Why isn’t CAM mainstream?

[RationalVetMed]

What is the reason, historically, that orthodox medicine has risen to predominance?

I hear frequent assertions that the predominance of orthodox medicine is political and as a result of lobbying by powerful, self protecting groups from about the middle of the 19th century as the primordial medical mish-mash which existed then started to diversify into what we now know as CAM and conventional medicine.

Now, I’m not sure what the state of medical science was in the 1800’s but it can’t have been anywhere near as advanced as we are used to today. So I am curious as to what criteria would have been used back then by medics, surgeons and pharmacists (apothecaries) to ensure their disciplines became predominant over other emerging fields such as homeopathy, mesmerism and phrenology. Was it ‘primitive science’ including clinical trials or was it politics and toadying influence in the corridors of power.

How could the science that existed then have been able to distinguish between the genuine effect of aspirin and the apparent effect of homeopathy?

Yuri

 

[Miss_Kitt]

Yuri -- While the level of knowledge possessed by the scientific community was lower in the 1800's, the method of science was the same. Test, test, test; examine the results; draw tentative conclusions; do more tests.

The standard of "orthodox medicine" is that efficacy is what determines what is orthodox. Nobody has a particular interest in ensuring that their disciplines become predominant, as you put it. The discipline isn't the concern; what the concern of any doctor, pharmacist, dentist, or field medic is, is What Works.

Phrenology and mesmerism have faded because they clearly didn't work in even simple trials. Homeopathy, however, has special legal protection (at least in the US) because of exactly that "toadying influence in the corridors of power". A prominent doctor and US Senator (Royal Copeland) was also a believer in homeopathy, and he made sure that the emerging legislation of 1938 to define drugs versus supplements, etc. included homeopathic remedies as "drugs". You can check the history of homeopathy at any number of websites and in the encyclopedia as well. Since hundreds of homeopathic remedies already were listed at that time, they all became established drugs at the stroke of a pen.

As more stringent testing standards of effectiveness for drugs have been brought into law, older drugs have been "grandfathered in" since were already long in use and presumed therefore to be harmless. And that is what a homeopathic remedy is, just water or a sugar (or starch) tablet, totally harmless in its effect on the body. But they consistently fail in double-blinded tests, and rational people don't use them unless they're ignorant of those tests.

Just my thoughts, MK

 

[Rolfe]

The History of Medicine is quite a sizeable discipline in itself, so somebody has probably studied the topic.

I think that most doctors in the 19th century weren't adherents of any particular discipline. They'd go with what appeared to be rational and appeared to be beneficial. This would give "stuff that works" an inherent edge. Homoeopathy was obvioulsy struggling on the "rational" criterion right form the get-go, and again that probably militated against its being perceived as working, because if you think something is unlikely to work, you'll be less inclined to give it credit for any little improvement.

Rolfe.

 

[Darat]

What is the reason, historically, that orthodox medicine has risen to predominance?

...snip...

It worked better than the alternatives.

 

[T.A.M.]

It worked better than the alternatives.

beat me to it!

Doh!

TAM

 

[arthwollipot]

It worked better than the alternatives.

Fixed it for you.

 

[Mojo]

What is the reason, historically, that orthodox medicine has risen to predominance?

I hear frequent assertions that the predominance of orthodox medicine is political and as a result of lobbying by powerful, self protecting groups from about the middle of the 19th century as the primordial medical mish-mash which existed then started to diversify into what we now know as CAM and conventional medicine.

The basic problem with this argument being that the rise of "orthodox" medicine has to a large extent coincided with the rise of medicine as a science rather than as a ragbag of traditional ideas. The development of things like the germ theory of disease etc.

Darat put it much more succinctly.

 

[fls]

I suspect much of it can be traced to the reform of medical education around the turn of the century (1900). There were a plethora of medical schools, teaching various models (including homeopathy and osteopathy), of highly uneven quality, producing these physicians. This allowed non-scientific practices to be easily incorporated within medicine. By the end of the first quarter of the 20th century, most of these schools were shut down, as they didn't conform to the new standards of medical education which was supportive of science-based practices. And with that, SCAM practices became marginalized.

Linda

 

[Cuddles]

Now, I’m not sure what the state of medical science was in the 1800’s but it can’t have been anywhere near as advanced as we are used to today. So I am curious as to what criteria would have been used back then by medics, surgeons and pharmacists (apothecaries) to ensure their disciplines became predominant over other emerging fields such as homeopathy, mesmerism and phrenology. Was it ‘primitive science’ including clinical trials or was it politics and toadying influence in the corridors of power.
How could the science that existed then have been able to distinguish between the genuine effect of aspirin and the apparent effect of homeopathy?

I was going to post something along the lines of all the others, but actually it's a fair question. The interesting thing is, homeopathy was actually largely responsible for the rise of real medicine and the realisation of the importance of blinded, controlled trials. Before then, as Rolfe says, people tended to go with what seemed to make sense and what seemed to work. This led to all kinds of nonsense such as bloodletting, trepanning and so on. However, when homepathy came along, even people who engaged in such current "treatments" could mostly see what obvious nonsense it was. The problem they had was that it actually worked better than many existing treatments, since although it couldn't actually help anyone, it wasn't actively harmful as many other things were.

People therefore realised that there must be something else going on. Since homeopathy could not be responsible, perhaps patients were just getting better by themselves, or ever just thought they were getting better. As we now know, it's both, along with various other effects. In order to find this out, sensible scientific trials were required, rather than just relying on anecdotes and the say-so of doctors.

So to answer the question, the reason real medicine rose to predominance over quackery is because of the quackery itself. Since pretty much any idea could be tried and accepted, it was inevitable that eventually there would come along ideas that were so silly that practically everyone could recognise them as nonsense. Since the obviously silly appeared as succesful as accepted ideas, proper testing was forced into being, and real medicine was born.


Another point more related to the present is that there is no such thing as "orthodox medicine". There is just medicine that works. Anything that works is accepted by real doctors. Real doctors don't care where a drug came from or whose ancestors thought of it first, all they care about is what it does. The reason that all the various "alternative" quackeries are not accepted is, quite simply, because they don't work.

 

[RationalVetMed]

I suspect much of it can be traced to the reform of medical education around the turn of the century (1900). There were a plethora of medical schools, teaching various models (including homeopathy and osteopathy), of highly uneven quality, producing these physicians. This allowed non-scientific practices to be easily incorporated within medicine. By the end of the first quarter of the 20th century, most of these schools were shut down, as they didn't conform to the new standards of medical education which was supportive of science-based practices. And with that, SCAM practices became marginalized.

Were they forcibly shut down by a politically entrenched medical elite? Did they fail because of lack of funding, and was funding obtained for conventional medicine by means of personal influence rather than based on science?

My point is that at that time (1850 to 1900ish) science was in its infancy, we didn't have any of the obvious, self evident, 'wonder drugs' we have now (antibiotics, insulin, glucocorticoids etc), anaesthetics and consequently surgery were crude butchery by today’s standards. What I am curious about is exactly what things were tested and how - when was rational scientific method systematically applied to the field of medicine?

Yuri

 

[Soapy Sam]

I'm going to guess January.

 

[HansMustermann]

Well, actually the way I see it, what really happened was that "orthodox" medicine started having much better results at various points.

E.g., a big turning point was penicilin. Before the 30's, if you got syphilis or tuberculosis you'd eventually die. After that, you'd get a few shots and lived. Sulpha was discovered in the early 30's, too, and it was pretty much a wonder drug. Etc.

At one point there simply was plenty of evidence that you have more chances of living when you go to a real doctor than when you go to a witch-doctor, so people started going to a real doctor.

Nowadays we see a return of the woowoo because most of the formerly deadly diseases have been all but eradicated. (Though thanks to idiots avoiding vaccines, some are making a return.) Most people ever get to see a doctor with at most a flu, or with chronic problems which can't be cured one way or another.

But the thing is, we're still lousy at curing viruses. Anti-virals do far more damage than a flu, so you don't get them unless you have AIDS or bird flu. Usually the real doctor gives you a placebo anyway, whether you realize it or not. Antibiotics for a flu or a cold _are_ a placebo. They don't even vaguely inconvenience the virus. Whether you take the latest antibiotics, or a homeopathic remedy, or pray to your favourite deity, or just drink tap water, in the end it's still just your own immune system that cures a flu or a cold.

So to make the story short, _nowadays_ people start noticing again that for most of their diseases, a real doctor is about as effective as a quack. And they start going to quacks again. (Then eventually get something which actually is deadly, and die.)

But way back when it mattered, death by disease was a huge problem. Just see the plagues in the middle ages for a nasty example. Tuberculosis killed millions all the way into the early 20'th century. Smallpox was a real killer until cowpox started being used as a vaccine. Malaria _still_ kills millions in Africa. Or as a soldier, all the way to the late 19'th century, you'd be more likely to die of dysentery than in actual combat. There were even kings who died of it while campaigning. Etc.

There were real deadly diseases around, not just "oh, johnny got a cold again" like these days. I'd say that makes one think twice about whether they want to try the woowoo stuff or go to those guys who actually cure it, no?

 

[RationalVetMed]

The History of Medicine is quite a sizeable discipline in itself, so somebody has probably studied the topic.

I think that most doctors in the 19th century weren't adherents of any particular discipline. They'd go with what appeared to be rational and appeared to be beneficial. This would give "stuff that works" an inherent edge. Homoeopathy was obvioulsy struggling on the "rational" criterion right form the get-go, and again that probably militated against its being perceived as working, because if you think something is unlikely to work, you'll be less inclined to give it credit for any little improvement.

Rolfe.

But things that look rational or irrational to our modern eyes wouldn't have necessarily appeared that way to people of that age.

Bleeding might have appeared very rational - someone is red faced and agitated, you draw off a bucket of blood and hey presto they turn pale and calm down - instant result.

Was giving lemons to sailors with scurvy or injecting exctract of cow pus into people to prevent small pox any more rational than dosing with very dilute camphor to treat cholera, especially when the results of homeopathy in epidemics were several orders of magnitude more impressive that the conventional medicine of the day? If it was solely about what works then everyone ought to have been a homeopath after the cholera outbreaks in the 1830's and 50's but instead the medical orthodoxy of the day tried to supress homeopathy by blocking parliamentary debate about the outcomes of treatment during the epidemics. Why did the docs of the day persist in believing their stuff was better when plainly it wasn't?

I really need to work this through .

Yuri

 

[fls]

Were they forcibly shut down by a politically entrenched medical elite? Did they fail because of lack of funding, and was funding obtained for conventional medicine by means of personal influence rather than based on science?

My point is that at that time (1850 to 1900ish) science was in its infancy, we didn't have any of the obvious, self evident, 'wonder drugs' we have now (antibiotics, insulin, glucocorticoids etc), anaesthetics and consequently surgery were crude butchery by today’s standards. What I am curious about is exactly what things were tested and how - when was rational scientific method systematically applied to the field of medicine?

Yuri

Well, what did we have at the time that made a difference. Big differences were made in surgery with the use of anti-septic practices and ether. Drugs came later with things like insulin and penicillin. Initial testing probably led to the discovery that things didn't work, rather than discovering things that did work. You didn't need testing for the early drugs - the results spoke for themselves.

Medical schools were shut down because of lack of accreditation. You can't practice medicine unless you have a recognized medical degree, which means you don't have access to a hospital and you can't prescribe drugs. I'm not sure to what extent this inhibited homeopaths, etc., since as you mentioned, there wasn't a lot that we were accomplishing with drugs and hospitalization anyway.

I think there was a lag period from the application of the scientific method to medicine until effective therapies became available, so what were we basing the distinction on in the meantime, and how was it sold to the public? Maybe it rode in on the coat-tails of the benefits from science people were enjoying otherwise - electric lights, automobiles, radio. The food and drug laws had an influence on removing snake oil, but again the main focus was safety, rather than efficacy, and that will have less of an effect on noticeable outcomes.

I think ultimately, regardless of whether these changes were driven by an entrenched medical elite (which may have been the case), the reason that they persisted and were strengthened is because (as everyone has pointed out), we began to obtain dramatic results which won over hearts and minds. And I think HansMustermann's post makes a good point - that the reason for the resurgence in SCAM is because the dramatic changes are now taken for granted and we're back to fighting over the scraps.

Linda

 

[fls]

If it was solely about what works then everyone ought to have been a homeopath after the cholera outbreaks in the 1830's and 50's but instead the medical orthodoxy of the day tried to supress homeopathy by blocking parliamentary debate about the outcomes of treatment during the epidemics. Why did the docs of the day persist in believing their stuff was better when plainly it wasn't?

I really need to work this through .

Yuri

Was this really the case, though? I know the homeopaths make a huge deal about this, but when you look into it, the homeopaths treated a tiny number of people compared to the tens of thousands treated in orthodox hospitals. Did their results get any real notice among other doctors or the general public? We all know that you cannot depend upon information coming from homeopaths to be an accurate representation of the state of affairs (you're usually better off assuming that it isn't). And I'm not sure that a doctor would conclude that their own stuff wasn't better on the basis of the homeopaths' results. Drawing from a highly selective population could easily account for differences in outcome without the need to conclude that orthodox medicine was actually harming people.

ETA: Also quotes from doctors of the day, such as Osler or Holmes, show that the results from homeopathy did contribute to the idea that orthodox medicine may be harmful, so that the application of the scientific method first led to discarding harmful practices (rather than discovering helpful practices).

Linda

 

[RationalVetMed]

Well, actually the way I see it, what really happened was that "orthodox" medicine started having much better results at various points.

E.g., a big turning point was penicilin. Before the 30's, if you got syphilis or tuberculosis you'd eventually die. After that, you'd get a few shots and lived. Sulpha was discovered in the early 30's, too, and it was pretty much a wonder drug.

So could it be said that orthodox medicine started with the development of antibiotics and effective pharmaceuticals? Or were there other, earlier 'points'. When were anaesthetics first devised?

So to make the story short, _nowadays_ people start noticing again that for most of their diseases, a real doctor is about as effective as a quack. And they start going to quacks again. (Then eventually get something which actually is deadly, and die.)

Excellent summation, consider it stolen!

Yuri (must get a decent medical history book)

 

[HansMustermann]

Well, every bit helped, and some goes all the way to IIRC the 18'th century. E.g., the cowpox vaccine. But basically when medicine really had its golden age was when antibiotics were discovered. IMHO.

 

[RationalVetMed]

Was this really the case, though? I know the homeopaths make a huge deal about this, but when you look into it, the homeopaths treated a tiny number of people compared to the tens of thousands treated in orthodox hospitals.

Do you have a reference for this Linda?

Did their results get any real notice among other doctors or the general public?

Well, they got noticed by parliament and the House of Lords in the UK (or whatever acronym our country was at that point):

Now, a circular was addressed by the President of the Board of Health to various Metropolitan hospitals and to qualified practitioners, requesting returns of cholera cases... to determine by comparison, for the public good, what treatment experience showed to be the best for the new plague. Returns were sent in from the London Homœopathic Hospital, giving the names and addresses of the patients treated, the symptoms, remedies, and result in each case, and a summary of those results. This was not a question of theory, or of any particular school; it was a question of facts and statistics affecting the public health. But the report of the Board of Health was presented to Parliament without the slightest reference to the London Homœopathic Hospital or to the brilliant results which its physicians had achieved... The perversity was too plain, and Lord Robert Grosvenor... moved on May 17, 1855, in the House of Commons for "Copies of Letters addressed to the General Board of Health complaining of the omission of any notice of certain returns in relation to the treatment of cholera and correspondence between the President of the Board and the Medical Council, with copies of the returns which have been rejected by the Medical Council." The House of Commons, which was more anxious for the "progress of science" and the "value and utility of averages" than for "the operation of known remedies," to say nothing of its great duty to the people it represented, forthwith ordered a special return of the ignored homœopathic statistics, which was in due course made by the Board of Health, and these returns were ordered by the House to be printed on May 21, 1855.

Also quotes from doctors of the day, such as Osler or Holmes, show that the results from homeopathy did contribute to the idea that orthodox medicine may be harmful, so that the application of the scientific method first led to discarding harmful practices (rather than discovering helpful practices).

According to this account orthodox medicine was extremely harmful:

Treatment usually followed traditional lines. In the first stage the diarrhea was treated with Opium 1½ grains, twice in 24 hours. Calomel was added if the bowels continued to be purged, but no emetics were administered for vomiting. ‘Cautious’ bleeding should have relieved headaches and muscle cramps... Most doctors stressed total abstinence from all liquids... occasional mustard emetics ‘comforted’ the patient. Galvanism was tried without success, as were rectal injections of 4 to 6 oz of turpentine. If patient survived into the third stage, the milder cases only required a few leeches or a blister. Moderate cases had small amounts of blood removed by venesection from the arm.

The seriously ill were kept warm with mustard plasters... brandy, aromatic tinctures and camphor were administered, as well as more purgatives to clear out poisons...

Yuri

 

[fls]

Do you have a reference for this Linda?

I did. I spent a lot of time trying to track down the details of this story from primary sources. Most of my searches led back to the homeopathic source, but I did find the reports of cases and mortality statistics from the hospitals including the London Homeopathic hospital. I will see if I can recreate my search for that information and provide the links.

Well, they got noticed by parliament and the House of Lords in the UK (or whatever acronym our country was at that point):

I could not confirm this information.

Linda

 

[jj]

What is the reason, historically, that orthodox medicine has risen to predominance

Because it works.