Alternative medicine (theories)

Alternative medicine is defined by the Oxford English Dictionary as "any of a range of medical therapies not regarded as orthodox by the medical profession", citing chiropractic, spiritual therapies, herbalism, homeopathy and reflexology as examples. There is, however, another common definition of complementary and alternative medicine, which distinguishes between complementary techniques that will collaborate with mainstream practice, and alternative practice that completely rejects orthodoxy. The latter is also called, by the National Center for Complementary and Alternative Medicine, a "whole system", which neither needs nor wants other methods. The approach of integrative medicine is to encourage collaboration between mainstream and complementary practitioners, thoroughly involving the patient.

There are, however, a wide range of ideological, economic, emotional, philosophical, religious, and scientific arguments of utility that may be considered complementary or alternative. A number of techniques once described as alternative therapies are often tried, along with different conventional approaches, in clinical situations where response is apt to be individual, such as acupuncture for the nausea of cancer chemotherapy.

It is difficult to get unbiased information on the field. An unidentified study, cited by Burton Goldberg as in the New England Journal of Medicine found that over one third of the general public preferred alternative medicine to conventional methods, citing the medical establishment's emphasis on diagnostic testing and drug treatments that did not consider the patient's well-being and health as a whole. A randomly selected specific study that can be identified in the New England Journal of Medicine, however, concludes

Among women with newly diagnosed early-stage breast cancer who had been treated with standard therapies, new use of alternative medicine was a marker of greater psychosocial distress and worse quality of life.

This comparison is not made to say Burton is right or wrong, but that information from alternative medicine proponents may have it own bias. There is little doubt that some mainstream organizations, such as pharmaceutical companies, may have manipulated safety reports to protect profit. Commercial interest may exist on the alternative side, such as the statement on Burton Goldberg's website,

When you need expert advice, counseling, the right alternative and integrative physician referrals you need to talk to Burton Goldberg first.

</ref> Edzard Ernst, a Professor of Complementary Medicine at the University of Exeter in the U.K puts usage even higher, saying that "about half the general population in developed countries use complementary and alternative medicine". And in some countries, notably China and India, what are considered 'alternative' treatments are central to government health strategies. "In 1948, the Committee by Planning Commission in 1951 and the Homoeopathic Pharmacopoeia Committee in 1962 testify to this. At the instance of the recommendation of these Committees, the Government of India have accepted homeopathy as one of the national System of Medicine and started releasing funds for its development"

In fact, there are social and cultural dimensions to health policy as well as scientific and historical ones. Nowhere is this more apparent than in the response and acceptance of 'alternative' approaches to encouraging health and treating disease. Acceptance and popularity are not evidence of efficacy, as is often demonstrated by the actual performance of some elected officials. In the United States, celebrity endorsements demonstrably help sales, until the celebrity is involved in scandal. Other celebrities, however, have a consistent record in promopting public goods.

While classical philosophical and cultural traditions indeed are critical to an outlook on health, so are direct-to-consumer pharmaceutical advertising and the fearmongering of some alternative principles. Balance is needed; one approach is the integrative medicine paradigm.

Health as bodily harmony

The underlying assumptions of alternative medicine are that health is a state of bodily harmony or balance, and disease is a disharmony or imbalance . This idea, central to traditional Chinese and Indian herbal treatments, is also present in the Western medical tradition, often taken as starting with Hippocrates. Hippocrates believed that the elements of good health were essentially environmental, such as a calm mental state, a balanced diet and physical exercise. Even that 'commonsense' health mantra of ‘fresh water, sunshine and exercise’ is by no means universal, it has its own social and cultural roots.

Vitalism, the doctrine that the functions of a living organism cannot be fully explained by the laws of physics and chemistry alone, has a long history in medical philosophies. Where vitalism explicitly invokes a vital principle, that element is sometimes referred to as the 'vital spark', 'energy' or élan vital, which some equate with the 'soul'.

Most traditional healing practices propose that disease reflects some imbalance in those vital energies that distinguish living from non-living matter. In the classic, pre-scientific Western tradition, these vital forces were identified as the four humours; Eastern traditions posit forces, such as qi, particularly important in conceptualising acupuncture and prana in Yoga. Such forces are not a major element of conventional medicine.

Philosophically speaking, the split between modern Western approaches and traditional, Eastern ones seems to have come about in the seventeenth century, around the time that René Descartes (1596-1650) split the world into two parts - the mental world of minds and the physical world of bodies - the theory known as 'dualism' and the English philosopher Thomas Hobbes described people as 'but an Artificial Animal, the heart but a spring, and the nerves but so many strings, and the joints but so many wheels'. (It is no coincidence that Descartes' Meditations starts with an account of the French philosopher's dissection of a monkey...)

Concepts in the 19th Century

However, medicine, of the time, is seen to have split away from the 'bodily harmony' approach in the nineteenth century, particularly following the discovery of disease-carrying pathogens and frameworks for their role, such as Koch's postulates. Prior to this, medical practitioners in Europe shared what is sometimes called the 'humoural' model of the human body, but no one school had a monopoly of authority in health matters. The nineteenth century microbiologists, however, had no effective approaches to individual treatment, but the knowledge of the origins of infectious disease led to major improvements in public health. Well before Koch, but in the nineteenth century, John Snow and Florence Nightingale greatly improved health through statistical analysis and evidence-based decisionmaking.

It would be, however, an instance of scientific revisionism to attribute to statistical analysis and evidence-based decisionmaking, the tools of modern clinical epidemiology and evidence-based medicine, the major improvements in population health that were observed in the XIXth century. The public health reforms that were initiated during this period were designed and enforced because thinkers of the time adhered to the view that decomposing matter and excreta were vectors of spirit-like entities that accounted for the epidemic nature of diseases like cholera. In the minds of clinicians and public health reformers, the miasmatic theory of disease allowed to design concerted efforts against major sources of disease.

John Snow explicitly rejected the theory of miasmas (i.e., "spirit-like entities that accounted for the epidemic nature of diseases like cholera"), through use of statistical analysis and evidence-based decisionmaking. Ironically, the UCLA School of Public Health, one of the main Snow resources cited below about general beliefs in "miasmas", gives his specific arguments against miasmas, beginning in 1831.

Snow felt that the miasma theory could not explain the spread of certain diseases, including cholera. During the outbreak of 1831, he had noticed that many miners were struck with the disease while working deep underground, where there were no sewers or swamps. It seemed most likely to Snow that the cholera had been spread by invisible germs on the hands of the miners, who had no water for hand-washing when they were underground...As more cases appeared, Snow began examining sick patients. All of them reported that their first symptoms had been digestive problems. Snow reasoned that this proved that the disease must be ingested with polluted food or water. If the victims had absorbed cholera poison from polluted air, as the "miasma" theorists believed, then their first symptoms should have appeared in their noses or lungs -- not in their digestive tracts.

Only later was it possible to demonstrate that the miasms they were containing by promoting purity and eradicating unnatural accumulations of waste, were, in actuality, bacteria, amoebas and viruses.

The germ theory for cholera was finally established, although earlier changes in the sanitary environment, called for by the erroneous miasma theory, had actually done much to reduce the transmission of disease. London provides an example of how useful a wrong theory (miasma) can be for addressing an epidemic (improvement of air, solid waste and water supplies), in this example cholera.

Two paragraphs above the above quote, in the same source, was the observation that the germ theory

...was supported by observations and epidemiological studies of John Snow (1813-58) in London and William Budd (1811-80) in Bristol, England.

Since that seems to be not enough about Snow's use of evidence, statistics, and causality, let us, then, consider his own words.

There is one class of diseases -- intermittent fevers -- which are so fixed to particular places that they have deservedly obtained the name of endemics. They spread occasionally, however, much beyond their ordinary localities, and become epidemic. Intermittent fevers are Undoubtedly often connected with a marshy state of the soil; for draining the land frequently causes their disappearance. They sometimes, however, exist as endemics, where there is no marshy land or stagnant water within scores of miles. Towards the end of the seventeenth century, intermittent fevers were, for the first time, attributed by Lancisi to noxious effluvia arising from marshes. These supposed effluvia, or marsh miasmata, as they were afterwards called, were thought to arise from decomposing vegetable and animal matter; but, as intermittent fevers have prevailed in many places where there was no decomposing vegetable or animal matter, this opinion has been given up in a great measure; still the belief in miasmata or malaria of some kind, as a cause of intermittents, is very general. It must be acknowledged, however, that there is no direct proof of the existence of malaria or miasmata, much less of their nature. Intermittent fevers were attributed to such agents from the absence of any other known cause, especially as they were observed to come on after exposure to the air of Certain localities, more particularly at night.

He continued a discussion of the implausibility of miasmas and the plausibility of disease transmission through contaminated water, using retrospective analysis. He goes on at great length. Is more necessary?

Revolutions as major as the discovery of pathogenic microorganisms, however, came first with the clinical use of antibiotics in the 1940s, and again with breakthroughs in immunology, and molecular pharmacology later in the twentieth century. The point that the standard of care in conventional medicine is arguably no more than 30 to 50 years old, yet some alternative advocates hammer at the undoubted incompetence of nineteenth century medicine. Integrative proponents look for evidence rather than conspiracies, although they are very aware that knowledge is imperfect, and that there indeed are both conventional and alternative practitioners that agree that gold, applied to their palms, is the ideal therapy. To equate nineteenth century medicine to twenty-first century medicine is as logical as equating nineteenth century and twenty-first century war.

The Theory of the Four Humours  The humoural theory, developed by the Roman doctor Galen, held that the four elements in nature - fire, air, water and earth - corresponded to four fluids in the body: blood, yellow bile, black bile and phlegm. Herbs were believed to positively affect the humours through four key properties: being hot, dry, cold or moist. Health was a matter of balancing the humours or ‘bodily juices’.

Nonetheless, Europeans at this time were particularly open to new treatments that arrived from abroad as a result of trade in far-off and mysterious lands. These were seen not merely as a response to a more fundamental bodily imbalance, but as the essential 'cause' of the imbalance. Hence they could be treated in isolation, usually through drugs.

Where conventional medical treatment is seen as effective in dealing with certain emergencies, such as physical injuries, other long-term illnesses and bodily disfunction's seem to some people to remain poorly understood and conventional treatments ineffective and even harmful.

Another objection to conventional medicine is its emphasis on treatment rather than prevention, although prevention is not defined in terms of the preservation of vital forces. It is interesting, however, that some of the greatest achievements in prevention came from physicians, from Jenner to Koop. Almost all direct healthcare spending in Western countries is on the former - some 85% in the case of the United States - as opposed to the latter. A very large expenditure of infrastructure, such as water and sewer systems, food safety inspection, and other indirect prevention factors are not always recognized by advocates of alternative medicine. It is probably safe to say, however, that more morbidity and mortality from cholera have been prevented by water and sewage treatment than by treatment of human beings. The epidemiology of cholera, and prevention by breaking the Broad Street Pump, was established by a conventional physician, John Snow.

The importance of lifestyle  A unidentified report cited by Goldberg by the US Centers for Disease Control (CDC) stated that 54%of heart disease, 37% of cancer and half of cerebrovascular [sic; perhaps Goldberg meant to say cerebrovascular accidents?] and atherosclerosis (hardening of the arteries) was preventable through changes in lifestyle. Such information is readily available, however, from as mainstream a physician as the director of the Centers for Disease Control, rather than as a revelation from a vendor of alternative health materials.

As Roberta Bivins puts it, "medical practices are typically culturally specific - that is, they are internally coherent with and respond to practically the cultures in which they initially developed". Bivens puts it thus:

The incorporation of dissection in to medical training and knowledge production was clearly integrated with Enlightenment ideas of rationalism and empiricism."

And today, advocates of enlightenment thinking cite examples of treatment by Alternative Health practitioners as dire evidence of the spread of 'irrationality". Yet how rational is say, modern medicine, and how irrational are alternative remedies? It has been said that unidentified World Health Organisation (WHO) figures, in the 30 years from 1967 to 1998, just under 6000 adverse drug reactions world-wide can be traced back to the prescription of herbal and other alternative medicines.

The WHO is indeed quite concerned with adverse drug reactions, including, in its 2002 report, Safety of Medicines: A guide to detecting and reporting adverse drug reactions; Why health professionals need to take action', which says "There are differences among countries (and even regions within countries) in the occurrence of" [adverse events], including:

the use of traditional and complementary drugs (e.g. herbal

remedies) which may pose specific toxicological problems,

when used alone or in combination with other drugs.

If, according to World Health Organisation figures, in the 30 years from 1967 to 1998, just under 6000 ‘adverse events’ world-wide can be traced back to the prescription of herbal and other alternative medicines. This figure does not reflect either the ratio of adverse events per total doses of medicines, nor the efficacy stated in terms of outcomes of treatment. It also does not appear in the cited report on adverse events.

Hind contrasts it with another unidentified University of Toronto study, in 1998, which found that were at least 106 000 fatalities each year, in the US alone, from side-effects of drugs approved by the Food and Drug Administration. Every FDA approval lists potential side effects of prescription drugs, and expects prescribers to balance risk and benefit. Approval does not, in any way, imply the drug is "proved" or always safe. .

The Right to Culturally Appropriate Healthcare  The World Health Organization determines four criteria for the adequate delivery of health care and the realization of the "highest attainable standard of health": Availability, Accessibility, Acceptability, and Quality (AAAQ) Acceptability : All health facilities, goods and services must be respectful of medical ethics and culturally appropriate, as well as sensitive to gender and life-cycle requirements.

However, anatomical dissection is opposed to the social values of Confucian China and Buddhist India, contributing to the continued acceptance of 'alternative medicine' in these cultures and conversely the added resistance to it in the West. Anatomical dissection is also anathema to most Orthodox Jews, a population that embraces may, but not all, aspects of mainstream medicine. Orthodox Jews, however, will accept autopsy when a rational justification can be made. Equally, approaches such as acupuncture and moxabustion were in harmony with the philosophical beliefs of the East, but opposed to those of the West. Central to both techniques is "an immense pharmacopoeia, a detailed disease classification system and a set of body-maps" which define relationships between the body's organs and systems, as mediated by a circulatory system "that moves both tangible and intangible substances" around the body. In particular, the strange (to Western eyes) concept of ‘’qi’’.

At certain points on the body's surface, the various vessels or channels through which these fluids move, and which connect different functional and sensory organs, can be stimulated, thereby altering the flows of qi within them and between the organs. In moxabustion, this is done through the medium of small cones of fibre (extracted from the leaves of Ateresia vulgaris or mugwort) that are burnt on top of the points. In acupuncture, needles, inserted to different depths and sometimes manipulated, are the means of intervention

The mystical lore of plants crosses virtually every cultural boundary. For example, according to Kathleen Karlsen , an advocate of herbal medicine, a 60,000 year old burial site excavated in Iraq included eight different medicinal plants. “This evidence of the spiritual significance of plants is echoed around the globe”, she adds. In Europe, works such as Pliny’s Natural History, which describes the supposed properties of plants gathered from numerous cultural traditions including the herbal practices of the Celtic Druids, and Dioscorides’ ‘’De Materia Medica’’ , which is a work regarded by some as the cornerstone of modern botany and by herbalists today as a key pharmaceutical guide. But the Romans were not the first.

In ancient times, healing formulas existed for almost every known disease. Specific conditions were treated with a variety of methods such as tinctures, teas and compresses or by inhaling the rejuvenating fragrances of essential oils.

Indeed, as Kathleen Karlsen also notes, “Shamanistic medicine, alive and well in traditional societies today, often incorporates the use of hallucinogenic plants which enable the herbal practitioner to reach unseen realms to obtain higher knowledge and guidance." Michael Harner, a participant observer trained formally in both anthropology, describes the manner in which the ritual of shamanic spitting was taught to him as generally compatible with concepts of psychosomatic medicine.

The doctrines of ancient healers and of plant lore has been central to medicine since ancient times, not only spawning approaches such as herbalism, traditional Chinese medicine, biofeedback, and homeopathy, but also influencing mainstream approaches to illness.These approaches draw upon general theories, such as sympathetic magic or the related theory of signatures.

For instance, the onion was favoured by the Egyptians not only as a food, and used as a medicine, but also respected for reflecting their view of the universe's multi-layered structure. Important oaths were made while holding an onion! Egyptians identifed medicinal properties in plants such as myrrh, aloe, peppermint, garlic and castor oil. Healing plants are also featured extensively in ancient Arabian lore, in the Bible, and in the druidic tradition of the ancient Celts. Herbal tradtionswere central to life in the Mayan, Aztec and Incan civilizations, and north American Indian herbal rituals.

The medical use of plants by the ancient Greeks reflected their idea that each of the twelve primary gods had characteristic plants. Such approaches are clearly methodologically incompatible with conventional medicine, to say the least. The US Food and Drug Administration strictly patrols claims made for herbal medicine, to prevent medical claims being made to promote them. On the other hand, herbs lacking such elevated 'connections', such as parsley, thyme, fennel and clery were allowed correspondingly more everyday roles in health, and are to many today more easily accepted as having 'health-giving' properties.

The transition from mystical and supernatural understandings of illness to scientific ones is still highly controversial.

Different languages for discussing health

One way to approach the debate (and lack of debate) between alternative and conventional approaches to health and biology is by comparing their two languages and trying to find proper translations, as Thomas Kuhn suggested, and acknowledge when there is incommensurability :

Incommensurability thus becomes a sort of untranslatability, localized to one or another area in which two lexical taxonomies differ ... Members of one community can acquire the taxonomy employed by members of another, as the historian does in learning to understand old texts. But the process which permits understanding produces bilinguals, not translators ... The bilingual must always remember within which community discourse is occurring.

Alternative medicine operates under a holist paradigm. It tries to identify shapes, as in the doctrine of signatures, and make them "resonate", as in homeopathy, which lies on the law of similars. It should be reminded that Plato, when he conceived the notion of Ideas, was also referring to the notion of shape (eidolon, from which "idea" comes, also means shape or structure).

Occasionally, Alternative and Conventional Medicine Meet  When the Yellow Emperor, in Ancient China, in 2700 BCE, asked his Chief Minister, Qi Bo, why it was that people 'nowadays' did not live as long, Qi Bo replied that it was because in the past people practised the Tao, and appreciated the flow of yin and yang and the principle of balance in all things. But 'these days', he added: People have changed their way of life. They drink wind as though it were water, indulge in destructive activities, drain their jing [that is, in traditional Chinese medicine, the body's essence, centred on the kidneys] and deplete their qi [life energy]... Seeking emotional excitement and monetary pleasures, people disregard the natural rhythm and order of the universe. They fail to regulate their lifestyle and diet, and sleep improperly. Qi Bo went on to recommend Dao-in, an exercise involving massage, stretches and special breathing to improve the flow of qi in the body and to return it to harmony with the rest of the universe. The notion of qi and of 'cosmic harmony' are 'incommensurable' within the Western mechanical view of the body. Eastern and Western medicine are talking in different languages. However, in some limited ways, the two languages can occasionally speak about the same thing. Researchers for several respected western institutions have shown that acupuncture points do exist, even if 'how' they work rests mysterious.

Alternative medicine proponents as well as others who are critical of materialism often state it is erroneous to assume that molecular biochemistry can cover all shapes and forms found in the living universe, and formulate doubts about logical reductionism. The axiom of this method of enquiry is that, by reducing life to its most fundamental components, by analyzing all its details, it will be possible to account for the observed universe, including how life and thoughts result or emerge from matter. The alternative view (which was the conventional view before the Enlightenment), on the contrary, adopts a phenomenological perspective. Observing that one plant, because of its shape, evokes an image, an idea, or an impression, the alternative-minded practitioner will immediately use it as a tool to discover occurences of this Idea in the sick or healthy body or mind. What anthropologists term sympathetic magic, which is often called "magical thinking", is prevalent in dreams and normal thought processes, but is not integrated in the scientific discourse. There are scientists with theological training, such as Pierre Teilhard de Chardin, S.J., who saw not alternatives, but complementary ideas that could be integrated. Some integrative thinkers wonder if the more strident advocacy for alternative views fear the idea that there might be multiple views, and that the mystical and the rational may form a new, more perfect union, rather than continuing to insist that something was lost in the nineteenth century.

But does science have, in its own terms, a way to account for the shapes we see in nature -- not at the microscopic level? A heated debate is taking place today on these matters, and raises hopes that alternative and conventional views might understand each other much better and propose an integrative view of life and health. Rupert Sheldrake, a Cambridge molecular biologist, came to the conclusion that the tools he was given were logically incapable of explaining how life develops the way it does: it provided the building material, but not the blueprints. Sheldrake started his enquiry with the problem posed by Sydney Brenner, an influential molecular biologist who later received the 2002 Nobel Prize in Physiology: development is the activation of the right genes, at the right place and the right moment -- but knowing that does not enable us to create a mouse or any other organism, as we don't know how this is orchestrated. When Sheldrake published A New Science of Life to present his analyses and hypotheses, the scientific journal Nature called his book "a book for burning" through the voice of John Maddox, the editor-in-chief. Rupert Sheldrake had proposed an expanded version of morphogenetic fields, called morphic fields, a notion not unlike Plato's Ideas. (in progress)

Democritus – scientific wizard of the 5th century bc  Roughly 2400 years ago, during an era largely characterized by unscientific thought, a school of natural philosophers led by Democritus of Abdera developed a remarkably accurate understanding of our physical world. How could this small group have discovered so much at a time when technology and mathematics were at such a rudimentary level? What if their methods and ideas had caught on immediately, instead of being virtually ignored for 2000 years?

In the Western world, the debate between idealism and materialism dates back to ancient Greece, some 2 millenia and a half ago. Democritus, who formulated, with Leucippus, the atomist doctrine "had a remarkably modern understanding of concepts like the conservation of mass/energy, the indirect nature of perception, the continual formation of and destruction of physical systems, the reality of empty space, the basic theory of colours and the fundamental principles of causality and determinism".