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Aspects of Scientific Identity Traced
Inaugural CAM Lecture Compares Today's Medicine with Yesterday's

By Carla Garnett

Photos by Bill Branson

On the Front Page...

To offer perspective on the concept of complementary and alternative medicine (CAM) that seems to have the modern public captivated, medical historian Dr. Charles E. Rosenberg said he journeyed back hundreds of years in time. What he found — and shared with a packed Masur Auditorium recently — were quite a few medical thoughts and practices that in many ways were not too different from today's.


"Medical ideas were accessible and plausible to a wide range of people," he said, providing a sketch of health care as practiced in the 17th, 18th and 19th centuries. "They also were multicausal and holistic, with enormous emphasis on the relationship between lifestyle" and health, "including what kind of work you did, how you slept, what kind of exercise pattern you had. Also, everyone assumed that body and mind were related, that emotions could lead to sickness, that excesses in emotions could make you predisposed for illnesses."

Dr. Charles E. Rosenberg
To an extent, Rosenberg explained, earlier generations' concept of health was similar to today's: "Everyone was in a sense dealt a particular hand of cards, but environmental circumstances and life-styles determined how you played those cards."

Titled "Alternative to What? Complementary to Whom? On Some Aspects of Medicine's Scientific Identity," Rosenberg's talk was the first in a new series of lectures launched by the National Center for Complementary and Alternative Medicine on the science of CAM. The timing for the series probably could not have been better, said Dr. Stephen Straus, NCCAM director. "This is a subject — as you can see from the size of the audience — that is fascinating to the American public today," he said. "The CDC estimates that 29 percent of Americans use one or more of these [CAM] modalities each year. It's that popularity in part that led to the creation 3 years ago of the national center. What we hope to do in this series is not to promote alternative and complementary medicine, but to promote understanding about it by looking at it from various perspectives. We intend to bring in truly distinguished scholars who can speak about the practice, the science, the ethics and various aspects of it. Today we're beginning by providing some social and historical context."

Introduced by Straus as "one of the country's most eminent medical historians," Rosenberg, a professor of the history of science at Harvard University, began by discussing core traditions of medicine. He then explored the American medical experience and gave background on several relevant social factors that have come to define legitimate — and illegitimate — medical practice.

"When I was asked to speak about this topic," he said, "I thought it would be a challenge. And it has been, because the more I thought about it the more elusive — yet more interesting — it became. Where there is so much social affect, there have to be a lot of very deeply held thoughts and feelings."

Rosenberg acknowledged the existence of a broad spectrum of opinion about CAM, ranging from those who assert that all unconventional approaches to medicine are little more than quackery that divert resources and attention from scientifically tested therapies to people who believe in using methods of prevention and treatment not accepted in the mainstream. His research into medicine's history suggested the wisest course may be to adopt a wide view of health and disease.

NCCAM director Dr. Stephen Straus welcomes guest lecturer Rosenberg to NIH for the first talk in a new series on complementary and alternative medicine.

The history of medicine can seem very narrow if viewed simply as the history of doctors (or those identified as progenitors of today's doctors), he said. However, "if you think of the history of medicine as social function — what happens when people get sick — it's a different history. It's a bigger history."

Until recently, he continued, "it was never assumed that most medical practice was done by doctors. Whether we're talking about 17th century, 18th century or most of the 19th century, most medical practice was in the home and was done by laypeople through a mixture of traditional skills — for instance, how you deal with a wound, or a fracture."

Rosenberg explained that of necessity, practitioners who were quasi-professionals, including barber-surgeons, bonesetters, bleeders and clergymen, often practiced medicine because they were the only educated people in a community.

"The predecessors of today's doctors were very text-oriented, very academic," he pointed out. "In some ways their skills were more like that of a professor of classics or professor of history than our idea of a laboratory scientist or a clinical investigator. They were people who knew how to read texts, how to think about texts, how to compare texts and they were able to convince educated people that they could help them prevent disease or cure disease. It's not an accident that until the 19th century, the regular medical profession was called 'the faculty' as a synonym for the profession. It's also not an accident that the term 'empiric' was a pejorative synonym for 'quack,' because an empiric meant someone who did something because it worked and they had no rational basis for doing it. There was no theoretical framework to justify what they did."

Therein lies the challenge that medicine faces now, he said. "There have always been problems of boundary setting and boundary maintenance," Rosenberg noted, referring to the current conflict between so-called conventional medicine and CAM, and the value placed on either or some combination.

"A number of the things we associate with modern medicine and with what's legitimate or normal weren't there," long ago, Rosenberg said. For instance, "the site of medical practice in almost every western European country was the home, not the hospital. Until the late 19th century, the hospital was a minority urban institution for the urban poor.

"Medical knowledge was diffused very widely in society," he explained, noting that grandmothers of the time were just as likely to diagnose fever as a doctor, and that medical specialties were nonexistent. For example, he continued, barbers often pulled teeth and stitched wounds; doctors routinely performed double duty as pharmacists.

Turning to the history of health care in the U.S., Rosenberg traced the roots of several sects that could be viewed as early alternatives to what had at the time become mainstream medicine: the Thomsonian sect touted remedies largely based on native herbs and sweat baths; homeopathy, imported from Germany, gained popularity in this country in the 1830s and 1840s "as sort of an indictment of regular medicines," which were viewed by many as severe and more toxic when compared with homeopathy's emphasis on strict measurements and milder dosages; and the Water Cure was a hygienic regimen based on improved sanitary conditions and purifying the body through bathing and water consumption. Later on, many of these therapies tended "either to dissipate into ad hoc individual practice or they became assimilated into regular medicine," Rosenberg said, stressing that criticism of mainstream medicine also has a long history.

"We all know who won," he said. "The laboratory won. The notion of medicine tied to science — even if imperfectly applied — won in terms of dominating public policy, dominating licensing and dominating the notions of educated people as to what they should expect, what 'normal' medicine should be."

As for where medical practice finds itself these days, Rosenberg concluded, "Optimists will say, 'We have a genuinely plural system. We're going to look everywhere for things that work.'"

In reality, he said, the topic of CAM continues to inspire at least two well-defined factions, a circumstance possibly due to an inherent conflict: the science-based evidence required by most mainstream physicians versus CAM approaches founded solely on experience-based claims.

"Most [physicians] I know don't believe in narratives," Rosenberg admitted, "because narratives imply contingencies or arbitrariness, a historical accident. It's not a way of thinking that is congenial to most people in the medical world."

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