The Horseshoe Theory of Alternative and Conventional Care

I remember learning about the Horseshoe Theory in tenth grade as it applied to totalitarian communism and fascism. I probably am too liberal in applying the concept to everyday life. That said, I never thought of how it applied to something I think about every day. I am grateful to Mo Petty for pointing it out to me.

Adam Cifu

In 2017, at age 36, I developed an ulcer in my esophagus, seemingly out of nowhere. I hadn’t been experiencing regular acid reflux that I was aware of, nor had I ever been particularly sensitive to spicy or acidic foods. But suddenly I had intense pain in my chest.

I saw a gastroenterologist, who performed an endoscopy and diagnosed the ulcer. After the procedure, lying in bed while the anesthesia wore off, I asked the gastroenterologist what the cause could possibly be. He said, “You’re probably either obese or abusing NSAIDs.” I have a BMI of 23, which he presumably could see by looking at me. “I take a single ibuprofen maybe twice a year,” I told him. “And I’m clearly not obese.”

“Well, then I don’t know what to tell you,” he said, as he scribbled out a prescription for Prilosec.

Thus began my journey toward functional medicine. The conventional practitioner’s toolkit was obviously under-equipped, containing only pills and surgical implements. Even specialists whose whole focus was the gut didn’t understand nutrition, had no knowledge of the microbiome, and seemingly had neither the time nor sufficient interest to help people help themselves.

I found a functional nutritionist who had me fill out an elaborate questionnaire about my dietary and lifestyle habits. She helped me slowly wean off the Prilosec while supporting my gut with digestive enzymes, homemade beet kvass, bone broth, and celery juice. It was a slow process, but it seemed to be effective. I haven’t had any issues since then. Now I have a passion for making my own sauerkraut, drinking kefir, and keeping my stress levels in check.

I’ve been following prominent voices in functional medicine for years. I’ve found a lot of value there, but recently I’ve grown increasingly wary of the constant sales pitches for new supplements, new gadgets, and new ways to practice vigilance against the insidious and invisible toxins infiltrating our lives.

I have friends who I find overly trusting and enthusiastic about the offerings of conventional medicine -- Another elective surgery! All the boosters! More scans, please! -- but then I see myself trundling off to my local Quest Diagnostics lab to get 10 vials of blood drawn for my annual Function Health lab tests, and I think, “Is this not the mirror image of their behavior, on another end of the continuum?”

My friend wants a third surgery to fix a roving pain in her neck, and I want to optimize my biomarkers so I can avoid surgeries and pills for as long as possible. But ultimately, we’re both thinking a lot about our health. And maybe that’s not really healthy.

In politics, there’s something known as the horseshoe theory — the idea that the far left and the far right, instead of sitting at opposite ends of a straight line, actually bend toward each other like the tips of a horseshoe. At both extremes, you start to see a strange overlap in habits of mind: certainty, purity tests, distrust of institutions, and authoritarian impulses.

Perhaps there’s a similar phenomenon when it comes to attitudes toward health. One end of the spectrum is “pursuing health” (often associated with biohacking and the wellness world), and the other is “pursuing disease and dysfunction” (often associated with overuse of conventional medical tools). Go far enough in either direction, and you can end up at a similar place — one where you’re simply doing too much.

On the conventional care end, people go shopping for doctors who will agree to perform procedures other doctors have deemed unwise or unnecessary. They want every vaccine available, regardless of the risk/benefit calculus for their age and health status. At the first sign of a cold, they go to urgent care and demand antibiotics. They want all the scans, with detection settings cranked to the max.

In this view, the medical system is the only entity capable of delivering health and healing. If there’s a symptom, it’s because something is chemically or mechanically broken, and only a doctor can fix it. If the system can’t or won’t fix it, failure is chalked up to negligence, gaslighting, stingy insurers, or a heartless bureaucracy withholding the cure.

On the other end of the spectrum, doctors are useless at best and harmful at worst. The body is wise; if you just fix the terrain, it will heal itself. Pharmaceuticals are toxins, surgery is mutilation, and vaccines are a plot, or at least a profit center. Instead of shopping for surgeons, people shop for protocols: stacks of supplements, detox regimens, infrared saunas, coffee enemas, ozone, stem cells, NAD drips, fasts, and cleanses with names that sound vaguely spiritual and cost an arm and a leg. They optimize their sleep scores and send vials of blood, stool, saliva, and hair to functional labs. If symptoms persist, the culprit is likely mold, or parasites, or heavy metals, or some subtle imbalance that only the right guru can treat.

Both ends curve toward the same mistake — toward an outsourcing of agency (whether to the white coat or the wellness influencer, the hospital system or the biohacker podcast) and a hunger for certainty and control. And like those at the far ends of the political horseshoe, they become bubbled and isolated from views and information that would mitigate their extremism.

Few people reside at the true extremes. But we’re all situated, by some combination of nature and nurture, somewhere along the spectrum. I’m an optimist with a strong internal locus of control, so I’ll always be on the “pursue health” side of the divide — though I like my wine and cheeseburgers too much to ever get close to the far end. Growing more aware of the pitfalls of the extremes (and learning evidence appraisal techniques from this very Substack) motivates me to strive even more for the healthy middle.

The middle is where you’re taking responsibility for the foundations of health (sleep, exercise, healthy diet, purpose, and social connection) and have the flexibility to slide in either direction as needed — take an antibiotic when a rash shows up following a tick bite, take a vitamin D supplement in the winter, get your Shingles vaccine after you turn 50, try acupuncture for your PMS and pain reprocessing therapy for your chronic back ache.

Look at the tools available, and have the discernment to fit the right one to any given issue. Don’t go looking for issues that don’t exist. And try not to judge the people who fall elsewhere on the spectrum — even those at the extremes can serve as a cautionary tale.

Mo Perry is a freelance writer, health journalist, and professional stage actor in the Twin Cities, Minnesota. Her bylines include The Atlantic, Elemental, Tangle News, Star Tribune, Minnesota Monthly, and Experience Life, where she’s a contributing editor.

Photo Credit: Med McDonald