As a second year medical student, many times in Pharmacology class I learn to have contempt for so-called “alternative medicines.” Lecturers usually make two points: 1) the alternative medicines that have been tested are no more efficacious than placebo, and 2) alternative medicines are not regulated by the FDA, and hence may contain less or more than the therapeutic level, or worse, be contaminated. I agree with both points. This attitude about alternative medicines is not limited to the pharmacology of herbal drugs, but it is also the way conventional Western doctors view therapies like Acupuncture, Chiropractic, Reiki, etc. I agree that many of these treatments are not shown to be more effective than placebo for treating a particular disease. Yet, I myself use a very Complementary and Alternative Medicine (CAM) treatment on myself. What follows is an explanation for how I can incorporate these seemingly contradictory thoughts in my life.
Some of my classmates wonder why many Americans spend so much money on CAM when CAM “doesn’t work.” I have an answer for them, and it starts with my personal story. I grew up in Bangladesh where the holistic Ayurvedic system is embedded in the culture, even though the predominant medical system follows a Western model. When I suffered from acne, my family would tell me to “keep my digestive system clean, drink lots of water, etc.” Being a typical teenager, I scoffed at these suggestions. Once we came to America, my acne got worse, and I finally saw a Dermatologist and took Tetracycline for about 7 months. A couple of years later, my acne flared back, and this time I took Doxycycline for a year. Meanwhile, I learned that studies have shown that diet has no link to acne, so I had found even more reason to disregard Mom’s advice on chocolate and coffee. The antibiotic therapies worked, but I was concerned about the effects of such long-term antibiotic therapy on other bodily functions. In medical school, I used birth-control pills instead of antibiotics for my acne for a while, then stopped using any medication once my skin was reasonably clear.
In medical school, however, I’ve been struggling with a number of issues, from weight gain to depression, to ADD. While receiving Western biomedical treatment for ADD, the side effects of my therapy convinced me that western medication alone would not provide a solution to my problems. That’s when I sought the advice of a doctor who had the knowledge of CAM therapies, even though he’s trained in traditional Western medicine. He does not advise me by himself, but receives advice from his teachers in India who practice holistic healing they call Jeevan Sanjeevani. It was hard for me to accept their suggestions at first. When they suggested that I should have faith in their recommendations, I immediately wondered whether I’m just paying for placebo effect. However, with their suggestions for lifestyle changes and even life outlook changes, I began to experience a new sense of direction in life. Finally, I also realized why my family would recommend “cleaning my digestive system” to cure my acne. It was because eating the wrong kinds of foods, along with other stressors like studying all night, raises the inflammation of the body. For some people, it manifests as acne, for others, it might be arthritis, for some it might be cancer. Cleaning the digestive system, however, is not as simple as it sounds. Because I had not received the medical directions and herbal medications to help me do it before, I was not able to use my family’s advice to cure myself. Now that I’m getting advice from a learned practitioner, I’m realizing how much goes into making such a simple advice work. Granted, I have to be very patient with my results, as this is not a quick fix. This therapy has not only started to help me with some short-term health concerns, but it has renewed my confidence and eased my depression in a way that traditional Western biomedicine could never have done. That is why I’m sticking to this holistic therapy, and that is why many Americans are drawn to CAM. For me, my current therapies are not at all “alternative,” but they are the ideal way of treatment, with some help from Western medicines for short-term problems.
Note that I did not say Western medicine does not work, or that I don’t have faith in it. Western medicines have cured illnesses for me before, and continue to help me. But with Jeevan Sanjeevani, I’ve reduced my dependence on certain medications and hope to not need them in the future. I’m not in the group of people who have such distrust for Western medicine that they refuse to accept results of valid scientific studies. I’m also not critical of using Western medications just because of the fear of side effects, since I realize that a ratio of benefits to risks justifies each individual treatment. But neither am I in the group of Western medicine trained students or doctors who refuse to see other medical systems in their own rights, and therefore cannot make sense of why patients seek alternative treatments.
What is complementary and alternative medicine? NCCAM defines it as a “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.”[1] Why do we lump all of these very different systems and practices of medicine into one category called CAM? What are these alternatives to? Missing from the picture is that CAM is only alternative to a Western biomedical system of medicine, and one form of CAM might be considered an alternative by a practitioner of a different CAM. This Eurocentric attitude, that the traditional Western biomedical system is the epitome of medicine itself, exists in even international organizations like WHO. WHO defines “traditional medicine” as:
The sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses. Traditional medicine that has been adopted by other populations (outside its indigenous culture) is often termed alternative or complementary medicine.[2]
The Eurocentric bias becomes clear when WHO explains who uses traditional medicine: “In some Asian and African countries, 80% of the population depend on traditional medicine for primary health care. In many developed countries, 70% to 80% of the population has used some form of alternative or complementary medicine (e.g. acupuncture)”[3]
Why are Africans and Asians said to use “traditional medicine” but not Europeans or Americans? In America, the Western biomedical system is our tradition. Yet, we continue to view traditional Western medicine as the norm for all of the world, while we call other systems of medicine CAM, even when they’re the primary medical system many people follow! We forget to qualify our approach as “traditional,” or “Western/biomedical,” and instead imply that our system defines medicine itself.
It is because as Westerners we refuse to see our own bias in the Western biomedical system that we fail to understand why people use so called CAM therapies even when they’re “quackery” to us doctors. We use research methods of the Western biomedical system to evaluate medicines that don’t even fit the mold of the Western biomedical system, and then we conclude that these therapies “don’t work.” Don’t work how and why? They might not work within the Western frame of medicine, but who says that they don’t work within their own systems? Have we stopped to wonder if Western biomedical therapies are considered effective by the Acupuncture system or the Ayurvedic system? No, we don’t wonder that because we, in our Eurocentric view of the world, refuse to believe that other medical systems are different but equally respectable systems of medicine. I know from my experience with Jeevan Sanjeevani that for them, relief of a single disease by medication does not equal to cure. Cure refers to an entirely healthy state of mind and body. Even when some CAM therapies are shown to be more effective than placebo in a Western biomedical experiment, we remain skeptic about it, as blogger PalMD exemplifies:
When evaluating a therapy for a complex disorder whose natural history is variable, we must very carefully parse out causation from correlation, recognize our own biases, and remember that a positive result of a randomized-controlled trial does not necessarily confirm a hypothesis. If an intervention has no plausible way or working, any positive results are likely a statistical artifact. Science isn’t a contest to see who can crank out at least one positive study. It is a way of evaluating hypotheses to see which ones most closely fit reality.[4]
Have we really recognized our own bias when evaluating a CAM therapy? We haven’t even removed the biggest bias of all, which is to see the Western biomedical system as the one and only valid form of science and medicine, instead of admitting that it is one system among many. Perhaps a CAM therapy does not work using ligands and receptors. Perhaps it works in a way that Western doctors are not trained to understand or accept. When we evaluate hypotheses to see which ones most closely fit reality – whose reality are we talking about? Ayurveda is very much a reality among Indians; if a hypotheses fits Ayurveda, who are we to call it quackery just because it doesn’t fit our biomedical model?
Western medicine is a detail oriented, small picture discipline. Our medical education encourages such an approach, and therefore attracts people who like that approach and are good at practicing it. Patients who fit this model come to us with various illnesses, and we give them medications, and/or surgery for each illness. If they have psychological problems, they can go to a therapist for counseling. That therapist does not know about the physiological problems of the patient, and doctors do not know how the therapist is treating the life issues of the patient. This model of specialized healthcare works for many people, both practitioners and patients. This model works not just in America, but elsewhere in the world. Colonization has imposed such a Western biomedical system on many different countries, most of whom have made it their predominant method of healthcare. With globalization, however, the indigenous medical systems of other countries have come to the West, and are appealing to some people just as the Western system appealed to many people of colonized countries. Some of these other medical practitioners know how to incorporate various medical and social illnesses of a patient into a big picture, and therefore attract patients who are looking for a holistic cure. Every CAM practitioner might not be qualified enough or even truthful, but neither are all biomedical doctors perfect. If a surgeon cannot do one surgery right, that does not mean that the surgery does not work, and it does not mean the whole discipline of surgery is quackery. Can we evaluate all surgeries through double blind studies? No, because surgery requires individuality. Many CAM practices are the same way.
To whom do these non-Western medicines hold an appeal? The appeal generally to “big picture” people, people who are not satisfied with treating one single illness at a time with one practitioner, but see their illnesses connected to every other aspect of their life. In other words, traditional Western doctors can treat acne, ADD, arthritis and indigestion separately in a patient, but there is a sense in many people that there is a root cause behind all these illnesses that can be cured. In Western medicine, we look for symptoms of diabetes in a patient, but in certain other medicines, the diabetes itself is a symptom, not a diagnosis.
Understanding and appreciating other medical systems might seem unnecessary to doctors who are satisfied with traditional Western medicine. But we need to understand that this is because of our inherent bias in the traditional Western culture, and the misguided view that our medical culture is the norm. We make fun of alternative therapies and conclude that it’s the patient’s faith in the treatment that makes it work, not the treatment itself. But in fact, Western medicine also requires patient’s faith in the treatment or otherwise, it won’t work. That faith is reflected in patient compliance. Our therapies are successful for patients who follow our directions, experience few side effects, and when they do experience side effects, come to us for additional treatment. They need to have faith to stick to both medications for depression and medications for obesity and hyperlipidemia. Otherwise, failure in one can aggravate the other. Before long, we’re admitting that several factors need to be addressed to manage a patient condition. How is this any different from the way a good acupuncturist may treat? The difference is that in acupuncture, the patient has to follow a holistic therapy that might not solve one problem quickly, but will solve several problems ultimately. It’s the other way around for traditional Western medicine.
I cannot comment on the efficacy of each non-Western medical system, because I’m not being trained in any of them, and I don’t have the understanding to praise or criticize those systems. Our version of medical reality has receptors, hormones and nerves, etc. Someone else’s medical reality includes energies, meridians, or doshas. We may be so ingrained in the traditional Western biomedical model that we’re unable to make sense of anything that doesn’t use the same concepts or language. However, many patients accurately see that there seems to be different ways of understanding a health condition, and they will choose the one that makes them feel the best at any given point in time. Even if we can’t accept their logic, we’ll have to accept that traditional medicine from other cultures will gain a stronghold in our population, just as we have imposed our traditional medicine on theirs.
[1] http://nccam.nih.gov/health/whatiscam/
[2] http://www.who.int/mediacentre/factsheets/fs134/en/
[3] Ibid.
[4] http://scienceblogs.com/whitecoatunderground/2009/09/fibromyalgia_alternative_medic.php
