On Medicine, a perspective

Following extract from The Slow Moon Climbs, a very interesting perspective on medicine:

"It is reasonable to identify two broad types of medicine for our purposes. One is the type I am calling “traditional” medicine—those medical systems attested in every horticultural and agricultural society that I am aware of (though not as much in foraging populations), the roots of which mostly predate a society’s exposure to modern medicine. “Traditional” does not mean “unchanging”—traditional medical systems evolve on their own, and almost all have evolved faster in recent decades, under the influence of one another and of modern medicine. Most traditional medical systems, and especially those most highly standardized and widely practiced today, have changed fundamentally in the modern period, as the process of standardization rationalizes and streamlines enormously complex and variable traditions. For similar reasons, modern medicine, while recognizable everywhere, is not everywhere the same—it has adapted to different social and cultural environments, and incorporates local traditions and ideas.

Some agricultural societies developed written intellectual traditions with theories of physiology and disease; these survive in ancient Greek, Chinese, Sanskrit, Arabic, and other “classical” (that is, scholarly) languages and some vernacular languages. Virtually all agricultural societies have relied on traditions about which plants, substances, rituals, objects, or incantations can treat the conditions and diseases they recognize and describe. Some traditional systems, such as Traditional Chinese Medicine (often abbreviated as TCM), Ayurveda, or Unani (Greco-Arab) medicine, are regulated, taught in professional schools, and widely practiced around the world, but countless other systems not as globally influential are practiced by traditional healers or by grandmothers who serve as the expert healers for their own families.

In many rural parts of the world, people have limited access to modern medicine and rely mostly on traditional practitioners; also, it is common for people in highly modernized societies like the United States to use practices like acupuncture for certain problems. While practitioners of modern medicine are often hostile to traditional practitioners and vice versa, the trend today is to recognize the value of traditional medicine. Because of their deep roots and local origins, traditional systems often do a good job of addressing social and psychological factors in illness. Imposing modern medical technologies can cause many unexpected problems if it is done without sensitivity to the cultural factors that traditional medical systems reflect so exquisitely. And although efficacy is not the main strength of traditional medicine, some traditional remedies do work; in recent years modern medicine has devoted a great deal of research to identifying traditional materials and practices that might have broader (that is, cross-cultural) use. An important example of such a crossover remedy is artemisinin, a first-line malaria drug derived from the plant Artemisia annua and used in classical Chinese medicine to treat intermittent fevers. Traditional practices can also improve the efficacy of modern medicine by reaching more people, by making patients less resistant to treatment, or by reducing social and psychological stress. For chronic or painful conditions that modern medicine is not very effective at treating, traditional medicine can provide some relief.

A 2012 study of the use of traditional medicine by doctors in Japan illustrates some of these points. Although Japan is one of the most modernized nations in the world, researchers found that 84 percent of the doctors they surveyed used kampo—Japanese traditional medicine—in their practice, and 80 percent of patients used both kampo and modern medicine. National health insurance covered 148 kampo prescriptions. Traditional medicine was especially important in obstetrics and gynecology; almost 45 percent of these patients used only kampo medicine. In private practice, most of the conditions treated with kampo were common, non-life-threatening, and not especially responsive to modern medicine; ...

Traditional medicine has strong support from a number of governments and organizations worldwide. The government of the People’s Republic of China, continuing Maoist policies, promotes both traditional and modern medicine, partly because bringing modern medicine to its large population has been a Herculean task, and partly because of its goal of encouraging a strong sense of national identity. For other reasons, the official policy of the World Health Organization is “to support Member States in harnessing the potential contribution of T&CM [Traditional and Complementary Medicine] to health, wellness and people-centred health care and to promote the safe and effective use of T&CM through the regulation of products, practices and practitioners.”

Although traditional systems differ widely from one another, the system I am calling modern medicine, which developed in western Europe in the late nineteenth century, diverges in important ways from all of them, and today it is at least equal to all the others combined in influence and in the resources dedicated to it. While it has clearly played a part in the transformation that created the modern era, it is actually not that easy to define what modern medicine is. Its roots in the natural sciences are one of its defining features; practitioners of modern medicine learn systems of biology, biochemistry, physiology, and pathology that are quite new, having been invented or totally transformed in the last 100 years or so by drastic “paradigm shifts” (to use the famous phrase coined by Thomas Kuhn in The Structure of Scientific Revolutions, first published in 1962). Modern medicine includes a tendency to seek cause and explanation inside the body (and not, for the most part, in society, the environment, or the supernatural world) and at the microscopic level—in the world of microbes and cells, of molecules like DNA and hormones, and of other entities that we can see only with advanced technologies. It tends to assume that these microbiological forces affect all bodies in standardized ways according to a set of natural laws, and to rely on statistics and, increasingly, on what is now called “big data.”

Modern medicine is mostly new, but it inherited certain very old features from the Mediterranean background in which it arose. Ancient Greek medicine included a unique tradition of anatomy and dissection that was transmitted and developed over centuries by mainly Islamic scholars in the medieval period, and then revived in western Europe in the Renaissance. That tradition has influenced modern medicine’s tendency to look inside the body using technology and to view the body as a collection of assembled parts working together. 

With regard to disease, modern medicine’s overwhelming tendency is to identify and name a huge number of discrete conditions and pathologies, differentiating them, when it can, by their microscopic causes—a system that works well for conditions caused by germs and parasites, some cancers, and some diseases with genetic causes, and less well for chronic conditions like heart disease, most mental illnesses, and a huge variety of problems whose micro-level causes are complicated or poorly understood (osteopenia, which simply means “too little bone,” and hypertension, which means “high [blood] pressure,” are examples of unhelpful modern names for conditions). Modern medicine’s much greater efficacy against infectious disease compared to traditional medicine is responsible for some of the transformations that created the modern era."