1.1 ALTERNATIVE AND COMPLEMENTARY MEDICINE (Part 1)

I. INTRODUCTION

There are a variety of systems of health belief and practice active in the United States today. Far from dying out in the face of advances in scientific medicine, many non mainstream health belief systems are growing in popularity. In this course, we will use the following arbitrary classification:

1. Allopathic Medicine

2. Complementary and Alternative Medicine

3. Folk Medicine

4. Quackery

This classification is as eclectic as the field that we are reviewing in this article. It is my own classification; however, it does reflect the general trends in the literature.

.....

Why is there a resurgence of interest in alternative medicine in this country? One reason is cost. Here are figures from 1996. As this is being edited (August 1999), news reports tell of a sharp rise in health insurance costs after several years of single-digit or even flat cost increases.

• •US health expenditures as of 1996 total $1.035 trillion annually
• •Health care consumed 13.6% of the Gross Domestic Product in 1996.
• •Health care spending per person was $3,759. in 1996.

Spending for retail pharmaceutical drugs for 1999 increases are in the 10 - 20% range. Approximately 43 million Americans have no health insurance as of late 1998. Figures quoted in the press often say that the number of uninsured is increasing by 100,000 per month. All of these figures are projected to increase dramatically over the next ten years.

.....

A second factor is freedom of choice. As managed care administered through health maintenance organizations restricts access to expensive health services, many want to choose their medical care. People want control of their destiny.

Recently, a physician told me the following joke: "Why was Jesus born in a manger? Because Mary and Joseph belonged to an HMO!"

.....

Impersonalization is a third factor. Long waits in waiting rooms followed by hurried physician visits has turned many people off. Hospitals in particular can be brutally impersonal as many health workers circulate in and out of the room during a 24-hour day. Each of us wants someone to listen to us and really care.

.....

A desire for natural products and natural healing is a fourth factor. Increasingly, many people seek herbals and other natural products in health stores.

Finally, when mainstream conventional medicine fails--as it often does for chronic and progressive diseases, people will search out an alternative. Above all, in the egalitarian spirit of this country, people want alternatives and the right to choose.

.....

II. CONVENTIONAL WESTERN MEDICINE

This is considered the "scientific" healing art. It is known by many names: allopathic, orthodox, modern, cosmopolitan, conventional, or most frequently as biomedicine. It has impressive credentials and its achievements in this century as truly the stuff of legend. Practitioners who earn the degree of MD practice biomedicine. They view disease as the result of specific natural causes.

.....

What is the basis of biomedicine? It considers itself the "scientific" healing art, while the alternatives are considered "nonscientific." Some of the central ideas of biomedicine are very powerful, but they can also blind us in our understanding of disease. The studies of dead tissue, life processes, and the quest for "magic bullets" to combat disease are based upon a materialist view of health and healing. .....

Mind-body medicine, a new approach, requires a broader perspective. There is strong evidence, for example, that the mind does influence the immune system and that environment does affect the hard wiring of the brain. These ideas would have been anathema two decades ago. Extensive documentation now exists to support the mind-body interactive model.

Contemporary biomedicine is a scientific paradigm (model, remember?) with a particular history. Science requires the making and testing of hypotheses. It is a distinct system of knowledge. It seeks to understand reality and it does so by validating hypotheses. One reason that biomedicine is so troubled by alternative medicine is that if it works, the mechanism of action is unknown. For example, acupuncture seems to help many people. Yet, mainstream biomedicine cannot explain why tiny needles inserted into the body do something. Qi and meridians are unacceptable explanations to biomedicine, but yet it is stuck with a problem (no pun intended). For whatever reason, acupuncture does work for some conditions in some people. (My note: an NIH panel found acupuncture clearly effective for postoperative pain from dental surgery, nausea and vomiting from chemotherapy and anaesthesia. See Time 17 Nov '97 p 84.)

.....

Here are some distinctive traits of biomedicine:

• Objectivism. The observer must be separate and detached from the observed. This is illustrated most eloquently by the "gold standard" of clinical testing, the double-blind study.
• Reductionism. This is the consolidation of complex symptoms into a single diagnosis. Complex data is "reduced' to a category, a single disease entity which exhibits a distinctive set of symptoms.
• Use of measurable data. Information is derived from what can be quantified.
• Determinism. This requires that phenomena can be predicted from a knowledge of scientific law.

.....

Many cultures accumulate a body of knowledge about illness and healing. Often they are a collection of bits of knowledge with no underlying understanding of how the body operates. Many ancient medical traditions from Mesopotamia and the New World at the time of contact were anecdotal (observational) in nature. They were observations without regard to underlying natural law.

It was a singular achievement of the Greeks to conceptualize observed events as systematically caused by underlying universal laws. We don't accept the four 'humors' today as underlying causes of disease, but we have followed in their footsteps by seeing disease in the light of underlying principles. A good example is the germ theory in understanding infectious disease.

Biomedicine, therefore, seeks to observe, find underlying causes, test its ideas, make unbiased observations, and perceive the world in a rational manner. It tends to dismiss that which it cannot explain, thus its bias against alternative medicine. If it can't be explained, biomedicine says, it isn't so. Practitioners of the alternative systems are more pragmatic: if it works, they'll use it even if they can't explain the mechanism of action in a "scientific" manner.

.....

You are well aware that biomedicine has enormous influence. It enjoys the approval, cooperation and protection of the country's legal system and other supporting social institutions: government licensing and regulatory bodies, third party payment systems, preferred access to federal and private research monies, and social status, lobbying power, and authoritative professional publications. Haven't you heard of the New England Journal of Medicine? A quotation from that journal on the news is just short of Biblical authority.

Above all, biomedicine has enormous economic power. It controls large amounts of money, now in excess of a thousand billion dollars! In anthropological terms, it indeed has wealth, prestige, and power on an unprecedented scale.

.....

III. WHAT ARE ALTERNATIVE AND COMPLEMENTARY MEDICINE?

Alternative medicines are health care systems not routinely taught in a university affiliated U.S. medical schools or routinely underwritten by third party payers. Or, at least, this is the way biomedicine perceives it.

As we begin, let us note some common beliefs held by alternative/complementary medicine systems.

• •The body has a natural ability to heal itself and maintain homeostasis. This next point is important, so read it carefully: alternative medicine usually has a clearly stated definition of health. Biomedicine, in contrast, merely defines it as the absence of disease. If your tests come back negative, you are healthy.
• •A person is a subtle and complex blend of body, mind, and spirit. This is why these systems claim to be holistic: they don't treat the physical body in isolation. Practitioners seek to know the whole person.
• •Treating root causes is more important than just managing symptoms. Take note, however: their perception of cause may or may not go along with
• •Each person is unique.
• •The patient must take responsibility for himself/herself. Deleterious habits such as tobacco, alcohol, and recreational drugs must be eliminated. The health practitioner cannot do what one won't do for oneself. Taking control of life is expected of the patient.
• •Good health requires a state of balance (some see imbalances as a cause of disease).
• •There is a natural healing force in the universe. Some call it an "energy" and therapy are based on it.

.....

(My note: Doesn't a desire to take personal control of life resonate in these ideas? Not ago, there was a made-for-TV program about a dietary regimen for management of children with seizures. Apparently the diet does work, but must be pursued rigorously. If you have had a child treated for seizures (I have), you worry about the long term effects of prescription drugs. A 'natural' resolution is indeed appealing. This diet offers such an alternative. It is cheaper, too!)

.....

IV. THE CONCEPT OF VITALISM

Vitalism is the proposition that more is needed to explain life that just physical or mechanical laws. Practitioners of most alternative healing believe that one source of their intervention is a kind of "vital energy" their system uses that is not appreciated by conventional biomedicine. The idea is not their creation, however. It came from elite European universities in the 18th and 19th century. Vitalism has been forced to retreat in the face of scientific discovery and has largely faded from mainstream biomedicine.

Vitalism can be an attractive idea. According to it, life is more than chemistry and mechanics. Its imprecision allows for enormous flexibility and adaptability. Unfortunately, its vagueness places it beyond scientific evaluation.

(My note: Vitalism suffered a fatal blow in 1894 when German physiologist Max Rubber demonstrated that the energy produced by the body from food was exactly the same in quantity as it would have been if those foods were burned in a fire. This meant the laws of thermodynamics governed living tissues as well as the inanimate world. Haven't you wondered were those calorie figures come from on food labels? See Warshofsky, F. Stealing Time p 48.)

You may think that biomedicine doesn't measure energy systems in the body. Indeed it does! A familiar one is the electrical energy produced by the heart recorded by an electrocardiogram (EKG). The electrical energy of the heart is significant. It is 40 to 60 times more powerful than electrical activity in the brain. It emits about 2.5 watts of electrical power, about that needed to power a flashlight bulb. You are familiar with it being recorded on the chest; however, cardiac electrical activity recorded anywhere on the body.

.....

V. HOMEOPATHY

Homeopathic medicine is a method of self-healing assisted by small doses of medicinal substances and is practiced by both licensed and "other" health care professionals throughout the world. Homeopathy is undergoing a resurgence as part of a lay movement of people seeking to help themselves.

Historically, homeopathy traces its origins to Samuel Hahnemann who lived nearly two hundred years ago. Hahnemann, a German physician, was disillusioned with the medical practice of the time (which included bloodletting, blistering, and purging).

His first experiment involved cinchona bark, which contains quinine. He took it himself and experienced headache, thirst, and fever--symptoms of malaria. From this experience, he developed the law of similars which says that like cures like. (My note: the 'law of similars' is encountered widely in herbal and indigenous medical systems; it is not unique to homeopathy.) Homeopathy has as its cornerstone the Latin phrase similar similibus curantur (that like shall be cured by like). According to Hanhemann, the proper remedy for all illness is that substance, which in a healthy person, will produce the same symptoms as in a sick person.

Homeopathy will prescribe only one remedy at a time. This is in contrast with conventional physicians who will issue several prescriptions at once. Homeopathic medicines include vegetable remedies such as belladonna chamomilla, animal remedies such as venoms (bees, snakes, tarantula), and nosodes from pus, bacteria, and so on.

Drug doses are very small. (My note: critics say that the doses are so small as to be ineffective. On the other hand, side-effects are few to nonexistent.

Their administration of a homeopathic remedy is expected to stimulate the body's "vital force" to heal itself (by restoring homeostasis). Weak drugs are considered to stimulate normal physiologic processes, whereas strong drugs (in their view) inhibit or prevent healing. The minute drug dose, some as low as 10⁶⁰ (a one followed by sixty zeroes) dilution is vigorously shaken (called succussion) to 'activate' its potency. A feature of homeopathic medicine is that, due to its extreme dilution, it will do no harm. Homeopathic medicines are very safe.

Read this next sentence very carefully: In homeopathic theory, it is not necessary to determine the disease from which a patient suffers. This is the opposite of biomedicine which insists that any treatment modality must be based on a specific diagnosis. Homeopaths can initiate treatment based on the symptoms that have been identified by the practitioner.

The initial visit is long (maybe 90 minutes with the most frequent question being, "what else?"). Symptoms are determined, and are matched with a reference of symptoms (often now on a computer) from which the suggested medication is suggested.

Homeopathic remedies are recognized by law as drugs, but they are exempt from the 1938 Federal Food, Drug, and Cosmetic Act. Such remedies are listed separately in the Homeopathic Pharmacopeia of the United States. They are exempt from the testing required of regular medications. In recent years, several European journals of science and medicine have reported positive results in rigorous double blind studies. The vast majority of mainstream physicians remain unconvinced. (See the Consumers Reports article listed below for more detailed information about homeopathic medicine as perceived by mainstream medicine.)

In the United States, homeopathy is considered the practice of medicine and can be done legally only by health professionals who are licensed to prescribe drugs. In three states, they must ALSO be licensed to practice homeopathy. In some states, other providers (such as nurses and dentists) can practice homeopathy, depending on the scope of the license in that state. As of 1995, there were about 4,000 licensed health care providers that include homeopathy in the treatments that they offer. You are urged to consult the Internet for the most up-to-date information.

Homeopathic physicians freely refer patients to mainstream medical doctors for care. Examples of such referrals are extreme infections, surgical emergencies, and serious injuries. An important point to remember is that patients of regular physicians will seek out homeopathy as an alternative treatment when conventional, orthodox treatment fails. Homeopathy is enjoying a resurgence in popularity today.

.....

Resources:

Weider, M and Goes, K. The Complete Book of Homeopathy. New York: Bantam Books, 1982.

"Homeopathy Much Ado About Nothing" Consumers Reports March, 1994, pp 201-206. (This article is very informative but is rather hostile to homeopathy.

National Center for Homeopathy, 801 North Fairfax Street, Alexandria, VA 22314

.....

The following is a special section on allopathy and homeopathy. It is a brief technical and historical overview. Warning: the definitions for both are awkward and the categories are not mutually exclusive.

.....

VI. ALLOPATHY AND HOMEOPATHY

Many practitioners of alternative medicine in this country make a distinction between allopathy and homeopathy. Homeopaths will often use the term allopathy in a critical way. We begin with two definitions that will be difficult for you because they go against the way you probably perceive of medicine and healing.

• ALLOPATHY is the method of treating disease by the use of an agent, producing effects that are different from those of the disease being treated.
• HOMEOPATHY is the method of treating disease by drugs, given in minute doses, which produce in a healthy person symptoms similar to those of the disease.

Allopathic physicians are those of the regular, conventional, rational school. They are the ones in our society who practice orthodox, widely accepted medicine. Most of us attend to our medical needs with an allopathic physician who is a graduate of an accredited medical school and is licensed in the state where he or she practices.

Why are they called 'allopathic'? The reason is largely historical.

There are several healing concepts based on the concept of homeostasis. You probably remember this term from high school biology. Homeostasis is the tendency of a living organism to maintain balance or stability. You see it in temperature regulation in mammals, maintenance of pH (acid/base balance), and other physiological processes. Blood testing in modern medicine assumes homeostasis in their selection of 'normal' values for the many characteristics that are now measured in modern laboratories. Body temperature is another example. Faces with a hot or cold environment, your body has several mechanisms to maintain body temperature. In homeopathic medicine, the notion of homeostasis is at the very core of its philosophy of healing.

.....

The fundamental reason for medication in homeopathic medicine is totally different from mainstream biomedicine with which you are familiar.

Read the following slowly and carefully: The use of aspirin to bring down fever is an example of allopathic medicine thinking. Aspirin (or Tylenol) gives relief when given for fever that accompanies the common cold. We may feel better, but the disease--the viral infection of the common cold--isn't eliminated. Only the symptoms have been changed. How is this use allopathic? The aspirin that is administered produces an effect opposite from the disease being treated.

Is this use of aspirin a wise decision? Possibly not. Why does a fever accompany infection? There is convincing evidence that fever is an adaptive response to infection--the result of hundreds of millions of years of natural selection.

In laboratory animals, recovery from a disease induced fever is slower when aspirin in administered. Fever enables the body to defend itself more effectively against many organisms. Before the antibiotic era, patients with syphilis were infected with malaria to induce fever in an attempt to wipe out the spirochete that causes syphilis. Aspirin, incidentally has many valid medical uses: relief of arthritic pain, extending platelet clotting time, and many others.

.....

Related to fever is another body mechanism of which many people are not aware. In many diseases, the blood iron level goes down. This is often seen as pathological. It is not. Iron is a crucial and scarce resource for bacteria. The reduction of blood iron is an evolved defense against infection. In the pre-antibiotic era, egg white (which binds iron) was administered for infection management.

.....

We take for granted the remarkable achievements of allopathic medicine in this century. It wasn't always so. In the nineteenth century, many treatments were without scientific basis. Many treatments actually killed people instead of making them better. Many alternative health delivery systems emerged during this time when purging and blood letting was a mainstay of modern medicine. Some of the many reactions to these dreadful treatments survive today as distinct disciplines. Among them are homeopathy, osteopathy, and chiropractic. Others, like hydrotherapy has disappeared; however, one widely known brand name survives: Kellogg breakfast cereals. Did you eat some this morning?

.....

VII. THE TRIUMPH OF BIOMEDICINE

We are a society that functions through political and economic institutions. Examples are governments that license them and third party payers that provide health insurance for large numbers of people. In 1900, one-sixth of practicing physicians were homeopathic physicians. They numbered about 15,000.

By 1976, only 225 remained. Homeopathy became a sub specialty of internal medicine today. Homeopaths see that trend as a result of deliberate policy by allopathic physicians to drive them out of medicine.

In 1910, Abraham Flexner, representing the Carnegie endowment, rated all of the medical school in the U.S. There was a strong bias against the homeopathic ones. Schools with low ratings had graduates who couldn't get a license to practice. Homeopathic schools either converted to allopathic medicine or closed. By the 1930s, the last of the schools giving homeopathic instruction converted to biomedicine.

Biomedicine has made giant strides in this century. It has gone far beyond the ineffectual treatments of the nineteenth century as the causes of disease came to be understood. Effective therapies, unimagined in the last century, have become commonplace in the twentieth century.

So, while the definition of allopathy in the strict sense is no longer true, the classification of orthodox medicine as allopathic persists. None of us taking penicillin for a staph infection consider that treatment to be allopathic. We see it in the biomedical disease model of cause and effect: infectious agent and antibiotics that will destroy them.

.....

Resources:

Nesse, R. and Williams, G. Why We Get Sick. Random House Times Books, 1994.

Weider, M. and Goes, K. The Complete Book of Homeopathy New York: Bantam Books, 1982.

.....

VIII. OSTEOPATHIC MEDICINE

Osteopathy, or osteopathic medicine celebrated its 100th birthday in 1992. This field is a distinctly American development. Andrew Taylor Still formulated its basic precepts shortly after the Civil War. 1892 is considered the birth date of osteopathic medicine because it marks the founding of the American School of Osteopathy in Kirksville, Missouri. From its opening, it encouraged the admission of women and minorities.

Osteopathic physicians (known as D.O.s) are complete physicians. They are licensed to perform surgery and prescribe medicine in all 50 states. They nevertheless clearly distinguish themselves from M.D.s (allopathic physicians). Osteopathic medicine traces itself to the Civil War physician, Andrew Edward Still (1828-1917). Like Hahnemann, he objected to leeches, bloodletting, purges, and toxic drugs. In 1864, an epidemic of spinal meningitis claimed the lives of three of his children. This personal tragedy caused him to reexamine medicine as he knew it. In 1874, he broke with traditional medicine and announced his philosophy of osteopathy.

Osteopathy is based on establishing proper body rhythms and stimulating various organ systems in order to restore health. Dr. Still applied the art of manipulative treatment, a 'hands on' treatment applied to the musculoskeletal system. He believed that the person should be studied as a total unit, and he believed that the human body contained substances necessary for health. Taken strictly, he considered disease to be a normal response to an abnormal body situation.

There are three basic osteopathic principles:

• (1) The first principle is that the human body is a unit; no part of it works independently.
• (2) The second principle states that the body, through a complex system of internal checks and balances, tends to be self- regulating and self healing in the face of stress and disease.
• (3) The third principle states that adequate function of all body organs and systems depends upon the integrating forces of the nervous and circulatory systems.

.....

Osteopathy employs a wide range of manipulative techniques, varying according to the part of the body being treated. Tight muscles will be relaxed in order that fluids may flow freely, allowing blood to carry nutrients and oxygen to where they are needed, and allowing the waste products in the lymphatic fluid to drain away. Some regions may require gentle, slow, low-velocity touch, while soft tissues and some joints may need flexing or message. Joints with reduced mobility may require joint mobilization therapy. At all times, however, it is the entire body that is undergoing treatment. The local body area, which is subject to the presenting complaint, naturally receives close attention, but the osteopath also minutely examines the rest of the body for other factors that predispose or contribute to the complaint.

Osteopathic medicine today has increasingly merged into the allopathic/biomedicine model and in many ways is very similar. Classifying it here as an alternative medicine is debatable.

There are 15 colleges of osteopathic medicine in the United States. Close to Indiana University Northwest (Gary) is one in Downers Grove, Illinois. Another one close to IUN is in Pontiac, Michigan. There were 35,182 osteopathic physicians in the United States as of 1995. DOS serve in the Armed Forces, Public Health Service, and are on hospital staffs nation wide.

.....

Resources:

American Osteopathic Association, 142 East Ontario Street, Chicago, IL 6061

American Association of Colleges of Osteopathic Medicine, 6110 Executive Boulevard, Suite 405, Rockville, MD 20852

.....

VII. CHIROPRACTIC

Chiropractic is the third largest independent health profession in the western world. Only allopathic medicine and dentistry have more practitioners. They are licensed for both diagnosis and treatment.

Unlike dentistry, podiatry, and optometry, chiropractic is limited not by anatomic region but by procedure. The scope of chiropractic practice excludes surgery and pharmaceutical therapy. It centers on manual adjustment or manipulation of the spine.

Chiropractic was forged in a crucible of controversy. It has its origin in a single person, Daniel David Palmer. In 1895, Palmer treated a deaf janitor who lost his hearing when he felt something 'snap' in his spine. Palmer found a prominent vertebra, gave it a sharp thrust, and the janitor's hearing was restored. From this event, Palmer deduced that proper structural and bio mechanical integrity are necessary to maintain homeostasis. Chiropractic therapy dictates that disease processes may result from disturbances of the nervous system.

Literature from the American Chiropractic Association states that the educated chiropractic practitioner recognizes multiple courses of disease and multiple methods of treatment. Referral to allopathic physicians is recognized.

Treatment and patient management procedures are designed to achieve structural adjustment, with particular attention to the spinal column. The goal is to make structural alignment and restore normal motion.

Spinal manipulation is old, predating chiropractic: it was practiced in Greece, ancient China, and by New World Native Americans. Overall, chiropractic practitioners like many practitioners of alternative medicine, consider their art as a holistic approach to health.

All fifty states license chiropractors. The course of study requires at least two years of college and four years of chiropractic college. As of 1994, there were 71,604 licensed chiropractors in the U.S. There are fourteen accredited colleges in the U.S., the closest to IUN is in Lombard, Illinois.

.....

Resources:

American Chiropractic Association, 1701 Clarendon Blvd., Arlington, VA 22209

"Chiropractors" Consumer Reports, June, 1994 pp 383-390. My note: I find this article is very informative, but very hostile to chiropractors. Do understand that the physicians and chiropractic associations have fought in court for years. Chiropractic won a critical court victory against the AMA a few years ago.)

..... C.J. '99

Resources for information about alternative/complementary medicine are many. Start with the Internet. Many books and articles are available.. I used these books for this article:

Micozzi, M. ed Fundamentals of Complementary and Alternative Medicine. New York: Churchill Livingston, 1996.

Shealy, C. ed The Complete Family Guide to Alernative Medicine. New York, Barnes & Noble Books, 1996.

Rosenfeld, I. Dr. Rosenfeld's Guide to Alternative Medicine. New York: Random House, 1996.