“Natural” is such a pretty word. It conjures up all sorts of nice mental pictures: waterfalls, butterflies, the slow return to spring after a long winter. When someone makes reference to nature and all things natural, odds are that’s the kind of thing you’re meant to think of in response. Presumably they’re not expecting you to think of amoebic dysentery.
The trouble is that there are horrible things that are also entirely natural. Nobody really celebrates freezing to death in January or being pursued by predators, as natural as they may be. But for skeptics of evidence-based medicine, “natural” is a handy go-to word to make the target audience share their skepticism. Modern medicine isn’t easily found in nature, the thinking goes, and so it is something of which to be wary at best.
This kind of rationale clearly undergirds the practice of a recently-profiled pediatrician who doesn’t vaccinate her patients routinely. "I think we're just messing with nature,” says Dr. Stacia Kenet Lansman of vaccinating children on the standard schedule (or, in the case of several preventable illnesses, at all). We are then meant to imagine immunizations plowing, bulldozer-like, through the primroses of a child’s pristine immune system. (Never mind that the immune system is quite capable of handling all those vaccines and more.) Nature is not to be messed with!
“It is the natural course of type-1 diabetes for the patient to waste slowly to death, but nobody questions the benefits of exogenous insulin.”
What she doesn’t want you picturing is measles spreading like wildfire through her unvaccinated patients. Which, of course, would be a perfectly natural outcome.
There are plenty of wonderful ways of maintaining health that come from nature. I am on essentially the same page as Michael Pollan when it comes to what constitutes a healthy diet—basically foods as close to their natural forms as possible. I tell patients that good sleep habits and regular exercise will probably do more under most circumstances to make them feel good than anything I can prescribe. There is at least some evidence that letting your kids play in dirt is probably better for them than raising them in an ultra-clean germ-free zone.
“Natural” and “healthy” often go hand-in-hand. But they’re not synonymous, and the former doesn’t always lead to the latter.
It is the natural course of type-1 diabetes for the patient to waste slowly to death, but nobody questions the benefits of exogenous insulin. Albuterol inhalers come mass-produced from a factory, and yet asthmatics still prefer them to wheezing uncontrollably. Presumably if any of Dr. Kenet Lansman’s patients get stricken by the rotavirus she declines to protect them against, they will avail themselves of the wholly unnatural IV fluids that will keep them from dying of dehydration after days of non-stop vomiting and diarrhea.
If you flush your waste away to be processed in a treatment facility, you are messing with nature. (Those of you taking a break from digging your own latrines to read this essay, please carry on.) If you are plugged into the electrical grid in order to power your home, nature has been messed with to a great extent by the time you flip the switches. If you’d rather pop a couple of Advil than hunker down with a strip of willow bark the next time you get a headache, then you understand that sometimes an unnatural route to feeling better is still the right one.
Do these manipulations of nature sometimes cause ill effects that must be managed or mitigated? Of course. But good sanitation, electrical power, and telecommunications are manifest benefits to humanity that we all recognize as worth the deviation from a purely primeval life.
So, too, with modern medicine. Some interventions, like chemotherapy for leukemia, have serious side effects that must be closely monitored but are still obviously worth it in pursuit of curing the patient. Others, like vaccines, carry such an overwhelming benefit at minimal risk that any decision to refuse them requires a justification other than logic. Hence, vague words with unclear meanings like “natural.”
Doctors are charged with keeping our patients healthy. Often there is a natural route to that, but sometimes there is a human-made one instead. That doesn’t make it wrong, and leaving children vulnerable to preventable diseases makes no more sense than swearing off flush toilets.