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Alternative to What? Complementary to Whom?


"What we hope to do in this series is not to promote CAM [complementary and alternative medicine] but to promote an understanding of CAM by looking at it from various perspectives," said Stephen Straus, director of the National Center for Complementary and Alternative Medicine (NCCAM) in Bethesda, Maryland, when introducing the brand-new NCCAM lecture series called "Distinguished Lectures in the Science of Complementary and Alternative Medicine."

Speaking to a full auditorium on the National Institutes of Health's (NIH's) Bethesda campus, Charles Rosenberg, a professor of the history of science at Harvard University, delivered the inaugural talk on 18 July 2002. NCCAM plans to hold two lectures each year; the next will be held on 7 November 2002.

In opening his lecture called "Alternative to What? Complementary to Whom? On Some Aspects of Medicine's Scientific Inquiry," Rosenberg observed that although CAM has apparently become popular, there's still a tension--a "polarizing" force--between modern medicine and CAM. He cited a New York Times letter to the editor, published in 1992, that criticized the apparent legitimacy that NIH was giving CAM by establishing the Office of Alternative Medicine, the precursor of NCCAM. "There is so much social affect--deeply felt thoughts and feelings" associated with CAM, Rosenberg said.

Rosenberg went on to explain that what we think of as "alternative" today was, in fact, ordinary medicine. "Until recently, it was never assumed that most medical practice was done by doctors," he said. Instead, people relied on family members or other laypeople with certain skills, such as barber-surgeons, bone-setters, and clergy, who practiced medicine in people's homes--not at a hospital or other designated place. The predecessors of modern doctors were more like learned scholars and professors. "They were people who knew how to read texts and think about texts," he said.

Until the mid- to late 19th century, patient care was not disease-centered but patient-centered. Accepted medical practices were characterized by holistic philosophies that took many causal factors into account. "There was an enormous emphasis on the relationship between lifestyle and chronic disease, between lifestyle and predisposition to acute infectious diseases," Rosenberg explained. "They believed that you were dealt certain cards, but that environmental circumstances and lifestyle determine how you play those cards."

In the United States, a number of sects formed in the 1800s that were antagonistic to the modern medicine movement. According to Rosenberg, these sects were organized and had political agendas. Examples include Thomasonian, or herbal, medicine, which was based on native herbs; homeopathy, which relied on low doses of medicines; and the so-called "water cure," the proponents of which advocated water as a cure-all. Although some of the sects disappeared over time in the United States, some of their ideologies were assimilated into modern medical practices. For instance, Rosenberg says, "homeopathy, by the 1860s and 1870s, was beginning to look more and more like 'regular' medicine. They set up schools, adopted a code of ethics, had a national certification, set up hospitals." Later on, osteopathy followed a similar course.

By the late 1800s, modern medicine was dawning. Important diagnostic tools, such as the x-ray, were developed, and hospitals were becoming the accepted place to go for medical treatment. Modern physicians were becoming disease-oriented. Rosenberg explained that most historians describe the thinking style of the period as "reductionist": People started looking at smaller and smaller pieces of problems. Paradoxically, he said, while social and political science were taking shape, Christian Science (an "antireductionist" movement) was also developing at this time. Rosenberg commented, "There was a lot of polar opposition" between these two groups: those who viewed treatment from a pure physiological and molecular perspective versus those who felt that treatment should take the whole person and his or her environment into account.

"We all know who won," said Rosenberg. "The laboratory won. The notion of medicine and science, even if imperfectly applied, won. It won in terms of dominating public policy, dominating life, dominating the notion of educated people for what they should expect in medicine."

In examining the situation today, Rosenberg posed the question: Although the laboratory won, so to speak, "why is there always a substantial number of people who employ practitioners and modalities that are not taught by medical schools, that are perceived as 'other'?" He cited six reasons for this:

  • The importance of chronic disease in our society: With better modern medical techniques, people are living longer. Simply by lengthening life-span and getting older, people are developing more chronic diseases. He said that this "is creating a lot of unmet expectations." As a result, people are searching for anything that might help. Also, geriatric research is "not a high-status area" for physicians.

  • Body-mind issues: The fact that emotions could contribute to disease progression or onset "is not in the foreground of the regular medical world," which causes some people to explore alternatives, he pointed out.

  • Subjective diagnosis: Many ailments that cause a great deal of pain, such as headache, addiction, and chronic fatigue syndrome, are difficult to diagnose with today's medical methods. These patients "are not very treatable" with modern medicine, he said, so they might look elsewhere for relief.

  • Existence of underserved or inaccessible populations: Another type of person who might try CAM approaches is one who is not well served by the medical establishment because of socioeconomic status, class, ethnic background, or geographical isolation.

  • Holism/desire for meaning: Some CAM seekers are looking for "a meaning that transcends mechanism: Why did I get sick? How does that fit into my environment; my religious beliefs?"

  • Diet and regimen: "Medicine has not dealt very well with diet and regimen," he observed. Food fads and the like have always been in the background, but they have not been a major focus of modern medicine.

Looking toward the future, Rosenberg doesn't think that "the relationship between core medicine and something larger than core medicine" is going to change. There will always be a problem of "boundary maintenance" and "guerilla warfare." He concluded by saying, "The details are going to change. The modalities are going to evolve. But the notion of boundaries, the notion of emotional and social tension at the point of the boundary, is not going to change either."