The world-wide influenza epidemic (which is then called a pandemic) of 1918-1920 infected an estimated one-fifth of the world’s population and killed 50 million people, far more than even died in World War I. It was a new strain of flu which, unlike previous epidemics, struck young adults in their prime. What I didn’t know about the 1918 strain of flu is that, essentially, it is still with us. It is the ancestor of many subsequent, milder epidemics. It is also the direct ancestor of the current flu strain we are all calling “swine flu.”

The 1918 strain did disappear for a time between 1957 and 1977. Its reappearance in the population probably was the result of an accidental release from a research laboratory that was studying the 1918 virus. Once it escaped and was back in the wild, so to speak, it never left us.

The natural reservoirs for influenza are humans, birds, and swine. How the various versions of the virus recombine and jump from species to species and back again is a fascinating story. If you are interested in how that works, you can read some excellent discussions here and here.

I’ve been doing research for my next book (tentative publication date is next spring) and have been looking into what is usually termed complementary and alternative medicine, or CAM, as it applies to children. The term CAM covers a lot of things — herbal therapy, hypnosis, massage, acupuncture, homeopathy, and many others. It is so broad a term that it seems inappropriate to talk about it as a single entity. But all these modalities do share one thing — a fair measure of antipathy toward standard medical practice, which is to say medicine practiced by doctors like me.

It is true that I was trained, like my peers, to regard all these alternative approaches as silly at best, dangerous at worst. But I’ve also been practicing pediatrics for thirty years now and realize that much of what I do is not particularly scientific, is sometimes guesswork, is and occasionally just blind luck. I’ve seen children make amazing, even miraculous recoveries from things I never thought they would heal from. And the pediatrics I practice is as high-tech as it gets.

It is becoming increasingly clear that the immune system and healing in general has direct connections to the brain, to our consciousness. For example, people with high anxiety levels or severe depression do not heal as well as those who do not suffer from these things. The scientific explanation for these effects appears to be alterations in brain neurotransmitters and how these substances directly affect other cells in the body.

The implication of these findings is that anything that brings a sense of well-being will promote healing. So it doesn’t matter to me if a particular herbal remedy, for example, helps a person simply by accomplishing that and nothing else. (I’m assuming, of course, that the alternative treatment doesn’t cause real harm, and a few of them do cause harm. I’m also assuming that the person doesn’t ignore proven medical treatments, things known to work.) It seems to me that proponents of CAM are often barking up the wrong tree when they strive to prove scientifically that what they are doing works in some direct fashion. That’s almost beside the point.

There is a good recent book about CAM if you’re interested in a detailed analysis. There are many strident books on this topic, loudly proclaiming the utter truth or total falsehood of CAM. This one, Snake Oil Science, has an inflammatory title, too, but on balance the book itself is actually quite sympathetic to the goals of CAM as a whole, even as it criticizes its claims. The author, Dr. Barker Bausell, is a biostatistician who was for some time with the Center for Complementary and Alternative Medicine at the federal National Institutes of Health. So he knows what he is talking about. Since I’ve written a few books myself, I know the choice of title is not up to the author, and I suspect Dr. Bausell would have chosen a less pugnacious one if it were up to him. (The publisher, of course, is mainly interested in selling books.)

Dr. Bausell’s conclusion is that whatever benefits CAM gives patients come from the placebo effect, our tendency to believe the treatment is working. I have no problem with that, since a physician’s job is to comfort and, if possible, to heal. If the child gets better, I’m happy, even if I have little idea why.

One of the chief dilemmas of healthcare reform is that, without some sort of intervention, increased access will raise costs enormously. That is what happened in Massachusetts, which chose to attack the problem of access first and costs second. When all those uninsured people finally got insurance, there was an explosion of pent-up demand. After all, as a nation we cannot afford what we’re spending now, even with millions of Americans without access to care. If we just provide the access through universal coverage without doing anything else, the cost will bankrupt us in short order.

Michael Porter, in a recent editorial in the New England Journal of Medicine, points out the obvious solution — finally, finally, we need to get good value for our health dollars. We certainly don’t get that now; as a nation we spend far more than any other Western nation for mediocre results. He reminds us that the goal is to take care of people: “Good outcomes that are achieved efficiently are the goal, not the false “savings” from cost shifting and restricted services. Indeed, the only way to truly contain costs in health care is to improve outcomes: in a value-based system, achieving and maintaining good health is inherently less costly than dealing with poor health.” We can save money, but this will come as a byproduct of doing the job right.

For America this truly can be win-win, although there will be losers. The losers will be physicians and hospitals that do too much of the wrong things, because they can and the present system rewards doing things. These potential losers have powerful friends. The insurance companies, I think, have finally realized that they cannot keep passing increased costs on to their subscribers. No business can survive if they make their product unaffordable, and healthcare premiums have reached that point.