Overview of Alternative Biomedical Systems
Aug 14th, 2008 by admin
In the United States many people think of mainstream biomedicine as the world’s standard health care system, assuming it is used by most people most of the time. Actually, careful estimates reveal that worldwide only 10 to 30 percent of human health care is delivered by the conventional, biomedically oriented health care system. The remaining 70 to 90 percent of health care sought out by people includes everything from self-care according to folk principles to care rendered in an organized health care system based on an alternative tradition of practice (Dean, 1981; Hufford, 1992).
Such strikingly high usage of alternative health care systems also is reflected in a number of recent surveys. For example, a nationwide telephone survey of 1,539 people, conducted in 1990, indicated that up to one in three Americans used alternative therapies (Eisenberg et al., 1993). Another telephone survey conducted in 1992 in the States of Maryland and Pennsylvania reported that someone in 33 percent of 1,165 households consulted chiropractors, 25 percent, massage therapists; and 16 percent, spiritual healers (Kirby, ~1992). One biomedical clinic survey of 660 cancer patients showed that 54 percent used alternative medical care along with conventional care, and 8 percent used strictly alternative care (Cassileth et al., 1984). In addition, a survey of 628 cancer patients found the utilization rate of folk treatments for cancer to be 70 percent (Hufford, 1992). Finally, an acupuncture clinic survey of 180 general-care patients showed that 70 percent sought other alternative professional or community-based health care in addition to biomedical and acupuncture care (Cassidy, 1994).
Given the immense political and economic investment this country has made in its “mainstream” medicine, these statistics are quite surprising. However, to better understand why alternative systems of medicine not only survive but thrive, it is worthwhile to first examine how people typically go about choosing their health care.
Studies show that most people go through a “hierarchy of resort” when seeking health care assistance (Romanuicci-Ross, 1969). That is, when ill, they usually begin by trying simple home remedies, often consulting friends and family about what to do. Only if the condition persists and worsens do people typically seek help from health care specialists.
The hierarchy of health care specialists includes the popular, community-based, and professionalized (Hufford, 1988; Kleinman, 1980). All are similar in that they aim to help people stay or get well and use manipulation (from laying on of hands to surgery), chemical substances (foods and drugs), or psychospiritual approaches (e.g., talking, suggesting, praying, drumming) as therapeutic techniques. They differ, however, in factors such as how much training they require of practitioners, how intensely they scrutinize and theorize about their own methods, how widely their practice is spread, and to whom they primarily aim their care.
Popular health care is what most people practice and receive at home, such as drinking hot honey and lemonade to relieve a sore throat. People get information about popular health care primarily from family or friends; it can be centuries old or relatively new to that family or social circle. People also learn about popular medicine from magazines, television, and other informal sources. In the United States, popular medicine often uses the words but not ~necessarily the underlying thinking of biomedicine.
Community-based health care refers to the nonprofessionalized yet specialized health care practices of both rural and urban people. The term community-based is used to avoid the stereotypes associated with the terms folk and tribal. Information in such systems is commonly passed on orally (through workshops, apprenticeships, and so on) and through informal and popular media sources. Some community-based practices have ancient roots (such as rootwork among African-Americans, powwowing among European-Americans, curanderismo among Hispanic-Americans, and religious pilgrimage and psychic healing traditions), while others have developed relatively recently, such as the various 12-step programs (e.g., Alcoholics Anonymous), popular weight loss programs, and various health and natural foods dietary practices. In contrast to popular and professionalized systems, these community-based systems characteristically focus on community health care or on the individual as part of the community. They also usually fuse concepts of medicine and religion or spirituality in such a way that all care is explained as being influenced by a “higher power.”
Professionalized health care is characteristically urban and complexly organized. It is the most intellectualized and formalized type of health care. Certain of these have been called the “Great Tradition” medical care systems. Examples of such professionalized health care systems include conventional Western biomedicine, Asian-Indian Ayurveda, traditional oriental medicine, and traditional Persian medicine (Unani), all of which have evolved over time within major urban cultures. Other systems such as chiropractic medicine, osteopathic medicine, anthroposophically extended medicine, environmental medicine, and homeopathic medicine have been the result of the formalization and expansion of the teachings of a specific creative founder within the Western rational and intellectual culture. Each of these major formal systems of medical practice has the following general characteristics: (1) a theory of health and disease; (2) an educational scheme to teach its concepts; (3) a delivery system involving practitioners who usually practice in offices, clinics, or hospitals; (4) a material support system to produce its medicines and therapeutic devices; (5) a legal and economic mandate to regulate its practice; (6) a set of cultural expectations on the role of the medical system; and (7) a means to confer “professional” status on the approved providers.
Two major types of illnesses are recognized in most of these systems, though one or the other is usually emphasized: the naturalistic illness (which results from an accident, infection, intoxication, malformation, aging, environmental stress, etc.) and the personalistic illness (which is the result of malfunction in relationships between people). A third category of illness is increasingly proposed: the energetic illness, which is the result of abnormalities in the flow of subtle energies.
Studies show that people are quite astute at knowing what sorts of conditions to take to what sorts of practitioners. The practitioners at the top of the hierarchy, those that are the most “socially foreign” (i.e., hard to reach from the point of view of the patient), are consulted last and usually only when the condition is unresponsive, very serious, or chronically debilitating. For example, rural Mexicans go to the curandero or curandera for “folk” illnesses, to the nun or nurse for mild biomedical conditions, and to the biomedical physician for the most serious conditions (Young, 1981). Likewise, in urban America many people consult a registered nurse, pharmacist, or health food salesperson before taking their concerns to the medical doctor. One-third of the users of unconventional therapy are estimated to use it for “nonserious” conditions, health promotion, or disease prevention. However, in the case of more serious health problems, the medical doctor is not the most socially foreign type of practitioner in the United States, because M.D.s and D.O.s (doctors of osteopathy) are abundant. People consulting alternative practitioners for an identified health problem are much more likely to have first consulted a medical doctor (Eisenberg et al., 1993). This point suggests that many of the alternative practitioners are rendering care to people with conditions either unresponsive to or unsatisfactorily treated by standard biomedical care.
Of the types of health care listed above, only the professionalized practitioners have received much, if any, scientific study regarding the causes of illness and the explanations and results of treatment. Indeed, community-based practices have been virtually ignored by conventional medicine on the assumption that these superstitious ways are dying out. On the other hand, popular and community-based systems have been studied primarily by social scientists, historians, and folklorists. These researchers, though not primarily concerned with clinical results or health outcomes, have provided most of the clinical material currently available. Health educators have made use of such studies in designing culturally sensitive outreach programs (see the “Diet and Nutrition” chapter).
In recent years, the professionalized biomedical health care system has initiated a number of programs in an attempt to influence popular health practices on the basis of sound epidemiological concerns, addressing such issues as smoking and health, diet and cardiovascular disease, sexual behavior and human immunodeficiency virus (HIV), and healthy childbirth practices. The comparative clinical effectiveness of indigenous community-based health care practices remains, however, a fruitful field for further research.
The remainder of this chapter comprises three major sections, the first of which describes several examples of professionalized alternative health care systems. The following section focuses on community-based practices. Except for the epidemiological issues addressed in the “Diet and Nutrition” chapter, popular practices are not discussed in this document, because the emphasis is on health care delivered by the community of alternative medicine practitioners rather than by laypeople. The last major section addresses the barriers, key issues, and overall priorities for research in alternative systems of medical practice.
Conclusion
This report has covered a broad spectrum of alternative medical therapies and systems of medicine. Some of these medical systems, such as Ayurvedic medicine and traditional oriental medicine, are centuries old and are still in extensive use in other nations and cultures of the world. Others, such as osteopathy and naturopathy, evolved in the United States in the not-too-distant past but were relegated to the fringes of medicine because they differed from conventional biomedicine in the concepts of health and illness they embraced. Still others, such as some of the mind-body and bioelectromagnetic approaches, are on the frontier of scientific knowledge and understanding.
Many alternative practitioners face numerous economic, political, and scientific barriers that block their acceptance by mainstream biomedicine. On the other hand, some alternative medical practitioners do not expect to be brought into the fold. Rather, they just want the opportunity to coexist peacefully with mainstream medical practitioners and to be allowed to offer consumers alternative health care options. Consumers, however, are not waiting for mainstream science to give them a “green light” on many alternative treatments before using them. The fact is that today alternative medicine constitutes a significant and growing portion of the Nation’s health care expenditures.
Recent surveys have demonstrated that most people who opt to use alternative treatments or systems of medicine believe that conventional medicine has not adequately addressed their needs, or they want to supplement and thus improve on their conventional treatment. This is especially true of people with chronic, debilitating illnesses such as arthritis, pain, cancer, and AIDS. People often are attracted to alternative medicine practitioners who emphasize the patient’s role in the healing process as well as the importance of the patient-practitioner interaction.
Studies also show that individuals who seek out and use alternative medical treatments tend to be the better educated and the more affluent. Thus the stereotype of the alternative medicine consumer as an uneducated, poor person succumbing to the sideshow lures of quacks and charlatans appears to be greatly overblown. The reality is that because patients, in general, are demanding more health care options at a lower cost, a growing number of conventionally trained American physicians have already begun incorporating alternative medical modalities into their everyday medical practices.
The dominant biomedical U.S. health care system has made countless technological discoveries and innovations in the past half century, revolutionizing the way the body, the mind, and the environment are viewed. By all measures, however, it is an extremely expensive system offering limited accessibility. In other words, the patients who have the most money and live nearest the best health care facilities often receive the best care. Increasingly, this situation will dictate that the elderly, the disadvantaged, people with chronic illnesses, and the very young go without adequate health care–the populations that need health care most.
One of the simplest and most effective ways to significantly lower health care costs and thus increase access is through a major focus on preventive medicine. In this clinical arena, many of the alternative health care systems may have much to offer. Homeopathic and naturopathic physicians, for example, strongly advise their patients about diet and other health-promoting lifestyle choices as a matter of routine care. In contrast, many conventional physicians do not routinely give such advice until a patient has already become chronically ill, by which time the patient may need expensive high-tech surgery and face a lifetime of expensive drug therapy.
Another major factor contributing to the skyrocketing health care costs in this country is the amount of time involved in officially certifying a drug or medical intervention as clinically effective and safe. Millions of dollars may be spent, and years may pass, before a potentially lifesaving drug, instrument, or intervention winds its way through the complex Federal approval process. That same process too often ignores or discounts related, potentially valuable Canadian, European, and Asian data that could significantly shorten the assessment process.
In addition, standards of testing drugs and therapies in the United States are inconsistent with standards in many other technologically developed countries. For example, U.S. regulations on testing herbal medicines require a much more circuitous testing process than is required overseas. There, evidence of prior use without adverse side effects may be accepted by medical authorities without data from extensive clinical trials; preliminary clinical trials can therefore focus immediately on the effectiveness of the herbal remedy. In the United States, however, Phase I trials focus solely on safety issues, and effectiveness is not dealt with until much later.
Furthermore, in many European and Asian countries it is completely acceptable to test an herbal extract as a single drug rather than require every potentially active ingredient in the plant to be tested, as is the rule in the United States. Thus in other developed countries significantly less time and cost often are involved in bringing a potentially beneficial herbal or naturally occurring remedy to market.
As U.S. consumers continue to use alternative medicine, the challenge for health care policymakers and Federal regulators is not only to protect the public from unscrupulous medical practitioners but also to ensure the public’s access to the most effective treatments available. Certainly, patients should have recourse if it can be shown that their practitioners or the treatments they offer have no clinical or psychological benefit. By the same token, patients with debilitating severe or chronic illnesses should have the right to have access to–as well as insurance to cover–an alternative therapy they believe offers them relief.
Many of the alternative therapies described and discussed in this report–hypnosis, art therapy, music therapy, chiropractic, massage therapy, acupuncture, and many herbal and nutritional supplementations, to name a few–have already received extensive and positive clinical evaluations. However, no critical mass of researchers, clinicians, and policymakers has formed to give them more exposure and recognition. Therefore, many of these therapies should be included in any serious discussions about developing a truly comprehensive health care system. Others, as the report has indicated, need to be quickly and thoroughly evaluated before any judgment can be passed. However, they still may represent a great and largely untapped resource for improving the Nation’s health.
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