althernative therapies

Zinberg, Norman E. 1984. Drug, Set, and Setting: The Basisfor Controlled Intoxicant Use. New Haven, CT: YaleUniversity Press.

Robin Room (1995, 2004, 2014)Director, Center for Alcohol Policy Research, Turning Point

Professor, Melbourne School of Population andGlobal Health, University of Melbourne

ALTERNATIVE THERAPIESThis entry consists of the following:

I. SOCIAL HISTORYRobert C. Fuller and Justin Stein

II. ETHICAL AND LEGAL ISSUESJames F. Drane

I. SOCIAL HISTORYHealing is a profoundly cultural activity. The very act oflabeling a disease and prescribing treatment expresses ahealer’s commitment to a particular set of assumptionsabout the nature and structure of reality. These assump-tions not only help specify the agents thought to causedisease but also contain implicit understandings of whathealth optimally or normatively enables humans to do.Because rival medical systems typically subscribe todiffering philosophical and cultural outlooks, the notionof orthodoxy pertains to medicine as surely as it does toreligion or politics. What makes a therapy “orthodox” isits adherence to a belief system that, for intellectual andsociological reasons, informs the practice of the dominantmembers of a culture’s medical delivery system. A therapyis therefore “unorthodox” to the extent that its diagnosesand treatments are not deemed legitimate by thedominant belief system.

The philosophical and professional differences thatseparate orthodox and unorthodox therapies give rise tocomplex ethical questions. How, for example, are we tounderstand medical “legitimacy” when this notion is theproduct of ever-changing philosophical, cultural, andsocial factors? What does it mean for a medical treatmentto be unethical? Must it in some way bring about negativeresults, or is it unethical even if it is merely a harmlessfraud—such as vitamin placebo treatment? What con-stitutes a therapeutic benefit? Is it solely determined byimprovement in a person’s physical well-being, or does italso include consideration of a person’s mental or spiritualwell-being?

First, the sheer diversity of alternative therapieshampers attempts to generalize about the kinds of ethicalissues that unorthodox treatments present. There is analmost bewildering array of alternative therapies, ranging

from chiropractic, osteopathy, and acupuncture to shiatsu,herbal medicine, and religious faith healing. Furthercomplicating this task is the fact that these alternativetherapies find themselves labeled unorthodox for quitedifferent reasons. Some, for example, are practiced byhealers committed to an alternative belief system orworldview that grants reality to causal forces that differgreatly from those specified by medical orthodoxy. Such isthe case with Ayurveda and Chinese medicine, whichdescribe fluids in patients’ bodies that have no directcorrelates in biomedicine. It is also true for religioustherapies such as “faith healing” traditions and New Agemedical systems that invoke overtly metaphysical explana-tions of the causes of physical illness and depict humanhealth in terms of adherence to specific spiritual or moraloutlooks on life.

Second, healing systems may become unorthodoxwhen they employ therapies that, though they arepredicated upon the consensus worldview, have not yetbeen validated or confirmed as efficacious by orthodoxmedical standards. Many of the treatments suggested forcombating cancer or acquired immunodeficiency syn-drome (AIDS) are considered unorthodox for this reason.Third, healers find themselves outside the medicalmainstream when they provide services that are typicallyignored or deemed of secondary importance by a culture’sdominant medical practitioners. This has been the case,for example, with dentists in the nineteenth century,podiatrists in the early twentieth century, and midwivesthroughout most of modern history.

The case of midwifery is instructive. While it wasnever as widespread in the United States as in other partsof the world, midwives provided the only obstetricalassistance available to many women until early in thetwentieth century. As obstetrics became a recognizedmedical specialty, primarily under the control of malephysicians, hospitals equipped with surgical facilitiessupplanted the home as the normal site for giving birth.Increasingly the last resort of those who could not affordhospital births, midwifery generally fell into disrepute.Midwifery, then, became an “unorthodox” form ofmedical care not because it employed an alternativeworldview or because it could not be validated as atreatment but because the dominant providers of medicalservices decided that the home and the assistance of otherwomen at childbirth were not of primary importance.Interestingly, midwifery has witnessed a modest resur-gence as part of a general cultural trend toward “natural”medicine and woman-centered health care. From 1980 to2010, births attended by certified nurse-midwives wentfrom just over 3 percent to about 8 percent of total birthsand 12 percent of all vaginal births (Declercq 2012).These numbers are roughly the same in Western Europe,with the exception of the Netherlands, where roughly

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Alternative Therapies

(c) 2014 Cengage Learning. All Rights Reserved.

one-third of all births are home births monitored bymidwives and where midwives monitor almost 70 percentof hospital births (DeVries 2001).

What alternative therapies have in common iseconomic, legal, and cultural disenfranchisement fromthe socially empowered institution of scientific medicine.Any attempt to reflect upon the ethical questions raised bythese “alternative” approaches to healing requires sensitiv-ity to the historical and philosophical roots of thisdisenfranchisement. “Regular” physicians coalesced intostate and local medical societies during the nineteenthcentury, securing an institutional power base for what wasto become medical orthodoxy in the United States. Thisemerging corps of physicians shared a more or lesscommon approach to medical practice, and they wereeventually able to “institutionalize” this approach throughthe influence they exerted over licensure laws enacted bystate and federal governments, the accreditation ofmedical schools, and access to technologically equippedhospitals.

The American Medical Association (AMA) (foundedin 1847 but lacking strong organization and sufficientmembership until the early twentieth century) eventuallysucceeded in organizing and promoting the interests of thenation’s dominant medical practitioners. The AMAencouraged state and federal agencies to enact stricterlicensing regulations and to restrict hospital access tograduates of AMA-accredited medical schools. Theseefforts undoubtedly furthered the cause of scientificmedicine and surely protected the public from potentiallyharmful forms of quackery. They also, however, forced tothe margins of the medical marketplace those whoseapproaches to healing utilized a nonscientific worldview orwhose medical services did not fit with dominantapproaches to medical care.

Medical orthodoxy aligned itself with the worldviewspawned by the Western scientific tradition. Its approachto therapeutic intervention has been firmly rooted in theevolving body of information that has emerged fromadvances in physiology, chemistry, and pharmacology.Accompanying this reliance upon the Western scientifictradition has been an implicit endorsement of a secularistand rationalist ontology (i.e., a worldview skeptical ofclaims concerning the supernatural or other unquantifi-able influences). What has given scientific medicine its“public” character is its insistence that theories concerningthe etiology and treatment of disease specify causal forcesthat are physical, as opposed to spiritual or metaphysical.Its theories and strategies for therapeutic intervention arethus more susceptible to empirical verification, anddisputes can at least potentially be resolved by an appealto observable and quantifiable sets of data. This is alsowhy scientific medicine found itself more amenable thanmany of its alternative counterparts to the economic and

legal institutions of modern Western governments.Rejecting the “private” claims to truth made in religiousarguments, Western democracies have required that allcivic discourse be advanced according to rationalistic andpublic grounds of argumentation.

To the extent that scientific medicine’s academic andexperimental foundations facilitate such “public” argu-mentation, it has largely merited its enfranchisementwithin the legal and economic institutions that makejudgments about the allocation of medical resources. Anyconsideration of the ethical status of these judgments andtheir effect upon the practice of alternative medicalsystems in the modern West must take into account theimportant role that such rational and public discourse hashad in the development of Western culture.

EARLY CHALLENGES TO REGULAR MEDICINE

The Thomsonian System. One of the first challenges tothe orthodoxy of “regular physicians” occurred in theearly 1800s. Samuel Thomson (1769–1843) was a poorNew Hampshire farmer whose mother and wife hadsuffered from the bleedings and mercurial drugs forcedupon them by regular physicians. Thomson believed thatbetter treatments must be available, and he beganstudying the therapeutic value of herbs. He soondeveloped his own system of botanical medicine predicat-ed upon the assumption that there is only one cause ofdisease, cold, and one cure, heat. Thomson believed thatby restoring heat to his patients’ systems, he could cureany ailment. Using botanics such as cayenne pepper,supplemented with steam baths, Thomson sought cureswithout the incessant bloodletting or mercurial drugsutilized by the era’s orthodox physicians.

The Thomsonian system reached the height of itspopularity in the 1820s and 1830s. Some estimate that itsmethods were employed to varying degrees by as many asa million Americans. One obvious reason for its appealwas that its treatments were generally more benign thanthe aggressive arsenal of bloodletting, alcohol, opium,mercury, arsenic, and strychnine that many regularphysicians used to stimulate their patients’ systems.Perhaps more important, Thomsonianism could bestudied relatively inexpensively (although the official pricefor the right to use his methods was a substantial $20) andpracticed by family members. During the early days ofmedical professionalization in the United States, Thom-sonianism strengthened the role of parents and especiallymothers in caring for family members.

Thomsonianism also fit nicely with the period’smoral and religious climate, which urged individuals totake responsibility for their own moral and spiritualregeneration. It endeavored “to make every man his ownphysician” and encouraged individuals to take responsi-bility for restoring their rightful relationship to the

164 BIOETHICS, 4TH EDITION



divinely decreed laws of nature. Of lasting significance isthe fact that Thomsonianism was the first system to takeon the issue of licensing of medical practitioners and toassert the public’s right to free choice of healers.Thomsonians led the successful campaign to repealmedical licensing legislation in the mid-1800s and drewpublic attention to the somewhat predatory tactics withwhich orthodox physicians sought to restrict the right ofwould-be healers to practice whatever system they wanted.

Homeopathy. A second form of sectarian medicine,homeopathy, emerged more or less concurrently with thepublic’s gradual loss of enthusiasm for the Thomsoniansystem. The homeopathic system of medicine was thecreation of the German physician Christian FriedrichSamuel Hahnemann (1755–1843), who grew increasinglycritical of the indiscriminate prescription of drugs bycontemporary physicians. He coined the term allopathic torefer to orthodox medicine’s alleged overreliance uponinvasive therapeutic treatments (e.g., bloodletting, sur-gery, or the administration of strong pharmacologicalagents). In contrast to allopathic medicine, Hahnemannenunciated a medical theory that he thought relied moreupon the body’s natural powers to bring about recovery.The first principle of homeopathic medicine is “like curedby like.” By this Hahnemann meant that physiciansshould treat symptoms by prescribing drugs that producesimilar symptoms in a healthy individual. The secondfundamental principle of homeopathic medicine is thedoctrine of infinitesimals. It was Hahnemann’s convictionthat the greatest therapeutic benefit was to be achieved byadministering diluted doses of a drug, sometimes only1/1,000,000 of a gram.

Homeopathy spread quite rapidly in the UnitedStates. It was introduced by Hans Gram (1786–1840),who opened an office in New York after studying thehomeopathic system in Europe. By 1835 a homeopathiccollege had been formed, and in 1844 the AmericanInstitute of Homeopathy was organized. Throughoutthe second half of the nineteenth century, 10 to12 percent of the country’s medical schools and medicalschool graduates were adherents of homeopathy.In contrast to Thomsonianism, which was practiced bynonprofessionals, homeopathic practitioners were educat-ed professionals who often came from the ranks ofregular physicians. Moreover, while those who receivedThomsonian treatment tended to be rural and poor,homeopathy thrived among the urban upper and middleclasses. This latter fact led to direct economic competitionwith the regular system and proved an important catalystin the formation and success of the AMA as economicmotives joined with scientific ones to rally regularphysicians in opposition to their now “irregular”competitors.

As the most popular of the century’s alternativesystems, homeopathy raised a number of importantethical questions. For example, could allopathic physiciansconsult “unscientific” practitioners? (The AMA’s originalcode of ethics included a consultation clause thatprohibited such interactions.) Or should homeopathicphysicians be allowed to practice in publicly supportedhospitals or in the military? Even in the late twentiethcentury there was debate about whether pharmaciesshould be required to stock homeopathic medicines.

Hydropathy and Dietary Regimens. In the mid-1840sanother alternative therapy, hydropathy (water cure),began to attract a following in the United States. Based onthe theories of Vincenz Priessnitz (1799–1851) of Austria,hydropathy was based on enhancing the body’s inherentvitality and purity. Priessnitz believed that pure watercould be used to flush out bodily impurities and stimulatethe body’s inherent tendencies toward health. Water-curetreatments emphasized drinking large amounts of waterand applying water externally through baths, showers, orwrapping wet sheets around the body. Most Americanadherents of water cure advocated an eclectic approach tohealth based on the curative powers of fresh air, diet,sleep, exercise, and proper clothing. The philosophy ofwater cure also had a decidedly moral tone.

Hydropathy equated disregard of the laws of healthfulliving with defiance of God’s will. Systematic efforts topromote healthful living were not only the means tophysical well-being but also the key to the spiritualrenovation of Earth. The hydropathic cause naturallyattracted many of the period’s moral and religiousreformers. William Alcott, Lucy Stone, Amelia Bloomer,Susan B. Anthony, and Horace Greeley visited majorhydropathic retreat centers, where they circulated reform-ist agendas ranging from vegetarianism to utopiansocialism. Critical of the alleged superiority of “official”medical authorities, advocates of hydropathy had a naturalaffinity with the feminist thought of the time. Hydropa-thy looked to nature, not credentialed male physicians, asthe ultimate source of healing; in so doing, it provided avehicle for those seeking to redress what they thoughtwere faulty notions of social and political authority.

Another nineteenth-century forebear of contempo-rary alternative therapy in the United States was SylvesterGraham (1794–1851), who combined conservative reli-gious beliefs with zealous concern for health reform. Anordained Presbyterian minister and itinerant evangelist,Graham believed that human physical, moral, andspiritual well-being required scrupulous adherence to thenatural order established by God. Graham admonishedhis followers that avoiding alcohol and the overstimulationof the sexual organs could help them maintain moral andphysical health. His advice for a healthful diet included a




coarse bread, which was later produced in the form of acracker that (in modified forms) still carries his name.Graham’s dietary principles, widely circulated throughoutthe nineteenth century, served the cause of keeping thesoul’s “bodily temple” free from impurities.

Ellen White (1827–1915) occasionally visited ahydropathic resort in Dansville, New York, where shebecame a convert to Graham’s dietary gospel. Whitethereafter had a series of mystical visions in which Godrevealed to her that he expected humans to follow thedivinely given laws governing health and diet as faithfullyas his moral laws. The Seventh-day Adventist denomina-tion founded by White has since then adopted Grahamiteprinciples and a vegetarian diet as essential parts ofpurifying themselves in expectation of the SecondComing of Christ. Seventh-day Adventists, one of thelargest religious groups to originate in the United States,combine their evangelical religious faith with a strongemphasis on healthy dietary practices. This emphasisupon a healthful diet does not in and of itself constitute analternative medical practice. Their dietary concerns are,however, closely connected with their belief in the efficacyof petitionary prayer. Furthermore, the Adventist churchopened health sanitariums, including the renownedBattle Creek Sanitarium overseen by John HarveyKellogg (1852–1943) of breakfast cereal fame. Thesesanitariums stressed hydrotherapy and nutrition but havesince developed into a system of hundreds of biomedicalhospitals and clinics around the world.

THE RISE OF MENTAL HEALING PRACTICES

Mesmerism. The introduction of Franz Anton Mesmer’s“science of animal magnetism,” commonly known asmesmerism, in the 1830s and 1840s popularized a beliefin the power of the unconscious mind to draw upon aninvisible healing energy. Mesmer (1734–1815), aViennese physician, believed that he had detected theexistence of an almost ethereal fluid that permeates theuniverse. This fluid, called animal magnetism, flowscontinuously into and is evenly distributed throughout ahealthy human body. If for any reason an individual’ssupply of animal magnetism is thrown out of equilibrium,one or more bodily organs will begin to falter. Mesmerproclaimed, “There is only one illness and one healing.”The science of animal magnetism revolved around theidentification of techniques for restoring a patient’s innerreceptivity to this mysterious, life-giving energy.

Mesmer held magnets in his hands and repeatedlypassed them over the heads and bodies of his patients inan effort to induce the flow of animal magnetism intotheir systems. His followers later dispensed with themagnets, finding that oral suggestions from the healercould induce patients into a trance, ostensibly heightening

their receptivity to the influx of this metaphysical healingagent. Mesmerized patients claimed to feel pricklysensations running up and down their bodies, which theyattributed to the influx and movement of animal magne-tism. Awaking from their sleeplike trance, they reportedfeeling refreshed, invigorated, and healed of such disordersas arthritis, nervousness, digestive problems, liver ailments,stammering, insomnia, and the abuse of coffee, tea, oralcohol. Some patients even claimed that the mesmerizingprocess enabled them to open up the mind’s latent powersfor telepathy, clairvoyance, and precognition. These claimscontributed as much or even more to mesmerism’s growingpopularity than its reputation for healing.

A good many of those drawn to mesmerism weremiddle- and upper-class individuals who styled themselvesprogressive thinkers and were interested in uniting scienceand religion in a single philosophical account of humannature. Mesmerism struck them as an important step inthis direction. The phenomena surrounding mesmerictrances were thought to provide empirical proof that eachhuman is inwardly connected with higher, metaphysicalplanes of reality. Adherents of mesmerism believed thatunder certain conditions of psychological receptivity,humans are able to open themselves to an influx of energyor guidance from these higher realms. American mesmer-ists borrowed terminology from transcendentalism, spiri-tualism, and Theosophy to provide their middle-classreading audience with a new vocabulary for understandingthe interconnection of their physical, mental, and spiritualnatures.

Mind Cure and Christian Science. A popular philosophyknown as the mind cure, or New Thought movement,grew out of the mesmerists’ healing practices. Mind-curewriters in the United States published books andpamphlets describing how thought controls the extentto which we are able to become inwardly receptive tospiritual energies. From Phineas P. Quimby and WarrenFelt Evans in the 1800s to Norman Vincent Peale,Norman Cousins, and Bernie Siegel in the 1900s,to Rhonda Byrne in the early twenty-first century,Americans have displayed a remarkable enthusiasm forthis “power of positive thinking” literature. The mind-cure movement gave rise to a novel form of religious pietybased on the belief that the deeper powers of our mindscontrol our access to a metaphysical power that caninstantly help us to achieve peace of mind, improvedhealth, and a never-ceasing flow of energy. The holistichealth movement of the late twentieth century reliedheavily upon this cluster of metaphysical ideas.

Mesmerism was also instrumental in the formation ofChristian Science. In 1862 Mary Baker Eddy, in greatphysical and emotional distress, arrived on the doorstep ofthe famous mesmerist healer Phineas P. Quimby.




Quimby’s treatments gradually cured her of her ailments;they also gave her a new outlook on life, based uponthe principle that our thoughts determine whether weare inwardly open to or closed off from the creativeactivity of a spiritual energy (animal magnetism). Soonafter Quimby’s death, Eddy transformed his mesmeristteachings into the foundational principles of ChristianScience. Her principal text, Science and Health with Keyto the Scriptures (1875), reveals her intention to shiftthe science of mental healing away from the categoriesof mesmerism to those that bear more resemblanceto Christian scripture, albeit her own unique inter-pretation of it.

The basic theological postulate of Christian Science isthat God creates all that is and all that God creates isgood. Sickness, pain, and evil are not creations of God,and therefore they do not truly exist. They are simply thedelusions produced in an erring, mortal mind that has losta firm hold on the belief that only those things created byGod have true existence. For Christian Scientists theuniverse is spiritual. What we call matter (e.g., bacteria,viruses, and so on) consequently does not really exist andtherefore has no causal power. Christian Science healers,known as practitioners, help individuals to overcome theirfaulty thinking and to elevate their mental attitudes abovethe delusions of the senses. Healing occurs as theindividual learns to function on a metaphysical ratherthan a physical plane. Healings are understood not asmiracles or faith healings but as the lawful consequence ofexchanging false conceptions for true ones, which centersolely on the higher laws of God’s spiritual presence.

Both Christian Science and the “holistic” philoso-phies that emerged from the mind-cure tradition teachthat our thoughts control the degree to which we availourselves of the higher spiritual source from which healthproceeds. As a consequence, illness or disease is under-stood as something the sufferer has brought upon himselfor herself through failure to sustain a “correct” mentalposture toward life. Any ethical analysis of these forms ofalternative therapy must take seriously their built-inskepticism about whether a medical system really needsto attend to material causes of illness (bacteria, viruses,and others). The issue is not as acute for holistic healingpractices that do not deny that there are physical andmaterial causes of illness but simply maintain that mentaland spiritual factors are entailed in the etiology of mostillnesses and must be taken into account in anycomprehensive medical system. Although they insist thata patient’s mental outlook often is a significant factor inthe creation and cure of illness, they generally do notespouse a medical theory that puts all the “blame” forillness or “credit” for recovery upon the patient.

Christian Science, by contrast, goes much further inchallenging the empirical and rational foundations of

Western science. By denying the ontological reality ofmatter, and hence the causal power of viruses or bacteria,Christian Science is clearly at philosophical loggerheadswith both medical orthodoxy and the legal systems ofmost Western, democratic nations. Although the courtsallow Christian Scientists and others to avoid immuniza-tion, concern over the medical well-being of children hasprompted judicial action to limit Christian Scientists’ rightto prevent minors from being denied medical treatment. In1990 the US courts decided that two Christian Scienceparents were guilty of child neglect when their sole relianceon Christian Science methods was deemed responsible fortheir child’s death Such cases draw attention to theimportant ethical distinction between “private” religiousbelief and actions that have consequences in the “public”domain regulated by the legal system.

CHIROPRACTIC AND OSTEOPATHIC MEDICINE

Osteopathic and chiropractic medicine provide interestingexamples of the fate of alternative philosophical, religious,and ethical interpretations of healing in an age dominatedby scientific medicine. Osteopathic medicine emergedfrom the healing philosophy of Andrew Taylor Still(1828–1917). A former spiritualist and mesmeric healer,Still developed techniques for manipulating vertebraealong the spine in ways that he thought removedobstructions to the free flow of “the life-giving current”that promotes health throughout the body. Still explainedthe healing principles of osteopathy (a term derived fromtwo Greek words meaning “suffering of the bones”) inovertly metaphysical terms that described the origin andnature of “the life-giving current” ultimately responsiblefor human well-being. His followers largely discarded theoccult-sounding dimensions of Still’s philosophy andinstead insisted that osteopathic medical education begrounded in anatomy and scientific physiology. Thus,although osteopaths originally relied only upon manualmanipulations of the spine as a means of restoring health,they soon added surgery and eventually drug therapy totheir medical practice.

By the 1950s, so few differences existed in thetraining or practice of osteopaths and medical doctors thattheir two national organizations agreed to cease the rivalrythat had existed for several decades and to cooperate insuch matters as access to hospitals, residency programs,and professional recognition. Having jettisoned thealternative worldview of its founder, osteopathy no longerbore any overt signs of unorthodoxy and finally founditself within the medical mainstream. Interestingly, duringthe 1960s many osteopaths were concerned about beingabsorbed into allopathic medicine and gave renewed focusto osteopathy’s philosophical origins. Their commitmentto osteopathy’s historical concern with enhancing thebody’s natural powers for recuperation made them




champions of holistic medicine long before the termholistic became commonplace among alternative healers.As of 2012, there were over 82,500 osteopathic physiciansin the United States, with the number estimated to top100,000 by the end of the decade (American OsteopathicAssociation 2012, 2).

The case of chiropractic medicine is more complex.Chiropractic medicine originated in the work of DanielDavid Palmer (1845–1913), a mesmerism-inspired mag-netic healer in Iowa. Palmer, who knew of Still’sosteopathic techniques, theorized that dislocations of thespine are able to block the free flow of the life force, whichhe called Innate (his nomenclature for animal magnetism).Palmer and his son, B. J. Palmer, explained that InnateIntelligence is a part of the Divine Intelligence that fillsthe universe, bringing full physical health whenever itflows freely through the human body. Chiropracticmedicine represents the Palmers’ art and science ofadjusting the spine in ways that remove obstructions tothe free flow of Innate Intelligence within the body.

Over the years, chiropractic physicians began playingdown the movement’s metaphysical origins and empha-sized its scientific approach to the treatment of musculo-skeletal disorders. In this way, they minimized theirtheoretical unorthodoxy and identified an area of medicalpractice largely ignored by most medical doctors.Chiropractic physicians’ sustained attention to this voidin the “orthodox” medical system has earned them aviable niche in the medical marketplace. In 1990 morethan 19,000 chiropractic physicians in the United Stateswere treating more than 3 million patients annually; asurvey by the National Institutes of Health estimated thatby 2006 osteopathic and chiropractic physicians weretreating over 18.7 million Americans through manipula-tive treatments (Barnes, Bloom, and Nahin 2008, 10).Even though most medical insurance companies havecome to recognize the medical functions performed bychiropractic medicine, medical doctors are still largelywary of chiropractic medicine because it has failed toelucidate an empirically validated theory that wouldsubstantiate its therapeutic claims. This professionaltension provides a fascinating example of a continuingtheme in the history of alternative medicine: the clashbetween orthodox medicine’s rationalism (its insistenceon an acceptable scientific explanation for all methods)and alternative medicine’s pragmatism (discovery oftherapies that produce results regardless of whether theyare “proved” with rational theories).

ALTERNATIVE MEDICAL SYSTEMS

Around the world, a wide variety of therapies existalongside those based on medical science. An estimated 80percent of the world considers “alternative medicine” their

primary health care option, while biomedical care isunavailable or is prohibitively expensive. Within theUnited States, variations of pow-wow, an eclectic traditionusing charms, prayers, and rituals to prevent and curedisease, continue to be practiced by Pennsylvania Dutch;curanderismo still flourishes among Mexican-Americancommunities in the American Southwest; and immigra-tion from the Caribbean has rekindled African-Americanfolk medicine practices. The continued presence of such“ethnomedical” treatments may represent attempts topreserve cultural identity, economic disenfranchisementfrom the nation’s more expensive conventional medicalsystem, or the revival of genuine medical pluralism. Thecontemporary medical landscape is not, however, one thatensures even ground for all competing systems. The verynotion of “conventional” versus “alternative” revealsenduring discrepancies in legal status, institutionalfunding, and access to insurance coverage. Furthermore,conflicts between multinational pharmaceutical corpora-tions and indigenous peoples and their advocates over theintellectual property rights to medicinal plants point to anideological chasm between biomedicine and ethnomedi-cine. In any case, both legal and economic attitudestoward alternative therapies must be philosophically andculturally nuanced.

Immigration from Asia has increased the presence ofAyurveda and Chinese medicine in the West, and, in thecase of the United States, use of these therapiesdramatically increased immediately following the immi-gration reforms of 1965. The National Institutes ofHealth’s National Center for Complementary andAlternative Medicine (NCCAM) classifies these asalternative medical systems or whole medical systems becausethey are “complete systems of theory or practice that haveevolved over time … apart from conventional or Westernmedicine.” NCCAM distinguishes such systems, whichalso include homeopathy and naturopathy, from biologi-cally based therapies, such as supplements and diets;manipulative therapies, such as chiropractic and osteopath-ic manipulation; mind-body therapies, such as meditationand breathing exercises; and energy-healing therapies, suchas Reiki and therapeutic touch. The fact that the“alternative medical system” of Chinese medicine includestherapies from the other four categories (e.g., herbs,massage, and internal and external qigong) demonstratesthe arbitrariness of this delineation. Orthodox medicine’srelationship with these systems lies somewhere between itsacceptance of osteopathy and its continued mistrust ofchiropractic: therapies like acupuncture are consideredefficacious, although practitioners’ explanations of how itworks are still largely rejected.

Ayurveda. The best known of India’s indigenous medicalsystems, Ayurveda is founded on ancient (c. 500 B.C.E.–600 C.E.) Sanskrit texts that emerged from the




heterogeneous religious traditions of Brahmanism, Bud-dhism, and Jainism and circulated in translation acrosspremodern Eurasia, from Italy to China. These textsoutline Ayurvedic physiology, etiology, and diagnosis aswell as surgical techniques and the preparation anddispensation of plant- and mineral-based medicines.Despite some similarities to biomedical procedures,Ayurvedic practices operate under different models ofthe body than biomedicine’s aggregate of anatomicalstructures and physiological systems. Ayurveda describesthe body as a series of seven layers (dhatu), animated by avital energy (ojas) and circulating three fluids (doshas):wind (vata), bile (pitta), and phlegm (kapha). While oneor two of these fluids dominates each individual’sconstitution, good health relies on a balance of the three,and Ayurveda tends to stress prevention over cure.

Even though biomedicine has achieved orthodoxyin postcolonial India, receiving the majority of statefunding, indigenous practices like Ayurveda continue tothrive, partly through their adoption of the discursive,institutional, and technological practices of scientificmedicine. In the West, however, where interest in Asianmedical systems grew dramatically at the end of thetwentieth century, it is precisely Ayurveda’s differencefrom biomedicine that makes it attractive to medicalconsumers.

Traditional Chinese Medicine. Since the second half ofthe nineteenth century, waves of migration have broughtChinese medical practices, including herbalism, acupunc-ture, massage, cupping and moxibustion, to the Americas,Australia, and Europe. Like Ayurveda, Chinese medicaldiscourse describes the body as a microcosm of theuniverse, through which courses a series of channels thatcarry the fluid called qi (or chi). Blockages, excesses,deficiencies, and imbalances of qi are considered to be theroot of disease, and these are treated through diet, herbs,acupuncture, and other therapies. Several types ofimbalances can occur, the most important being thosebetween heat and cold; damp and dryness; and the “fivephases” (wuxing) of wood, fire, earth, air, and water,which each correspond to one of five viscera.

There have been many competing schools of thoughtand practice in Chinese medical history, but massivestandardization efforts in twentieth-century Chinaresulted in what is called Traditional Chinese Medicine(TCM). This standardization is the result of professionalunification by practitioners in the face of competition byWestern biomedicine in the first half of the century as wellas the state control of education and health care after theestablishment the People’s Republic in 1949. While otherChinese practices, such as taijiquan (or tai chi) andqigong, have also received international attention for theirhealth benefits since the second half of the twentieth

century, the NCCAM classifies them as “mind-bodytherapies” rather than part of the “alternative medicalsystem” of Chinese medicine.

HOLISTIC MEDICINE

During the last few decades of the twentieth century, theholistic healing movement led a surge of popular interestin therapies based on an explicitly religious, or quasi-religious, interpretation of the healing process. The precisemeaning of the term holistic medicine varies among healingsystems. Among its meanings are emphasis upon “natu-ral” therapies, patient education and responsibility,prevention, and treating patients as “whole” people. Alsocommon to holistic healing is the basic assumption that,as one handbook put it, “every human being is a unique,wholistic, interdependent relationship of body, mind,emotions, and spirit” (Belknap, Blau, and Grossman1975, 18). The term spirit, alongside body, mind, andemotions, carries holistic healing beyond psychosomaticmedical models; it also represents commitment to a beliefin the interpenetration of physical and nonphysicalspheres of causality. Even holistic healing’s exhortationsconcerning reliance on the body’s own regenerative andreparative processes are typically laden with references toopening individuals up to the inflow of a divine healingenergy. Persons who call themselves holistic healthpractitioners typically operate according to a worldviewthat is incompatible with the naturalistic framework of themodern Western scientific heritage.

One example of such a holistically oriented healingmovement and its methods is Alcoholics Anonymous(AA) and its twelve-step program, which has influencedmany other self-regenerative therapies. Founded in the1930s, AA has well over 1 million members, with about35,000 groups meeting weekly in over ninety countries.The principal founder of the movement, Bill Wilson, wasan alcoholic who became aware of his inability toovercome his addiction. A mystical experience of “a greatwhite light” (Kurtz 1979, 19) convinced him that a lovingpresence surrounds us and is capable of healing ourbroken inner lives. Wilson maintained that we need onlycease relying upon our own willpower and surrender tothis Higher Power. Wilson was wary of institutionalreligion’s moralism. From psychologists such as WilliamJames and Carl Jung, he pieced together a spiritualitybased upon opening the unconscious mind to a highermetaphysical reality. AA counsels its members that “inorder to recover, they must acquire an immediate andoverwhelming ‘God-consciousness’ followed at once by avast change in feeling and outlook” (Alcoholics Anony-mous 1955, 569). AA’s mystical, nonscriptural approachto personal regeneration sets its doctrines apart from mostof the United States’ religious establishment; its denunci-ation of both material and psychological/attitudinal




factors in favor of an overtly spiritual view of healing setsits practices apart from the American medical andpsychological establishments. But its open-minded andeclectic sense of the presence of spiritual forces in thedetermination of human well-being made it one of themost powerful mediators of wholeness in twentieth-century America.

The various religious and healing groups thatconstitute the New Age movement also endorse a holisticapproach to health and medicine; they envision everyhuman being as a unique combination of body, mind,emotions, and spirit. Central to New Age piety is theconviction that each person exists simultaneously on boththe physical and the metaphysical (i.e., the astral andetheric) planes of reality. Many New Age therapies seek tochannel healing energies from higher metaphysical planesinto the physical body. Energy healing, for example,maintains that illness in the physical body is frequentlycaused by a disruption or disharmony of energies in thepart of the body that extends into the metaphysical plane,called the etheric body or the subtle body. Healingconsequently requires techniques to achieve harmonybetween the physical and metaphysical bodies.

Crystals are thought to have unique properties thatenable them to serve as receptors and capacitors ofenergies from the metaphysical planes. Used properly,crystals are assumed to be capable of transmitting theseenergies in ways that bring the individual’s physical,moral, and spiritual natures back into harmony. To thisextent, New Age adherents do not reject the efficacy ofestablished medical science (though they do condemnwhat they perceive to be an overreliance on drugs andinvasive surgical techniques) so much as its secularist,materialistic worldview, which fails to take into accountour spiritual potentials. Healing, for New Agers, is a by-product of the more fundamental goal of expanding theirspiritual awareness. Many Westerners’ attraction to Asianpractices, including yoga, tai chi, and Reiki, is bound upwith agendas left over from such nineteenth-centurymovements as mesmerism, spiritualism, and Theosophy.Even acupuncture is embraced by many Americans notonly for its obvious physical benefits but also for itsconnections with Eastern mystical philosophies.

THE CHALLENGE TO BIOETHICS

Persons with life-threatening diseases who have not beenhelped by conventional treatments understandably be-come interested in pursuing alternative therapeuticstrategies. The highly publicized debate in the late1970s over the effectiveness of laetrile for retardingcancer drew attention to the potential risks of theregulation of medicine by the US Food and DrugAdministration. At stake was the unresolved issue ofwhether a drug should be restricted only when it is known

to cause harm or only when laboratory testing has failed toreveal measurable physical benefits. This debate continuedin the 1980s and 1990s over various treatments for AIDS.Persons given a bleak prognosis by medical doctors soughtimmediate access to experimental drugs that had justentered the slow and laborious regulatory processesmandated by US federal law. Although much has beendone to try to speed up the evaluation of experimentaltreatments for AIDS and other prevalent diseases such ascancer, there is always a subset of the population that findsitself barred from access to innovative scientific treatment.

The central ethical question raised by alternativetherapies is whether genuine medical treatment can bedistinguished from various forms of quackery. Except forisolated instances in which individuals engage in deliber-ate medical fraud, quackery is difficult to identify orprove. Any reliable definition of therapeutic benefitrequires being able to define the factors “known” toaffect human well-being and what optimal health consistsof. The practitioners of many forms of alternativemedicine criticize the assumptions they believe underliecontemporary medical science. They argue that alternativetherapies better understand human well-being and arecognizant of mental, moral, and spiritual factors that gowell beyond the physiological considerations on whichscientific medicine relies. To those who say that theirpractices or those who utilize them are “irrational,” theyrespond that every therapy is rational insofar as itsmethods of treatment are logically entailed by itsfundamental premises or its assumptions about the natureof disease.

Establishing criteria with which to mediate betweencompeting medical systems is complicated by the fact thatthe plausibility of the beliefs or assumptions that underliethem are every bit as dependent on sociological factors ason intellectual “proofs.” What we consider valid evidence,whom we consider expert authorities, and how we shouldgo about separating relevant from irrelevant informationturn not on objective, rational criteria but on the ways wewere socialized into one belief system or another. Who,then, is in a position to decide what is an “irrational”medical choice? With what degree of confidence orphilosophical integrity can orthodox physicians seek todissuade persons from seeking alternative treatments? Dopersons have a right to what seems, to adherents of“accepted” forms of Western medicine, to be an utterlyineffective therapy simply because it conforms to theirpersonal belief system?

Alternative therapies may reasonably be expected todemonstrate their benefits to patients and to substantiatethe claim that their distinctive healing practices directlycause these therapeutic results. Medical ethics is con-cerned with protecting persons from intended or inadver-tent harm. Well-intentioned tolerance of alternative




therapies should not preclude their undergoing rigorousscrutiny. Governmental agencies, health care facilities, andinsurance companies are forced to allocate limitedresources and to ensure the welfare of the general public.They must be prepared to make reasonable assessments ofalternative medical systems that are based on beliefsystems at considerable variance with modern Westernscience. Because quackery poses an inherent threat to bothpersonal and public well-being, those who make ethicaland policy-related judgments must exercise caution andstrive for the unrelenting application of “public” (openlydemonstrable and subject to empirical scrutiny) standardsof evidence. Perhaps the most important considerationin assessing scientifically unvalidated therapies is thatcontemporary medicine differs from its predecessors notbecause we have become more rational but because wehave learned to use the controlled trial to determine therelative merits of competing treatments.

Medical systems that are labeled alternative becausetheir concerns or treatments are at the periphery ofmainstream medicine are reminders that dominantprofessional groups tend over time to employ predatorytactics to ensure their continued supremacy and keeppotential competitors at a distance. These “medicallyperipheral” systems alert us to the fact that medical sciencehas philosophical and institutional blinders that may closeoff, rather than open, innovative approaches to humanhealth. The presence of alternative health professionals inthe wider system of health care helps safeguard against thekinds of complacency and narrowness of vision thatfrequently creep into economically entrenched profes-sions. By providing a range of services that address bothcurative and preventive issues typically neglected bybiomedical physicians, many of these alternative therapiespotentially contribute to a comprehensive understandingof human health and well-being.

The twenty-first century is perhaps no closer toadjudicating the scientific, economic, and ethical contro-versies surrounding alternative medicines than previouseras. In 1991 US Senator Tom Harkin spearheaded theeffort to create a special division of the National Institutesof Health dedicated to the research of promisingunconventional therapies. The Office for AlternativeMedicine was initially launched with a budget of $2million and, by 2010, had grown into NCCAM with anannual budget of about $120 million. The center’s useof the descriptive phrase “complementary medicine”seemingly endorses the view that alternative medicinesmight be used in combination with conventional medicaltreatments, as is also implied with other phrases such as“integrative medicine.” The creation of NCCAM coin-cided with the United Kingdom’s decision to fundhomeopathic hospitals under the National Health Service.Governmental support for these alternative medicines

predictably generated considerable criticism from physi-cians, scientists, and public policy analysts. Critics notethat the use of public funds to research and promotecomplementary and alternative medicine (CAM) gives themisleading impression that these treatments have beenclinically validated in addition to diverting research fundsfrom the most scientifically promising treatments (Bausell2007; Ernst 2008; Singh and Ernst 2008). Debates aboutwhether NCCAM is driven more by scientific method orideological agendas reflect the continuing public dilemmaabout how to assess the clinical and economic merits ofalternative medicine.

SEE ALSO America, Bioethics in: I. United States; Bioethics:VIII. Sociology of; Health and Disease: III. Anthropo-logical Perspectives; Medicine, Anthropology of; Medi-cine, Philosophy of

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Robert C. Fuller (1995, 2014)Professor of Religious Studies, Bradley University

Justin Stein (2014)Doctoral Candidate, Department for the Study of Religion,

University of Toronto

II. ETHICAL AND LEGAL ISSUESAlternative medicine covers a dizzyingly heterogeneousgroup of medical theories and practices that are not part ofmainline conventional medicine. Alternatives range fromthe different forms of folk medicine to more scientificsystems such as homeopathy, chiropractic, acupuncture,and naturopathy. Also included under the term alternativeare hypnotherapy; herbalism; iridology; the traditionalmedicines of India, China, Japan, the Philippines, andindigenous peoples; yoga; diet; meditation; music therapy;massage therapy; and reflexology. Certain shared negativeelements justify lumping together such diverse medicaltheories and practices. These include marginal socialstanding or fringe status in advanced cultures; exclusionfrom mainline professional journals; little public fundingfor research; exemption from mainline licensing require-ments; and conflict (but sometimes cooperation) withmainline medicine. The essential ethical and legalconsiderations raised by alternative medicines are scientificobjectivity, veracity, and beneficence and nonmaleficence.Because false claims of healing efficacy can cause directand indirect harms to patients, such claims violate theessential ethical obligation of all medical practice, whetheralternative or conventional—that is, to help and not toharm. On the other hand, there is an ethical issue thatsupports many alternative medicines: the frequent failuresof mainline conventional scientific medicine to connectpersonally with the patient, to establish and then continuea personal relationship, and to pay primary attention tothe patient rather than to technologies. Into the ethicalvacuum in mainline medicine, created by the loss ofpersonal relationship with patients, step many differentforms of alternative and unconventional medicines.

THE MEANING OF ALTERNATIVE ANDCONVENTIONAL

Once the Flexner Report (Medical Education in the UnitedStates and Canada: A Report to the Carnegie Foundation forthe Advancement of Teaching) commissioned by theAmerican Medical Association (AMA) was published in1910 in order to improve medical education in the UnitedStates and bring quality controls to medical curricula,




althernative therapies

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