Patients, Consumers, and the Enduring Challenge to Medical Authority

It has become a mantra of retailers that “the customer is always right.” This tenet, however, has not traditionally been a guiding principle of medical practice. In the familiar narratives of medicine, physicians, not patients, have the expert knowledge and authority; physicians expect patients to follow their prescriptions. Histories have often told a story of the rise and fall of this medical authority, from the chaotic marketplace of nineteenth-century American medicine, to a “golden age” of medical authority and prestige in the 1950s, and then to the challenge that emerged as new commitments to informed consent and patients’ rights in the 1960s and 1970s introduced a consumer ethic that transformed patients into customers.

Although historians have understood this narrative to be an over-simplification, the extent of the historiographic problem is demonstrated with unprecedented clarity by three new books. Of the three, only Tomes’ Remaking the American Patients focuses explicitly on the consumer transformation. However, each examines patients who, for different reasons, became skeptical of physician expertise, challenged physician authority, and asserted their right to make their own decisions. The authors treat patients’ “unorthodox” behavior with seriousness and respect, showing how and why patients became disillusioned with medicine and with the commercial interests behind it. The result is not simply another patient-centric perspective on the history of medicine, of the sort launched by Susan Reverby and David Rosner’s “Beyond the Great Doctors” (1979) or Roy Porter’s “The Patient’s View” (1985).¹ The books reviewed here go further and offer a fundamental correction to many historical claims that have long been taken for granted. They demonstrate that there was never a golden age of unquestioned medical authority. Instead, medical authority has been consistently challenged ever since it first took its modern form in the late nineteenth century. Patients as consumers have repeatedly asserted their right and ability to evaluate critically physicians’ claims and to make their own decisions.

Cayleff’s Nature’s Path is the most straightforward. It provides the first full-length account of naturopathy as both a therapeutic practice and a way of life. As she defines it, “Naturopathy is at once a medical system and a way of living in harmony with, rather than conquering, the natural world” (p. 1). Naturopathy was one of many therapeutic systems that emerged in the nineteenth century, alongside homeopathy, hydropathy, osteopathy, and others. All share a similar narrative, with a charismatic founder who proposed an idiosyncratic theory of pathophysiology and therapeutics that found adherents but existed on the margins, increasingly persecuted as orthodox (allopathic) medicine consolidated its authority. These systems were part of broader cultural critiques, not just of medicine but also of capitalism, monopolies, pharmaceuticals, environmental pollution, and atomic energy (p. 4).

Cayleff takes this basic framework and fills in the fascinating story of naturopathy, focusing on the history of the profession and its leaders, without a correspondingly detailed exploration of the experience of its patients or the ways in which its remedies provided relief (or not). With roots in German water cures, naturopathy appeared in the 1890s. Benjamin Lust, who had trained in allopathy, homeopathy, and eclectic medicine, received rights to the term “naturopathy” in 1896 and led the discipline for over half a century. Lust adopted a big-tent approach to therapeutics: his naturopathy “blended methods from nineteenth-century domestic medicine, Thomsonianism, homeopathy, botanical therapeutics, physical and health cultures, hydrotherapy, osteopathy, chiropractic, vegetarianism, electricity, eclecticism, sun and light cures, fasting, iridology, dietetics, hypnotism, neuropathy...