Book Review

Herbal and Magical Medicine: Traditional Healing Today

N Engl J Med 1993; 328:215-216January 21, 1993

Article

Herbal and Magical Medicine: Traditional Healing Today
Edited by James Kirkland, Holly F. Mathews, C.W. Sullivan III, and Karen Baldwin. 240 pp. Durham, N.C., Duke University Press, 1992. $45 (cloth); $18.95 (paper). ISBN: 0-8223-1217-4

“Indigenous medical systems,” writes coeditor Holly Mathews, “are known by a confusing plethora of terms including alternative, unorthodox, vernacular, fringe, nontraditional, unofficial, and ethnomedicine.” In this book 10 authors from various disciplines comment on the “indigenous,” “naturopathic,” and “magicoreligious” medicine practiced in North Carolina and Virginia. Their stated purpose is “to describe and explain the logic of traditional medical systems to health planners and practitioners in order to suggest how they can be integrated more effectively with biomedicine.”

This book is a welcome addition to an area of scholarship that remains understudied. Reliable reference materials concerning the history, theory, practice, and efficacy of “alternative” medical interventions remain inadequate. The essays in this collection introduce the reader to a variety of folk medicines, including “rootwork,” “talking fire out of burns,” “treating spiritual heart trouble,” and herbal medicines among the Lumbee Indians. Although these regional folk practices are less well known than chiropractic, acupuncture, or homeopathy, the themes and hypotheses posed in discussing them are applicable, nonetheless, to the study of all unorthodox medical practices.

The strength of this book is its emphasis on patient-doctor communication. Hufford, in a thoughtful essay, asserts that conventional medicine will neither assimilate nor “stamp out” folk practices. Clinicians, therefore, must learn “an effective diplomacy” in order to deal responsibly with a variety of medical models and practices. This task, according to Lichstein, “requires a blend of intellectual flexibility and nonjudgmental open-mindedness.” It requires one to master the art of listening. “Resolving cross-cultural differences,” says Mathews, “is ultimately dependent on sensitivity to, and respect for, alternative systems of belief about health and disease. Respect, however, does not necessarily mean approval.” This is the key message of the book. As summarized by Hufford, “understanding must often substitute for agreement.” Although these impressions emerge from analyses of Appalachian wart removers and rootwork conjurers, they offer valuable suggestions for clinicians who must contend with patients' ongoing “alternative” beliefs and practices.

Regrettably, the book is uneven in content and style. The chapter by Blaustein summarizes the other nine chapters but offers little new information. The essay by Camino is hampered by its dense anthropologic jargon. Similarly, the chapter by Baldwin on “aesthetic agency” is stylistically unappealing. Consider the following example: “Artistic patterning, symbolic meaning, cultural value, and authoritative source exert what can be a tremendous influence on the continued use or, at least, remembrance of folk medical information.”

The book is weakest in its efforts to address issues of efficacy and proposed mechanisms of action. Sammons suggests that a variety of folk cures “are effected through hypnotic suggestion -- a theory that provides a bridge between folk medicine and current scientific medical knowledge.” Although this hypothesis is intriguing, Sammons supports it only with anecdotal information, including an unreferenced study in which a subject was reportedly “given suggestions to remove warts on only one part of the body while no suggestions were given to eliminate warts on the opposite side.” Sammons writes that “one study has demonstrated the efficacy of this procedure” but provides no documentation. In the chapter describing herbal medicines, Croom discusses the complexity of designing adequate control trials; however, he freely acknowledges that the “scientific data are insufficient” to confirm the efficacy of the herbs he has catalogued.

Fortunately, throughout this book there is a recurrent plea for additional scientific research on alternative medicine. The book's authors contend that research in this area is relevant to patient care, scientifically complex, and expensive. Hufford summarizes the challenge best: “If we assume that we can answer the question, `Does it work?' in a medical sense with less than the kind of effort that we expend on new medical techniques, we are trivializing folk medicine and studying only bits and pieces of it.” Hufford is correct. Herbal and Magical Medicine contributes to this valuable line of inquiry.

David Eisenberg, M.D.
Beth Israel Hospital, Boston, MA 02215