Transformative Health Strategies (eBook)

Chapter 1

Integrative and Alternative Medical Modalities

There are various terms in use that refer to the dominant medical system practiced today in the US and around the world. These include conventional medicine, biomedicine, allopathic medicine, and Western Medicine. I consider all these terms synonymous. Note that the term “Western Medicine” is somewhat ethnocentric. Although this approach originated in Europe and the US, biomedical scientists and physicians worldwide have contributed to knowledge and therapeutics over the last one hundred years, making it a collaborative effort. Having said this, there is considerable worldwide variation in the extent to which competing or complementary, traditional, and indigenous medicine are practiced, sanctioned, and incorporated into a country’s healthcare system. The World Health Organization Traditional Medicine Strategy: 2014-2023 provides a wealth of information regarding the status of traditional medicine in each member state.

In the US, providers with a Doctor of Medicine (MD) degree are often referred to as allopathic physicians to distinguish them from Doctors of Osteopathy (DO). This distinction is rooted in history. Osteopathic medicine was developed by frontier physician Andrew Taylor Still in 1895 to protest the medicine of his day. Initially, it began as a holistic approach involving the manipulation of joints and bones to treat disease and maintain health [8]. Nineteenth-century osteopathy was considered alternative medicine, but now DOs receive virtually the same training in osteopathic medical colleges as MDs receive in allopathic medical schools. Both MDs and DOs attend the same residency programs and are licensed physicians.

Throughout this book, I will use the term “conventional medicine” to refer to the mainstream Western Medicine or biomedicine that we encounter in most clinics and hospitals. In contrast, the following modalities are often considered “alternative” medicine, although some, such as chiropractic, have gained mainstream recognition and are covered by health insurance in the US:

• Chiropractic
• Homeopathy
• Naturopathy
• Mind-body practices like yoga and meditation
• Ayurveda (ancient medical system of India)
• Traditional Chinese Medicine, including acupuncture
• Indigenous medicine of native peoples 
• Herbal medicine

The phrase “Complementary and Alternative Medicine” (CAM) is often applied to non-Western or non-allopathic medical practices that may be used in conjunction with conventional medicine. The phrase is considered by many to be outdated, and some have criticized it as ethnocentric because it reinforces a hierarchy designating traditional/Western/scientific medicine as superior and other medical systems and approaches as subordinate to it. In contrast, integrative and functional medicine combine conventional and alternative medical diagnostics and treatments and differ philosophically from conventional medicine. In this chapter, I discuss the history of medicine as it applies to practices today and review select approaches that are considered alternative or integrative.

Historical Background

During the 20th century, biomedicine became the predominant medical system in the United States and worldwide. Before this, medicine in the United States was pluralistic and, in some other countries, consisted of traditional healing practices developed over centuries. Some regions had evolved complete medical systems dating back to antiquity. Prime examples are Traditional Chinese Medicine (TCM) and Ayurveda, the medical system of India. Both modalities are rooted in religious beliefs and maintain a holistic view of body and mind. Both use herbal medicine as well as mind-body practices. TCM is noted for the development of acupuncture, and Ayurveda is recognized for surgery. In contrast, biomedicine is not rooted in religious philosophy and has been characterized as both mechanistic and dualistic, reflecting Descartes’ separation of mind and body [9, 10].

Medical modalities practiced in 19th-century America included Thomsonianism, homeopathy, chiropractic, osteopathy, naturopathy, and eclectic medicine. Eighteenth and 19th century “heroic” medicine practiced by Euro Americans and Europeans derived from humoral theory originating centuries ago in Ancient Greece and Rome. Heroic medicine used treatments such as bloodletting, leeches, the dispensing of heavy metals, opium, and other harmful regimens. A famous case is that of George Washington, who probably died from blood loss due to the “heroic” treatments he received, rather than pharyngitis, his presenting illness. The shift toward scientific medicine began in the late 19th and early 20th centuries with the development of Louis Pasteur’s germ theory and advances in diagnostic technologies (e.g., the stethoscope and microscope), public sanitation, vaccination, and surgery, as well as discoveries like penicillin and insulin [11]. This transition accelerated in the United States following the Flexner Report of 1910 [6, 12].

The Flexner Report

The pluralistic landscape of the 19th century changed dramatically during the first two decades of the 20th century. A major catalyst was the Flexner Report of 1910, which transformed medical education in the United States and aligned it with biomedical science. The impetus for the Flexner Report came in 1904 when the American Medical Association (AMA) created the Council on Medical Education (CME). The CME sought to promote the restructuring of medicine in the US per the AMA’s goals. The CME requested that the Carnegie Foundation for the Advancement of Teaching survey medical schools in the US and Canada. Henry Pritchett, President of the Carnegie Foundation, chose Abraham Flexner, an educator from Louisville, Kentucky, to do so. Flexner visited 155 medical schools over one year and wrote a detailed report in 1910. Flexner’s model was that of Johns Hopkins School of Medicine, which emulated German academic medicine. His recommendations included reducing the number of medical schools and poorly trained physicians, increasing the prerequisites, aligning medical schools with universities, training physicians to practice scientifically, and engaging the faculty in research [6].

The Flexner Report contributed to the standardization of medical education in the US. Following the report’s publication, 70 of 155 medical schools closed, including five out of seven black medical schools, six out of seven women’s medical colleges, and 13 out of 15 homeopathic medical schools. Many of these schools closed because they could not secure the funds needed to meet the standards Flexner recommended or because they failed to satisfy increasingly stringent state licensing and accreditation rules championed by the AMA and the Federation of State Licensing Boards, founded in 1912. In some states, “alternative” medicine practitioners such as chiropractors and naturopaths were prosecuted for practicing medicine without a license. State licensing boards succeeded in restricting “alternative” practices and enforcing the adoption of biomedical curricular standards [6, 13].

Flexner’s recommendations have continued to influence medicine over a century later via support from philanthropists such as John Rockefeller and Andrew Carnegie, medical educators, the AMA, and licensing and accrediting bodies. The American medical school curriculum has been somewhat modified, but the four-year program and most of the pre-medical requirements that Flexner championed remain today. In addition, the alliance of allopathic medical schools with universities and the archetype of the academic physician engaged in biomedical research endures. However, tenure-eligible positions for physician-scientists are vanishing, and the new generation of physicians who work in university systems tend to be clinical faculty on renewable contracts. The achievement of academic tenure in US medical schools often requires that faculty secure highly competitive National Institute of Health grants to fund science-based medical research on topics of programmatic interest to the funding agency. Physician-scientists also conduct randomized clinical trials, often sponsored by pharmaceutical or medical device companies.

Positive outcomes attributed to the Flexner Report include the following: medical students received uniform training in the basic and clinical sciences; medical education became standardized and regulated; the alignment with science eliminated any vestiges of heroic medicine as practiced in the 18th and 19th centuries, and the affiliation with universities upgraded teaching and fostered research as well as the translation of findings into clinical practice. Nevertheless, the report, which bolstered the power and authority of the AMA, also fostered an elitism that endures to this day. Women, minorities, residents of rural and poor areas, and alternative medical approaches have suffered from a lack of support or marginalization, and the definition of what constitutes “medicine” in the US narrowed. Clinical practice guidelines are the norm in conventional medicine, and medical malpractice cases have shaped the definition of standard of care. This further constrains physician behavior, particularly concerning the use of unconventional treatments [6].

Consumers, by contrast, make considerable use of alternative treatments. In 1993 Eisenberg and colleagues published a landmark study showing...