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‘We, the public, have been led to expect too much [from medicine] and have been more than willing partners in the process. We have come almost to believe in magic cures and the waving of wands. The reality is a constant disappointment.’ [1]

Take your medicine with a pinch of salt is based on two premises: first, that when choosing between orthodox medicine, other therapies, self-medication, or simply letting our body’s natural defences do their work unaided, we need to be well informed; and second, that a healthy scepticism is our best defence against quackery, overly enthusiastic advertising and media hype.

In tracing the development of the major elements present in today’s health care industry, this book does not pretend to be a concise or exhaustive historical account of events.

Instead, it focuses on the topics, themes, principles and practices that are relevant across three treatment options: self-medication, orthodox medicine, and complementary and alternative medicine. (CAM as the latter is now commonly known among its therapists.)

Looking back over the centuries, several recurrent themes have shaped health practices and continue to do so, such as the prevailing medical and health dogmas, spats over professional territory and the entrepreneurial activities of quacks. Today the media, pharmaceutical companies and advertisers are additional factors that shape much of the way we view of health and illness.

Since we are now expected to participate in health care decisions, the burden of balancing the risks against the benefits has shifted towards the patient, and the phrase ‘the doctor knows best’ no longer has the influence it once did. Even so, many people still trust that diagnoses and treatments are based on scientific evidence and are justified by clinical experience. Apart from a few scientifically literate individuals, people are likely to be ignorant of, and uninterested in, the theoretical underpinnings of medicine and other therapies, and the procedures therapists use. By the time you reach the end of this book, I hope you will be convinced that while faith, and trust in others, are nice attitudes to have, they can be dangerous. History demonstrates that a healthy scepticism can help to protect us from medical incompetence or fraud.

Another theme in this book is that, although western medicine has some magnificent achievements to its credit and is the premier healing discipline, its history is not one of unmitigated progress. There is no doubt that health care is vastly improved, but in the process, there have been a few devastating disasters. Now twenty-first century science has made enormous strides in understanding the human body through genetic and intestinal discoveries. Hence it is scarcely surprising that the public’s view of the medical profession has ranged from ridicule to reverence. Like the rest of the scientific community and the general public, the members of the medical profession are a mixed bunch. They can fall prey to overweening pride, be guilty of fallacious reasoning, make hasty decisions, or be seduced by the thought of making a fast buck. George Bernard Shaw, who frequently satirized medicine, said he would ‘make it compulsory for a doctor using a brass plate to have inscribed on it, in addition to the letters indicating his qualifications, “Remember that I too am mortal”.’[2]ii

Nonetheless, it is important to keep the following in mind. Over the centuries the medical profession has prospered despite the waxing and waning of public opinion. The scientific age and the profession’s organizing ability are partly responsible for that. But medicine would never have prospered were it not for the fact that most practicing physicians have treated their patients with the best means they had at their disposal, sincerely convinced that their duty was to do good, just as Hippocrates recommended in the 4th century BCE.

All the players in the health care industry are heavily involved in promoting their own interests. As an introduction to the content of the chapters that follow, ten of the reasons we need to take their claims with a grain of salt are briefly sketched here.

One, it is not wise to believe that all plant-based products sold over-the-counter, or prescribed by your doctor, are free from unwanted effects. Thus, some degree of trial and error is still present whether we are self-medicating with unproven remedies and quack therapies, or taking a prescription drug.

Two, claims that orthodox medicine and complementary and alternative medicine (CAM) are based on totally different systems of medicine are only partially true. Since they are in competition with one other it suits the members of each discipline to present their practices in this way. However, an examination of their historical roots shows that their foundations and development did not happen independently.

Three, the idea that the medical profession is based on a solid scientific basis should be treated with caution. Its scientific foundation began when a diagnostic revolution in the 1800s broke the two-thousand-year thrall of the Greek texts, and most of the key components of presumptive medicine were discarded. A century later vaccinations and antibiotics led to a therapeutic revolution that raised the hope of curing many diseases and completely eradicating others. Careless and ethically irresponsible testing led to some notorious disasters, however numerous therapeutic breakthroughs rendered the second half of the twentieth century the most optimistic and dynamic period in medical history.

Four, professional organizations emphasize the humane and caring nature of their disciplines as though their entrepreneurial activities are of no account, and this tends to skew the way in which they are viewed. Medicine is now regarded as the epitome of professionalism—a well-educated and organized discipline working to improve the health of citizens, but the motivations that brought about this state were far more self-serving. Until the nineteenth century medical practice was a small-scale and fragmented enterprise, and often badly taught. It was divided by petty rivalries between individual doctors, and whatever professional standing it had was seriously threatened. The registration of practitioners and the setting of professional standards arose primarily to address these internal problems.

Five, despite enormous improvements in the education of orthodox physicians and of CAM therapists we can still be attended by incompetent practitioners. Registration at the end of medical education does not ensure that physicians and surgeons continue to be competent practitioners. As far as healthcare consumers are concerned incompetence only seems come to light when a patient’s complaint reaches the courts.

Six, over the last century hospitals have become much safer places and are no longer a short stop on the way to the morgue, but they are still not entirely free from risk. The overuse of antibiotics in the twentieth and twenty-first centuries has resulted in the infestation of modern hospitals with multi-resistant pathogens; while the number of adverse events (a euphemism for medical or bureaucratic errors) is a constant cause of concern. Considering the overwhelming size of busy teaching hospitals, the complexities of chronic illnesses and modern treatments, plus the grave shortage of professional staff, it is not surprising that errors occur.

Seven, there are many sources of health information which influence the way we view health and illness, some of these are reliable but many are not. In the past the prevailing medical dogma heavily influenced the education, and eventually held sway over, the advice given by a physician or an apothecary to those who could afford it. While religious and healthy lifestyle movements were very influential among sections of each community, the most pervasive source of information was the market place. Views of health and illness are coloured by stories of ‘breakthroughs’ in the media that are usually based on a press release from a medical research institute. Consumer self-help groups or watchdogs seek to make us more responsible for our own health and to shape our views in the process. Magazines and blogs promote the latest health fad. Pharmaceutical manufacturers and advertisers try to make us believe that the everyday events and traumas from which we all suffer are treatable conditions so that their prescription or over-the-counter drugs find a ready market.

A thread running throughout these chapters is that the enormous health industry we know today has been built on people’s fear of illness and hopes of cure, or at least, the reduction of symptoms. Such hope has often been amazingly rewarding to both professionals and patients. But at other times these hopes have been unjustified, or even based on fraudulent claims. Most of the health industry is incredibly profitable and as consumers age, we are increasingly the source of its profitability. The genetic nature of cancer explains the apparent paradox of medicine. As we survive other illnesses, more of us will live long enough to develop cancer. The challenge, which genetics may help to meet, is to turn cancer from a fatal disease into a chronic one. The unanswered question is, will that result in a lifestyle which we are happy with?

This book is written in the belief that the more we understand the evolution of the major components of the health care system, the more we can determine the validity of a medication or a therapy and the more we can minimize the risks attached to self-medication, orthodox medicine and CAM therapies. Health literacy, plus a dose of healthy scepticism, are requirements for deciding which claims of efficacy and safety should be taken with ‘a grain of salt.’

[1] Kennedy, I (1981), The unmasking of medicine, London: Allen & Unwin, p. 46.

[2] Shaw, G B (1913), The doctor’s dilemma: A tragedy (preface), London: Constable and Co, p. xciii.