The mere affectation “alternative” is a misnomer – a contrivance – purposely designed to marginalize what at one point in our history were welcomed and rising forms of therapy. In researching my book, “The History & Evolution of Health Care in America: The untold backstory of where we’ve been, where we are now and why healthcare needs more reform,” I chronicle the rise of the battle between the various forms of treatments and how, those methods that seemed then to be the most promising and accepted, ultimately became damned and “alternative.”
If you were becoming a physician in the early 1800’s there were a number of popular schools to choose from:
- Allopathic – the dominant practice of the day emphasized bloodletting, purging, and high-dose injections and enemas of metal and metalloid compounds containing mercury and antimony.
- Eclectic – placed an emphasis on plant remedies, bed rest, and steam baths
- Homeopathic – outlined a different set of medicines in much smaller doses – as well as allowing the body to heal itself. Improved diet and hygiene played a huge role, as well as methods for stress reduction.
- Osteopathic – techniques relied heavily on the manipulation of joints and bones to diagnose and treat illness.
To the population of the day, the results of Allopathic, treatment (bloodletting, surgical intervention and large doses of medications) were typically painful, and often fatal. The potential negative results of Eclectic and Homeopathic treatments were often allergic reaction or no result at all. The rise of the latter two schools grew quite rapidly in the early 1800s. As most of the medicinals from the non-alopathic disciplines were readily available – and significantly less expensive – private allopathic physicians and apothecaries soon became very concerned about the drop in their respective businesses.
Power Shifts from Physicians
In the mid-1800s two developments significantly changed the landscape for physicians. In the early 1800s wealthy “pay” patients would not seek treatment at a hospital due to the stigma associated with them. Hospitals were squalid institutions for the insane and diseased where sick poor people went to die. Hospitals were the realm of “Doctors,” not “Physicians.” No self-respecting physician would refer a patient to a hospital because; A, physicians were not eligible to charge for services rendered at the hospital and B, if the patient could not pay – or even worse if they died – the referring physician would find themselves responsible for the payments and C, the patients they treated would not have been caught dead there – literally.
In 1846, with Dr. William Morton’s demonstration of the anesthetic properties of Ether, hospitals began their rise from squalid almshouses – where the sick-poor go to die and for the insane to be locked away – to places of medical education and painless surgical interventions. The creation of painless surgery with Ether allowed doctors in hospitals the ability to conduct longer and more precise surgical procedures resulting in better outcomes. In 1865, Joseph Lister’s discovery of the antiseptic qualities of carbonic acid (phenol) and publication of ” on the Antiseptic Principle of the Practice of Surgery,” literally revolutionized surgical process and lowered the mortality rate from surgical infection from sixty percent to less than four percent in under five years. With these two developments hospitals and their doctors gained a significant edge on physicians. Physicians were not able to readily use these technologies in one’s home. Larger rooms were required to house the antiseptic equipment (often sprayed as a fine mist into the surgical fields) and provide ventilation for the powerful and flammable anesthetic. It would do little good for the physician ministering to a patient in the sick-room in their home to pass out alongside the patient; or for the extremely flammable Ether vapors to reach an open flame and cause an explosion.
By the mid-1800s, many doctors complained of poverty and their extremely low social status. Some physicians were well off, but most others were not. We forget that cash was not a ubiquitous commodity outside of metropolitan areas. Those that attempted to practice in the country found bartering their only form of payment. Cash was not a currency they could deal in. During this time, an increasing number of people used home remedies or relied on patent medicines – except when dealing with serious injury or significant illness. In those cases, patients sought out “painless” and antiseptic procedures at a hospital where the physician was barred from charging.
New Politics Causes More Problems for Physicians
Most of the cures and treatments prescribed by physicians and pharmacists were simply not working. After the election of Andrew Jackson as President of the U.S. in 1829, public skepticism and the rise of “Jacksonionism” (a new way of thinking that encouraged Americans in general to play a greater role in the democratic process, also empowered the ordinary citizen through the belief that they were just as capable as the elite and highly educated) left the medical profession in a sorry state. As New York’s Medical Society journal reported,
“There is a handsome income for a few, a competence for the many, and a pittance for the majority.”
Many of the elite physicians were loath to look at their mode of practice and its efficacy, so they decided that they needed to reduce the number of physicians to increase their rate of pay and use the national interest in the exciting discoveries of science to elevate their chosen profession.
In addition, the rapidly growing and very powerful “Patent Medicine” industry was also starting to note the competition from the hands of these new medical disciplines. Powerful interests would soon line up against these alternate schools. By the mid-century other technological innovations soon put serious additional pressures on the private physician’s business interests. But due to the quick thinking by one New York physician, by then end of the century allopathic medicine would again become the sole discipline of licensed healthcare in America.
To recap, along with the rise of Homeopaths, Eclectics, Osteopaths and the patent medicine manufacturing industry, another blow was delivered to the physician in terms of business prospects. Hospitals were rapidly rising in power. Their staffs were training many of the new doctors, often in new less heroic competing disciplines, and now private physician’s paying patients wanted to go to hospitals for care. As this trend began to grow, it was apparent something needed to be done. In 1847, Doctor Nathan Davis founded the American Medical Association in order to elevate the standards of the practice of medicine and to advance the interests of physicians–Allopathic physicians!
In the view of the AMA, the medical profession in the United States in 1847 faced a crisis in public confidence. Medical licensure laws in most states had been repealed creating an atmosphere where uneducated practitioners and charlatans began to compete with educated physicians. Proponents of a “code of ethics,” as described by the membership of the AMA, hoped that the public would cooperate with allopathic (the now re-described, scientific practice of medicine) physicians in establishing standards for medical practice in the assuming that such action would reinstate public respect for the medical profession. They also hoped it would limit the public’s interest in non-scientific practices.
As a result, a three-pronged strategy was developed to enable the AMA to gain control of hospitals. The strategy was as follows:
- The AMA would assume control over the granting of physician licenses in order to control the number of doctors licensed.
- The AMA would stimulate physicians to open private physician-owned board-and-care homes to provide a competing location for upscale patrons.
- Wage a national campaign to convince the public that only AMA certified medical science could bring real cure and relief to illness, injury and disease, and position any other form of care as nothing more than “quackery.”
If the AMA could control the licensure of physicians then they could also gain control over the hospitals and force them to let private physicians charge for services.
The initial seizure of control over licensure by the AMA provided only limited success in garnering influence over the hospitals. The AMA was largely composed of allopathic physicians. A growing number of medical schools were granting licenses to homeopathic and eclectic doctors as well.
While the allopathic physicians voluntarily agreed to have the AMA act as the licensing authority, foregoing their authority to license their apprentices directly, they could not force the same for Homeopaths, Osteopaths and Eclectics. However, in 1858, the AMA established its Committee on Ethics and this next stage of development invited a series of systematic and successful steps to lobby states to adopt the AMA’s standards for licensure of physicians.
Physicians Regain Control
Further, the AMA adopted a campaign to embrace only the development of “medical science” as the legitimate basis for medical education. In 1889, in a report published by the Illinois Board of Health “on the Status of Medical Schools in the United States and Canada” there were 179 medical schools in North America: 26 were homeopathic, 26 eclectic, 13 miscellaneous, and another 13 were condemned as fraudulent. The remainder was allopathic schools or “regular sect,” as they referred to them in the report.
To deal with the problem of the other schools of medicine once and for all, and gain control over the hospitals, the AMA began to orchestrate a campaign to demand the evaluation of all medical schools in the U.S. Of course, only the AMA was qualified to conduct the study. In 1883 the AMA created the Journal of the American Medical Association (JAMA),to promote the treatment of disease with drugs and surgical process through “Medical Science” (allopathic medicine). The AMA quickly became the arbiter of what was good medicine. By 1909, a land-breaking milestone occurred: doctors were now allowed to charge for services performed in hospitals. The end-game was now in sight.
So Where are We Now?
The result of this organized effort by allopathic physicians was to stifle and obscure many promising, effective and less expensive and heroic treatments. How many effective options would we have today if these actions had not been taken? How many more cures would we have discovered if this early work had not been squashed? We will never know!
Was there any benefit to the public for the AMA’s action? Yes there was! It is true that in this period medical charlatans existed. Mortality rates were much higher. Treatments were often more deadly that the disease of which one suffered. There was a very good argument for the position of Nathan Davis and his colleagues that they needed to get some standards and laws in place to clean up the practice of medicine. It is interesting that during this period the AMA was in lockstep with and fully supportive of the Proprietary Association (makers of patent medicines) who shared a vested interest along with John D. Rockefeller and Standard Oil who supported the founding of the AMA and along with Andrew Carnegie funded its founding and the surveys that helped cripple medical schools and the hospitals gaining influence.
In the end the question, is how much was for the good of the profession and how much was for the good of the professional? We will never truly know. Reading the minutes of various associations meetings of the day there are clear indicators that the business gains were at least the driving discussions at the professional gatherings. Both Rockefeller and Carnegie had clear financial reasons to support Allopathic medicine and initially the Patent Medicine industry. unfortunately for the patent medicine men the tide of public opinion would turn against them in another 50 years and the other members of the cabal would unite against them.
History has at last begun to vindicate many of the damned practices lost to the purge against non-scientific medicine. In some cases we know have scientific basis for the observed results. In other we simple have overwhelming observable results that have yet to be explained. Or perhaps it is more appropriate to say that have yet to be explained away.
In the end, this cautionary tale is a lesson – a guidepost. Its message, to us, is that we should be cognizant of the unintended consequences of our actions, and vigilant in the roles of each participant, and their relative benefits, in any critical system like health care. Today, as we all recognize the need to redesign how we can deliver care to all with effective safety nets, efficient and cost-effective solutions, and preservation of choice; we need to assimilate the lessons of our own historical mistakes and develop a new and comprehensive health care supply chain. This is something we can do – something we must do!