Alternative medicine (theories)

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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.[1] Edzard Ernst, a Professor of Complementary Medicine at the University of Exeter in the U.K. says that "about half the general population in developed countries use complementary and alternative medicine",[2] 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. Following the recommendation of these Committees, the Government of India accepted homeopathy as one of the national System of Medicine and started releasing funds for its development." [3]

There are social and cultural dimensions to health policy as well as scientific and historical ones. This is apparent in the response to and acceptance of "alternative" approaches to encouraging health and treating disease. In the U.S.A., celebrity endorsements demonstrably help sales of all products and services in general but acceptance and popularity are not evidence of efficacy.

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 [4]. 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 17th 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 19th century, particularly following the discovery of disease-carrying pathogens and frameworks for their role, such as Koch's postulates. Before this, medical practitioners in Europe shared what is sometimes called the 'humoral' model of the human body, but no one school had a monopoly of authority in health matters. The 19th 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 19th century, John Snow and Florence Nightingale greatly improved health through statistical analysis and evidence-based decisionmaking.

The Theory of Miasmas and the Youngest Science

One theory of the origin of disease is that they ware caused by miasmas, or spirit-like entities. Some public health and preventive medicine measures were taken in an attempt to prevent or limit miasmas. These measures, however, were effective, for the wrong reasons, because they prevented the propagation of real disease-causing microorganisms (i.e.,pathogens) or the vector (epidemiology) by which the pathogens spread, such as rats, lice, or food and water contaminated with pathogens.

When pathogens were identified in the 19th century, a variety of evidence-based methods were developed to prevent infection with them, fighting their effects with methods such as active and passive immunization, and eventually with specific antibiotics. Much of the understanding came in the 20th century, with the rejection of ideas such as miasmas. [5] and molecular pharmacology later in the 20th century. Infectious disease are still not a solved problem, as there are diseases that are not affected by any antibiotics. Some pathogens, previously susceptible to antibiotics, have become resistant to them. Antibiotic resistance, in part, is due to insistence on their use in self-limiting conditions not likely to be effective, or to their overuse as agricultural growth stimulants.

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 19th century medicine. Integrative proponents look for evidence rather than conspiracies, although they are aware that knowledge is imperfect, and that there are both conventional and alternative practitioners who agree that gold, applied to their palms, is the ideal therapy. To equate 19th century medicine to 21st century medicine is as logical as equating 19th century and 21st century war.

The Theory of the Four Humours 

The humoral 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’.

Vital force versus etiologic agent

Most forms of alternative medicine believe that disease is a fundamental bodily imbalance of the vital foce, but rather as specific, isolated etiologic agents that could be treated in isolation, usually through drugs. Europeans at this time were particularly open to new drug treatments that arrived from abroad as a result of trade in far-off and mysterious lands. [6] In reality, very few new treatments of this time had any effect on the actual disease. Cinchona, the bark of a tree containing quinine, was one of the few exceptions; quinine does have a real effect against some forms of malaria. The lack of efficacy of those pre-scientific treatments was seen by vitalists as a rejection of the idea that there was a specific etiology that drugs would correct.

The drugs of that time, selected without any real understanding of their mechanisms, were usually ineffective and often toxic. Their lack of efficacy, however, did not necessarily confirm the idea of vital force. Conventional medicine now often sees a body imbalance in terms of genetic or environmental failures of some normal body function, such as the inability to absorb Vitamin B12 creates pernicious anemia, or the death of insulin-producing islet cells in the pancreas causes Type I diabetes. In each of these cases, the medical response is to provide, in useful form, the substance that the body cannot provide by itself.

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

Most mainstream health workers emphasize prevention rather than treatment- but do not define prevention in terms of preservation of vital forces.[7] Some advocates of alternative medicine insist that most healthcare spending is on treatment rather than prevention, and this would not be the case if they had their way. There is no question that lifestyle changes would avoid much disease, but making these changes involves personal choices of behavior that may not be acceptable to many people. When people are unwilling to make these choices, then the ethical choice becomes either using a treatment-oriented approach, or condoning suffering. Even healthy lifestyle choices may be overridden by genetics; Jim Fixx, an advocate of unquestionably healthy lifestyles such as distance running, died at 52 from cardiovascular disease.[8] The deposition of cholesterol in coronary artery disease is significantly affected by genetics as well as diet and exercise; if lifestyle changes do not reduce measurable risk factors, the first stage of intervention is to use drugs that help the body avoid atherosclerosis, but, if they are not enough, then far more intrusive steps, such a coronary artery bypass graft surgery, may extend life, or preserve quality of life.

Culturally appropriate practices

The World Health Organisation (WHO) posits a right to culturally appropriate practices. To be able to discuss practices, however, one needs to have some structure.

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. [9]

A taxonomy from the National Center for Complementary and Alternative Medicine to categorizing them, in part, breaks them into 'biologically based therapies, as opposed to manipulative and body-based practices and energy medicine. herbalism and dietary disciplines tend to fall into the former. Biologically based CAM often is cited as an alternative to drug treatment, where the others may be more related to surgical methods and drugs that address localized symptoms.

Yet how rational is say, modern medicine, and how irrational are alternative therapies? This is a question that can be addressed, but not in broad generalities.

Biologically based alternative methods

One of the key challenges in CAM versus conventional medicine is the concern over the safety and efficacy of pharmacologically-based models versus alternatives. Nowhere is this more evident than in comparisons between phytotherapy and molecular pharmacology. 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. This is a tremendously long period when compared with the development of molecular pharmacology, which largely in the laboratory in 1967. More recent, finer-grained comparisons may be more meaningful. 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.[10]

This does not reflect either the ratio of adverse events per total doses of medicines, nor the efficacy in terms of outcomes of treatment. It also does not appear in the cited report on adverse events.

The mystical lore of plants crosses virtually every cultural boundary. For example, a 60,000 year old burial site excavated in Iraq included eight different medicinal plants.[11] . 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.

Shamanistic medicine in traditional societies often incorporates the use of hallucinogenic plants. 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. [12]

Anatomically based alternative methods

The incorporation of dissection in to medical training and knowledge production was clearly integrated with Enlightenment ideas of rationalism and empiricism." [13]

Dissection provides greater knowledge of anatomy, which is directly relevant to the energy and manipulative disciplines.

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. [14] 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. [15] 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 [16]

General theories of signatures and similars

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! [17] 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.[18]

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. [19]

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. Some conventional scientists think that acupuncture points might exist, even if 'how' they work rests mysterious.

Alternative medicine proponents 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), 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 occurrences 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. The scientists-theologian Pierre Teilhard de Chardin, S.J., who saw not alternatives, but complementary ideas that could be integrated. [20] 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 is a former plant biochemist who now researches and writes on parapsychology[21] and who proposed his own theory of "morphic resonance". Sheldrake concluded that genes and molecules were incapable of explaining how life develops the way it does: that it provided the building material, but not the blueprints. When Sheldrake published A New Science of Life[22] 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)

In the Western world, the debate between idealism and materialism dates back to ancient Greece, some 2 millennia 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".[23]

Still, the remarkable insights of atomist Presocratics were not well received by Plato and other major thinkers. They only reappeared, two millennia later, to form the basis of the modern scientifically-based view of nature. What kind of fundamentally different views superseded Presocratic materialism, and what does it tell us about the now alternative views of health and living, i.e. health as bodily harmony, as a holistic process, a privileged relationship with nature and ideas?

We find, in Plato, these major philosophical objections to materialism that are heard from various quarters in the alternative medicine community. (in progress)

References

  1. Oxford English Dictionary, ninth edition 1996
  2. Ernst E. (2003), "Obstacles to research in complementary and alternative medicine.", Medical Journal of Australia 179 (6): 279-80
  3. Department of AYUSH, Government of India, Homeopathy. Retrieved on December 16, 2008
  4. Goldberg 2002, p. 6
  5. Lewis Thomas (1995), The Youngest Science: Notes of a Medicine-Watcher, Penguin
  6. Roberta Bivins (2007), Alternative Medicine?: A History, Oxford University Press, p. 46
  7. Julie L. Gerberding (January 17, 2003), CDC's Role in Promoting Healthy Lifestyles, U.S. Senate Committee on Appropriations, Subcommittee on Labor, HHS, Education and Related Agencies
  8. Lawrence K. Altman (July 24, 1984), "The Doctor's World; James Fixx: the Enigma of Heart Disease", New York Times
  9. [www.who.int/entity/mediacentre/factsheets/fs323_en.pdf Joint fact sheet WHO/OHCHR/323], August 2007
  10. World Health Organization (2002), Safety of Medicines: A guide to detecting and reporting adverse drug reactions; Why health professionals need to take action, WHO/EDM/QSM/2002.2, p. 9
  11. Shamanism and the Ancient Mind: A Cognitive Approach to Archaeology, Rowman Altamira, 2002, p. 114 Goldfrank's Toxicologic Emergencies, By Lewis R. Goldfrank, Neal Flomenbaum, Robert S. Hoffman, Mary Ann Howland, Neal A. Lewin, Lewis S. Nelson (McGraw-Hill Professional, 2006) ISBN 0071437630, 9780071437639 explicitly notes the eight plants on page 665
  12. Michael Harner (1982), The Way of the Shaman: A Guide to Power and Healing, Bantam New Age Books, page to be provided ASAP
  13. Bivins 2007, page?
  14. Bivins 2007, p. 44
  15. Rabbi Abner Weiss, Autopsies and Jewish Law(Excerpted with permission from Death and Bereavement: A Halakhic Perspective)
  16. Bivins2007, p.45
  17. see for example, http://www.allsands.com/history/places/egyptplant_zxg_gn.htm accessed December 22 2008. The same claims are repeated in Britannica Online.
  18. Kuhn, Thomas S. (1990), The Road since Structure, Proceedings of the Biennial Meeting of the Philosophy of Science Association, Volume Two: Symposia and Invited Papers
  19. Martin Cohen, 101 Ethical Dilemmas, Routledge 2003, p.200
  20. Louis Savary (January 19, 2008), "Spirituality and Teilhard de Chardin", Washington Post
  21. [http://www.sciam.com/article.cfm?id=ruperts-resonance Rupert's resonance} Scientific American October 2005
  22. Sheldrake, Rupert (1995). A new science of life: the hypothesis of morphic resonance. Rochester, Vt: Park Street Press. ISBN 0-89281-535-3. 
  23. Rl, O. (1998), "Democritus-scientific wizard of the 5th century bc", Speculations in Science and Technology 21 (1): 37–44, DOI:10.1023/A:1005301728335