the ages. It's in their application that fashions and practices have changed with the times.
From earliest times, in every society, efforts have been made to relieve suffering and heal disease with every conceivable intervention – from fruits and roots, bush teas and other brews, and many far less savoury concoctions. Many of the traditional medicines in various cultures have been validated and developed into modern medicine. Such drugs are morphine, from the poppy; digoxin from the foxglove, and aspirin from the willow. Even the modern drug for diabetes, metformin, was discovered from a plant source.
Conversely, many, indeed most, practices of the past have been "debunked" and discarded with the advance of knowledge. An outstanding example of this is the once hallowed practice of "blood-letting" and aggressive purging. Thousands must have died from this horrendous "treatment", including George Washington, bled to death for a cold!
Thus "conventional" medicine is dynamic, with the practices of yesterday replaced constantly by new, scientific knowledge, based on evidence – the modern medicine of today.
Alternative medicine suggests, by its very name, "other" approaches or systems of medicine, or unconventional medicine. Some of these are very old, for example acupuncture (from China) or Ayurvedic medicine (from India). Many derive from the ancient, universal use of plants and are based on a mixture of practices, but chiefly the use of herbs (the term used for any plant taken with the hope of a beneficial effect – from the hallowed "weed" or 'erb (ganja), to granny's bush tea, or $50-bottles of imported herbs, and also called "erbs" by our American friends!
Other alternative treatments are based on a single concept or theory, e.g. aromatherapy, homeopathy, purgation or colonic lavage. A good example, familiar to Bajans, is the phenomenon a few years ago of the millionaire Dr Torrey, a musicologist-turned-alternative-practitioner. He descended on Barbados with enormous publicity, expounding on his multiple purgatives for the more frequent "elimination of waste".
Unlike modern medicine, most alternative techniques are unchanging, although some modern acupuncturists are using non-invasive electrical stimulation.
With the mass marketing of herbs and so called "dietary supplements", and the popularisation of acupuncture and holistic practices, there has been a recent tendency of some doctors to add certain techniques, particularly acupuncture, to their practices, while many patients happily use a bit of everything!
But "observation" and evidence remain the key to rational medical practice.
The use of drugs and nostrums began thousands of years ago, with sometimes simple and sometimes mystical concoctions, like eye of newt and toe of frog, described by Shakespeare in Macbeth. Similar concoctions, with "magical" roots and many ingredients, rich in folklore and elegant packaging, sell well at equally elegant prices, for restoring "male vigour", the elixir of youth or "tired blood".
Meanwhile, an enormous body of scientific knowledge has produced an equally wide range of powerful modern medicines of great purity and predictable effects, but like all powerful drugs, possible toxicity.
The difference between popular herbs and modern drugs is the absence of scientific study on the one hand and the wealth of scientific evidence on the other. Another important, appealing difference is that most herbs are quite harmless (and quite useless) while most modern drugs are potent; conversely a few herbs do cause toxic effects, but drugs more commonly do, and overdoses can be dangerous.
Alternative therapies are promoted as "non-toxic", but unexpected toxicity of some herbs is a risk and the lack of effective treatment can be a serious problem. Modern medicine is also misrepresented as comprising only drugs and surgery. These aspects may attract the most attention, but many other therapies are integral to modern medicine, e.g. diet, exercise, physiotherapy, radiotherapy, rehabilitation, counselling and psychotherapy.
The term holistic is increasingly applied by alternative practitioners to describe the use of several techniques, with emphasis on encouraging a positive attitude. This is ironic as medical teaching is unrepentantly wholistic, emphasising the importance of treating the whole patient.
Every doctor who recognises the social setting, emotional problems, physical disease state and strengths or weakness of the patient in helping, counselling and prescribing, is providing holistic/wholistic care. But how many are too rushed to do so?
The body has enormous capacity to heal; and mild, self-limiting diseases usually heal without help. A placebo, peppermint tea, a massage, a day in the garden, good news or a little love may all work well! Even laughter, we know instinctively, "is the best medicine", and its healing power now has scientific support.
Powerful treatments may have powerful side effects if overused or used at too high a dose. Conversely, harmless treatments are often harmless because, like placebos, they have no effects whatsoever! Paracelsus said of medicines 500 years ago: "All things are poisons – the dose alone decides."
Healing techniques should have some plausible biological basis over and above any placebo effect, as well as objective effects on the body and disease. Plant remedies will continue to yield valuable medicines, but much costly research is needed to progress from bush tea to "best results"!
When should we doubt the advertiser's claims? When it claims to cure practically everything, with no side effects!
* Professor Henry Fraser is Dean of the School
of Clinical Medicine and Research.