“Natural?” you can keep it…..

BMJ  28 April 2005 Cite this as: BMJ 2005;330:1033

“I don’t want any drugs,” she said, “I’d like something natural.”

The term “natural” is a broad and much-abused church. In terms of Things GPs Don’t Like To Hear, it’s right up there with “He’s pulling at his ears.” It refers to the material world and to those phenomena that function independently of humans, but somewhere along the line , like “detox” and “herbal,” it became hijacked by the marketing men into a Sunday feature magazine bourgeois conceit: shampoos with “natural” spices, skin creams with miraculously anti-ageing “natural” herbs, “natural” products evangelically and uncritically fêted as remedies for every conceivable complaint, with attractive exotic names like black hellebore, ginkgo biloba. It’s even better if they come from the rain forest—endangered rainforest is best, especially if it has dolphins in it.

In the latter mode “natural” really means “completely untested, bugger all use, but probably safe and nicely expensive and a good earner for some crafty sod.” Strangely, people who have to live in the rain forest would prefer to have antibiotics and vaccines and maybe some antifungal creams for those eternally sweaty armpits and groins.

Opium is natural, as is phlegm, and vomiting and diarrhoea. If we left it up to nature, life would be nasty, brutish, and short; as hunter-gatherers we rarely lived to be 40, infant mortality was at least 250 per 1000 births, and half of us were dead by 5 years of age.

On the positive side of this pre-Raphaelite fairytale existence, there were no worries about the side-effects of hormone replacement therapy ,because the menopause was nature’s way of telling us we were mouldy and obsolete and to make room for the young and good-looking. Lifestyle changes were not an issue because we didn’t live long enough to get cancers and heart disease (we could have smoked our brains out in those days, no problem).

Nature is not cuddly and benevolent; it is cold and unfeeling and indifferent, and surrenders its charms grudgingly; any concessions have been wrested from it only by thousands of years of painstaking effort laced with occasional flashes of genius, often in the face of prejudice and persecution, thumbscrews, and iron maidens.

“Well,” I replied, “we could just do nothing and let you die; it doesn’t come any more natural than that.”

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