Unbeholden to any corporate administration, insurance, or pharmaceutical company, there are a group of practitioners who are often highly educated and effective, underestimated and mostly brushed aside by the mainstream medical system. Most often they are women. Most often there is no employment to be had with any degree of job security, paid time off, maternity leave, or matched 401K's. They are self-employed or underemployed, often in precarious financial positions. Some of of their work is running triage in situations where mainstream medical professionals are unavailable or unattainable. At times, they are essentially filling in for specialists who may be booked months in advance, offering relief and advice when none can be offered at the ER or with a primary care physician. They have time. They listen. They practice evidence based medicine, and the science as well as the art of healing.
How did we get here? A brief recap of the birth of the mainstream healthcare system as we know it today can inform us. Formed in 1847, the American Medical Association played a major role in defining the practice of medicine in the United States. This small group of wealthy white men were highly influential in shaping how our culture thinks of medicine and the laws that govern how it is practiced. In the early 1900's the AMA hired a man named Abraham Flexner to visit all the medical schools in the US as well as some in Canada and evaluate them. His conclusions were laid out in "The Flexner Report", published in 1910. Flexner specifically stated that medicine should be "looking to draw from the society of upper-class, educated students". He was also a proponent of segregation in medicine; "only black doctors should treat black patients and should serve roles subservient to white physicians". His recommendations were mostly adapted by the AMA who flexed their power in effectively shutting down over half of the medical schools that were evaluated. Any school deemed "un-scientific" or not rigorous enough was shut down, and this included all of the schools of Herbal Medicine (the Eclectics and Thomsonians), Homeopathy, Naturopathy, Midwifery, and some schools of Osteopathic Medicine.
These decisions shifted the socio-economic landscape of medical schools, as typically wealthier white men were the only people in society who had the means to complete the undergraduate education necessary for admission. Not only were the poor or people of color much less likely to have the opportunity to practice as licensed physicians, so were women. The Harvard School of Medicine didn't even admit their first female student until 1945. The doctor knows best doctrine of the 1950's served to further enforce the patriarchy, as there were even fewer female physicians in the 1950's than in 1900, and the doctor was almost certainly male. By 1985 only 16% of physicians were women. If you've been to your doctor lately, chances are you saw a nurse practitioner rather than an MD. In most states, Nurse Practitioners typically have to work under an MD to be considered primary care physicians. In 2019, 88% of nurse practitioners were women, and they are taking on many of the responsibilities in primary care today. The Bureau of Labor Statistics reported in 2017 that the average full time salary for a nurse practitioner in the US was $107,480 compared to the average MD salary which was nearly double at $208,560. Ladies and gentlemen, we have a long way to go.
Ok, back to the turn of the twentieth century. The AMA at this time put practitioners into two separate categories, "regulars" and "irregulars". Under their rules "regular" physicians were under no circumstances to interact with "irregulars". (Is this the reason MD's never call me back when I call to discuss a patient we have in common?). The answer is, well maybe. In fact, even as late as the 1980's, the AMA stated that physicians should have "nothing to do with" alternative healthcare practitioners. Essentially, the dogma was that any medicine besides western biomedicine was "unscientific", and thus, could not be relied upon to cure disease. Personally, I'm a big proponent of science, I love it, I find it fascinating, and it informs much of what I do in my practice. I do believe, however, that putting a complex organism into a tiny little box, or a bunch of tiny little boxes, is a major disservice to the human race. I feel like mainstream medicine is saying, "look, we don't understand how your medicine works, so let's just assume it doesn't work. And when it appears to work, let's have a good chuckle about the power of the placebo effect".
The words we use as a culture to describe something create powerful connotations. The term "alternative medicine" became popular in the 1970's to describe anything other than western biomedicine. This term implied that a patient could choose one system or the other, but that both were not recognized as being able to co-exist. Popular literature exemplified the most extreme cases of patients choosing one over the other, such as refusing to treat cancer with standard treatments and opting instead to use a juice fasting regime were used, seemingly, in an attempt to ridicule those who made "alternative" choices. In the 1990's the term Complimentary and Alternative Medicine (CAM) replaced just "alternative". It was a big step to recognize that other forms of medicine could be used alongside mainstream therapies, though still not quite fair. In 2018, AMA's position paper listed both meditation and prayer as forms of complementary therapies, and though I'm a proponent of both it feels a bit dimunitive to lump my four year Master's degree in with this terminology. The AMA approaches CAM therapies with great caution, and even appears to have a little fear of competition in the following statement "Consumer investment in unproven medicines and therapies also risks patients being unable to afford necessary, evidence based treatment when there are out of pocket costs". I've been in practice for ten years and I don't believe I've had a single patient that couldn't afford their western medical treatment due to their expenditures for acupuncture, massage, or herbal medicine. Nearly 100% of the time, it is the other way around. Since I'm on a roll, I also wanted to mention that in this same paper the AMA stipulates in their "Regulation of Advertising" clause that direct to consumer advertising must not "exploit patients' vulnerability or lack of medical or health related knowledge". Feeling hopeless? Are you often worried?. Ask your doctor about Zoloft. And do not think about your shitty underpaid office job, global warming, or your deteriorating personal relationships.
I digress. Do I believe that practicing and using holistic medical therapies is a form of activism? I do! I believe that a medicine that embodies a nature model and creates harmony within our own bodies and between ourselves and the earth is a tool that can be used to perpetuate healing on multiple levels. We may not have much money or political power from where we stand, but practitioners of holistic medicine have the power to imbue our practices with a kind of social justice that big medicine can't even touch. We can form grassroots organizations within our communities to address immediate needs and alter the face of the typical workplace. Worker-owned cooperative health centers, community supported health insurance, free integrative medical clinics to help the underinsured and uninsured: these are all ways to fight the dysfunctionality that capitalistic and corporate medicine has created in our medical system. Real change can happen from the ground up, and I have to believe that it will.
Stay tuned for a discussion about what scientific medicine means. What kind of therapies were "regular" physicians employing the early part of the twentieth century? How does the "Gold Standard" of research work and how effective is it in proving the efficacy of a therapy? How many of the methods of treatment most commonly employed today are actually born out of a solid scientific understanding of how they work?