A key issue is the popular concepts of disease. These – often relating to the
causative agents acting from both outside and within the body – involve both
natural and supernatural explanations. Depending on the demographics of
their practice, a practitioner will want to be familiar with aboriginal diagnoses
and treatments that confound conventional medicine, e.g. susto, a condition –
especially among aboriginal people in south-western USA – viewed as the loss
of ‘soul’ during a fright; it is best treated by an aboriginal healer rather than
conventional medicine. Although such diagnoses were once regional, recent
migrations of populations throughout the USA and Canada mean that all
practitioners should be aware of supernatural explanations. Another note-
worthy example is rootwork among African–Americans that generally
perplexes those who have not been alerted to its existence.^27
Whatever the belief or beliefs held by a patient, a conventional practi-
tioner will wonder about, for example, the role of the argument that
assumes that an intervention accounts for an effect or outcome and placebo
effects. Moreover, less tangible matters must not be overlooked in consid-
ering persistence of beliefs, e.g. the mystique that has long surrounded
‘Indian’ herbs and is partly reflected in such common names as Indian chick-
weed, Indian hemp, Indian pennyroyal, Indian pink, Indian plantain, Indian
sage, as well as squawroot and squawvine. Although such a mystique
contributes to a ‘pedigree’ of empirical knowledge, it must be pointed out
that relatively few plants used by North American aboriginal peoples had a
lasting impact on North American and European professionalmedical prac-
tice – as distinct from domestic usage – which raises doubts about the
generaleffectiveness of many of them, even black cohosh.^28
Depending on the patient and the questions (perhaps about the different
views that currently exist over the efficacy and safety of black cohosh), prac-
titioner–patient discussion might notice the uncertain historical record, at
least for use for menopausal symptoms. As noted, not only is there a history
of uncertainty, even when black cohosh was in fashion, but also there are
issues over current promotion that selects information to support a case, or
even over ‘reading’ uses into older texts to support current views on a
substance’s reputation in menopausal symptoms.^29 It is noteworthy that the
uncertainties found in the historical records continue into modern clinical
and scientific studies, which led to the title of a 2006 commentary: ‘Black
cohosh: will there ever be an answer or answers?’ In reporting on (1) uncer-
tainty over efficacy for menopausal symptoms (data are mixed) and (2)
adverse effects, the article also raised a significant issue, namely whether
black cohosh is oestrogenic with potentially analogous concerns to those
raised by HRT:
... the bulk of current thought and data do not support the idea that
black cohosh is estrogenic. However, [recent] studies... which report
54 |Traditional medicine