DAYTON, Ohio -- In 1900, medical scientists were learning
exciting new ways to prevent diseases through municipal sanitation
and vaccinations. A hundred years later, we are learning exciting
new ways to prevent diseases through diet, exercise and gene
therapy.
At the end of a century that saw the obliteration and taming of
many horrific illnesses and injuries, medicine is turning its
attention in many ways to some of the things it focused on 100
years ago. The age-old notions of preventing disease, enhancing the
body's own healing process, treating the mind and body as
intricately connected, and taking part in one's own health care are
coming back into vogue. And with them, so are unregulated quackery
and some terrifying medical mysteries.
Medicine certainly isn't abandoning the remarkable technological
advances that helped boost the average American lifespan from 47 to
76 years. It is merely shifting its aim of such life-saving weapons
as antibiotics, antiseptic surgery and harnessed radiation. It also
is broadening its definition of health beyond the absence of
disease or injury to include the presence of vitality.
``I think our progress has taken us to a place where we're
rediscovering the value of ideas we may have discarded,'' says
psychiatrist Dr. David Bienenfeld of Good Samaritan Hospital and
Wright State University's School of Medicine. ``Ideas like
prevention, the mind-body connection.''
This was the century when organized medicine went from knowing
very little about the disease process to thinking it knew almost
everything to realizing it still had much to learn. Some problems
cannot be explained by the germ theory, it turns out, and so not
everything is subject to pharmacological bombardment. What is it
about the body that explains why clean-living football player Brian
Piccolo died of lung cancer at 26 and chain-smoking baseball
manager Casey Stengel lived to 86?
Western medicine is too sophisticated to use the term ``balance
of humours'' that described this enigma 150 years ago, and too
technical to acknowledge the system of energy channels that Chinese
medicine identifies as ``chi.'' But just as osteopathy, naturopathy
and chiropractic sprung up in the late 1800s on the foundation of
the body's own healing mechanism, medicine once again is exploring
the innate ability to heal or head off diseases as more promising
than science's ability to attack them.
``That is the only way you're going to really cure anything,''
says Joseph Mantil, Kettering Medical Center's director of nuclear
medicine. ``Because drugs can't cure. Even antibiotics really don't
kill an infection. They stop it from doing anything until your
immune system can kill it. They're buying time.''
With antibiotics and other 20th-century marvels, ``We're down
the stream fighting off the damage,'' says Dr. Richard Reiling, a
Kettering surgeon. In the next medical paradigm, ``We've got to go
up the stream and see what's causing the damage.''
There is no better example of applying new technology to those
old goals than gene therapy, which looms as the driving force
behind 21st-century medicine.
FROM THE GERM THEORY TO GENE THERAPY
Twentieth-century medicine was shaped by the germ theory,
articulated by German scientist Robert Koch in an 1882 paper that
showed specific diseases are caused by specific micro-organisms.
It was the germ theory that gave healers an identifiable enemy
and spawned an era of attack medicine often likened to military
assault, says James Edmonson, a professor of medical history at
Case Western Reserve University's med school in Cleveland.
The standard cancer therapy, for example, was ``If you see it,
wherever it is, cut it out,'' Reiling says. ``We've gotten over
that,'' and started approaching cancer through the body's immune
system.
People generally think of gene therapy in terms of repairing the
defective human genes that cause cystic fibrosis or often trigger
breast cancer. But the application that excites doctors at least as
much is manipulating microbiotic genes in ways that help the immune
system fight off many cancers and heart disease.
``This is a huge revolution that's going to kill cancer cells,''
Mantil says. ``We've been doing chemotherapy for the last 50 years
with no significant improvement. A drug just can't get to all the
cancer cells. There are too many. But the immune system can. That's
what the immune system is designed for.''
Even for people without catastrophic illnesses, a suddenly
flourishing school of thought insists that bolstering the immune
system through healthy lifestyles ``is really the way to go,'' says
Dr. Mark Clasen, WSU's family medicine director. ``The benefits of
exercise, of laughter, of a significant spiritual dimension in
one's life, of nutrition'' are now embraced by mainstream medicine.
The next step, say alternative practitioners, is to stop
interfering with the immune system by attacking some unpleasant
symptoms it produces. Fevers, inflammation and the mucous
discharges of common colds are all signs the immune system is
working properly, says Dr. Judith Boice, a Portland, Ore.,
naturopath.
``Colds do not require treatment,'' she says. ``They are the
treatment.'' Instead of using drugs to dry up congestion and cool
off fevers, she says people with colds are better served in the
long run by the herbal remedies and simple warm liquids that
accelerate the discharges ``rather than pushing it under the
carpet.''
ANTIBIOTICS MEET THEIR MATCH IN AIDS
American medical doctors ridiculed the immune-system approach
for much of this century because they truly believed they had
developed something better. They could kill the body's microscopic
invaders with drugs. When the first diphtheria vaccines of the
mid-1890s clearly curtailed the country's largest killer of
children, Edmonson says attack medicine had its first stunning
victory.
The three decades after World War II, when new antibiotics and
vaccines kept arriving to wipe out our nightmares, ``were truly a
high point in medicine, and they raised people's expectations,''
Edmonson says.
``We thought we would be able to wipe out all diseases and
nirvana would occur,'' says Reiling, who has been practicing for 32
years.
``And then along came the AIDS virus,'' Edmonson says, ``and
suddenly the confidence that doctors had acquired was shaken to its
roots.''
``We seemed to reach the end of the antibiotic era and lost
faith in these magic bullets,'' says Janet Golden, a medical
history expert at Rutgers University's Camden, N.J., campus. Even
vaccines were losing their luster in light of evidence that
flushing toilets and sanitary sewers were ``really the bedrock of
our transformed health in the 20th century.''
Conventional medicine recently succeeded, as Edmonson pointed
out, in turning many AIDS cases into a chronic disease, incurable
but survivable like diabetes, but disillusionment is a wall that's
not easily papered over. Cancer still baffles medical science, and
practically every American knows of someone who has been from
doctor to doctor, looking for some way to explain hazy but
debilitating symptoms of chronic fatigue and achiness.
Medicine has limited its mysteries to the marginal few percent,
compared with the vast majority late last century, but the
mysteries that remain are no less frightening than tuberculosis and
cholera epidemics of old. Two of every five Americans now has tried
some form of alternative medicine. About one-fifth of our health
care dollars goes to alternative practitioners, most of it not
covered by insurance, the federal government pays for research in
these fields and two-thirds of the traditional U.S. med schools
offer courses in such practices as acupuncture, herbal remedies and
mind-body medicine.
``The legitimization of non-Western medical tradition in the
last 15 years is striking,'' says University of Rochester, N.Y.,
medical history Professor Theodore Brown. ``This is an interesting
broadening of treatment possibilities after a period in which the
boundaries had become very rigid.''
THE PERSISTENCE OF ALTERNATIVE THERAPIES
These alternative practices aren't new. As the limits of drugs
and surgery become apparent, today's disenchantment with
conventional medicine reminds historian Edmonson of 19th-century
challenges to the medical establishment. Medicine of the 1830s and
'40s was painful and dangerous, based on bloodletting and purging
in the belief that disease was caused by excesses of bodily fluids.
So people tried other approaches. Dr. Samuel Hahnemann developed
homeopathy earlier in Germany after some of his children died from
ineffective and caustic medical treatment. He believed in
stimulating the immune system with diluted substances that caused
the same symptoms as an illness. That may not have helped people,
Edmonson says, but at least it didn't kill them.
Osteopathy was founded on the belief that studying the
musculo-skeletal system more closely would shed light on the
healing process. Chiropractors believed skeletal misalignments
obstructed the healing process. Naturopaths embraced a variety of
healing strategies and believed plant-based medicines would be more
effective and less harmful than the tar, sulfur and petroleum of
establishment physicians.
All these disciplines jostled with drug-based allopathic
medicine for supremacy in 1900.
But within two decades, the allopathic medical doctors'
germ-killing arsenal of drugs had shot down their competitors.
M.D.s also flourished, says Golden, because painless and
infection-free surgery was a marvel that kept people alive by, say,
removing a ruptured appendix, because new insurance plans made
hospitalization affordable and nurses made it comfortable, and
because of unprecedented abilities to diagnose diseases and answer
the question, ``What's wrong with me?''
Today's proliferation of medical alternatives is bringing with
it the dangers of unregulated practitioners, the mixed blessing of
self-care and the benefits of linking the mind with the body -- much
as it did 100 years ago.
Most states actually stopped licensing physicians in 1833.
Jacksonian democracy of the time empowered commoners to challenge
established authority in medicine along with everything else,
opening the door to any quack with a door, a sign and a nail.
The state's medical licensing returned in 1896 and now includes
osteopaths and chiropractors, but the only regulated practices that
might be considered alternative are massage therapy and dietetics.
There is no certification to separate the acupuncturist with three
years' training from the M.D. practicing acupuncture after taking
night classes.
Herbal remedies and dietary supplements also have returned to an
era of ``buyer beware'' because of a 1994 federal law that removed
them from the Food and Drug Administration's oversight. The FDA was
created in 1906 because annual sales of impotent and even harmful
nostrums, elixirs and medicine-show concoctions had reached $75
million.
SELF-CARE GROWS INTO AN INDUSTRY
Patent medicine advertisements also went unregulated before
1906, which reminds Brown of today's Internet. The ``Jesus' Diet''
Web site is able to claim, without contradiction, that ``Urine is a
medicinal, cleansing, and nourishing food ... with a surprising
ability to cure an amazing variety of ills.''
But the Internet also offers some advantages of self-care. It
makes scientific information available to people who don't have
easy access to medical specialists, much as the herbal recipe kits
of New England farmer Samuel Thompson made medicines available to
19th-century Americans who lived days away from a doctor.
Today's self-care is far broader, of course. Much of the public
has been ahead of established medicine on the value of good
nutrition and exercise, notions largely regarded as quackery 100
years ago. Along with drugs and surgery, Dr. Herbert Benson calls
self-care ``the third leg of health care's three-legged stool.''
Benson is the Harvard cardiologist who became the father of
mind-body medicine 30 years ago. He demonstrated the connection
between stress and high blood pressure and proved the physical
benefits of meditation, biofeedback and his own stress-reducing
``relaxation response.''
Since then, Benson also has shown the role of stress in other
heart disease, infertility, insomnia and clinical depression.
``Mind-body medicine as self-care is not alternative medicine. It's
scientifically proven,'' he says today. It can eliminate many of
the 60 percent to 90 percent of doctor visits that he attributes to
``the mind-body-stress realm.''
``One of the most exciting recent developments,'' Brown says,
``is that research has caught up with what astute clinicians have
been saying -- that there are connections between emotions and the
disease process, between mind and body.''
When Sigmund Freud introduced psychoanalysis at the turn of the
century, he inadvertently created separate medical worlds for the
mind and the body. His intention was eventually to show the
connection between brain chemistry and mental and neurological
illnesses. But the relationship couldn't be proven until the past
10 years, when new PET scan images began displaying brain
chemistry. They revealed what might even be called ``an imbalance
of humours.''
Even for the 80 percent of Americans without brain disorders,
this understanding shows promise for people who simply want to feel
better. Health is no longer a yes-or-no question, says Wright
State's Clasen, ``with so many chronic diseases people are
acquiring now because they don't die at 50.'' He says managing and
preventing those diseases are becoming the primary focus of primary
care.
``When prevention became prominent in the second half of the
19th century,'' Brown says, ``it really was a desperation move.''
Doctors realized they didn't have good medical options after a
person became sick. As prevention surfaces again now, Brown says it
is for entirely different reasons.
One is to enhance the quality of life, he says, ``to go beyond
whatever levels already have been achieved by the advances of
medicine.''
The other is to save costs. Medicine never was so expensive
before. If American society cannot prevent more of the illnesses
that cost six figures to treat, we won't be able to afford the
extraordinary improvements medicine can offer. So we have become
desperate not to avoid the hopelessness of disease, but to take
advantage of all the hope that medical science is finally offering.
``The more things change, the more they remain the same,'' wrote
19th-century Frenchman Alphonse Karn. Even before his time, French
philosopher Voltaire had pointed out, ``The art of medicine
consists of amusing the patient while nature cures the disease.''
