Twenty years after the first version, if I were to rewrite this essay – which has brought me more hatemail than anything else I’ve ever published – I’d perhaps moderate the tone: here was anger and sorrow that have since diminished. But there’s little I’d change in the substance. In the intervening years, I studied and wrote about medical education and public health (which is more a matter of rhetoric than of science). I re-affirm the central point: due respect for folkways and the people who sustain them and are sustained by them should not displace rational, evidence-based medicine. Folk medical practices that are deeply interwoven, richly interactive with the rest of the group’s life are a very different matter from the same things as exploited by dilettantes and appropriators – who operate on an ethical spectrum from sincere seeking to frank charlatanry. As I write this headnote, we have not yet emerged from a plague where hundreds of thousands of entirely unnecessary deaths, untold losses to families, and an unforeseeable amount of future suffering are directly attributable to the conscious rejection of science, scientific methods, and scientific authority in purely scientific matters. In the late 20th century, the non-native practitioners would’ve been classified as New Age, and the strongest indictment of them might be for naivete. Well into the 21st, we see something different: Dunning-Kruger effect to be sure, strengthened by the way the internet readily supplies someone somewhere who more or less convincingly supports whatever one happens to believe. But something darker, too: nihilism went mainstream. Folklore, considered as a cognitive universe, is in some ways at odds with the world of the Enlightenment, and there are examples enough of people who found it useful for organizing a more general rejection of rationality, for other ends. ABD 2/20/22
I counsel great caution in dealing with purveyors and promoters of what are usually called “folk,” “natural,” “alternative,” “traditional,” “home” “organic” “holistic” and “other” medicines and therapies. I don’t indulge much in editorializing on these pages, but bear with me; it is in fact an issue in the nature and uses of folklore as it competes with other approaches to knowledge, and as such, I feel a professional responsibility to say something about the potential for abuse.
There are very good reasons why it takes a few years to get through medical school…
Much of my doctoral work was taken up with medieval and modern day medical folklore. In the pages of my dissertation I paid solemn tribute to the wisdom of such practices. But that turned out to be, on reflection, a sentimental conclusion I was determined to reach prior to and in spite of the facts. Further study left me horrified: many — most — of the remedies that weren’t simply useless were actively harmful; these traditions were quick with purgatives even in the case of corrosive poisons, laxatives, bloodletting, cauterization (an engraved invitation to gangrene), and so on.The universality of the human pharmacopeia (the presumably therapeutic application of feces, urine, saliva, tears) is not proof of its effectiveness or safety. On the plus side, many traditional remedies that involved the breaking of the skin, often in response to filth-diseases, have been rendered comparatively harmless by the modern innovations of plentiful clean water and cheap soap. On the other hand, I have personally recorded contemporary midwives encouraging hippocratic sucussion — including anvil-lifting and massage so rough as to qualify, under other circumstances, as assault — in cases of stalled labor.
No one has more admiration for folk wisdom than I do. But I guess I’d class it with my deep respect for the Bible, which reaches its limits when some readers try to make it a manual of astronomy and natural history, for example. My thinking was turned, I admit, by the needless death of a fine young man, a close friend certain to do much good in this world. Some traditional practices have very real therapeutic benefits: the alien protein of raw meat does in fact have hemostatic properties (but the practice invites horrifying infections); cupping can increase circulation (although increasing circulation can be very bad for some of the conditions it’s applied to). Standard medicine is beginning to see some value to leech-work (for example, stimulating circulation in burned tissue that would be disrupted by massage), and also to the psychological support given the healing process when the patient is treated with what s/he regards as familiar procedures, less alienating than scientific mystifications practiced by strangers in harsh, sterile environments. Certainly the recognition of the essentially religious nature of healing in Native American eyes by practitioners of scientific medicine has had measurable as well as intangible (though nonetheless real) benefits. The impulse to humbly accept hard-won, genuine knowledge from the primitive empiricism of folk medicine is praiseworthy. The rejection of demonstrably effective medical practice on the basis of what are essentially the aesthetic furnishings of a nebulous political philosophy seems to me a lot less so. I don’t regard this as one of those great philosophical conundrums; the basis for drawing the distinction is actually quite clear and simple: when we want to relieve pain and cure disease or injury, science is our best bet.
What that remark means is this: scientific medicine, in the strictest sense, responds to the disruption of the closed system which is the individual human body. In principle (though often not in practice) the scientific practitioner is utterly indifferent to any consideration other than the patient and her/his symptoms. Not long ago, some medical schools prided themselves on what they themselves called the “heartlessness” of their approach; a graduate of Washington University Medical School in the 1950s recalled to me how he had ventured a question, once, on an ethical matter, and the professor responded icily, “I’m sorry sir. You seem to be looking for the department of philosophy. That would be on the other side of campus.”
That’s a moment of the profession long past, and everybody’s glad of it. Some philosphy is called for. Quite recently, I was conversing with a very senior researcher in tropical medicine about suspicion, at the local level, of unquestionably effective treatments for the traditional scourges. He was inclined to see this resistance in terms either of superstitious fear of the unfamiliar, or, alternatively, a more sinister impulse among the witch doctors to maintain their monopoly. That is, operating from within his own myth of steady technological progress, he assigned native fear of scientific medicine to a primitive phase in technological history, or (he’d laugh if he heard this) a moment in economic development Marx would recognize as a rear-guard action in defense of economic privilege. Had he been an anthropologist, he’d have known that the methodologically conservative analysis assumes that a practice which has been carried on for any length of time probably benefits its practitioners, even if that benefit is not immediately visible to people outside the system in question. In the case of genuinely traditional medicine, practiced in traditional settings and for traditional purposes, for example, relieving the illness of a single individual may in fact be relatively unimportant, compared to maintaining a sense that things happen for a reason. This will scandalize some methodologies, but it will be easily understood by practitioners of family medicine, which early in its history was regarded with some suspicion — in rigorously scientific circles — as a subversion of the simple model of physician-as-mechanic.
Here is a not-at-all-hypothetical example; it’s been replayed numerous times: the western doctor can easily relieve a nasty infection with a broad spectrum antibiotic. But if this cure comes at the expense of communal belief in the need to gather around the patient and pray for a favorable outcome to the predictable course of escalating fever leading to a crisis which will result — at the will of the local deities — in death or recovery, this doctor has in fact done considerable damage. S/he then goes home, leaving behind one cured patient and one badly crippled community. That’s a pyrrhic victory if ever there was one. Of course, we could decide to re-work these societies from the ground up, civilize these savages properly (and that attitude has certainly governed a lot of our contact with traditional societies), but I don’t think our scorecard in the cultural wisdom game justifies us in the attempt. In fact, something of the same problem is now current within western medicine: many psychologists are deeply disturbed by the fact that fluoxetine seems to relieve severe depression in about 80% of cases, without recourse to insight, cognitive analysis or talk-therapy. Prozac, in short, requires us to rethink our own mythology about the value of painful experience, the need for self-understanding — or in an earlier mythology, the nature of sin, repentance, contrition, conversion and redemption. Are we better for a pill that makes all these things obsolete? And if you think so, would you then make that decision for everyone else? Is a comparatively quick and reliable cure for melancholia well-purchased at the expense of our deepest understandings of human nature, of the world, of experience?
All I’ve just said is to make the case for traditional medicine in its traditional setting and on a clear understanding that effective disease management is not the immediate objective. On that basis, and only on that basis, are these frankly ineffective practices to be esteemed, and I can see no grounds but contrariness, and an ego-driven desire to serve as the center of wisdom which has no place in the humanitarian cause of healing, for adopting these practices outside their traditional settings. Let’s recognize that this is to some extent an ideological divide, and part of the reason I’m a folklorist is my lack of complete enthusiasm for the notion of progress, on the whole — I’m a long way from denying the reality of progress, just critical of the attitude that records success according to one measure (let’s say gross national product) and thinks that improvement on this scale renders change along any other axis (for example distribution of income) uninteresting. But I’m also suspicious of those with an agenda and a willingness to let someone else’s illness test the latest home-hatched theory. People have a more than intellectual investment in these issues; an anthropologist once flung a plate of spaghetti in my face when we differed at a dinner over the wisdom of the BIA’s efforts to discourage a traditional Inuit practice of dipping newborns in a vat of stale urine.There are good reasons to be suspicious of technology; not everything it brings is good. Even medical technology has its drawbacks: resistant strains of strep, tuberculosis and other pathogens produced by the overapplication of antibiotics, for example, and the appearance of hospital-specific pathogens. But it took the physiology, case history, diagnosis, prognosis and prescription which depend on literacy, libraries, Linnaean classification, computer databases, the development of sytems for exchange of knowledge, falsification of hypotheses and cumulative learning to eradicate wild smallpox from the earth (though we may be insance enough to bring it back), and to render bubonic plague a curiosity in the west.
Both the system theory of western physiology and the acupuncture practices of the east (which do show clinical effectiveness, although the process is at present poorly understood at a theoretical level) depend on university-type training and testable hypotheses. No progress whatsoever against cancers and AIDS can be found in the folk materia medica. None. But “folk” remedies for these things have cost countless lives and caused untold unnecessary suffering. At their best, folk medical traditions provide psychological comfort and placebo effects, not trivial benefits, but they also delay the application of truly effective measures. I have heard more than one M.D. or D.O. sigh heavily about “cowboy doctoring” as s/he considered how, if at all, the effects of incompetent treatment could be ameliorated. It is a simple but alarming fact that the most common serious consequence of snakebite is not from venom (which may actually be delivered in fewer than half of all attacks), but the irreversible crippling of a hand or foot (most common locus of injury) as someone confidently cuts the traditional two x-marks between the bite and the heart (and right through tendons, which heal weak if they heal at all). Training of the laity in first aid is a good thing, but inexpert application of tourniquets by mythologically-driven persons who regard “binding” as valuable in itself has done its share of harm as well. And the familiar whiskey-cure has taken more lives than all the rattlesnakes put together, as anyone would expect who considered the synergy of muscle-toxins and the CNS depressant action of ethanol. The victims doubtless died happy, and maybe there’s value in that, but I’ll take the antivenin, thanks, along with careful monitoring for allergic response.
It is absolutely true that some herbal medicine has value — for example, the Chinese traditions. However, these are systematic science, based on written records going back centuries, not rooted in oral lore and inexact botany. Here’s just one example: feed the term “arrowroot” into your browser, and you’ll find lots of plants, related and not related, that go by that name, from the plant which gives us tapioca, to maranta arundinacea — its roots are said to be useful as a poultice against poison arrows, scorpion stings and black-widow bites, as well as for arresting gangrene. None of this is correct. The poultice keeps dirt out of the wound, it’s true, but so would a slice of potato or, even better, how about a nice clean Band Aid? The juice is said to be good as an antidote against vegetable poisons, but no one seems willing to say which ones. It’s kind of important: ingesting foxglove can stop your heart, while chewing poison ivy provokes a massive histamine response and closes the airways. And “arrowroot” also refers to maranta malaccensis, which is quite certainly used as, not against, arrow-poison in Borneo. Oh, and it is very effective indeed for that purpose. You see the problem? Most proponents of alternative pharmacy are moved by philosophy rather than profit. But democratic worldview, sentimental good intentions and low-tech, green thinking aren’t enough.
The frank silliness of herbalists’ claims that their remedies are “pure” but effective because they are chemically identical with the pharmaceutical versions is a good example of the triumph of advertising over intelligence: obviously, if you want the pure form, you don’t want something contaminated with God-knows-what congeners and additives, even if they were put there by Mother Nature (Nature kills more people than all the doctors ever did. In fact, as C.S. Lewis pointed out, the last thing Nature always does is kill you). If you think about it, what does “alternative medicine” mean except “that which has not been shown consistently to be effective?” It is widely recognized, and often repeated, that many chemically active substances were known in the Native American pharmacopeia, but close examination shows that they were rarely used in such a way as to release their specific virtues (people were smoking what they should have been infusing or poulticing, and vice versa). The number of naturally occuring medicines known and used to therapeutic effect by the aboriginal americans can be counted without taking off your shoes, and their medicine chest was heavy on laxatives, emetics and poisons. Hallucinogens like mescal and psilocybin were in ritual use, and coca was a common stimulant (as were caffeine and theobromine outside North America). The sumerians understood the uses of opium, as suggested by their ideogram *HUL*, probably translating “joy” or “rejoicing.” It’s not hard to reconstruct the rough empiricism which led to these discoveries. But you will search in vain through the annals of folk medicine for the crucial counterindications with which that big, thick PDR is quite properly taken up. Lacking a paper history, folk medicine relies on mythological or narrative patterns and on folk statistics, which amounts to counting the successes and ignoring the failures (characteristic, even definitive, of all superstitions).
Your grandmother loved you, and was no doubt a wise woman. But would you let her work on your computer, or on an airplane you’re flying? These are infinitely simpler mechanisms than your body. In the southwestern United States right now, beloved babies by the hundreds are being crippled and killed with large, well-meant doses of powdered red lead, said to be good for “blood conditions” — which, in the absence of labwork, seems to mean nothing much at all. This is just the kind of mystification to cover crucial ignorance with which critics charge the medical profession, except that scientific medicine has channels and institutions for identifying and countering such abuse. Folk medicine doesn’t.
I know this sounds like a bit of a rant. But if the century just past has taught us anything at all, it is that ideas have human consequences, often a body-count. As a folklorist, it is my job to share knowledge of folk practices, but I cannot entirely dissociate myself from responsibility for what results from abuse of knowledge I helped to transmit. I send you on to these links with the recommendation to study them as ethnographic data, not medical advice, whatever their claims; understand the psychology behind them, admire the folk who got along the best they could under the circumstances, but leave the practice of medicine to physicians; imperfect as they are, they know more about what they’re doing than the folk do.
Adam Brooke Davis
Truman State University
last edit 4-3-03