Not so long ago, “alternative medicine”—a heterogeneous mélange of healing practices that includes everything from herbalism to acupuncture—was regarded as nothing more than a relic of medicine’s prescientific past or, worse, a cultish fad. That is hardly the case any longer. Each year, millions of Americans use some form of alternative medicine. In fact, according to a 2007 survey, 38 percent of American adults and approximately 12 percent of U.S. children use complementary and alternative medicine, or CAM.
The medical establishment has even embraced alternative medicine, albeit somewhat begrudgingly, allowing that unconventional therapies may be used when conventional options fail. A 2008 survey of US hospitals found that more than 37 percent of responding hospitals offered one or more alternative medical therapies, up from 26.5 percent in 2005. Today, dozens of medical schools offer programs in CAM.
The sea change taking place in the public’s perception of alternative medicine has even gained the endorsement of Congress. In 1991, the Appropriations Committee, the body that oversees the NIH, created the Office of Alternative Medicine to explore alternative therapies. In 1998, that office was upgraded to the status of center and renamed the National Center for Complementary and Alternative Medicine.
NIH’s acceptance of alternative medicine initially drew strong criticism. A 1996 New York Times op-ed piece entitled “Buying Snake Oil with Tax Dollars,” compared alternative therapeutics to magic. “The shaman shakes his rattle, the faith healer lays on hands—sometimes patients die, some make surprising recoveries,” observed the authors, two scientists. “The only thing that has changed is that the ‘healers’ of today apparently have the endorsement of the National Institutes of Health.”
Alternative medicine has always seemed contrarian. All alternative medical systems—from hydropathy to homeopathy and from chiropractic to herbal medicine—originally stood in opposition to orthodox medicine. Although presently alternative systems seek to integrate with conventional medicine, historically unconventional medical systems have aimed not at compromise but overthrowing what their founders regarded as the misguided practices of the medical establishment.
Ironically, the conventional medicine that was overthrown by the modern therapeutic system looks a lot like today’s alternative medicine. To understand this about-face, one must go back to the origins of scientific medicine. Hippocrates, the ancient Greek physician who is often called the “father of medicine,” rejected all forms of supernatural healing and insisted that only naturalistic methods could be admitted. The foundation of the Hippocratic system was the doctrine of vis medicatrix naturae, the “power of nature to heal.” Guided by the rule (as enshrined in the Hippocratic Oath) “At least do no harm,” the ancient physician placed his trust in the sick person’s power to recover.
For fully two millennia, doctors accepted Hippocrates’s understanding of medicine, which required that the healer take into account a patient’s inherited constitution and to prescribe a regimen, including diet, exercise, sleep, sexual activity, and emotional state, that would bring the body’s constitution back into harmony with nature. In the Hippocratic tradition, there were no diseases, only sick people.
By the 18th century, the emphasis on illness as a condition unique to each individual patient was being challenged by a concept of diseases as pathologies localized in specific parts of the body and caused by specific pathogens. The germ theory of disease, developed by Louis Pasteur and Robert Koch in the 19th century, placed that theory on solid scientific foundations. The search for “magic bullets” that would unfailingly knock out diseases became medicine’s heroic quest.
Historians have long assumed that this theory of disease was a product of the modern scientific and industrial age. In fact, however, its roots are much deeper, reaching all the way back to the Renaissance. No figure better illustrates this than the 16th century Italian “professor of secrets” Leonardo Fioravanti.
The physicians of Fioravanti’s day adhered to the basic tenets of the Hippocratic doctrine. They also inherited a theory devised by the 2nd century A.D. Roman physician Galen, which explained disease as an imbalance of one or more of the four humors that constituted the human body: blood, phlegm, choler, and black bile. Like the Hippocratic physician, the Renaissance doctor sought to adjust the sick person’s regimen in order to restore the patient’s proper humoral balance.
Fioravanti, a brash and unconventional surgeon from Bologna, vehemently rejected this doctrine. He challenged the medical establishment on virtually every count and became a celebrity by touting an alternative medical system he called “the new way of healing.” Claiming to be a pure empiricist, he based his system on the observation that the animals know how to cure themselves by instinct: When they are sick, they purge themselves with herbs they find in nature. To him it was proof that all diseases are caused by bodily corruptions engendered in the stomach.
The cure? Rid the body of pollution by evacuating the stomach and bowels with robust purges. A devotee of alchemy, Fioravanti touted one “natural” cure above all others: his trusty Precipitato, mercuric oxide, a powerful vomitive when administered in small doses but a dangerous poison if taken in excess. His was a martial style of therapeutics appropriate for a martial age, when Europe was divided in a religious cold war and exorcists purged the body of demons.
Fioravanti claimed that his therapeutic system was a return to the natural way of healing, a methodology that was used by the earliest physicians, who learned it from the animals, but was lost because of the corrupting influence of theories. Like later advocates of alternative medical systems, he attributed valuable medical secrets to the common people and touted folk wisdom as superior to science. “The physician studies a fine theory,” he would say. “He thinks he understands the causes of diseases and knows how to cure them, but when he encounters a difficult case he won’t have any idea how to proceed. Then along come some experienced hag, and with the rules of life and an enema makes the pain go away, and in so proceeding the old hag will know more than the physician.”
Fioravanti’s theory of the origin of disease had radical implications: It amounted to the claim that the doctrine of the four humors was the Great Lie of the physicians. The humoral theory enabled the physicians to sustain the orthodox view that proper treatment had to be grounded in an understanding of the subtle physiological differences among patients, the kind of theoretical understanding available only to academically trained doctors. But if all illnesses stemmed from a single cause, as Fioravanti claimed, then all could be cured by a single universal medicine, regardless of the patient’s individual humoral complexion. It was a theory that perfectly matched the marketplace’s growing demand for fast and cheap cures.
Leonardo Fioravanti was the harbinger of an age of magic bullets in medicine. While modern medicine does not claim descent from his “new way of healing,” he foreshadowed the age of heroic medicine against which alternative medicine so strenuously rebels. And, in his valiant battle against bodily corruption, he heralded an age of medical celebrities, from Pasteur and Koch to Jonas Salk, whose discoveries caught fire in popular culture.
Fioravanti’s martial therapeutic style—widely imitated by marginal healers of the day—eventually won out and became the dominant ideology of modern medicine. Of course, neither Precipitato nor any of his other wonder drugs became medicine’s “magic bullet,” and the idea of bodily pollution as the universal origin of disease would be discarded, to be replaced by the germ theory, which ushered in a dramatic “therapeutic revolution,” forever changing the way we treat and think about diseases.
Yet the similarities between Fioravanti’s mode of therapy and the modern therapeutic model are unmistakable. Like the modern doctor, he insisted that the only rational therapy was one aimed at the cause of disease. And, he thought, it was possible to find a counter-agent that could eradicate that cause and expel it from the body.
The original magic bullet—Salvarsan, a chemical drug to cure syphilis—was discovered in 1908 by the German microbiology Paul Erlich. The age of heroic medical conquerors that opened as a result of his discovery was chronicled by Paul de Kruif in his 1926 book, The Microbe Hunters. De Kruif’s unforgettable but oddly inaccurate portrait of Erlich makes him out to be a figure not unlike Fioravanti: defiant, unorthodox, and a proponent of what was considered to be “outrageous thoughts” about disease pathology.
The idea of disease as an alien invasion that must be conquered became a model for all diseases, and it radically altered attitudes and expectations about illness. Even though that model is inappropriate for chronic illnesses, we continue to regard all diseases in terms of the “penicillin mode,” as Edward Golub terms it in his excellent book, The Limits of Medicine—that is, as entities that can be cured rather than being cared for or simply having to be waited out. The penicillin mode flourished during the Cold War era, when military metaphors were compelling, just as Fioravanti’s model resonated in Counter-Reformation Italy, when a religious “cold war” coexisted with the appearance of a host of new infectious diseases such as syphilis, typhus, and plague. In both periods, healing became a battle against an alien “enemy,” and a parallel was drawn between enemy foes and the causes of diseases.
We now are waging a “war” on cancer and a “war” on AIDS. Curing has replaced caring as the ideology of modern, technology-driven medicine. Fioravanti, the Paul Erlich of his time, had a similar ambition, but his dream did not come true for more than two centuries. Ironically, as chronic illnesses become society’s most intractable medical problems, the military metaphor seems less compelling, and the model that Fioravanti fought so hard to defeat is becoming more relevant than ever.
In 19th century America, the style of medicine that Fioravanti championed—a dose for whatever ails you—was scornfully repudiated by homeopaths, hydropaths, Thomsonians, and other irregular healers. Just as Fioravanti ridiculed orthodox medicine’s reliance on weak and ineffectual regimens, later alternative healers would condemn the regular profession’s reliance on “drug poisons” that debilitated and endangered the body.
Fioravanti’s “new way of healing” was as much a political as a medical movement. In attacking the regular doctors, he elevated surgeons and touted empiricism as superior to the hifalutin theories of the medical establishment. Alternative healers have always portrayed themselves as outsiders battling a corrupt and bankrupt medical establishment. That, as much as specific philosophical differences, accounts for the historical animosity between the two. Yet clients of alternative medicine rarely abandon orthodox medicine completely. Rather, just as in Fioravanti’s day, they consult both regular and alternative practitioners and create their own, unsystematic but pragmatic “integrative medicine.” Despite recent signs of progress toward reconciliation, however, the utopian vision of a medical world in which alternative and orthodox medicine form a single unified whole seems a long way off.
Meanwhile, with the public health at stake, patients in need of care, and medicine as a whole, might benefit from a little modesty on both sides of the debate.