Slow Medicine – an interview with Ladd Bauer

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Ladd Bauer is the author of the first journal article in English on Slow Medicine. The article had often been cited by Dennis McCullough as containing most of the essential principles of Slow Medicine in succinct form, while adding the first mention anywhere of environmental considerations. He is also  the organizer of the website listing on the history of Slow Medicine, which brings together an exceptional corpus of information on the development of the philosophy of Slow Medicine in the world. It is a great honor to publish this interview with Dr. Ladd, who answered our questions with great consideration and kindness, allowing us to catch a glimpse of the vision of a person who has lived and observed the growth of Slow Medicine movement in the world from its earliest days. This is one of the first bilingual articles that we publish on our website, with the precious collaboration of Claudia Araujo, who made an exquisite translation of the interview.

Slow Medicine Brazil (SMB): Would you like to introduce yourself and tell us about your professional activities?

Ladd Bauer (LB):

Oh dear. Which story should I tell?

I am a 62 year old white male US citizen of Northern European extraction, and therefore not terribly interesting. Perhaps if I had a genetic analysis performed, there might be some surprises, but even that is doubtful! It’ll all be German and English farmers. The only saving grace is that my background is unusual and provides both the blessing and a curse for my so-called “professional activities”. Let’s just say I’m not the Expert Doctor Stanford Harvard!

This fellow from Kansas was someone like Oskar in Günter Grass’s Die Blechtrommel (The Tin Drum). I refused as a child to develop along normal lines, and sought “other” answers to life’s questions. The result was that I was stunted as a modern adult, and slow to develop. Also, those questions have remained intact, as for example, “What are we here to do?” and “Who Am I?”. These are live questions, every day. I never left them behind.

A medical career came almost by accident, after a decade in the mechanical and construction trades as part of what is now called an “intentional community”. Exposure to a remarkable range of people from around the world was crucial to giving me the assurance that we are all crazy. A girlfriend talked me into giving medical school a try. I was not afraid of the medical school interviewers and their tricks, and I managed to fool them into taking me as an older student despite the lack of a college degree.

Psychiatric specialization was my aim, but the discovery that the profession had become almost completely drug-oriented caused me to switch to Family Medicine and Family Therapy. During training I attended the so-called First International Conference on Holistic Medicine in Bangalore, which led in part to a 25 year term as a strict reviewer on the editorial board of  The Journal of Alternative and Complementary Medicine . In the 1990s, while practicing the whole range of family medicine, I started experimenting with the use of online consulting, and became Clinical Advisor to the Alternative Medicine Foundation, which ran a scientific herbal database and promoted major conferences on traditions like Tibetan Medicine. Medical contributions and learning in Mexico, Afghanistan, England, and Eastern Tibet were interspersed. Simultaneously I was member, and later chair, of an ethics review board that examined standard and alternative medical research. For four years I hosted a radio program (called “A Pair o’ Docs” , a pun on the word “paradox”) with a colleague here, in which we conversed about doctor and patient stories and medical news, while listeners called in — probably the most useful thing I’ve ever done. In recent years I have concentrated on end-of-life issues and Slow Medicine as an idea for healing medicine itself.

SMB: How did you come to the philosophy of Slow Medicine?

LB: One day in early 2007, at her suggestion, my partner and I decided to go off to a local beach to brainstorm a simple way of referring to what I was doing and what was needed to heal medicine. Within fifteen minutes, the phrase “Slow Medicine” popped up out of the sand between us.

Within another thirty minutes, the internet said that the idea was not new, that five years earlier an Italian cardiologist had written an essay about “slow medicine” as a corrective to the overly rapid employment of medical treatments. The three main internet domains were taken by three other unidentified people. Yet as I spoke to friends about this idea, all I got were puzzled looks and sometimes comments like “I want my medicine fast!”.

A slow year went by, and I discovered that one of those domains had something on it: a new book written by Dennis McCullough MD . The presentation was promising, and focused on the need for elders to have a slow, respectful, and deliberative sort of care.  I quickly read the book the first day it came out, found his phone number and called him immediately.

The philosophy was already there long before the phrase, for many others in their own ways. It can be found in part in the founding principles of the then-new Family Medicine specialty in the 1960s. The common thread is the need for restored Time, Attention, and Listening.

SMB: How do you see the development of Slow Medicine ideas in the USA?

LB: The best image for this in my country, if you can picture it, is of “herding cats”. Each of the kittens wants to go its own way! Part of this has to do the individualism that is so ingrained here. This is positive in that various creative expressions are allowed to emerge, which contribute to a larger vision over time.

We’ve been like the blind people around the elephant in the ancient story — each of us sensing one part or another, but not able to grasp the whole. Slow Medicine is much bigger than an elephant. All of these people, here and around the world, are sensing whatever the creature is meant to be from where each of us stands.

The very greatness of this possible creation is why I am paying attention to slowly knitting together international perspectives. Containment is necessary, as in the Italian organization, and freedom to create without interference is essential also. One quality if overdone can lead to ossification and the other can lead to chaos. Slow Medicine reconciles seemingly contradictory principles like order and creativity.

SMB: How was your relationship with Dr. Dennis McCullough?

LB: It was really great. He was a remarkable gentleman and mentor, and his sudden death in June was a real loss. We became friends from the day in April 2008 I phoned him about his book. We were friends because he saw the best in almost everyone, could overlook my flaws, and wanted a team to form. We held a running argument about Slow Medicine: was it for geriatric medicine only, or was it applicable to everything in medicine from pre-natal care to the end of life? We even experimented with bringing the dialogue to my live program, which became “Slow Medicine Radio”. Gradually we rounded our positions off — I came to agree that geriatrics offered an easier place for people to swallow the idea of Slow Medicine in the US, and he came to be more admiring of foreign understandings, and of Slow Medicine’s applicability to children and adults. He went to an Italian Slow Medicine conference on my encouragement, and then called me from Torino excitedly, to say I had to come too!

The truth is that Dennis was good at being friends with most people, even those with whom he disagreed. He embodied Lincoln’s maxim: “I defeat my enemy by making him my friend.” Most crucially, he had a great sense of humor. I really miss him. He called two days before he died, to suggest a new project together. And then he was gone. But — he’s still here in the effect he had on many of us.

5. How do you see other initiatives in the USA, such as those led by Katy Butler, Victoria Sweet, Pieter Cohen, and collaborators ?

LB: Like I said, we’re all cats. These ones are good cats, doing particularly good work, and what they’ve written is well worth reading. The USA is a kind of workshop for ideas in Slow Medicine. I can’t say where it’s all going here.

SMB: An important issue: the interfaces between Slow Medicine and Integrative (or alternative) Medicine.

LB: This subject has engaged me since the 1980s, and presents many opportunities, for better or for worse. The word “interface” may not be the best one, because it suggests a borderline separating the two ideas. Slow Medicine offers an umbrella over all “medicines”, and I truly hope it is not turned into yet another euphemism for a stereotypical alternative medicine. My point is that all medicines suffer from a tendency to over-diagnose, overtreat, and overcharge as part of a cultural context that worships “experts”, fancy names, and money. The potential of Slow Medicine can be to be a “great idea” to bring into medical situations to alert us to the need for, say, just listening first. My vision for it is that it will serve as a meme for waking people up in moments where they habitually rush to an often expensive and useless or even harmful solution. Various alternative medicines can offer examples of unrushed listening, and they can also get us into costly ineffective schemes, just like standard medicine. Dennis cited his own experience with an acupuncturist who really listened better than anyone else. However, just because they’re alternative does not mean that people necessarily become so different. Pulling out a phrase like “Slow Medicine” can give a signal and permission to any kind of practitioner and patient to do the right thing. And unlike phrases like “integrative”, which launches stereotypes, or “right care”, which everyone assumes they’re already doing, it can do this “reframe” in any medical context.

SMB: Do you believe that the principles of Slow Medicine can have implications in Public Health policies?

LB: Well, yes, of course. While the movement exerts influence from below as the public learns its significance, the public health establishment responds by re-allocating resources to support more time for sitting with people and listening to them, up front. A nurse practitioner recently told me that a San Francisco health department has responded already to the writings and talks of great story-tellers like Victoria and Katy (who are in the Bay Area) by allocating more time for initial workups of patients in some departments. Studies are being done to demonstrate that this more effectively uses resources,  because it prevents hasty and expensive over-reaction, and gives better results. If patients call for this kind of approach more and more, systems will be able to respond as their directors’ comprehension of what works increases. The ideas work from both bottom up and top down, changing the “grassroots” and health systems at the same time.

SMB: There are at least four countries with initiatives to promote Slow Medicine. How do you evaluate this “internationalization” of the movement?

LB: Certainly more than four countries are involved. You may be referring to Italy, Holland, Brazil, and the US. Dennis gave talks in Singapore and Japan, and something significant may be happening in those places, too. Not to mention that the idea has popped up for years in places like a blog from an Indian obstetric nurse, another by an English doctor, and the web sites of alternative practitioners in Germany, for example. On down the scale, I met a doctor from Slovenia who became fascinated by the idea. So Slow Medicine may be like a therapeutic inoculation with effects here and there at various stages of development, that will eventually become confluent. Italy provides the most established and organized locus, just as it does with Slow Food.

Then, too, the story of the Tower of Babel comes to mind. Language presents all sorts of opportunities and obstacles for understanding what is going on. This “infectious idea” is therefore not likely to spread quickly from one culture to another. Some cultures “get it” quickly and others are more resistant. Various pockets of partial or corrupted manifestation may appear as well. Our work is to keep it clean and keep it going. The “fast medicine” that has spread around the world over many decades is toxic in many ways. Slow Medicine can be an antidote.

SMB:  Initiatives like Choosing Wisely, Alliance for Right Care, Less is More Medicine, seem to walk side-by-side with Slow Medicine. How do you see these campaigns?

LB: These campaigns are manifestations of Slow Medicine. They just don’t use that name. They’re part of it just the same, all clustered around the elephant and describing it as best they can. Even if there is never a Slow Medicine International organization, there will always be Slow Medicine. Dennis and I each tried to come up with a better term for years, and came to realize that it is the only designation that can carry most of the connected ideas, while helping people understand them more deeply by making them think a bit. It may or may not become a recognized catch-all term for all of these good projects. I think it would be helpful if it did. That’s the way the Slow Food meme works.

Look at us now. I haven’t really explained very much of Slow Medicine! Yet someone coming to this conversation will either have a sense of what we’re talking about already from these two simple words, or will look into the phrase and discover the richness of what it represents, including Choosing Wisely, Right Care, and the rest. As the meme spreads, it will serve as shorthand for shifting the direction and quality of responses to situations like childbirth or heart failure or medical system planning. It is already serving this way in gerontology in various parts of the US, and pops up in discussions even among hospital administrators.

SMB: Finally, the sick doctor or health professional…. Can the personal suffering or suffering of a family member raise providers’ awareness of the precepts of Slow Medicine?

LB: Yes. Too bad it can’t be the first part of our training! The practitioners I know who understand Slow Medicine best have gone through this one way or another. The need for re-balancing medicine becomes so clear as one experiences for oneself the automatic haste, waste, and unexpected harmful consequences of medical care mixed in with the good stuff. One also becomes grateful that we have so much available now. It’s on us, patients and practitioners all, to use it well and share our stories.

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Claudia Araujo is a physician and works as a specialized translator  in the medical-pharmaceutical field since 1987.

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