Last November, the Journal of the American Medical Association (JAMA) published a special issue on alternative medicine. It was surprising that the elders of the AMA should have countenanced such respectful attention to so blatant a challenge to their hegemony; the subsequent dismissal of the journal’s editor over an ostensibly unrelated matter of judgment suggests that they did not. But at least as surprising was the news within the issue itself: in a 1997 survey, 42 percent of Americans reported having used at least one of sixteen varieties of alternative therapy

The special issue of JAMA is only one of many recent signs of the growing respectability of alternative medicine. The National Institutes of Health (NIH) in Washington, D.C., harbors an office of alternative medicine about which I shall have more to say below. In a less exalted venue, one may randomly pick up a book on the home use of homeopathy and find a highly supportive preface by, no less, a faculty member at the Georgetown University medical school. And then there is the phenomenon of Andrew Weil, M.D., the best-selling author and recommender of many alternative therapies who directs a program in “integrative medicine” at the University of Arizona medical school.

Something is clearly afoot.

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There is no compact and lucid definition of alternative medicine, other than that it comprises medicine not taught (until very recently) in medical schools or employed in hospitals. But in surveying the universe of the alternative, the obvious place to start is with homeopathy. Although various therapies imported from the third world are older, in the West, homeopathy has seniority.

Homeopathy’s appeal is probably based on the simplicity, clarity, and, for lack of a better word, the niceness of the theories of its late-18th-century proponent, the German physician Samuel Hahnemann. Briefly, Hahnemann held that the causes of disease were essentially unknowable, but that symptoms were both caused and cured by one and the same substance. Quinine is the typical example: in large amounts, it causes the chills associated with malaria; in small amounts, it relieves them. Thus, the homeopathic pharmacopoeia was developed by administering a substance to a healthy person and seeing whether symptoms resulted. This was called “proving.” Once a substance was “proved,” the next step was to dilute it sufficiently to produce a homeopathic remedy that, following the principle that like cures like, would alleviate or indeed extinguish the symptoms.

Over the past two centuries, homeopathy has had its ups and downs. At its high point, it boasted nearly as many adherents in the medical profession as did allopathy—the forerunner of today’s mainstream medicine. The Sears catalogue at the beginning of this century contained the whole homeopathic armamentarium, labeled in two styles: for home use, the vials bore the name of the medical condition to be treated; for the doctor’s office, the Latin name of the medication itself.

By the mid-20th century, although homeopathy continued to be quite vigorous in Europe, it had dwindled here to a few elderly practitioners and their patients. (My father’s mother stuck by her homeopath until he died on her at eighty or so; she remained remarkably vigorous past ninety, complaining all the while that she had not passed a day in good health since the end of the McKinley administration.) But today homeopathy is back with a bang, and impossible to escape. Not only vitamin stores and “nutrition centers” but drugstores and even grocery stores stock a wide range of homeopathic remedies arranged in racks of vials, each of them bearing the Latin name of the active “principle” within (usually some plant) and an indication of what it is good for. Homeopathy has so penetrated the popular consciousness that one can now find novels for which it provides both the energizing idea and the plot.

Homeopathy began to get a grip on the American imagination in the late 18th and early 19th centuries. But it was an import; the next major developments in alternative medicine were homebrewed in the burgeoning economies of the post-Civil War period. In 1874, Andrew F. Still, a physician of Kirksville, Missouri, came up with the notion that all illness was caused by misalignments of the spinal column, and devised a realignment process that he named osteopathy—the treatment of bones. Today, at the dawn of the third millennium, osteopathy has essentially passed from heterodoxy to orthodoxy. Osteopaths now pursue a course of study nearly identical to traditional medicine; some years ago, California began allowing osteopathic schools of medicine to award the M.D. degree. But even as they have embraced the mainstream curriculum, osteopaths continue to study the spine very closely, and they enjoy a reputation, often justified, for being better at back pain than their traditional colleagues.

The year after Dr. Still’s discovery, Mary Baker Eddy published the first edition of Science and Health, promulgating the basic doctrines of Christian Science. Although some might bridle at calling her a figure in the history of alternative medicine, Mrs. Eddy’s system resembles other 19th-century alternatives in offering an all-sufficient theory of health. The views of several contemporary schools are surprisingly similar to Mrs. Eddy’s, albeit without the religious underpinnings.

Hardly had Mrs. Eddy’s book appeared when, in 1876, Dr. John Harvey Kellogg became medical director of what was shortly to become the Battle Creek Sanitarium. Kellogg’s best-known legacy is the cereal company founded to market his greatest therapeutic discovery, the corn flake. But he was even more influential in propagating the notion that most if not all diseases are caused by the wrong diet. Although his institution, known to its devotees as “the San,” has been gone for 70 years, much alternative nutritional theory descends from him.

In 1895, osteopathy gained an imitator in the form of chiropractic. Daniel D. Palmer, a merchant of Davenport, Iowa, concluded that all illness was caused by a spinal-column maladjustments—known as subluxations—that impinged upon nerves. Chiropractic has had a gaudier history than osteopathy, spawning schismatic schools of treatment.

At about the same time that chiropractic made its appearance, the last great 19th-century medical alternative, naturopathy, was being perfected by the wonderfully named Benedict Lust. The November 1921 issue of Dr. Lust’s organ, Herald of Health and Naturopathy, pictures a remarkably far-flung and flourishing enterprise. Dr. Lust himself was the proprietor of two large health resorts, Yungborn in Butler, New Jersey, and a similar institution in Tangerine, Florida. The tenets of naturopathy then included vegetarianism and fruitarianism, walking barefoot, and lots of sun and fresh air. Its modern-day variant is somewhat more complex.

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What all the foregoing alternatives, including homeopathy, have in common is that they were created in reaction to perceived or actual defects of contemporary mainstream medicine. That is true of today’s alternative medicine as well, which has under its wing not only the therapies listed above but a larger set imported from the third world or from older folk traditions.

Two of these are comprehensive systems of medicine, with many centuries of history in Asia: traditional Chinese medicine, now often called TCM, and ayurvedic medicine, which arose in India. The two share a number of features, including a belief in energy flows in the body, known as qi in China and as prana in India. Both systems use herbal medicines and rely on diet, and both emphasize the power of the body to heal itself, often with a little help from herbal prescriptions.

Acupuncture is both a part of TCM and increasingly a freestanding art practiced both by specialists and as an add-on by other healers, including dentists. It became famous overnight in 1971 when the celebrated reporter James Reston contracted appendicitis while covering President Richard Nixon’s trip to China. He was treated in Beijing’s Anti-Imperialist Hospital, and in addition to a mainstream appendectomy he received acupuncture and herbal medicine as part of his postoperative care. Writing up the experience in the New York Times, he seemed a thoroughly satisfied customer.

Acupuncture elaborates the theory of energy flow. Acupuncturists believe that there are invisible energy channels on the skin, known as meridians, along which are sited locations into which the acupuncturist inserts a thin, sharp needle. Depending on where the needle or (as is often the case) needles go, there will be different effects. Much of the acupuncture practiced in this country is a form of analgesia, as it was in Reston’s case.

Three other alternatives make use of the same meridians as acupuncture. One is acupressure: acupuncture without the needles. Another, more esoteric, is moxibustion, which involves burning a bit of an herb, Artemisia vulgaris, called moxa in Japan, in the vicinity of an acupoint; a study of it is reported in JAMA‘s special issue. The third, Shiatsu, is a modern Japanese adaptation of acupressure.

Standing astride the Pacific is macrobiotics, which originated in Japan but has enjoyed its greatest development in the United States. Macrobiotics is often characterized as a diet, and indeed its practice is almost entirely a matter of sticking to an austere regimen based primarily on boiled brown rice, to which are added certain sea vegetables and small amounts of fish. But its claims are very large, for it sees all diseases as dietary in nature, and the macrobiotic diet as a true panacea.

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Another group of alternatives is not Eastern but European in provenance and/or vogue. For example, flower-essence therapy, devised by an English homeopath at the turn of the century, employs diluted flower extracts (although it ignores the homeopathic law of similars). Aromatherapy, reported to have been used both on the Queen Mother and on Lady Thatcher, has its own history and mobilizes various essential oils in more modest dilution.

Foot reflexology must not be confused with acupressure. About 90 years ago, Dr. William Fitzgerald is said to have systematized a good deal of ancient wisdom under the name of Zone Therapy. The body, he postulated, was divided into ten equal zones, running from head to toe, and these zones were related to whatever subcutaneous arrangements lay beneath them. Thus, stimulating any point in a zone would stimulate everything else within the same zone. Somewhat later, a therapist named Eunice Ingham added the thought that each zone could be treated by appropriate pressure on a part of the foot alone: on the sole, for instance, there is a place that can be pressed in order to treat liver malfunctions.

Then there is “bodywork.” This is in effect a congeries of massage types—some gentle, some very forceful—each with its own theory, technique, and claims of curative powers beyond simple relaxation. Rolfing is named for its inventor, Ida Rolf; the Feldenkrais method for Moshe Feldenkrais. There is an immense number of these variants, many of them refinements by disciples of the original founder’s teaching. What binds them together is the belief that it is possible to control the soul—mind, spirit, whatever—by controlling the body.

The opposite principle—controlling the mind controls the body—informs a different group of alternatives, of which biofeedback and therapeutic hypnosis are the best-known. In this category, too, belong guided imagery and visualization, processes whereby one imagines what one wants to happen—e.g., bullets striking a tumor one wants to have killed.

Still another class of alternatives involves a pharmacopoeia composed of agents other than herbs. Bee pollen and royal jelly are among the most familiar, but substances as different as shark cartilage and oxygen are in use among alternative practitioners. These methods include the once-famous Niehans cell therapy, chelation therapy, and enzyme therapy.

Some years ago, there arose a dental heresy that has evolved into a branch known as biological or holistic dentistry. On the assumption that the mercury in amalgam fillings could leach into the body and cause disease, a simple if time-consuming and expensive treatment was developed: drilling out all one’s amalgam fillings and replacing them with other materials. Biological dentists today make use of a variety of alternatives—complements, they would probably call them—like acupuncture and homeopathy, as well as nutritional supplements.

Finally, there are alternative therapies that are difficult to classify, including the use of magnetism as medicine and the long-established practice of colonic irrigation, to which in recent decades has been added the fillip of coffee enemas. Moreover, each of the alternatives I have discussed has cognates of various sorts, and the survey itself is far from complete. Nor have I listed faith healing or a variety of nostrums that have been formally adjudicated as frauds. Suffice it to say that there are a great many alternatives out there.

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Now to the obvious and possibly tactless question: do any of these therapies work?

In assessing pharmaceuticals, the Food and Drug Administration (FDA) takes up a prior question, probably derived from the first law of Hippocrates: “Do no harm.” That is, the FDA begins with the question not of efficacy but of safety. This is sensible, because no manufacturer would waste time on the money- and labor-intensive licensing process for a medication that had not already shown substantial efficacy in controlled animal tests. The FDA’s authority kicks in when it is proposed to test a substance on humans, and safety is a reasonable place to start.

The plain fact is, however, that very few of the alternative theories I have been discussing have been rigorously examined either for efficacy or for safety. Nor, frankly, is this issue much engaged by the promoters of alternative medicine. The authors of Your Guide to Complementary Medicine, for example, are content to explain how each alternative works rather than showing that it does work. Otherwise, exponents of the various schools tend to support assertions of their products’ efficacy with anecdotal evidence, complaining all the while about the inclination of mainstream medicine to dismiss such evidence.

Indeed, within the framework of mainstream medicine—and of science generally—“anecdotal evidence” is something close to a term of reproach, and for good reason. Life, after all, is an unremitting sequence of anecdotal evidence. As individuals, that is all we have. If we are to make something of it, we must assemble, usually with the help of others, a vast array of anecdotes that can then be tested against one another and ordered according to some rational, even skeptical, scheme, which probably will include statistical analysis.

The need for such analysis in the present case should be clear. The anecdotes presented by most advocates of alternative medicine concern instances in which a particular nostrum seems to have been effective. One does not often hear from supporters of x a striking account of how x failed, or produced unacceptable side effects. Yet nothing is likelier than that such anecdotes exist.

Take acupuncture. The stories in its favor emphasize its painlessness and benignity, but recently I heard an anecdote from a friend. He had visited a highly recommended acupuncturist to see what could be done for serious pain that had proved intractable to the ministrations of mainstream medicine. The insertion of needles had indeed proved painless. But acupuncture itself had a different effect on his pain, increasing it over a period of ten days to the point where he terminated treatment. One will not read anecdotes of this kind in books about acupuncture, but they are the sort to which mainstream researchers must pay attention.

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To find anything approaching an organized survey of efficacies from within the alternative movement itself, one must turn to The Alternative Medicine Handbook1 by Barrie Cassileth. A cancer researcher affiliated with the University of North Carolina, Duke, and Harvard, Cassileth was a founding member of the advisory council of the office of alternative medicine at NIH. Hers is an impressively thorough treatment of the field, and in what follows I rely on her nuanced judgments.

Since homeopathy is the senior alternative therapy, and the only one that once was a full-fledged alternative in the sense that tea is an alternative to coffee, its claims to efficacy are the place to start.

At first glance, the homeopathic principle—that is, the supposition that like cures like, especially in reduced doses—sufficiently resembles mainstream immunization theory to entitle it to a hearing. But one obvious difference is that immunization has a theory behind it that is persuasive in its own terms and congruent with scientific theory in general. By contrast, Samuel Hahnemann taught that not only is the actual cause of disease unknown, it is unknowable.

Perhaps more importantly, homeopathic practice flatly contradicts basic chemistry and physics. According to Hahnemann, the more dilute a homeopathic remedy, the more powerful it will be. The trick, at each stage of dilution, is to “potentize” the medication—by giving it a good shaking. This dictum has led to dilutions so extreme that any given vial of homeopathic medicine may contain not a single molecule of the medicine itself. Instead, it will contain water, plus an unknown concentration of contaminants—animal, mineral, or vegetable.

Advocates of homeopathy have come up with a neat rejoinder to this problem: by a process not understood (and perhaps not to be understood), water somehow “remembers” what it was once mixed with, even after the last molecule has departed. But, unfortunately, there is no evidence for the notion of liquid memories; and, as Cassileth points out, if such memories should somehow be proved to exist, the liquid would presumably have to remember all the various impurities it once contained as well.

It is, of course, always possible that our present understanding of chemistry and physics is wrong and in need of major revision. After all, many of us were once taught that the moons of the outer planets were cold, dead masses of rock, and yet we have lived to see a volcano erupting on a moon of Jupiter. But the reason why physicists and chemists are not rushing to account for homeopathy is that, unlike in the Jupiter case, homeopathy does not present new evidence but merely a new “theory,” and one that is debonairly indifferent to its inability to account for any facts outside its own microcosm. Astronomers might as well rush to refute the cosmology of the Muggletonians, who believed not only in a geocentric universe but in a deity who looked much like thee and me except for being six inches tall.

Could it be that homeopathy works despite rather than because of its theory? Might it be an efficacious alternative with a ludicrous but irrelevant theory? The evidence is against this conclusion, too. The one study claiming success for homeopathy to have appeared in a peer-reviewed medical journal concerned infant diarrhea; according to Cassileth, it has been roundly exposed for inherent biases that invalidate its conclusion.

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If the proponents and sponsors of homeopathy—many of them holders of M.D.’s, trained in medical research—were to design and execute rigorous studies shedding more light on the efficacy of their discipline, that in itself would be news, and would certainly create an irresistible demand for further studies. But they have not done so—and neither, mutatis mutandis, has anyone connected with any other alternative medicine. Given the grandiose claims made for most of them, this is a damning fact, especially in today’s environment of deepening cynicism toward the medical establishment. As things stand, not one alternative medicine can show the validated efficacy—of the sort enjoyed, say, by aspirin—that would establish its therapeutic claims as anything more than puffery.

But suppose the grandiosity dial is turned down; what then? Some therapies, it is true, can claim a limited usefulness. My friend’s experience aside, acupuncture has indeed been shown to control some cases of chronic pain, the likely explanation being that it is a highly effective placebo. Hypnotism, too, seems to control pain—Cassileth cites the example of a fifteen-year-old girl with an intense allergy to pharmacological anesthesia who underwent heart surgery fully awake, without pain, and without even an aspirin.

Like hypnosis, biofeedback has also shown its usefulness within mainstream medicine, boasting success in treating alcoholism, drug abuse, chronic pain, and other problems. And yoga, too, has to its credit a wide range of documented benefits that can be explained as the consequence of relaxation. Within careful limitations, these therapies do sometimes seem to work.

But for the great majority of alternative therapies, not only is there no scientific validation of any kind, there is frequently evidence to the contrary. Colonic irrigation, for example, has been studied closely enough by mainstream researchers to have had its claims thoroughly disproved. This is fairly easily done, since the therapy is based on the idea that food remains attached to the wall of the colon where it quietly rots and becomes toxic. Every time a surgeon opens a bowel, the falsity of this idea is demonstrated anew.

Among nutritional theories, macrobiotics has the most comprehensive claims for efficacy—and, pursued with discrimination, it does offer the benefits of a low-fat diet. But these same benefits are available without limiting oneself mainly to brown rice. In its earliest formulation, moreover, macrobiotics was also troubled with a side effect for which the technical term is death. That is, when followed by a customer with exceptional willpower, the diet resulted in literal starvation, and before macrobiotics was modified to include fish, a number of pioneers were forced to give the Cause their All.

Different and more diverse threats are posed by herbal remedies and dietary supplements. Consumer Reports has recently (March 1999) published an extensive survey that raises alarming questions about the state of these products’ regulation. Unlike homeopathic medicines, supplements are not entirely outside the reach of the FDA; but in 1994 Congress and the President sharply restricted the FDA’s power over them as long as they do not claim to cure disease. It turns out that much depends on how you define “claim to cure disease.”

For example, as CR points out, the phrase “alleviates constipation” is a claim to cure a disease; but “promotes regularity” is not. Or consider the label of GarliPure™ capsules, two of which will provide you with 1,000 milligrams (or one gram, or 1/28 of an ounce) of garlic; for a daily dose, double the numbers. Now, why would one want to ingest two grams of garlic a day if one cannot taste it, even at the reasonable cost of 25 cents? At the top of the label, we are told why: this supplement “helps maintain a healthy cholesterol level.” But see the note: “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent disease.”

That is an astonishing set of sentences. Even putting aside the fact that “helps maintain” is a fudge for “maintains,” surely the only criterion of a “healthy cholesterol level” is a level that does not cause disease. Or are we simply to believe that, if one already has good cholesterol numbers, this product will assist in maintaining them? Whichever, potential customers are being lured in the expectation that they can substitute moderately-priced garlic pills for the high-priced cholesterol-maintaining medicine prescribed by their doctors, while at the same time being told sub rosa that they cannot.

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Reading such labels, one remembers which President signed the Dietary Supplement Health and Education Act of 1994 (DSHEA)—an enactment stipulating that a dietary supplement is presumed safe unless the FDA receives a significant number of reports to the contrary. (Mere medications, as I have noted, must be proved safe even before they are proved effective.) Under this bizarre law, simply by calling a substance a nutritional supplement one can market it as a medicine—“helps maintain a healthy cholesterol level”—and wait until it goes wrong often enough to attract the attention of the authorities.

Consumer Reports is illuminating on the ways in which such supplements can indeed go wrong. Chapparal, for example, is claimed to purify the blood and to fight acne and cancer (a coupling that is itself quintessentially “alternative”). CR cites no evidence either way, but the side effects have been identified: acute nonviral hepatitis and rapidly developing liver damage leading to transplants. Comfrey, claimed to alleviate arthritis, ulcers, and pulmonary disease, has caused cancer in laboratory animals. Ephedra, claimed to control weight and boost energy, sometimes achieves the first by means of a side effect that can kill you.

True, any number of real medications have had the same side effect. But they are available only by prescription. Moreover, when they are advertised they are accompanied by a full page or more of fine print describing those side effects. Under DSHEA, the American people provide the nutritional-supplement industry with a 50-state laboratory whose test subjects cannot give informed consent because they do not even know they are being used as guinea pigs.

In the end, whatever the effect or noneffect of a particular supplement, the most widespread danger this class of therapies poses is, so to speak, generic. (The same goes for alternative medicine as a whole.) The pursuit of a useless remedy, even if it is in itself harmless, may close the way to an efficacious course of treatment. If the condition being addressed is life-threatening, the danger is commensurately graver. The stated indications for many supplements are phrased in terms of symptoms: chronic pain, headaches, faulty digestion, and so on. Alternative medicine is not terribly concerned with what lies behind symptoms, but many of these can be the warning signs of diseases like cancer.

The danger is not that herbal or nutritional supplements will be used by terminal cancer patients—to whom they pose a risk of zero—but that they will be used, to no therapeutic end, by people whose cancer is just beginning to be apparent. For such patients, they present the terrible risk of delaying real treatment to a time when it will be less effective or indeed fail. The better an alternative therapy is at suppressing symptoms, the higher the risk.

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If the evidence in favor of alternative medicine is so thin, why, then, according to JAMA, have 42 percent of Americans availed themselves of it? Are we dealing here with people who cannot be expected to know better, or to afford better? Evidently not, as observation of the clientele at any upscale health store will confirm. A recent article in New York magazine finds the vogue of alternative medicine particularly well-entrenched in the upper reaches of the city’s conspicuous consumers.

One explanation may have to do with the one-man industry known as Andrew Weil, M.D., whose effectiveness as an advocate would be hard to exaggerate. Weil is intelligent, learned, and shrewd; he can be a charming writer; and he has the gift of saying quite irrational things in a thoroughly rational manner. Besides his natural talents, his credibility is strengthened by two Harvard degrees, and he benefits as well from a memorably striking appearance, sealed by a beard that would put Edward Lear in the shade.

Weil is certainly a success: he has a daily web column sponsored by a vitamin seller, and a search on Amazon.com currently yields no fewer than 54 listings. Although his most recent winner is Eight Weeks to Optimum Health, more indicative of his basic orientation is his first book, The Natural Mind, published in 1971 and still very much in print in a revised 1985 edition.

By the term “natural mind” Weil does not mean the minds we are born with. Rather, he quite explicitly means the drugged mind, or, as he prefers to call it, the stoned mind. With, he writes, the help of various controlled substances, some of them decidedly artificial, it is possible to experience reality directly. For reality is not something that exists independent of our consciousness; consciousness is all there is, and the important thing about facts is that there aren’t any.

Survivors of the 1960’s will remember that a great many trees gave their last full measure of devotion that this sort of thing could be published. If Weil has not let it pass beyond the mists now that he has an entirely new career as the guru of integrative medicine, the reason may be that he really believes it—believes, that is, that there are no facts, and that we see straighter drunk than sober—and is proud to be the expounder of that doctrine.

It is against this necessary background, in any event, that we should view not only Eight Days to Optimum Health but Spontaneous Healing, the 1995 book by Weil that marked a watershed in the legitimation of alternative medicine (and of which Eight Weeks is largely a repackaging).

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A substantial portion of Spontaneous Healing is given over to Dr. Robert Fulford, an osteopath of the old school who has declined to join his colleagues in adding drugs and surgery to his repertoire but has stood by bone manipulation alone. Fulford is also a practitioner of a schismatic species of osteopathy known as craniosacral therapy, which specializes in the bones from the cranium to the sacrum (the remainder of our once-useful tail) and is itself based on a theory, promulgated in 1939 by the osteopath William Sutherland, that energy circulates along a route from the skull to the tailbone in a process analogous to the respiration of oxygen through the pulmonary system. This “primary” respiration, as Sutherland called it, is driven by constant rhythmic movements of the bones of the cranium, expansion and contraction of the hemispheres of the brain, and other movements of the rest of the craniosacral complex.

As summarized by Weil, it is hard to tell whether Sutherland knew what if anything was being respired here, or how the mechanism was supposed to affect the operations of the nervous system. But Robert Fulford, whom Weil offers as almost an ideal exemplar of the physician, has developed his practice almost entirely in terms of Sutherland’s notions. As a frequent visitor to Fulford’s office, Weil reports a number of impressive results. These include the case of a friend, a nonbeliever in osteopathy, who was cured of a devastating bowel affliction that had baffled a world-class gastroenterologist, and the perhaps less striking case of an injury to Weil himself. Fulford has also routinely ended nagging childhood ear infections—media otitis—in a single treatment, by, as he puts it, “beating the heck out of their tailbones.” As Weil epitomizes his observations, “Dr. Fulford did not succeed with everyone, but he had a higher percentage of successful outcomes than any other practitioner I have met.”

This is another sentence that might fairly be called astonishing. Note the conspicuous absence of even a ballpark estimate of Fulford’s actual success rate, and note, too, the rather odd qualifier, “I have met.” Somehow, one doubts that every time Weil meets a practitioner he inquires about success rates, or gets an answer, or pauses to evaluate its correctness.

One obvious difficulty with the theory of primary respiration would seem to be the fact that, anatomists assure us, the bones of the skull do not move. Yet, under Fulford’s tutelage—he allegedly has a touch so sensitive that he can feel a human hair under seventeen sheets of paper—Weil says he learned to feel these movements himself. It would be interesting to see documentation of this claim, just as it would be interesting to replicate the study (cited by Weil) at the Michigan State University College of Osteopathic Medicine that “confirmed” motion of the cranial bones. Since Fulford is not the only craniosacral therapist in the country, more convincing testimony still might be derived from a double-blind test of his colleagues’ achievements. It is especially disappointing that the Center for Integrative Medicine at the University of Arizona, directed by Andrew Weil, has not undertaken such a study, for if craniosacral therapy really does live up to his billing, it would come close to providing a solution for the oft-proclaimed crisis in American health care.

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What all this points to is the essential romanticism (to use the most neutral term at hand) of the movement for which Andrew Weil serves as point man. This romanticism—a legacy, in its current, virulent incarnation, of the selfsame spiritual orientation one finds preserved in amber in Weil’s The Natural Mind—forms the starkest possible contrast with mainstream medicine.

Mainstream medicine has long been a cooperative and pragmatic enterprise: Drs. A and B publish a study showing that x cures y; Drs. C and D publish another that shows x does not cure y. Sic et contra. Eventually, by the time Drs. U and V enter the fray, a preponderance of judgment has been formed, deriving from processes conducted under generally agreed-upon ground rules. Without idealizing mainstream medicine, which like any human enterprise is subject to the normal quotient of human frailties, there can be little doubt that its search for the truth is grounded in the scientific method and limited only by those frailties.

Nothing like this can be said for alternative medicine. For one thing, the typical alternative theory is formed by a single romantic hero, sometimes a grand heretic like Samuel Hahnemann, M.D., sometimes an inspired naïf like Daniel D. Palmer, grocer of Davenport, Iowa. The pattern has been widely repeated: Benedict Lust invented naturopathy, Moshe Feldenkrais invented the Feldenkrais method, Ida Rolf invented Rolfing: we know their names in a way that we do not, and cannot, and need not know who invented diagnostics. This is a mark very much in favor of the latter, and against the former.

For another thing, in alternative medicine error and human frailty are not things to fight or overcome but things to ignore—or to exploit. Perhaps most exploitable of all in this regard is the universal human desire to believe that, by dint of “natural” methods, the ills to which all flesh is heir can somehow be negotiated without discomfort, without expense, and especially without pain. The attraction of such a philosophy to a generation now beginning to receive irrefutable evidence that it may not live forever cannot be exaggerated.

Here is an encomium lavished on homeopathy by an M.D. at Georgetown:

[W]e sense the rightness of a healing system that conceives of all symptoms as parts of a larger whole, that appears to stimulate the body’s natural healing force rather than attack its enemies. Homeopathy seems to work with us, not on us.

This sort of “medicine” has an appeal that goes straight back to Samuel Hahnemann himself. It is the appeal of the easier, indeed the easiest, way.

The orthodox doctors of the 18th century routinely relied on “heroic” treatments: huge doses of things like violent laxatives; painful techniques like blistering and bloodletting. By contrast, Hahnemann offered a road to Wellsville calculated to avoid even mild indigestion. Neither he nor any other alternative theorist would ever have been so incautious as even to mention the word surgery. That has been, mutatis mutandis, the appeal of almost every “alternative” offered in the two centuries since.

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So what? As we have seen, alternative medicine goes back a long way, and quackery still farther. But the current phenomenon is qualitatively different from its predecessors.

The University of Arizona is not the only respectable institution providing a home for “complementary” or alternative medicine (increasingly known by the joint acronym CAM). Others include Columbia, Stanford, the University of Texas at Austin, the University of Iowa, and the University of Minnesota. These programs have another thing in common: they are all funded by the federal government.

Which brings us back to the National Institutes of Health. Its center for alternative medicine was established in 1992 at the urging of Senator Tom Harkin (D., Iowa); by 1998, it had expanded into the National Center for Complementary and Alternative Medicine (NCCAM). Although its funding is still modest compared to mainstream centers, the trendline is telling: from $2 million in 1992 to $50 million in 1999. The center’s purpose is to conduct research into the possible effectiveness of various alternative therapies, a mandate it carries out by supporting some of the institutions listed above, as well as Bastyr University (a naturopathic institution in Seattle) and a consortium linking five colleges of chiropractic and two state universities.

It remains to be seen what this research will lead to. But already the very existence of NCCAM provides the most authoritative form of legitimation imaginable, conferring upon the movement something like mainstream status without requiring anything like a demonstration of the intellectual rigor that normally accompanies such status. In its train, we may expect others to follow.

In most states, most medical schools are publicly funded, which means that they are subject to political and indeed popular pressure. To judge by a recent issue of the University of Iowa’s alumni magazine, programs in alternative medicine are likely to become de rigueur at such schools. An article on the Iowa program regales us with the story of a seriously ill patient who, dissatisfied with her mainstream care, takes matters into her own hands, administers a variety of herbal and other treatments, and in time feels cured. Exactly the sort of case that merits critical scrutiny—but nothing in the article suggests it will get such scrutiny at the medical school of the University of Iowa.

The tradition of mainstream medicine is characterized by the constant testing of proposed new treatments; it is of the essence that the arena of testing not be tainted by prejudice, neither for nor against. But whenever medical schools accommodate new programs in alternative medicine, they also accommodate the severely relaxed standards of evidence that disfigure it. Over the long run, this cannot but weaken the standards applied in mainstream medicine itself. It may be true that, at present, the medical establishment is still using a prudently long spoon to sup with the alternative. But such spoons have a way of shortening, and the possible consequences to the national health are deeply disturbing.

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1 Norton, 340 pp., $19.95.

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