Concepts in alternative medicine

02-7-9336 56 SZ.iOO+000

PergUnon PresS Ltd

CONCEPTS

IN ALTERNATIVE C.

Socioloog.

Adviseur

Gezondheids

W.

welztjnszorg.

MEDICINE

AAKSTER

De Weijert

8. 7991 BP Dwingeloo.

The Netherlands

Abstract-After discussing some important alternative approaches, different interpretations are presented of the concepts of health. disease, diagnosis. therapy and patient. These differences are elucidated in thrre main frames of medical thinking: the pharmaceutical, the integrational and the holistic model. Attention is given to the problem of scientific proof, especially in relation to the effectiveness of alternative therapies. In a concluding paragraph it is attempted to analyse the (social) backgrounds of the controversy between regular and alternative medtcine.

Ke,v words-alternative

medicine,

paradigma.

medical

INTRODUCTIO‘

Medical sociologists are gradually becoming aware that at least two realities exist within Western health practice: the official and the unofficial. the legal and the illegal. the bright. scientific and heroic hospital doctor vs the unscientific therapist or quack. This article intends to explore the scientific and societal position of the latter.

\l.~liv

.Al.TERSATIVE

APPROACHES

In this section we discuss the main alternative approaches. at least in The Netherlands, in two respects. A short outline of the technical aspects is followed by consideration of its-assumedtheoretical and philosophical backgrounds. In the latter we rely rather heavily on Van Dijk [I] and the report of a Dutch governmental committee on alternative medicine [2].

Acrrpunclure

In acupuncture it is assumed that the human body possesses I2 meridians whose main function is to transport energy. Upon them w’e find about 950 points which are connected with internal organs. The notion is that by inserting small silver needles into these points and manipulating them, the energybalance may be influenced and, by so doing. the disease may be cured. As the acupuncture points are specific, it is essential that the needles are inserted into the right (combination of) points. The stimulation may be done manually. by electric means, by moxa burning or by pressure techniques. A special branch is the so-called auriculo-therapy. Diagnosis is arrived at by means of the acupuncture points and the sophisticated art of pulse-reading. A most interesting aspect of its underlying philosophy is the principle of Yin and Yang. Both are distinctive but unseparable poles of the life energy Tsji( = pneuma. prana or spiritus vitalis). They are involved in an ongoing dance. they presuppose the existence of each other. together they maintain a dynamic balance. neither of them betng better or

model,

scientific

proof

more valuable than the other. The life energy Tsji is acquired at birth and supplemented by breathing and food-intake. The principle of a dynamic balance between two poles of the same underlying phenomenon. has been described as a characteristic feature of the (old?) Chinese way of thinking. and contains a fundamental difference compared to Western thinking. The latter usually holds one of the poles to be the better one: masculinity is better than femininity, quantity is better than quality, material is better than immaterial, objective is better than subjective. body is better than mind (e.g. Jung [3] and Van Dijk and Aakster [4]). In acupuncture. illness is seen as a disbalance of Yin and Yang which may be restored by adding or distracting energy from the diseased organs. In its classical interpretation, this is done in combination with dietary advices. physical exercise, massage etc. Homeopath)

Hahnemann’s ‘Similia Similibus Curentur’ became a world famous adage. It points to the principle. already acknowledged by Hippocrates. that the disease may be cured by means that cause similar symptoms in healthy persons. Thus, therapeutic drugs are developed. mostly on a herbal base, by observing their main features when administered to healthy persons. A second characteristic of homeotherapy is that it tries to restore the self-healing potential of the organism. To this end it works with the lowest possible dose that is able to provoke a reaction in the organism, expressed in terms of Dl. DZ. D3. . Dn. which relates to first. second. third to n-order dilutions. These dilutions are prepared by a special way of shaking. the ‘potentializing process’. Homeopathy tries to arrive at a total-diagnosis of the person, in which the limited symptomatology of official medicine is extended into the realms of constitution, mental functioning. the body’s reactions to food, to sudden changes Fn temperature and so on. Though amazing effects have been observed by the applicatton of homeopathy. its theoretical base remains largely hidden and is the object of bitter polemics. even within the bosom of homeopathy

itself. A reasonable explanation seems the cybernetic one. This would explain why small amounts of a chemical compound diminishes the deviation or symptom complex (negative feedback). while larger amounts of it lead to increasing deviations (positive feedback). This would not explain why dilutions above D23 (the Avogadro number) above vvhich-in theory-no molecules of the compound should be found in the dilution) would have any effect. Others. however. hold that by means of the ‘potentializing process’ the structural information of the compound has been transferred upon the solvent (a matter of re-arranging positive and negative ions??).

illness. Illnesses are interpreted as attempts of the person to re-establish harmony between the self and its (cosmic) surroundings. In therapy, regular and anthroposophical remedies are combmed with expressive therapy, massages and other natural therapies. Other characteristic features of this approach are: the assumption that the individual human being and cosmic factors are related, the belief that the soul reincarnates, the conviction that mental forces are superior to physical ones. the idea that illness is the result of a disturbance of the balance between vitalizing and disruptive forces.

.Yaturopalh_v

Paranormal

The naturopathic physician (though many alternative approaches may also be practised by nonuniversity trained therapists) dedicates himself to restoring or stimulating the ability of the person to heal himself. The person is approached as a whole. living in continuous interaction and exchange with his environment, whose integrity may be challenged by unhealthy ways of eating, breathing, relaxing and so on. Disease is essentially the consequence of a disbalance of vitalizing and disruptive forces. which cause the organism to form auto-toxic or otherwise useless residues in the body, the so-called homotoxines hypothesis. At first the physician will try to clear the body of these homotoxines (by means of fasting or-even more drastically-provoked vomitting or the application of lavements). As a second step the vitalizing forces are strengthened by a strictly natural diet (whole foods only. no smoking, no alcohol, no meat. preferably raw vegetables and juices etc.) and physical exercises. These measures may be supported by hydrotherapy, massage, herbal medicines. blood letting etc. In its diagnosis, naturopathy interprets symptoms as signs of the regulation and restoration process the organism is engaged in. The driving force behind all this is ‘nature’. the principle that lends unity to everything that exists. It is the natural forces in the diseased person that should be strengthened, it is the natural means and life habits that should cure him.

This type of medicine is also known as Mesmerism or magnetism, or (slightly different) spiritual healing. The typical treatment exists in striking movements with the hands, by the therapist, close to but not on the body surface, especially at the sides where the disease has been located. The therapist may get information from the patient by clairvoyance. The mechanism is unexplained. Some theraptsts believe that they are the instrument by which cosmic energies are transmitted to the person, and to the diseased organs in particular. Healing at a distance (e.g. by concentrating on a picture of the patient) is said to occur regularly. One approaches the patient as a whole person, who is closely interconnected with his material and immaterial surroundings. Carlson [5] reported some interesting testings.

.Wanual fherapies

Under this heading we include osteopathy, chiropractics and certain types of other manual therapies. Generally speaking. these therapies concentrate on the spinal column and the stature of the person. Many. if not all diseases are believed to be caused by, at least related to deformations of or jammed nerves/arteries within the area of the spinal column. The therapeutic approach is mainly mechanical. Diagnosis is based upon information about the movement-pattern; diseases are interpreted as the result of a complex of factors. which drive the internal system out of balance. dnIhroposophica1

medicine

This type of medicine is based upon the ideas of the German philosopher Rudolph Steiner. It considers itself as an addition to regular medicine. rather than as an alterative. Anthroposophical medicine distinguishes between body. mind and soul. and tries to influence the three of them simultaneously in case of

medicine

Metltal therapies

Some of the better known of these are bioenergetics, Gestalt therapy, bio-release. re-birthing. unitive psychology, alfa-training. autogenic training. According to Capra [6], academic psychology still functions within the Cartesian schism of body and mind. The newer, alternative approaches transcend this age-long schism, they approach the world as a whole, and the person as a whole person. in whom physical and mental forces are almost inseparable. In doing so these approaches transcend determinism. Self-renewance and self-transcendance are important phenomena (Capra). They often work with methods of deep relaxation, in order that hidden and repressed tensions will be released and the person will become aware of his real self (however. see Schur [7] for a critical evaluation). Deep breathing is essential in many of these approaches to arrive at a relaxed state, suggesting a relationship to the concept of vital energy in yoga and acupuncture. Very interesting in this respect is Stephanie Simonton’s relaxation and visualization therapy for cancer patients [S]. This short presentation of some of the more important fascinating new (= old) approaches in health care give an impression of the various thoughts and practices in this field (also see ‘The Alternative Health Guide’ [9]). We consider next some theoretical concepts and frames of reference within alternative medicine. COSCEFTS

IN .ALTERN4TIVE

1lEDICIKE

Concepts are more than just words or building blocks of theories; they represent the observer’s im-

Concepts

in aiternati\e

age of reality (Whorf and others). This becomes very clear if we compare some of the concepts that are in use in regular, official or orthodox medicine, with their use in alternative medicine, as will be done below. Health

The World Health Organization’s definition of health (complete physical. mental and social wellbeing, and not just the absence of disease) is the best known and at the same time most misused and rejected definition of health. It has a socio-political connotation in that it defines what health shot&j be. not what it is. To fill this gap, enumerative and functional definitions have been developed [IO]. One may conclude that conventional medicine has considerable trouble in defining health. The development of a theory of health and of its determining forces. lagged behind that of the development of theories of diseases and their management. Apparently, this has been due to a pre-occupation with disease in regular medicine; health is taken to be a deviance from disease [I 11. Conversely, alternative approaches are much more directed toward maintaining health, with illness regarded as a deviation from health. In these approaches, health is a balance of opposing, forces: the life-building. constructive, vitalizing, positive forces or energies on the one hand. and the destructive, negative. disruptive and ill forces on the other hand. .A constant and dynamic interplay between the tvvo exists. Capra [6] speaks of an ‘eternal dance’. This dynamic balance is maintained in a continuous interaction between man and his environment. In other words: health is a matter of the simultaneous (and closely interrelated) maintenance of an internal and external balance. It follows that health points to a (unique) relationship. and that it depends on healthy life-habits and health promoting environmental conditions (not forgetting hereditary predispositions). If a person wants to be healthy, he should take care of his daily food intake, his physical movement pattern. a right balance between tension and relaxation, the right way of breathing, his mental attitude and so on (and influencing the environmental conditions). This is clearly expressed in ayurvedic medicine from ancient India. whose principles became known in the West via yoga and (other) meditation practices. For example. Swami Rama [I?] emphasizes bodily purification, a natural diet, and deep breathing within a context of physical and mental self-perfectioning. Healthy living is seen as a lifelong art [!3]. Disease

Conventional medicine has no general theory of disease and its deve!opment,,management. It has theories on the development of mental illness. of infectious diseases, of coronary heart disease. but none of disease in genera!. A general state of illness does not exist. as explained to me by a respected Dutch physician. notwithstanding the fact that on two occasions I have found empirical evidence for such a general state [14]: also Moss’ concept of genera! susceptibility seems to point to such a genera! state. It is interesting to compare this view with the approach of the German naturopathic physician

medxine

267

Reckeweg [ 151. Reckeweg‘s ideas (the homotoxine hypothesis) were developed on the basis of general system theory [!6]. Illness is a biologically appropriate reaction of the organism. in order to get rid of the homo-toxines (auto-toxic substances or residues). According to Reckeweg. the organism uses six defence-levels with increasing severity and threat for the integrity of the whole body. In cases of threat or an imbalance or overload, the organism’s first reaction will be to employ the normal excretion channels to get rid of the homotoxines: kidneys, lungs. menstrua! blood, catarrh. The second and third phases are termed reaction and deposition phases. The fourth to sixth phases lead to irreversible tissue changes: penetration. degeneration and neoplasmic. Always. Reckeweg argues, the organism first uses the lowest levels of defence before it falls back upon higher, more complex and radical defences. One can recognize from the type of defences that the organism employs which phase of progression the disease process has reached. and which therapeutic strategies are indicated. The alternativ,e cancer-approaches of Moerman. Gerson and Issels [!7] seem to support these views of Reckeweg. In these theories the appearance of tumours is interpreted as the last phase in a long process of increasing dysbalance in the human organism especially of its metabolic system. Diagnosis

Diagnosis is a holy matter in conventional meditine. No treatment without a diagnosis, even if in psychotherapy, the therapist may deliberately choose a more process-like approach, and considering that in genera! practice it is often impossible to arrive at a real diagnosis. The diagnostic system of regular medicine is examplified in the International Classification of Disease, Clinical Modification No. 9. It is based upon a classification in terms of location and/or etiology. This emphasis on identifiable signs and symptoms of a local character, can be explained historically as follows: when in 1560 Vesalius for the first time-at least in public-broke the taboo on opening a human corpse, he made it possible to investigate the deformations in organs that correspond to certain illnesses. It was discovered that different diseases correspond to different deviations in organs, and the need arose to classify these different diseases and to develop the art of diagnosis (Sydenham in about 1680 and Boerhaave in about 1730). Which lead to the location of disease in the cell (Virchov) or in DXX RNA structures, and to seeing micro-organisms as the prime causes of disease (Pasteur, Koch), all of u hich should be classified exactly to make rational therapy possible [18]. The type of diagnosis that regular medicine produces may be termed ‘morphological’. while the type of diagnosis in alternative medicine is more functiona!. In several alternative approaches we notice a lesser preoccupation with diagnosis (in the morphologica! sense): the diagnostic procedures rest more upon ‘body language’, frequently used techniques are those of iris-diagnosis. acupuncture points, stature. tenseness of musculature. dietarv habits, pulse reading. mental blocks. constitu;ion-type. though regular diagnostic measures are also relied

upon. But the predominance of computerized output as in regular clinical medicine. is quite uncommon in alternative medicine. The total person‘s evaluation comes in the place of matching symptom complexes with diagnostic categories on the basis of ‘objective’ data.

Two different though not mutually exclusive therapeutic strategies are the following, assuming that disease may be interpreted as the result of an imbalance between vitalizing and destructive forces. Strategy one is: destroy. or at least suppress, the demolishing or sickening forces. Strategy two is: strengthen the vitalizing forces. In both cases the result is the same (theoretically speaking): restoration of the (dynamic) balance. It is easy to see that most chemical drugs. surgical measures, and radiation, attempt to destroy the sickening forces. while several of the alternative approaches explicitly aim at strengthening the vitalizing. health-promoting forces. This, together with the morphological organ-based definition of disease as-often implicitly-applied by conventional medicine. has important consequences. For if a disease is something with a nonunderstandable Latin name. which can only be measured by experts and which can only be cured by doctors. who know the solutions. the doctor is by definition someone who should have had at least 7 years of university training, a man (rather than a woman) with great authority (expertness). who takes the lead in the patient’s problem-solving. If. however. diagnosis is of the functional type. and the therapeutic measures are of a rather simple nature and require the full and active cooperation of the patient (a profound change of dietary habits. regular exercise etc.) then medicine becomes more manageable. It reverts to the patient and may lead to deprofessionalization, by merely emphasizing basic rules for healthy living. the responsibility of the patient, explaining things in common language. seeing the person as in integrated whole, as the patient sees himself. In many cases (homeopathy, naturopathy) curing aims at strengthening the healing forces of the organism. In other words: a1ternativ.e therapies often work indirectly. they seek to defeat disease by strengthening the whole person’s resistance,‘defence immunity. Results are generally Concepts

in cowentionai

slower than in the more direct approach of conventional medicine. though spectacular ‘miracle cures’ have been seen in homeopathy and neural therapy (after Huneke). Therefore. in cases where the disease process progresses faster than the rebuilding process. not using conventional medicine is out of the question. The same applies to those diseases that have so progressed that inner resistance has almost completely disappeared. or whsre the organism fails to organize the correct counter-attack. Most alternative approaches, and especially their patients. share a general dislike of the use of ‘violence’ in therapy, of the input of chemicals that are foreign to the organism that cause various side-effects. of mutilating operations. of painful diagnostic investigations. The pntient Talcott Parsons described the ideal patient of conventional medicine. the one who does not ask questions and follows orders. When it became clear that not all patients followed this pattern, medical sociologists used the term ‘compliance’. In mental health and general practice more subtle forms of persuasion came into use (‘patient participation‘) but in alternative medicine. the position of the patient really is different. In traditional China. as in trdditional India. the doctor served the patient. not the other way around. In naturopathy the same principle is advocated. The patient is expected to cure himself. the doctor is his adviser. And this is the only way it can be, in naturopathy, because no one other than the patient himself. can change his dietary habits. his distorted movement pattern, or attitude toward life and illness. Granted, there are exceptions on both sides. but what we want to emphasize is that it follows from a functional definition of illness and a reliance upon health-promoting forces in therapy. that the position of the patient is basically of a more mature type than when disease (treatment) is mainly a matter of experts versus lay people who know nothing. Srcmmar~

To summarize, we present the following scheme in which the main differences in conventional ‘scientific’ medicine on the one hand. and alternative medicine on the other hand. are described, ideal-typically speaking. and alternative

Alternative

interpretation

Concept

Conventional

Health

Absence of d&ass

Balance of opposing forces. internail) as usll as extrrnally

Dlseass

Specific. locally defined deviations in organ or tissue structures

Bodg language mdlcating disruptive forces and or r*stofatiLe processes

Diagnosis

\lorphological

Functional

Therap)

Combating forces

Strenzthsning forces

The

patient

P;ljSi\e e*tern.il

interpretation

medicine

destructive

recipient of solutions

constructl\e

Acti\s participant regaining health

in

Concepts in alternative medicmc THE

COYTROVERSb

There is universal controversy between conventional (Western) medicine and alternative (indigenous) therapies. though in some cases a certain integration has been achieved [IS]). For the purpose of looking at some of the reasons for this conflict of ideas. we distinguish between pharmaceutical, integrational and holistic models. These will now be briefly discussed. T/re pharmaceutical

model

This corresponds to ivhat is commonly termed the medical model. but since two main options exist within conventional medicine (the other being the integrational model), and because Griffin [ZO] analysed the relationships between the pharmaceutical industry and medical education in the United States, it seems appropriate to prefer the term pharmaceutical model. According to Griffin the Rockefeller Foundation and through it the pharmaceutical industry-not to mention other industrial interest groups-have attempted since about 1900 to supporting medical education, by influence financially the better institutions. This led to effective improvement in these institutions. However, these educational systems also came to rest heavily upon pharmacology and research departments. On the other hand, universities that emphasized the role of diet, social and mental aspects, were not supported and many failed to survive. Gritin also holds that the influence of the pharmaceutical industry upon the staffing of the American Medical Association. and on the leading medical journals, is considerable. Support for this type of connections has come from others [2 I]. Assuming this analysis to be essentially correct, we may try to delineate more clearly what the characteristic features are of the pharmaceutical model. As depicted earlier it concentrates on disease as a demonstrable deviation of function and/or structure in organs, tissues or cells. Illness is usually indicated by a characteristic pattern of symptoms and complaints that should be carefully (= objectively) measured and classified (the diagnosis). The causes of disease are mostly of a germ-like nature. In therapy the emphasis lies upon removing or suppressing the outer signs of the disturbance, preferably by chemically and scientifically developed medicines, or through surgery. or by radiation. The application of technology (diagnostically, therapeutically) is dominant [Xl. The iutegrariorzal model

Almost paralleling the development of the pharmaceutical model. another model-though less pervasive and powerful+ame into existence, whereby physicians sought to reintegrate the fragmented body. Under the influence of the mental health movement. family practice, psychosomatic medicine, public health and medical sociology, it became realized that the human being is more than a composition of cells. that illness also has psychic and social aspects and consequences, and that poverty, overcrowdedness and unemplovment may have a severe infIuence on the spread of diseases and death rates of

26Y

populations. Essential features of this model are that the human being is considered as the integrated whole of the physical, mental and social aspect. and that the inter-relationships among these aspects are studied. One is aware that some illnesses may be of a pureI> functional nature, and that symptoms often should be interpreted as signals of serious. emotional or relational or social problems. Usually a combination of therapeutic measures is applied. at least advocated [23]. The holistic

model

Here the human being is approached as a Lvhole. oscillating internally as well as externally. within the boundaries of a continuous dynamic equilibrium. In addition to the three aspects of the integrational model, a fourth dimension is ‘added’ (actually it is not added, because it has never been separated), namely the existential. This is a time-dimension, it relates the human being to its past and future, it emphasizes the goal-striving behaviour, the realization of the self over time. Another difference-as compared to the integrational model-is that it does not distinguish between soma. psyche and social. The diagnosis is a total diagnosis. not just a description of symptoms. The therapy is a total-therapy in Lvhich the life-forces are strengthened instead of fighting the disease as such. A natural way of living and natural environmental conditions are emphasized. The patient is approached as a responsible and assertive individual [24]. These are ideal-type descriptions. The pharmaceutical and holistic models being the extremes of a gradual change of emphasis upon observable. measurable, quantitative aspects of life toward intuitive. qualitative, Gestalt-like configurations which extend in time, sometimes even transcending an indibidual’s lifetime and including cosmic aspects as well. The integrational model stands somewhere in between. It is an attempt to make the pharmaceutical model more humanistic, but in essence it remains within the boundaries of the strict medical model. John Heron [25] has developed a ‘paradigm of well-being’ that looks like a promising device for integrating, at least combining, these models. Scientific

proof

What constitutes scientific proof? According to an evaluation of acupuncture bv a committee of the Dutch Health Council, scien&ic testing should fulfil the following conditions [26]: (I) Patients should be classifiable into clear-cut diagnostic categories; duration and severity of the disease should be measurable (and controlled for), with a preference for quantitative variables. (2) Preferably a control group design should be employed, the patients should be randomly assigned to the experimental and control groups; both ‘therapies’ should be administered by the same. neutral investigator; in the case of therapy-refractory patients one may refrain from using a control group and only compare the starting situation with the end situation(!). (3) As to the evaluation of results. the evaluator should be independent from the therapist, objective

270

c.

w.

criteria should be preferred, and long-term effects should be taken into account. (4) The patients should not be familiar with acupuncture. any possible suggestive influence should be the same for both groups. the conditions under which the treatment takes place should be identical. There are several comments to be made in relationship to these requirements. First, according to the Dutch Health Council, a control group design is preferable but not necessary, it cannot be applied in case of therapy-refractory conditions. Secondly, these requirements are typical of the pharmaceutical model: they emphasize standardization. isolation, control, classification, quantification and randomization. These requirements are not applicable as such in holistic medicine: one who isolates destroys the whole, classifying destroys uniqueness. Thirdly. the control group design shows, in practice, many shortcomings. for example: the dissimilarity of control and experimental groups because of selection factors or matching, too small groups for preventing faults of type II, awareness among patients of their group belongingness, deviations from the protocol (e.g. in multi-institution participation), mistakes in the reading of results or their registration (sometimes estimated to equal 25%) low compliance, wrong dose or therapy, inadequate operationalization of parameters, and too short a period of follow up [27]. This explains that Burckhardt and Kienle [28]. after scrutinizing about 1000 German scientific publications, found that only 2-j% of the reported investigations were without mistakes. Fourthly, a different emphasis is placed in conventional and alternative medicines as to the performance of investigations in medical practice. In conventional medicine the emphasis is on research aspects: if one intends to perform a scientific investigation, the therapeutic process has to be adjusted to the procedures of scientific investigation. In alternative medicine, the therapeutic process is the starting point: it is strongly believed that research should not cause any disadvantage to the patient: the requirements of research must be accommodated to the needs of treatment (even though this has serious consequences for questions of generalization and validity). Fifthly, most. if not all, control group experiments are inadequately interpreted from a strictly logical point of view. This is due to the so-called falsification principle, which holds that truth can never be proven: what can be shown is that some statement is not untrue [29]. This is the reason for formulating and testing the null hypotheses. If we reject a nullhypothesis, i.e. drug A does not work. it should not be concluded that A works. Only if we successively WMO~ reject all alternative null-hypotheses, are we justified in accepting the proposition that A causes the effect. That this is true can easily be seen if we assume that A only works optimally if factor B is also present. By testing for A and B separately ue would find that in bad7 cases we would want to reject the null-hypothesis. And this will happen quite often if we assume that the effects of therapy are the outcome

hKSTER

of a complex of interacting variables of vvhich a drug may be a necessary though not sufisisnt ingredient. However, I know of no clinical trial that takes care of these logical precautions. Finally. these requirements suggest that this type of testing is the only valid vvsy of Arriving at true propositions. This implies that all medical knouledge has been empirically tested in the uay described (which actually is not true) and that all knouledgc that has not been tested in this way. is false (u hich is not true either). This point of vie\\ highlights the arrogance of Western rational thinking. As a matter of fact, other traditions in methods of ‘scientific thinking, as for example the trial and error method (in German, Erfahrungsheilkunde) have proved themselves valuable means for arriving at cohesive and complex theories on human dissase and its treatments. Now, considering the fact that con\:ntional medicine imposes its method of scientifi< proof (tvhich itself has methodological, theoretical. practical and ethical shortcomings) on alternative medicine--even without a willingness to seriously diwuss alternative methods-the question arises: u hyl LV’hy does conventional medicine require that the liternative and more holistic approaches have to be tested by its o\vn analytical methods? This question leads of necessity to the heart of the controversy. Why alternatke

is altrrnatire

According to Feyerabend [JO] a natural tendency exists to beheve and support theories that have once proved to be successful. Each findir.2 that supports the theory reinforces the strength oi ihe belief and a disregard for alternatives. Therefore. one invests energy and resources in the existing theory at the expense of serious alternatives [;I]. In so doing. the theory becomes more of a religion or ideolog!. In order to gain respect for any alternative therapy or theory, the evidence must be excellent. better than for established theory. For this reason Feyerabend defends a climate of intellectual freedom without prescribing strict rules. for only in such a !iberal climate can new intellectual developments fully profit. One example of an unexpected outcome from the free confrontation of old and new ideas evperience quoted by Feyerabend, is the rediscovery of acupuncture in China. Interestingly. he sees a clear association between politics and science. On the one hand the political establishment may- support the medical establishment and vice versa: on the other hand, government may take the Iearl in creating a climate of open competition of ofcial and nonofficial ideas. Also relevant is Needham‘s [32] analysis of the relationship between mysticism and empiricism. He places both of them opposite rationalism. Rationalism always lays a strong authoritative claim upon absolute knowledge. Therefore. testing of its assumptions is not considered necessary. Those who doubt these absolute truths are suspect. According to Seedham. it is not incidental that such a ntid for scientific reneual often coincides with radical political mov’ements. This relationship has been further bvorked out scheme, In this &sme. normal in the following

Concepts in alternative mednnr societal functioning system. as follows.

is interpreted

as a cyclic feedback (3 I

- lnstlrurional order Soctery

(1 I -

(2

Processes

t

(6)

in society (I) all kinds of processes (2) take place. which lead to certain problems (4) (i.e. poverty. delinquency. illiteracy, ill-health, environmental pollution. etc.). At the same time. society produces its institutions (3) in order to help solve these problems (churches. welfare departments, health systems etc.). In a state of equilibrium, the solutions (5) reached are effective. or at least tolerable. Feedback (6) of these effective solutions flows to society and consolidates (7) the existing balance of interests and values. If. however. the produced institutional order is not effective in solving society’s problems. quite a different feedback-loop develops. This can be demonstrated, heuristical!y,dnd hypothetically. for the case of alternative medtcme (Scheme 2). -

I *Problems

I

Feedback

(7)-

Consolldatlon

Consolldot!on (17’

271

(New1

(41

1 Solurlons(

-

I

t

ond resistance (12’

lnstltutlonal (18’

Dissatisfaction (7’ t

-

order I

-

_

AlternatIve (131 Extension order (8)

-

of

lnstttutlonal (3’ Processes

c~rcwts instltuttonol

order

(2)-Problems

-----I

1

-,

I v

(6)-

Feedback

(11

Feedback

(16)

I I

Escalarlng aroblems

(4’

S”tiety(“t Feedback

’

solutions are incorporated into the institutional order, or replace it completely (I@, and the original feedback loop of effective societal functioning has been restored. (However, in the case of alternative medicine this has yet to be seen, perhaps over the next two decades?) This analysis is partly based on the work of Roth and Wardwell [34]: also interesting in this respect have been the studies of Schwendter and Bouchier on general aspects of the rise and fall of subcultural movements, and the ideas of Gunitch on the deeper levels of value and attitudinal change [34]. Of soecial interest. however. are the insizhts of

r Protest

5

Noneffective SOlutlOnS (5

I

I91

(14

I

I

Non -effective

I-

solutIons(l0’

Here society (I) produces processes (2) which lead to problems (4). At the same time it creates the institutions (3) to solve these problems (e.g. a health care system based upon the germ theory of disease). This gradually proves to be ineffective (5). for example because present-day illnesses are mostly of a non-germ like nature. Feedback to society causes dissatisfaction (7). In the first instance this is interpreted as a capacity problem, and society decides to have ‘more of the same’-solutions (331: more doctors, more dollars, more drugs. In other words, the system chooses an extension of the institutional order (8). But. the problems escalate (the people ask for tender loving care. but get more drues and techniques): more cancer, more mental disease. more heart infarctions. traffic accidents, suicides, .addictions. So. the solution is ineffective (IO). Gradually. feedback causes irritation, protest and resistance (12). alternative circuits develop (13: acupuncture, the health food movement); these lead (sometimes) to effective solutions (I 5). feedback consolidates the new equilibrium of interests and values, the alternative

I Problem control

-

1

Effective

Capra [353. He argues that in Western culture. and thus in the history of science. a certain undulation can be recognized in the dominant way of thinking: rationalism or mysticism. Mysticism prevailed unttl, let us say. Hippocrates, then we saw about six ages of rationalism (Greek and Roman), thereafter came the middle ages with their strong mystical features. Until the Enlightenment (Descartes, Locke. Hume) started off present-day rationalism. Capra compares this to the Chinese way of thinking in which rational and mystical, quantitative and qualitative. masculine and feminine aspects are recognized as two essential aspects or components. neither of them being ‘better’ than the other. In other words. the Chinese would never let male values dominate female values. This, however. is what happened in the Western world. Therefore. we have a strong. dominating. ‘aggressive’ medical technology. nuclear power, environmental pollution. alienation. Capra’s plea points to the need for a deep change in our values. ways of thinking and dominant institutions. in order that a new equi-

371

c.

_I_

w.

hbrium may be attained among male and female values. rational and intuitive ways of interpreting reality. culture and nature. .\LTERI.%TIVE’S

COSTRIBLTIONS HE.1LTH C.%RE

TO FUTURE

What can alternative medicine contribute to the fulfilment of current and future health (care) needs’? First. it is important that we wish to learn. If we are not critical. if we do not constantly ask what is the benefit to people of our splendid societal institutions, we shall never be able to help solve these problems. Secondly. alternative approaches bring us back to the existential base of human suffering. No longer should illness be approached as a technical problem for which technical means are fitted. but as a human problem to be solved by human means, both at the individual level (awareness, lifestyle) and on the societal level (health conditions for life: income, housing. food, air. peace). Thirdly.

alternative

approaches

bring

back

into

our care system. simplicity. safety, individual responsibility and autonomy. Fourthly. it may be expected that the application of alternative approaches, with their emphasis on health-strengthening forces and life-style, means that our expensive, highly complex and almost unmanageable health systems might be replaced by a more horizontally organized. smaller professional care-system. of lower complexity on a reduced scale. Finally. we need to redefine concepts like health, disease. diagnosis. cure, in order to build up a new health system. This requires that we redefine reality.

REFERENCES

,hKSTER

Inrerdisciplinory Perspecrlres. Addison-Wesley. London, 1981. holuruche I2 Swami Rama S. .Mel hurl en :iel gr:ond-een ki/k. De Toorts. Haarlem. 1979 (English title: .4 Prtrc lid Guide 10 Holkric Healrh. Himalayan Intern.itional Institute. Honesdale. Pa. 1978.) S~.vrmf.v--.4 Comport~:~~ e 13 Leslie C. .-lsiun .tledicul SU~
P.

compendium

A.

van. coor

Geneeswij--en de

nierunicersiraire

in

Nederiandgeneeskunde.

Ankh-Hermes, Deventer, 1976. English translation to be published by Gill Norman, London. Final report of the Dutch Committee on alternative medicine, with an English summary. Dutch ministerium of Welfare, Healthcare and Culture, Leidschendam, Netherlands, I98 I. Jung C. G. Introduction / ning. Ankh-Hermes. Deventer, 1977. [English title: The I Ching or Book of Changes. Routledge & Kegan Paul, London.) Dijk P. A. van and Aakster C. W. Lireratuuronderzoek VAR-reeks 1980 No. 3. alrernarieue geneeswij:en. Ministerium of Welfare. Health Care and Culture. Keidschendam. Netherlands. Carlson R. J. The Fronriers of Science and Medicine. Wildwood House, London, 1975. Capra F. The Turning Point-Science. Society and rhe Rising Culrure. Wildwood House. London. 1982. Schur E. The .-I wareness Trap-SeIl‘-rlhsorprion lnsieati Change. Quadrangle The New York Times Book Co.. 1976. Simonton 0. C.. Matthews-Simonton S. and Creighton J. L. Gerring Well &yin. Bantam Books, London. I98 I. Inglis B. and West R. The Alrernurire Hecdrh Grride. Michael Joseph. London. 1983. For example: Aakster C. W. Psychosocial stress and health .disturbances. Sot. Ser. ,\let/ 8, 77-90. 197-t. Examplitied in Caplan A. L.. Engelhardt H. T. and McCartney J. J. Conceprs of Health and Diseaseo/’ Social

of

Biosocicll

R~sonu~ion.

Kanker als ger.olg L‘O om~olwaard~,~e t ordi~~g Xur ycue:en door dieel en rherapie. Ankh-Hermes. Debenter.

1978.

18 Reep

F. St. van der. Het geneeskundig denken en handelen. sezien vanuit een historisch gezichtspunt. Rapport sb. 18 van de Vakgroep Gezondheidslecr. Landbouu-hogeschool, Wageningen, 1377. 19 Unschuld P. U. Western medicine and traditional htaiing systems: competition. cooperation or integration’! Ethics 51. .Veri. 3, l-21. 1976. 20 Griffin G. E. World Wirhour Cancer--7‘he .Sfor~ 01‘ Viramin B 17. American Media. 1975. 21 Langbein K.. Hans-Peter Martin H.-P.. Hans Weiss H. and Roland Werner R. Geronde :nkrn-pruklijlien 1,~de fhrmaceurische

Dijk

D.vnamics

Wiley. Seu York. 1973. The general factor may be better identitied by the centroid method than by the principal components analysis, according to Harman H. H. .Ilodern Facror rlna/~.si.s. The University of Chicago Press. 1960. 15 As discussed by Stiekema in Haan H. de and Dijk P. A. van. !vier-rcniaersiraire geneeswjzen. Ankh-Hermes. Deventer and Intermediair. Amsterdam. 1978. 16 The same starting point is defended in Aakster 1972 and 197-l. and in Capra 1981. see Refs [6. IO. I-l]. der Malignome. Gesellschdft 17 Issels J. Ganzheitstherapie der Arzte fiir Erfahrungshcilkunde e.\ ., Heidelbera 1973 (1): Haught S. J. fin.7 Dr .Mu.Y Gerson o Tru; Cancer Cure:> Maior Books. Calif.. 1978: Moerman C

aangeutld Reijnders.

publication:

industrie

in Oostenr/jk

met

gegerens

ocer

Van

Gennep.

Amsterdam.

en IVexrtluirrk~md

jVederland

door

Lucas

198 I. Original

Gestrnde Geschijlie: die Prokrken Phnrma-lndtrsrrie. Kiepenheuer & Witsch. Koln

c/u

193 I. industry: a

Also: blurray M. J. The pharmaceutical study in corporative power. In/. J. Hlrh Serr. 3. So. 1, 1973, 22 Ottolander G. J. H. den (Red.) Interne gence.Awvlceen beknopr ieerhoek in IIIW tleicn. Academische Paperbacks. 0. Oosthoek’s Uitn.. 1969: Verbrugh H. S. Puradigmu’v en begripsoni,t,~~~eli,~g in de :~ekreleer. De Toorts. 1978: U.S. Department of Health and Human Services: .-lcl~ances in Cancer Re.veurch 1971-19Sl. N.I.H. Publication No. 81-2323. 1981; Caplan [I I] and manv others. 13. Querido A. The role of emotional factors in readmissions to general hospitals. In Fronriers in Gewrul Hospitul P.<~.chiurr~, (Edited by Linn L.). pp. 1899300. New York, 1961; Dijk W. K. van. Het Medisch model in sociale kontext. In Van kinderanalyse IOI Ychrontosoom (Edited by Riimke C., Boekel P. E. and Dijk VV. K. Lan). VLS-boek. Dekentsr. 1973: Green J. The challenge of the future: how to prebent psychosomatic disorders. _3t(/ Congress Inrernuiiowl Collegt~ r~l P.r~choromatic .Medicinr. Amsterdam: Kuiper J. P. Hzr xl once :ore -_ijn. Van Gorcum. Assen. 1975. 19SZ. see Ref. [6]: Blasius u’ Ganzheit und 24. Capra System: Erfahrungsheilkunde 1976 I: Relman A. S.: Holistic medicine. .Ven EngI. J. .\leii. 300, 3 12-313. 1979.

Concepts

in a!terrtative

‘5. Heron J. A pardigm of well-being. Paper. 1951. 26. Gezondheidsrasd. Advies inzuke Acupunctuur. So. 1977 20: Rijswijk. 1977. 2:. Carter S K and \lathi G. ,An overview of the 1978 international meeting on comparative therapeutic trials. Blonic&.i,ir Special Issue 2%. 6-I 3. 1978: Gehan E. H. and Freireich'E. J.: Cancer clinical trials-a rational basis for use of historical controls. Seniinclr.< Oncol. 8, 130436. 198 I.: Helman S. M. D.: Randomized clinical trials and the doctor-patient relationship. Cattcer C/in. Trul.v 2, 1899193. 1979. Medizin28. Buttner G.. Hensel H. er al. Biologische Grundlagen ihrer Wirksamkei!. V’erlag fur Medizin Dr Ewald Fischer. Heidelberg. 1977: also see Kienle G. .4r~,lrit,lirrelsicherl,eir und Gesell.scha/-eine krirische L’nrers~chmg. F. K. Schattauer Verlag. Stuttgart. 197-I.

29. The idea originally comes from Hume. and was further developed by Popper. as discussed in Lakatos I. IC~rrrlsclfap,-hloso~e en u~erenschupsgeschiedenis-de cot~rrorerse msen Popper and Kuhn. Boom. Meppel. Original title: Falsification and the methodology of scientific research programs. In Crilicisn7 a& rhe G,on,rli o/ Knowledge (Edited b? Lakatos I. and Musgrave A.). Cambridge Universtty Press, Cambridge. 1970. P. In strijd met de ntelhode-aanzet IOI een 30 Feyerabend c~,l~~rclri.vri.~c~~ekennlsrheorie. Boom. Meppel. 1977. (Original title: Againsl ,Mefhod. New Left Books. London. 1975.)

27;

medicine

31. Lailv. for example. highlights the mechamsms that underlie the differential allocation of research money in case of crib death and juvenile cancer. Lallk J. J. Social determinants of differential allocation of resources to disease research. J. Hlrh sot. Behar. 18. Il_i-13s. 1977. 32. Needham J. Science and Cirilkarmn in Cltino. C’oi. 2. Hbror,r of Scienrific Thoughr. Cambridge Lniversit> Press. Cambridge. 1975. 33. Watzlawick P.. Weakand J. H. and Fisch R. Her krru anders-over her onderkennen en oplossen ran menselijke problemen. Van loghum Slaterus. Deventer. 1975. (Original title: Chatwe. Palo Alto. Calif. 1973.)

W.- I. Limited, marginal and quasi34. Wardwell practitioners. In Handbook q/‘.\fedicul Sociolo?). 1972: Wardwell W. I. Toward a conceptualization of the process of emergence and disappearance oi hcalthrelated professions. Paper at the. Sociological Conference. Uoosala. 1978: Roth J. A. Healrh Pxrifier.y .. and Their Enemies. Croom Helm. London. 1976: Schwendter R. Visies op subkulluur. Boom. Lleppel. 1971. (Original title: Theorien der Subkrrl!ur. Verlag Kiepenheuer & Witsch. 1973); Bouchter D. fdw’ism und Recolurion-Net\, Ideologies 01‘ Liberalion in Brirtrirr and rhe Unired Srares. Edward Arnold. London. 1978: Gurvitch G. Handbook ran de sociologir. Aula. Ltrecht. 1968. (Original title: Truiri de sociologic. Presse Cniver-

sitaire de France. 1958.) 35. Capra F. The Tao offh~sics. 1978; also [6].

Fontana

Collins.

London.