Western medical practitioners today call alternative medicine. The term alternative medicine covers a broad range of healing philosophies, approaches, and therapies. It generally describes those treatments and health care practices that are outside mainstream Western health care. People use these treatments and therapies in a variety of ways. Alternative therapies used alone are often referred to as alternative; when used in combination with other alternative therapies, or in addition to conventional therapies they are referred to as complementary. Some therapies are far outside the realm of accepted Western medical theory and practice, but some, like chiropractic treatments, are now established in mainstream medicine.
Worldwide, only an estimated ten to thirty percent of human health care is delivered by conventional, biomedically-oriented practitioners (Fields of Practice). The remaining seventy to ninety percent ranges from self-care according to folk principles, to care given in an organized health care system based on alternative therapies (Fields of Practice). Many cultures have folk medicine traditions that include the use of plants and plant products. In ancient cultures, people methodically collected information on herbs and developed well-defined herbal pharmacopoeias. Indeed, well into the twentieth century much of the pharmacology of scientific medicine was derived from the herbal lore of native peoples. Many drugs commonly used today are of herbal origin: one-quarter of the prescription drugs dispensed by community pharmacies in the United States contain at least one active ingredient derived from plant material (Fields of Practice).
Twenty years ago, few physicians would have advised patients to take folic acid to prevent birth defects, vitamin E to promote a healthy heart, or vitamin C to bolster their immune systems. Yet today, doctor and patient alike know of the lifesaving benefits of these vitamins. Twenty years ago, acupuncture, guided imagery, and therapeutic touch were considered outright quackery. Now, however, in clinics and hospitals around the country, non-traditional therapies are gaining wider acceptance as testimonials and studies report success using them to treat such chronic maladies as back pain and arthritis.
The number of people availing themselves of these alternative therapies is staggering. In 1991 about twenty-one million Americans made four hundred and twenty-five million visits to practitioners of these types of alternative medicine; more than the estimated three hundred and eighty-eight million visits made to general practitioners that year (Apostolides). The U.S. Department of Education has accredited more than twenty acupuncture schools and more than thirty medical schools now offer courses in acupuncture (Lombardo; Smith). As the number of Western medical institutions researching alternative therapies increases, the legitimacy of at least some alternative therapies will also increase.
Does all this recent medical establishment attention mean that the non-conventional therapies really work? Critics say a definitive scientific answer must await well-designed experiments involving many patients. Up to now, most of the studies have relied on personal observation and anecdotal testimony from satisfied patients. The official position of the American Medical Association (A.M.A.)–alternative medicine’s chief critic–is that a patient’s improvement or recovery after alternative treatment might just as well be incidental to the action taken. This may be true for scientists and researchers, but the fact is that the people seeking alternative treatments disagree. The solution is obvious: more research needs to be conducted.
Some alternative treatments, such as acupuncture and herbal medicine, have impressive histories dating back thousands of years. In America, professional and public interest in the field of alternative care has grown to such an extent that, in 1992, the U.S. government established the Office of Alternative Medicine (OAM) within the National Institutes of Health (NIH).
Its mission is to speed the discovery, development, and validation of potential treatments to complement our current healthcare system. One of the OAM’s first tasks was to develop a classification system for the dozens of various therapies and practices. The systems of alternative medical practice the OAM has classified so far share many common therapeutic techniques. Traditional oriental medicine and naturopathic medicine, for example, both use herbal remedies, acupuncture, and mind/body control. However, some alternative systems, such as environmental medicine and homeopathic medicine are distinct and separate. Following are some the more popular alternative therapies Americans use.
Acupuncture is an example of a therapy once considered bizarre which has some scientific basis. An integral part of Chinese medicine for thousands of years, it is based on the belief that energy, which the Chinese call Qi (pronounced ‘chee’), circulates along meridians in the body in the same way that blood flows (Furman). A diagram of the meridian system looks similar to those of our circulatory and nervous systems (Crute). When the flow of energy becomes blocked, an imbalance is created, resulting in pain or disease. To restore the proper balance and energy flow, acupuncturists stimulate specific points of the body along these meridians. Puncturing the skin with a needle is the usual method, but acupuncturists may also stimulate the acupuncture points with finger-pressure.
Although Western physicians and researchers do not truly understand the concept of Qi, there is evidence that acupuncture can influence the movement or release of many chemicals in the body. Research conducted by Dr. Bruce Pomeranz, a neurophysiologist at the University of Toronto, established that acupuncture releases naturally produced, morphine-like substances called endorphins (Crute).
In addition to releasing endorphins, doctors and clinicians know that acupuncture can provide at least short-term relief for a wide range of pains by inhibiting the transmission of pain impulses through the nerves. Furthermore, recent studies also show acupuncture to be effective in alleviating bronchial asthma, bronchitis, and stroke-induced paralysis (Apostolides). I’m a healthy skeptic, says Johns Hopkins psychiatrist Mary McCaul (Apostolides). But look, we don’t have all the answers. Patients who choose acupuncture feel calmer. Even if it’s a placebo effect, placebos are powerful things.
Relaxation techniques like meditation and biofeedback–which teach patients to control heart rate, blood pressure, temperature and other involuntary functions through concentration–have also given respectability to alternative medicine and are routinely taught to patients and medical students. The basic premise of mind-body medicine is that the power of the mind can be used to help heal the body by improving the person’s attitude and also, as recent research has shown, by direct effects on the immune, endocrine, and nervous systems (Epiro and Walsh). Although many of the biochemical and physiological mechanisms remain to be identified, an increasing body of evidence is showing that the healthy mind is indeed capable of mobilizing the immune system-and that the troubled mind can dampen the functioning of the immune system and contribute to physical disease.
There is little doubt that state of mind and physiological processes are closely linked. The connection between stress and immune system response, for example, is well documented (Epiro and Walsh). Some scientists suggest that the power of prayer and faith healing, like some forms of meditation, might also be physiological in that they may protect the body from the negative effects of stress hormone norepinephrine. In addition, experience shows that relaxation techniques can help patients enormously. Medicine is a three-legged stool, says Dr. Herbert Benson of Harvard Medical School (Epiro and Walsh).
One leg is pharmaceuticals, the other is surgery, and the third is what people can do for themselves. Mind-body work is an essential part of that. In addition to preventing or curing illnesses, these therapies provide people the chance to be involved in their own care, to make vital decisions about their own health, to be touched emotionally, and to be changed psychologically in the process. Many patients today believe their doctor or medical system is too technical, impersonal, remote, and uncaring. The mind-body approach is potentially a corrective to this tendency, a reminder of the importance of human connection that opens up the power of patients acting on their own behalf.
Homeopathy, despite the American Medical Association’s characterization of it as a pseudo science, is a popular alternative that is drawing increased attention. Founded in the eighteenth century by German physician Samuel Hahnemann, it is based on the idea that like cures like (Kees); that micro-doses of substances, known in large amounts to cause illness, can treat that illness by stimulating the body’s own natural defenses and curative powers. In some respects, treatment with homeopathic medicines, nontoxic compounds derived from plants, animals and minerals, is akin to immunization or allergy treatments in which similar substances are introduced into the body to bolster immunity.
A substantial number of American doctors–among them Wayne Jonas, a family practitioner who is director of the National Institutes of Health’s Office of Alternative Medicine–have been trained in homeopathy, as have countless nurses, veterinarians, chiropractors. While critics contend that homeopathic remedies are no better than water at worst and placebos at best, a survey of studies published in the British Medical Journal a few years ago indicates that some are actually more effective than placebos, and a number of reports document their efficacy in treating hay fever, respiratory infections, digestive diseases, migraine and a form of rheumatic disease. I do what works best for my patients, says Dr. Jennifer Jacobs of Edmonds, Washington, a family practitioner and member of the NIH Alternative Medicine Advisory Committee (Squires). There are certainly situations where modern medicine is appropriate and lifesaving, but perhaps the pendulum has swung too far toward technology and standard pharmaceuticals and not enough toward some of the early healing methods that have a track record in many cultures.
Chiropractic science is concerned with investigating the relationship between the human body’s structure (primarily of the spine) and function (primarily of the nervous system) to restore and preserve health. Chiropractic medicine applies such knowledge to diagnosing and treating structural dysfunctions that can affect the nervous system. Chiropractic physicians use manual procedures and interventions, not surgical or chemotherapeutic ones. In 1993, more than 45,000 licensed chiropractors were practicing in the United States (Krizmanic). Chiropractic specialty areas are pertinent to other medical specialties, such as radiology, orthopedics, neurology, and sports medicine. Current chiropractic research focuses on back and musculoskeletal pain and reliability studies.
Although chiropractic clearly has its drawbacks, notably its stubborn insistence that spinal misalignments cause or underlie most ailments, including those not related to the backbone, its use of vertebral manipulation has proved useful in treating acute low-back pain and other muscular and neurological problems. Osteopaths, licensed physicians whose education is essentially the same as that of M.D.’s, also include manipulative therapy in their treatments. Studies at the University of Miami’s School of Medicine Touch Research Institute have found that premature infants gain weight much faster after being massaged than babies in an unmassaged control group (Cooper and Stoflet). Massaged infants cry less and are calmer than those who are only rocked. It is surprising that only now, in the late 1990’s, are we discovering the fact that not only infants but also children and adults respond favorably to the human touch–both emotionally and physically.
Many Americans flock to alternative practices either because their suffering has not been alleviated by standard medical or surgical treatment, or because the traditional treatments themselves are too expensive or dangerous. These patients often feel that the intrusion of increasingly complicated and impersonal technology has widened the gap between mainstream caregivers and patients. Too many doctors are thought to be coolly professional and emotionally distant, inclined to cure a specific disorder narrow-mindedly without comforting or caring for the patient. Americans have made it clear with their pocketbooks that they find this unacceptable.
Thomas Roselle, a licensed chiropractor and acupuncturist who runs an alternative-care practice in Falls Church, Va., states, Traditional medicine shines in crisis intervention, but where it fails at times is in day-to-day-care. We see a lot of different things where traditional medicine has failed to do anything about it. Too often the question of why the body is broken down isn’t asked (Lombardo). Of course, acceptance of alternative medicine by the medical establishment will not occur until research has proven its efficacy. However, with so many Americans already using alternative treatments, doctors need to better understand the principles of alternative medicine. It is incumbent upon doctors not only to know what medical treatments their patients are using, but what effect those treatments have. Only then can doctors provide effective and safe health care.