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Science, Faith, and Alternative Medicine

Wednesday, August 1, 2001

Years ago, people wore garlic around their necks to protect their health. There may have been a rational basis for this action: Wearing garlic kept others at a distance, thus decreasing one’s exposure to infectious disease. But the people who wore garlic did not know this, and what animated them was more superstition than science.

As a practicing physician, I see a related phenomenon. I see patients who ingest garlic and other herbal products even though the science supporting the efficacy of these remedies is unclear. Ironically, these patients do so in the name of science. My patients would blush at the idea of wearing garlic in the style of a necklace, but when garlic is crushed up, put into capsules, and then swallowed, they are convinced that they are acting scientifically. This eagerness to swallow what others once wore may some day find justification in science. Then again, it may prove to be nothing more than superstition.

Alternative medicine is not a recent phenomenon, and at different times, branches of the movement have enjoyed widespread public support. Homeopathy, for example, was extremely popular in the United States during the second half of the nineteenth century. Ancient Chinese medicine has been popular in Asia for over 2,000 years. What today is called alternative medicine covers a wide range of disciplines, most of which are guided by the belief that the human body has more than just a material reality. Supposedly, the human body has an energy to it that can be guided by external manipulation, much the way that matter and tissues are influenced by chemicals and radiation in allopathic medicine. This manipulation of energy harnesses the inner resources of the body to promote healing.

Still, the definition of alternative medicine is just as confusing as the science of alternative medicine. Acupuncture, herbal therapy, and biofeedback are commonly included within that definition, but so also are chiropractic and magnet therapy. The spinal adjustment technique used by chiropractors has been shown in clinical trials to be effective for the treatment of low back pain. Moreover, the theory behind spinal adjustment has links to the biomechanical model of allopathic medicine. On the other hand, not only has magnet therapy failed to show effectiveness in serious clinical trials, its effectiveness might not even be demonstrable within the scientific paradigm governing medicine. Alternative medicine includes some therapies that have proven value and are consistent with modern science, but it also includes other therapies that may have no value at all, and if they did, would challenge the basic assumptions of science.

The confusion surrounding alternative medicine is reflected in the political arena, causing deep divisions within both the liberal and conservative camps. Within the conservative camp, libertarians see any governmental regulation of the alternative medicine movement as a violation of individual freedom. Cultural conservatives, on the other hand, are suspicious of the movement’s links to anti-Western multiculturalism. Within the liberal camp, progressives like Sen. Ted Kennedy and Rep. Henry Waxman have pushed for greater regulation of the alternative medicine industry in the spirit of consumer protection. Yet multiculturalists want alternative medicine to flourish unimpeded because they see it as a powerful weapon to use against traditional Western ideas.

Alternative medicine does not fit neatly into either the conservative or the liberal worldview. The conservatives have tax cuts and school vouchers, the liberals have national health insurance and environmentalism — and almost as if to keep from running afoul of each other, the two camps remain silent on a subject that belongs to neither.

This cannot continue. From 1990 to 1997, the amount of money spent by consumers on alternative medicine increased 45 percent. In 1997, Americans spent over $21 billion on alternative medicine, with almost a third of the U.S. patient population buying products and services in this field. Last year, consumers spent more money for alternative medicine therapies than they spent out-of-pocket in the entire allopathic (mainstream) medical system. Alternative medicine is now large enough to command the attention of legislators and public intellectuals.

What is driving the demand for alternative medicine? Clearly science is not the driving force. Hospitals put alternative medicine clinics on their campuses because marketing surveys reveal intense public interest in the field, not because proven science demands them. Alternative therapies like Ayurvedic medicine, healing touch, and energy medicine may challenge the biomechanical theory of disease that has governed medical science for over a century, but they do not come close to overthrowing it. We are not witnessing a paradigm shift as described by Thomas Kuhn in The Structure of Scientific Revolutions.

Some of the patients popping garlic pills confuse pill-taking with science and endow compounds taken by mouth with the force of science. Much of alternative medicine relies on physical practices that are commonly used in conventional (allopathic) medicine: pill-taking, needle-poking, and the application of heat and pressure. But this does not mean that alternative medicine is somehow closer to science than the wearing of herbal necklaces. People have simply confused these physical modalities with “signs” of science, the way sitting cross-legged with bowed head is wrongly interpreted to be a sign of spiritualism. If this is true, and alternative medicine has gained respect only by copying the ways of science, then science has unwittingly allowed itself to become the basis of the major superstition of our age.

Nor is the medical establishment responsible for alternative medicine’s growing popularity. If anything, the medical establishment looks at the phenomenon with restrained anxiety. Many doctors think of alternative medicine as something shady, the way doctors have traditionally viewed homeopathy and chiropractic. While this view is changing — more than 70 American medical schools now offer courses in alternative medicine — doctors are still unreconciled to its popularity, and they often adopt an attitude of semi-indulgent contempt.

The explanation for the rise of alternative medicine involves far more than science, politics, or money. Policymakers need to understand this in order to deal sensibly with issues of research, funding, regulation, and licensing that are now starting to appear.

In the past, people found relief for many of their problems in two institutions: the medical profession and organized religion. Doctors and clergymen helped people endure often heavy, joyless lives and kept people from feeling alone in the world. By doing so, doctors and clergymen developed a real bond of affection with their clients. Sometimes the bond of affection took the form of stern counsel for a misdirected life; other times it was composed of nothing more than pleasant conversation or a pat on the back. Either way, doctors and clergymen exerted a powerful effect on people’s lives.

Important changes in both the medical profession and organized religion have caused the influence of these two institutions to decline. Many people now see the medical profession as too busy and too science-oriented to care about their everyday troubles, while organized religion seems totally irrelevant and antimodern. As a result, people’s lives have been swept outside of their normal channels and scattered among the innumerable disciplines that make up alternative medicine. Alternative medicine lies between the medical profession and organized religion, and so benefits from the decline of both. Life once forced people into the hands of medical science or religion. Now a hybrid is there to receive them.

Medical science without faith

I n an era of managed care, doctors keep a firm and unremitting control over their time, their labor, and most important, over their mental and emotional powers. In Maryland, where I practice medicine, the ideal office visit lasts no more than 15 minutes. Doctors keep a tight schedule for two reasons: to maximize reimbursement by seeing as many patients as possible and to husband their strength for the activities of private, nonprofessional life.

In order to get down to business as quickly as possible, doctors put their patients into diagnostic categories, at the very least because insurance companies will not reimburse for care unless a patient has a diagnosis. From there, doctors draw on a variety of algorithms to treat their patients. The result is extremely efficient patient management, though somewhat cookbook.

Doctors apply the right method to every disease the way experienced housekeepers choose the right key for every door. As a result, there is little room for the enigmatic and the mysterious in medical practice. Even psychiatrists rely heavily on classification schemes to treat their patients. Patients who are confused about life, or who suffer from a small crisis of the spirit, find it difficult to talk to doctors about their problems in this hyperrational environment.

Many doctors do not even try to conceal their lack of interest in human relations. They look upon a medical practice confined to the systematic management of physical illness as an ideal of repose. A young doctor told me, “Every day I pray, ‘God spare me the interesting case.’” He viewed patients who might try to talk to him about their secret struggles as a source of trouble. They interrupted the brisk flow of patients through his office.

The entrance of women into the medical profession has not changed this trend. Many female physicians resent the fact that patients expect them to be better, more attentive listeners simply because they are women. They shout back that they are no more free to talk to a patient for two hours than male doctors, since their office schedules are just as tight.

The medical profession was not always so narrow in its scope. In the past, physicians gladly talked to patients when asked for advice about life, and in a spirit that is almost incomprehensible today. Doctors would put their instruments aside, assume a more thoughtful mood, and discuss issues with an almost relaxed indifference to any scientific purpose. Their wisdom was not a “treatment,” and the sweet but slightly condescending tone of their voices would probably be an insult to today’s democratic sensibilities. It suggests a distinguished and urbane person deigning to illuminate the less well-educated — not the more acceptable notion of a technician empowered solely by his or her narrow scientific skill.

When today’s doctors do talk about the problems of life with their patients, they usually have at least one eye on the diagnostic categories of mental illness. Rather than exploring life’s issues philosophically, doctors wonder whether a whining patient has a form of depression that needs to be treated with medication. Thus, even the management of emotional trouble becomes rather cookbook. The doctor becomes a skilled tradesman, such as a plumber or electrician — someone whose work calls for little depth of human understanding.

Patients see this, and they are repelled by it. This is one reason they flock to alternative medicine. While alternative medicine encompasses different treatment modalities, most of these systems have something in common: They do not herd patients into diagnostic categories or cause patients to be managed according to some predetermined algorithm. Each patient is considered unique in alternative medicine, such that if 10 patients present to an acupuncturist with peptic ulcer disease, each one might be treated differently. The theory behind alternative medicine requires providers to listen carefully to patients, to talk to their patients about special feelings and circumstances, since these elements affect treatment. This is true whether a patient complains of a physical condition or simple everyday unhappiness.

Because so much time is spent on each patient in alternative medicine, providers note that it can be hard to make a living in their world, even though they are paid in cash. They cannot work on volume the way allopathic doctors can.

In the past, when patients asked doctors for advice about life, they did not expect the wisdom they received to be confirmed by experiment. Patients simply listened to their doctors and then gradually and unconsciously followed the wisdom dispensed by doctors on faith alone. The high social and economic position of doctors, combined with the propensity of every human being to believe in something, allowed a doctor’s untested wisdom to grab hold of a patient’s mind. Doctors influenced the direction of people’s thinking, and satisfied people’s demand for answers to life’s problems, simply by stoking the religious instinct to believe.

The connection between the religious instinct and doctoring persists. Important religious traditions form part of the alternative medicine complex, including ancient Chinese medicine, traditional Ayurveda, yoga, the Islamic Sufi tradition, and Native American healing. By going to a practitioner skilled in one of these arts, patients feel that they are getting a complete doctor — someone to treat their medical condition and to give them wise advice about life as well.

Physicians in the past were not so overt in tying their wisdom to any particular creed. They may have been schooled in the classics or Christian theology, but they generally clothed their advice in secular language or at least conveyed religious maxims with subtlety. Today’s doctors generally lack an extensive liberal arts background — medical schools are satisfied if their graduates are scientists alone — and so the best way for doctors to complete themselves as professionals, and to satisfy their patients, is for them to work directly within a religious healing tradition. Religious healing traditions combine medicine with ready-made wisdom.

An increasing number of doctors use alternative medicine to embellish their personal doctoring skills. This is why alternative medicine’s bias toward Eastern religions is not necessarily part of a sinister, multiculturalist plot to destroy the West. Since neither Christianity nor Judaism has an extensive healing tradition, these religions do not form part of the alternative medicine complex. Eastern religion has an extensive healing tradition, and so it does. The fact that alternative medicine serves the multiculturalist agenda may only be a coincidence; many doctors use alternative medicine for no other reason than to establish a rapport with their patients without leaving the realm of science altogether.

The science of belief

The role of belief in medical practice penetrates the science of medicine itself. In the past, many doctors gave sugar pills to their patients because they made patients feel better, even though the pills themselves were inert. This was called the “placebo effect.” The idea that patient belief was just as important to therapy as real biochemical interactions formed part of everyday medical practice.

Over the past 20 years, the placebo effect has been practically disowned by physicians. Sometimes doctors are even a little embarrassed to prescribe aspirin, even though aspirin has an effect and is not a placebo, since the drug is so benign. To many physicians, real medicine means dealing with serious toxins — this is how doctors defend their exclusive right to the prescription pad — and doctors look upon the use of inert substances as a vestige of some quaint, prescientific age.

Doctors have forgotten the important role played by placebos in the management of patients. If doctors tell patients, “This is powerful medicine,” patients tend to believe it. Patients then demonstrate a positive response to the medication even though the drug is inert. People’s perception of their treatment plays an important role in their attitude toward illness.

The medical profession’s contempt for the placebo effect is so intense that it has given way to confusion about what the placebo effect really is. In a recent article published in the New England Journal of Medicine, placebos were shown to have little effect on disease processes; they only affected subjective patient experiences like pain. But the article makes no sense. If placebos had objective healing properties, they would no longer be placebos. The placebo has three purposes: 1) to make a patient feel better when there is no illness, 2) to make a patient feel better (e.g., less pain) in spite of ongoing illness, and 3) to make a patient feel better by instilling hope when medical science deems a patient beyond hope. Placebos work on the mind; they are not supposed to have an effect on the body.

Because the placebo effect is a form of deception, today’s physicians are uncomfortable with this approach to therapy. Their science tells them that they are beyond such low cunning; their democratic outlook tells them not to lie to patients. Alternative medicine has simply taken up what the modern medical profession has thrown away. It relies heavily on the placebo effect, though in many cases neither the alternative medicine provider nor the patient knows whether the therapy being used is a placebo or not, since randomized clinical trials have not been performed on most alternative therapies. Providers who treat patients with shark and bovine cartilage therapy, flower remedies, juice therapies, or laugh therapy, for example, cannot point to any scientific study that condemns or justifies these treatments. Yet the providers believe in these treatments, and if they are sufficiently persuasive, they can get patients to believe in them too, producing a positive effect.

At my hospital, many patients come to the alternative medicine clinic to try therapies that are less invasive and less toxic than those prescribed by allopathic doctors. If the alternative therapies fail, patients return to allopathic medicine. They merely want to see if they can get by with an intermediate step. Other patients come to the clinic because allopathic medicine cannot help them. In both populations, the value of alternative medicine exists largely in the mind. A tincture of hope combined with a vague respect for anything scientific drives these nervous patients into our clinic.

Yet is this so wrong? In truth, conventional medical therapy has little effect on outcome in the vast majority of cases seen by doctors; patients will either recover on their own or stay with their disease. This is a confirmed epidemiological fact. If medical science has a definite limit and doctors are inconsequential in the majority of cases, then why not let patients pursue alternative, nonscientific modalities? Most of these therapies are harmless, and from an epidemiological point of view, they may not matter. Besides, most patients use them in conjunction with allopathic medicine and not as a substitute.

To the extent that alternative medical therapies produce an effect, it is likely to be positive. Patients may feel better because of the placebo effect. Moreover, because many subfields of alternative medicine draw on a religious tradition, patients find in alternative medicine ways of making their pain and misery more comprehensible. Because alternative medicine is not confined by the limits of rational or testable knowledge, its powers of explanation are enormous, and patients leave the alternative medicine clinic thinking that their troubles have real spiritual significance. When patients ask, “Why me?” or “Why must these things be?” allopathic medicine has few answers to give other than a descriptive, physical explanation of why painful things occur. But alternative medicine has persuasive dreams and seductive legends at its disposal. It can tell patients that their psychospiritual centers have yet to be awakened, or that their unique history as human beings is the cause of their illness. Alternative medicine has a tremendous capacity to put difficult situations in a new light, even to justify them, and this makes it as powerful as religion.

The connection with religion is important. Alternative medicine so artfully conspires to make patients believe that their illness has spiritual significance that once patients absorb the fiction, they are practically enslaved by it. As a physician, I have never been able to disabuse patients of their alternative medicine beliefs. Because these beliefs have no empirical basis, fighting them with an array of scientific facts is like shooting at a swarm of bees with a gun. Yet the ability of alternative medicine to mesmerize patients simply attests to an elemental truth about human existence: The only way for patients to stop believing in something is for them to stop living. When allopathic science reaches the limit of what it can offer and patients are told by doctors to simply get on as best they can, patients simply transfer their affections to alternative medicine.

The value of alternative medicine remains unproven in clinical trials. Yet the fact that it remains unproven only helps alternative medicine sustain people’s hopes; what is not impossible may still be possible. Scientific medicine operates with a completely different sensibility. It encourages an endless process of hypothesis, disputation, and refutation in order to prove the value of medical therapy. While this process makes scientific medicine more intellectually honest than alternative medicine, it leaves little room for a dream in a patient’s mind. The rational approach of scientific medicine often does nothing more than knock terminally ill patients on their heads, and with such determination that one wonders what conceit there might be in forcing sick people to know the unvarnished truth about their futures.

By contrast, alternative medicine deliberately courts mystery, even obfuscation. Patients who imagine their illnesses to be caused by a shift in their spiritual axis or a fall in Qi are shielded from the glaring light of scientific reality. They may not necessarily understand the concepts of alternative medicine, but they believe in them, and this can help ward off despair.

The hypnotic power of alternative medicine is especially important in patients with chronic disease. These patients form an ever larger share of this country’s patient population. Scientific research is not yet able to cure diseases like Parkinson’s, emphysema, and heart failure, so people who are afflicted with these conditions often lead unhappy, difficult lives. People want to believe that they have a chance for improvement, yet they find no outlet for their energies in scientific medicine. As a result, their psyches wither and droop — until alternative medicine animates them by telling them how therapeutic possibilities exist beyond the realm of allopathic medicine. While the future often shows alternative medicine’s promises to be nothing more than talk, the boundless possibilities that suddenly appear on the horizon raise the spirits of these patients in the present. This is not a bad thing.

Changes in the attitudes of doctors have caused allopathic medical practice to become regimented and precise, and to be geared toward complete and ready answers. When such answers are unavailable, doctors suddenly find themselves with nothing more to say. This has pushed people away from medicine and in a very specific direction— toward religion. Alternative medicine, which houses several authentic religious traditions, has become an important stopping point along the way.

Organized religion and the loss of faith

Today’s patients are finding options outside of medical science by moving in the direction of religion. Yet there is an equally important trend away from religion and toward medical science. Because alternative medicine lies between religion and science, it benefits from this second migration as much as from the first.

Over the past century, and especially over the past 30 years, organized religion has steadily lost influence among large sectors of the population. Elite, educated opinion increasingly views religion as something artificial, exceptional, and contrary to man’s nature. To some, religion is as a source of sweet dreams through which the weak and the superstitious forget their misery and fears. To others, religion is a harmless, generally wholesome preoccupation or entertainment. These condescending attitudes form the basis of today’s culture of disbelief.

The decline of the religious perspective on existence is difficult to measure statistically, since 90 percent of Americans profess to believe in God, and slightly less than half of all Americans go to church. But just as 100 percent voter turnout in an election staged by an authoritarian regime does not necessarily mean that democracy is at hand, neither does the profession of a belief in God among a majority of citizens make a society religious. A belief in God may be a very superficial thing, and not something on which to rely when life really grows difficult.

The decline of religion has created a serious void. Whether because of sadness, fear, regret, anxiety, or a general confusion about personal identity, people in our time enter the realm of melancholy with no idea of how to get out of it. Some have the will to believe in religion’s solutions, yet reason often causes their belief to give way. Even the outwardly religious sometimes discover that their faith rests on a wavering foundation and that it takes only the slightest contact with harsh reality to upset it. People suffering from unhappiness grope for ways to feel better, praying that a convincing inner voice will whisper to them that their troubles are not so. Their minds go full circle without ever arriving at any new answers to life’s more difficult questions.

One consequence of the decline of religion is the gradual medicalization of everyday unhappiness in our society. While before, a man experiencing trouble would have searched out a minister, a priest, or a rabbi to unburden himself, now he will just as often seek out a health care professional. Whether through medication or talk therapy, his goal remains the same — to shake off the disagreeable feelings that routinely penetrate life — only now it is medical science that counsels him, treats him, and feels for him, not organized religion.

Both doctors and patients are concerned with this trend. I have observed the rush to psychotropic medication in my own practice. An increasing number of patients coming for surgery at my hospital are on these medications, and this observation is consistent with the almost 50 percent increase in pyschotropic drug prescriptions nationally in the past decade.

The rush to medication sometimes borders on the ridiculous. Outside of the operating room, a woman once asked me to put her son on psychotropic medication. When I asked her why, she said that her son had recently graduated from college, but that instead of continuing on a professional path, he now wanted to go into the military. She thought this was “crazy,” since all the young men she knew became doctors, lawyers, or teachers. She wanted me to put her son on medication so that he would once again have “normal” career aspirations. Needless to say, I refused. In the end, she ended up on antidepressants, not her son, because her son’s career choice made her so miserable. Fortunately, her need for medication was short-lived; her son tried a submarine but became claustrophobic, tried a surface ship but became seasick, and so left the Navy for law school. When that happened, the woman no longer needed medication.

This rush to medication at the slightest misfortune is where alternative medicine comes in. Alternative medicine has a real connection with science, one that makes it seem more legitimate than organized religion to many secular-minded people. At the same time, alternative medicine uses religious notions to help people find contentment. Concepts like “wholeness” and “harmonious existence” guide alternative medicine providers when they treat patients for minor depression, the therapeutic goal being to help patients achieve inner peace. Antidepressants are not prescribed. For secular people who distrust organized religion but who also dislike the ultrarational approach to mental health found in allopathic medicine (including the heavy reliance on psychoactive medication), alternative medicine is an excellent compromise.

Many patients come to the alternative medicine clinic at my hospital without any major complaints. Some visit because they are unhappy and just want to talk. Others come by even though they are relatively content; they use the principles of alternative medicine to maintain their state of “wellness.” Such patients puzzle allopathic physicians. The latter expect people to go to doctors when they are sick, not when they are well or just feeling a little “down.” Doctors simply dismiss the phenomenon as an eccentric form of preventive medicine. They are wrong to do so. Because they see alternative medicine solely as a satellite of medicine and not also as a satellite of organized religion, doctors do not understand that some patients who use alternative medicine are unconsciously looking for a new faith.

While alternative medicine includes several major religious traditions, the tight connection between religion and alternative medicine is not readily appreciated in this country. Yet the connection was not lost on the communist regimes of pre-1989 Eastern Europe. Most of these regimes banned, or at least tightly controlled, the practice of alternative medicine because of the ideological threat it posed. They understood very well that alternative medicine was more than just a scientific application. Alternative medicine challenged the stereotyped models of existence perpetuated by communism, and it created rivals to the political authorities in the form of care providers who managed the very souls of their patients.

Ironically, even Maoist China put severe restrictions on alternative medicine, despite the fact that ancient Chinese medicine forms a core component of the field. The Chinese communists shared the fears of their Eastern European counterparts. They managed the problem by turning ancient Chinese medicine into a Western scientific application. Under communism, ancient Chinese medicine shed its spiritual, otherworldly manifestations and adopted a cookbook approach to patient care. The diagnostic categories of Western medicine replaced the need for faith.

A prejudice against alternative medicine also exists in noncommunist, non-Western countries for a slightly different reason. Many of these societies emulate the West. In their drive to modernize, they adopt allopathic scientific medicine while pushing aside the folk healing traditions in their native cultures. Some Asian countries, such as Taiwan, are reintroducing ancient Chinese medicine into their medical school curricula, yet the phenomenon is rich in irony. They see the United States as the pinnacle of modernity. So if the Americans are adopting traditional Asian medicine, Asians should too. Thus, we have the picture of a modernizing country trying to emulate the modernity of the United States, which itself is trying to become postmodern by adopting premodern medical techniques.

Alternative medicine is more than just about science. It is also about culture and, more specifically, about the crisis of organized religion. People who are troubled, unhappy, and looking for answers will not allow themselves to be persuaded by a lie if they truly believe it to be a lie. In this secular age, they naturally turn to science instead of religion, since science is considered a source of truth while organized religion is not. Because alternative medicine stands between religion and science, it benefits from this migration toward science.

The rapid growth of alternative medicine during the past decade can be understood in a slightly different way. For much of the twentieth century, human unhappiness was thought to stem from definite external causes — for example, war, economic depression, fascism, communism, or some large, organized power that was physically abusive. Neither religion nor science was seen as necessary to ease this suffering; people simply needed to become politically active. But with the end of the Cold War, the successful conclusion of the civil rights movement, and the permanent acceptance of the democratic welfare state as the best model for society, we have reached a stage that one philosopher calls “the end of history,” where the forces of abuse have been tamed and the need for politics muted. Those obvious external causes of suffering having diminished, the age-old internal ones have resurfaced and regained their prominence in the human psyche. These internal causes of unhappiness are like elemental forces that have no name, and those people who suffer at their hand suddenly feel powerless because now misfortune has no clear remedy. Political strategies are no longer appropriate, religion has long ago been discredited, allopathic medicine seems too extreme, and so people turn to alternative medicine for relief.

A policy toward alternative medicine

If a thoughtful debate on alternative medicine policy does not take place now, in another five to 10 years it will be too late. The subject will get divided up among intellectual and economic interest groups, causing both a liberal and a conservative orthodoxy to arise. Creative thinking will become politically impossible (the way it has on the issue of drug legalization), and policymakers who try to move beyond orthodoxy will be considered suspect for their deviations.

Signs of ossification are already evident. Among conservatives, the subject of alternative medicine now elicits chuckles and disdain. Influential writers like Dr. Sally Satel and Samuel McCracken have aroused suspicion that alternative medicine is at best a harmless sham, and maybe worse, an important new front in the culture wars. Writing in the June 1999 Commentary, McCracken calls alternative medicine “the new snake oil.” Satel reports in P.C., M.D. (Basic Books, 2000) how some feminist medical practitioners promote alternative medical therapies like “healing touch” in order to undermine what they contemptuously refer to as “patriarchal” (allopathic) medicine. There is a kernel of truth in Satel and McCracken’s criticism of alternative medicine. But the goal of policy should be to separate the legitimate from the illegitimate.

Policymakers should look at the treatment modalities of alternative medicine on a continuum between science and religion. They should adjust their recommendations according to where on that continuum a specific modality lies.

Closest to established science are those treatments in which patients do not have to believe in order for the treatment to work. One example is acupuncture. Acupuncture works not only on adults, but also on babies and even animals, especially in the area of pain management. Babies and animals lack the capacity to believe — the placebo effect is not operative in their case — and so the use of acupuncture is no different from the use of penicillin to treat an infection (i.e., the patient does not have to believe in penicillin in order for it to work). There is a science to acupuncture that transcends culture and the psychological disposition of patients.

In one case I am familiar with, a woman requiring an emergency Caesarean section had both an extremely difficult airway and a deformed spine, making both general and spinal anesthesia impossible to perform quickly. Because the baby was dying inside the uterus and time was of the essence, the doctor performed acupuncture anesthesia by placing a long needle up the midline of the patient’s abdomen. The needle, along with some intravenous sedation, helped the patient get through her surgery, thus enabling her baby to be delivered as quickly as possible.

Herbal medicine may provide similar medical benefits. Herbal drugs interact physically with human bodies. They are not simply persuasive words. If they work, they may do so because of the placebo effect or because of a potent biochemical reaction that is not yet understood. The need for faith in herbalism may be slight.

Acupuncture and herbal medicine are worth investigating. The National Center for Complementary and Alternative Medicine (NCCAM) housed in the National Institutes of Health (NIH) exists to conduct research on the value of alternative medicine. Yet such research has been poorly funded (NCCAM’s budget in 1999 was only $50 million), in part because the NIH is ambivalent about alternative medicine. For many of the hard-core scientists at the NIH, much of alternative medicine seems ridiculous. The NIH should not allow a general prejudice against alternative medicine to color its judgment of specific modalities that may be just a half-step away from established science.

Because herbal products may contain bioactive substances, and therefore may work through more than just the placebo effect, consumers have the right to know the quality of the herbal products they are purchasing over the counter. The Food and Drug Administration (FDA) does not now have regulatory authority to evaluate the herbal products sold to consumers. Such regulatory authority should be granted, especially since initial research has shown herbal products to have real biochemical effects.

In an article in the August-September 2000 Policy Review, authors Henry I. Miller and David Longtin recommend a nongovernmental regulatory regime because of the inefficiency so pervasive in bureaucratic officialdom. In Europe, for example, nongovernmental regulatory agencies allow new medical products to enter the market in half the time it takes in the United States. But since most herbal therapies are not complex products, the difference in efficiency between the governmental and private agencies that might test them would be small. Nor are herbal products trying to make their way onto the market for the first time; on the contrary, many herbs have been in use for thousands of years. Since the FDA is already in the business of evaluating drugs in this country, it seems reasonable to extend its authority to include herbal medicine.

I am not recommending that herbal products become available only by prescription. I am merely stating that if herbal products worked only on belief, then their purity would not matter, but since there is evidence that herbal products may cause predictable biochemical reactions and that these reactions may form the basis of the herbs’ salutary effect, assurance of the purity of herbal preparations would be appropriate.

Another issue surrounding this group of treatment modalities is the licensing of providers. Currently in the United States there are roughly 10,000 licensed acupuncturists, 10,000 naturopathic physicians (i.e., providers for whom herbal medicine is a mainstay of practice), but over 700,000 allopathic physicians. Moreover, the licensing for acupuncturists and naturopathic physicians varies from state to state (naturopathic physicians, for example, are licensed in 11 states) while allopathic physicians are licensed in every state. Many allopathic physicians are now interested in alternative medicine for reasons described in this essay, and they have the power, numbers, and prestige to take it over. As Dr. Marc Micozzi, a leading expert on alternative medicine has noted, the model may one day be that allopathic physicians are the gatekeepers to all alternative medicine providers — that in order to see a naturopathic doctor or an acupuncturist, a consumer will have to get a referral from an allopathic physician. This is assuming that physicians do not practice these arts themselves, which in the future may be less often the case.

Such a takeover of alternative medicine should be discouraged. The process of licensing nonallopathic acupuncturists and naturopathic doctors should go forward, and consumers should retain easy access to both. These providers made alternative medicine popular with the public by emphasizing those aspects of personal doctoring that were abandoned by the medical profession. They emphasized human relationships and took time to talk with their patients. If allowed to absorb all of acupuncture and herbal medicine, the medical profession might inflict the same damage on alternative medicine that it inflicted on scientific medicine. Treatment modalities would be turned into mere scientific tools, while the humanist element surrounding their use would be effaced.

Lying in the middle of the continuum that stretches from medical science to religion are those alternative medicine treatments that are part faith and part questionable science. Included in this category are energy medicine and healing touch. The idea that human beings are composed of energy fields and that a person’s energy can be “balanced” or “decongested” is revolutionary. If proven true, it would overthrow the paradigm that has governed medical science for over a century.

Perhaps there is a science to energy medicine. Yet it is equally possible that energy medicine works only because patients believe in it. Because governmental resources are finite and nothing prevents universities and research labs from exploring energy medicine, this treatment modality should fall below acupuncture and herbal medicine in NIH funding priorities. This is especially true since acupuncture and herbal medicine are physical contact remedies, and so present a small but finite risk to patients. Healing touch, where a provider runs his or her palms one to six inches above a patient’s skin, presents no risk. The government’s obligation to consumers is first to clarify the value of those treatment modalities that have a risk, no matter how infinitesimal, before exploring those modalities that pose no risk but are intellectually stimulating to researchers.

But there is a benefit to clarifying the value of healing touch and other energy therapies. The economy of the operating room would certainly improve. Several times, I have delayed the induction of anesthesia by 20 minutes while a healing touch therapist “scraped” away negative energy from my patients. The blood pressure cuff and EKG were going, my hands were filled with syringes, the patients were being billed for expensive operating room time, but both the surgeon and I had to wait until the touch therapy was completed.

Finally, there are alternative medical therapies that lie on the continuum at the very border of religion. These modalities require the active psychological participation of patients, and for all practical purposes, work on faith alone. Included in this cluster of therapies are transcendental meditation and the supernatural aspects of religious healing traditions, as well as alternative therapies like humor and dance, which are simply applications of everyday cultural life.

Government support of these religious treatment modalities would violate the separation of church and state. At a recent alternative medicine conference, prayer was described as valuable therapy. That may be true, but for government to involve itself in every worthwhile aspect of religion under the guise of promoting health would violate the Constitution. Government support of dance and humor therapy would cause similar problems. The outcome would be a society that creates a ministry of culture in the name of good health and then funds comics and dance classes to increase the longevity of its citizens. The whole notion is ridiculous. These branches of alternative medicine are best left to the providers and patients who think them worthwhile.

Alternative medicine stands between medical science and organized religion, and therefore stands between what is known and what is unknown. Patients are fleeing the medical profession because doctors concentrate on rational knowledge at the expense of life’s mysteries. Organized religion concentrates exclusively on the unknown, and therefore seems to know nothing. In alternative medicine, people have discovered a compromise. Considering that the two great misfortunes of life are illness and gloom, any discipline that promises to ward off both in a single stroke will not go away soon. Policy toward alternative medicine should be crafted in light of this truth: thoughtfully and sensibly, yet with a degree of sympathy toward those who have found something of value in alternative medicine.

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