Slow Medicine: A Conversation With J. Ladd Bauer MD.

March 8, 2018

Ann Armbrecht, The Sustainable Herbs Project,

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I came across Dr. Ladd Bauer’s work when I came across his website Slow Medicine which provides a brief history of slow medicine. My favorite of these was a lead editorial, ‘Slow Medicine’ that Dr. Bauer had written in the Journal of Alternative and Complementary Medicine in which he talks about, among other things, the ways we are all involved in the ‘fast’ medicine crises of American health culture. Dr. Bauer writes:

“We’re involved when a child has an ear infection and we go for a powerful antibiotic right away to ‘treat’ it, or if we have a minor heart arrhythmia with occasional slight symptoms and opt for a $100,000 procedure to ‘fix’ it… or when we want rare plant materials from the other side of the world for a minor condition. We’re involved if we make no effort to understand the multidimensional costs of our choices, as practitioners and as patients, to ourselves, our neighbors, our descendants, and to the earth and sky cradling us.”

In another article in the Point Reyes Light newspaper, Bauer writes: “This is the disease to be healed: that as a culture we’ve commodified everything, and devalued time and presence.” Slow Medicine, he writes, calls for a shift away from quick fixes, back to the slower, more long term qualities needed to bring about overall health and wellness.

I wanted to know more about Dr. Bauer’s thoughts both about slow medicine and about how to get there so I contacted him for an interview (for more on Slow Medicine, see our brief review of Victoria Sweet’s book, God’s Hotel).

Slow Medicine Defined

Ann: First, for those who aren’t familiar with the concept, can you define Slow Medicine?

Ladd: Slow Medicine is a movement for balancing fast medicine. The fast medicine we have — whether “standard” or “alternative” — tilts heavily toward hasty, reactive, reductionist, technologic, expensive, and often harmful means. Slow Medicine provides a shared language for asking for the right things for health within whichever framework of healing. Most systems reduce the possibilities to a few tracks. The right questions to ask are from outside those – for example, “Is there really a hurry on this?,” “Are these tests just looking for trouble and something to sell?,” “Is the treatment going to cause other problems to me or anyone else?,” “Would it be all right to watch and wait, to let this situation show itself more fully?”

If the term “Slow Medicine” catches on, it will serve as a shorthand for these sorts of questions that ask practitioners of any ilk to slow down and pay attention.

Language is important. I’ve tried for many years to come up with a better term than “Slow Medicine.” One good organization for health care reform has chosen “Right Care,” which represents a subset of Slow Medicine and is more comfortable and conducive to obtaining institutional grant money. That’s fine as long as the work stays within the academy – don’t get me wrong, it must be there, too. But try asking your practitioner for “right care.” Most think they already offer that. “Slow Medicine” gives them pause.

Ann: What does Slow Medicine offer that other forms of medicine don’t?

Ladd: Slow Medicine is not a technique. It is a social movement, a re-framed perspective and attitude arising publicly and professionally. The key addition from my perspective is that it starts with patients giving practitioners permission to do the right things, usually by spending more time, with good attention to understanding the patient as a whole. Various methods may or may not fall under its umbrella, and almost any can swing toward or away from Slow Medicine depending on the attitude with which they are used. Some, like traditional herbal medicine, are in more natural harmony for a number of reasons.

I once was called to an old farmhouse to see an old patient whose family had called 911 after she had collapsed. I met the rushing EMTs in her room, and after asking the first questions having to do with “seriousness,” gained more time to calm everyone down. She did need to go to the hospital 45 minutes away, but not that fast. She was nauseated, and the family asked if she could have something for that. I asked if any fresh ginger were available, and we ended up hunting through the refrigerator until we found some, a bit old, that she agreed to take as a slice under her tongue for the ambulance ride. We talked a while to clarify the situation and nurture a more relaxed and accepting atmosphere – including for the EMTs. She went peacefully, and I heard later that she didn’t need to vomit once.

I could have offered an anti-nausea medication. That might have worked, too, while creating other systemic effects (including those on the environment after she next excreted urine). The ginger wouldn’t hurt anything, and was just the right thing for a wonderful lady who had devoted her life to growing things for the benefit of people and offering them in ways meant to nurture the health of the community. Not just medicine, it became a multidimensional symbol. And it worked.

Medicine And The Environment

Ann: I was struck in your article on Slow Medicine by the link with ecological factors of medicine, that that is a key piece of what is needed. Can you elaborate? How did you come to place a value on the ecological impacts of medicines/systems of medicine? And finally, why do you think most people are slow to consider the ecological impacts of the choices they make regarding their medicine?

Ladd: Our culture generally treats its environment as a free box with stuff to take. We take something if we want it, without understanding its reciprocal relationships with larger systems. Until recently, medicine has gotten a free pass from the environmental movement. The sacred right of health has trumped balance with nature.

But then we started noticing things like active drug metabolites in city water systems, and toxic residues from medical waste, for example. We went after pesticides a while ago… are we ready to see that our medicines are often not so different from these pesticides? Aren’t antibiotics (“against living things”) another kind of pesticide (“pest[ilence] killer”)?

Once the discussion is someone’s health, we seem to have a shared cultural attitude that these other considerations are off the table. We have automatic catch-phrases to justify what is essentially extremely selfish behavior prompted by a forced urgency to act fast — understandable to everyone, but heedless just the same.

The worst of it is that we’re brainwashed — by the way we’re brought up, by advertising, by our friends and family — into wanting things that not only are very expensive to the shared environment (not to mention the shared economy), but that also make us and those around us worse off.

An example is that one in five people in the US dies in the Intensive Care Unit, many of them unnecessarily. There is obviously a place for fast medicine — someone invariably objects to the idea of medicine ever being slow and brings up the example of a heart attack. But even in an urgent situation, there is call for some internal balancing, because many errors are made by being rushed, whether as a practitioner or as a patient.

There is far more to say about this, and I’m trying to learn how to do that. I came to the ideas of Slow Medicine and ecological relationships backwards. I was educated first by growing up in a rural location and playing in the fields. Play meant observing soil, water, air, heat and light, with plants, animals, poles and wires and railroad tracks, interacting as a whole – an infinity of relationships, as many as I could see.

Then, in my early twenties, I received the start of another kind of education, still ongoing, on the relationships of various parts of and levels in life. One class extended my childhood by bringing us into the fields to spend hours observing a specific plant as a developing form, along the lines that Goethe taught. Not classifying and listing, but seeing. In medical school I was once berated – by a psychiatrist- for bringing up big-picture observations of the proceedings in a profit-oriented hospital.

Reminders that our purpose was to help patients and their surroundings get better were not welcome to the new vision of psychiatry for profit. I decided against my original plan to be a psychiatrist at that point. Since then, the field has become a paragon of fast medicine, in its use of toxic pharmaceuticals, overtreatment of a proliferation of sculpted diagnoses, and indulgence in payback schemes from pharmaceutical companies.

Seven years ago, after years in small town practice, I came up with the term Slow Medicine — while brainstorming for a term for what I was trying to do. There are other people who came up with the term from their own experiences. The first, an Italian cardiologist, wrote about it twelve years ago in Italy. Some of us have formed a loose collaboration. I seem to be the only one harping on the environmental angle, as you have noted.

Slow Medicine And Herbal Medicine

Ann: And what of herbal medicine? There is a lot that isn’t so great about the herbal products industry, but there is, I think, a lot of wisdom in the practice of traditional herbal medicine that uses plants wisely and sustainably. What do you see as the connections? What might herbal medicine offer the overall Slow Medicine movement?

Ladd: You’ve recognized that herbal medicine has potentials — as hinted earlier, it could be in Slow or Fast directions. Our culture, in contrast to many indigenous ones, is inclined to speed everything up — we go for more, faster. We got the Dust Bowl that way by rapidly and widely machine plowing before knowing what to nurture. Herbal medicine can be pushed in similar ways. But that is not its origin, as you know, and its natural potential favors Slow. Its ancient (and varied) experience has built up over a very long time in using plants that have evolved very slowly with internal and external relationships. Humans have slowly evolved (a debatable matter, I will agree) in tandem with nature, with those plants. A Slow Medicine experiment has been taking place over the entire history of humans in relation to plants. Traditional herbal medicines have been tested a wee bit longer than pharmaceutical products that have gone through the fast process used to vet them in an aggressive profit-based market economy. They have metabolites that the earth and sky are more used to.

Herbal medicine can see things in relationship, whereas pharmacy divorces a particular constituent from everything else and encases it, placing it in a linear and reductionistic context of “this fixes that” machinery.

Keeping the fast linear mind-set out of herbal medicine, and continually working to re-integrate ancient values that noticed relationships between elements and levels, will keep it on track. Appreciating the value of slow observation and listening promotes both the learning of well-tested means, and actually hearing what our patients are saying — more than their list of symptoms.

The herbal practitioners I know have something else going as well. They invite inquiry, and spend as much time as necessary to encourage understanding of the many relationships involved between the medicine, the person, the family, and the surroundings. That is true Slow Medicine. While there are many Slow Medicines, herbal medicine has a leg up.

What Next For Slow Medicine?

Ann: And finally, can you say a bit about your current work with Slow Medicine and your vision for the future?

Ladd: Slow Medicine is for me a huge idea. Like the Slow Food movement, it can head off in countless directions. It has that much potential and possibly more. One part of my work now is connecting the Italian Slow Medicine group with an institute in the United States that is working with the same medical reform perspectives. This brings up that many Slow Medicines not only are possible, but over the past decade many have already appeared from different people looking at this elephant with different partial perceptions. Several Americans have independently thought we invented the idea, the first being Dennis McCullough, though it was first Italian in conception. Dennis successfully promoted Slow Medicine as a geriatric and end-of-life concept, while I simultaneously (as his friend) advocated allowing it to expand into anything related to health care from before childbirth on. The Italians more recently formed a largely institutional yet broad notion of Slow Medicine that is aligned with Slow Food, but seems distanced from alternative medicine. We’re able to see, say, the trunk, the tail, and the legs. I see a whole gradually emerging out of sharing perceptions. This might be delusional, but what’s to lose?

My job as an “insider outsider” for each, is to translate between camps, try to bring them together, and continue to advocate an even bigger and more inclusive vision.

Patients may become able to communicate their wishes more effectively with practitioners when our culture has learned the meanings of this term. Not only that, but Slow Medicine presents another opportunity to bring other seemingly opposite groups under the same shelter at times. Conventional and alternative medicine have had a big problem here. We know the terms that have been used to bring them together, and they haven’t worked. I am a reluctant Associate Editor of The Journal of Alternative and Complementary Medicine, which has one of those names, and struggles with marginalization while amplifying it with many of its publication choices. If enough people from “standard” and “alternative” sides of the whole of people’s care in our culture would deign to stand under the same umbrella for a while, the suspicion and distrust might dissolve to some extent. Anyone who understands what Slow Medicine means has a germ of conscience on which to build trust, and the healing of medicine. Come to think of it, “heal” means “to make whole.”

Remember my little story of the home visit? That was standard (fast) medicine meeting Slow Medicine in the field. The result was better balance. That is my real work, regardless of what happens with the term Slow Medicine. Nonetheless, the movement has a decent chance of growing and doing its bit to midwife cultural transformation, especially of our inbred notions of health and healing.

Ann Armbrecht is a writer and anthropologist (PhD, Harvard 1995) whose work explores the relationships between humans and the earth, most recently through her work with plants and plant medicine. The Sustainable Herbs Project is a multi-media project seeking to launch a consumer movement supporting high quality herbal remedies, sustainable and ethical sourcing, and greater transparency in the botanical industry.

This article was republished from Sustainable Herbs Project.