In the Name of Medicine
A. Berkenwald
Feb 1, 1998
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6
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Journal
Annals of Internal Medicine
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Semantic Scholar
Key Takeaway Key Takeaway: Alternative medicine as "unconventional" or "counter-productive," but the power of name can control ideas and influence future health care discussions.
Abstract
In Medicine, as in statecraft and propaganda, words are sometimes the most powerful drugs we can use. Sara Murray Jordan In the history of medicine, there has never been a time when one methodology, one paradigm, one hierarchical classification of healing has been uniformly accepted. Different approaches to healing have continually found themselves in conflict over methods and even over the basic tenets of their profession. Samuel J. Melzer, the first president of the American Society for Clinical Investigation, founded in 1908, argued that clinical medicine has two components-science and art-and that they are separate, antagonistic, and incompatible. He warned his fellow physicians that the simultaneous cultivation of both is detrimental to the progress of either [1]. We are currently experiencing a health care revolution that is, arguably, less about health and more about money [2, 3]. We are also observing a growing interest in alternative medicine. A frequently quoted survey published in 1993 in The New England Journal of Medicine reported on the alternative health care practices of 1500 U.S. adults. Thirty-our percent of those surveyed had used at least one unconventional therapy in the preceding year [4]. On the level of national policy, the use of alternative methods is of increasing interest to the U.S. Congress. In the 1992 National Institutes of Health (NIH) Appropriation Bill, the language of the Congressional Appropriations Committee is clear: The Committee is not satisfied that the conventional medical community as symbolized by NIH has fully explored the potential that exists in unconventional medical practices. Many routine and effective medical procedures now considered commonplace were once considered unconventional and counter indicated In order to more adequately explore these unconventional medical practices the Committee request that NIH establish within the Office of the Director an office to fully investigate and validate these practices. Congress added $2 million to the NIH's $10 billion budget in order to fund this office (the first director of the office, Dr. Joseph J. Jacobs, called the amount homeopathic [5]). Because Congress is willing to mandate an office to explore alternative practices and because people are willing to spend so much for these practices out of pocket, future health care planners may need to discuss alternative health care in the same breath with regular medicine. In such discussions, the license to name brings with it the power to control ideas. All participants in the healing professions pejoratively label those not like themselves. They do this, in equal measure, to better define themselves and to gain a competitive edge. For this reason, the nomenclature used to describe competing healing practices is reviewed here. The Name Game What's in a name? That which we call a rose By any other name would smell as sweet. William Shakespeare As the term alternative medicine is popularly understood, it represents a wide spectrum of healing and health tactics, including acupuncture, acupressure, biofeedback, Chinese medicine, chiropractic, folk medicine, herbalism, holistic medicine, homeopathy, hypnosis, massage, naturopathy, psychic healing, relaxation, and reflexology. In fact, the term alternative has widely differing connotations for the very people who use it. Does it simply mean anything not taught in traditional western medical schools? Do the words alternative, complementary, holistic, natural, and fringe describe similar or different activities? It has been noted that alternative medicine defines itself by exclusion and that the term is no more helpful than the similar catch-all term foreign [6]: An Englishman setting out to comment on foreigners would be as accurate in his description of foreigners as most doctors are in their understanding of alternative therapies, and the Englishman's commentaries would tell us more about the prejudices of being English than the characteristics of non-English people. Alternative, as it is commonly used, may imply an equal choice between two things or may suggest a choice that, if taken, leaves the other behind. It suggests an order of choices, starting with the first and best and proceeding to those of less value. Naturally, we cannot forget the culturally popular concept of alternative lifestyles and the controversial social baggage that alternative carries in that context. Once again, depending on your politics and values, alternative can suggest a positively nurturing or a negatively hedonistic viewpoint, a warm fuzzy feeling springing from one's romantic youth or a stern reproach from a conservative superego. A closely related word, a relic of methodologies and concepts now extinct, may have given rise to (and been replaced by) the phrase alternative medicine. The definition of alternative, as in alternative medicine is, according to Zell's Popular Encyclopedia of 1886 [7]: Alternative (Med) Such medicines as induce a favorable change in the system, without any manifest operation or evacuation. The principal therapeutic employment of the Alternatives is as antiphlogistics or resolvents. Antiphlogistic is another dated medical term that, according to Zell's, refers to agents that counteract burning heat, or inflammation. Resolvent makes reference to an extinct class of medicines used by surgeons to dissolve or dissipate impacted humors, swelling, tumors, &c however, such remedies are more fanciful than real; for though mercury, lead, and ammonia are considered among the best of the class, there is one agent of more value than twenty such combined and that is the human hand. Friction with a soft hand-with or without lard, or oil-is the only reliable [resolvent] in the whole catalogue [7]. This is an interesting and prescient comment on competing techniques, the caustic drug therapeutics of the 19th-century regulars versus the laying on of gentle hands in a massage-like therapy. Alternative medicine lacked a visible assault on the patient, such as that seen with blistering, emetics, or purges, and it was a practice in sharp contrast to the heroic therapies of the time. (Early crude efforts to reduce fever and inflammation with these harsh techniques were referred to as heroic therapy [8]. In retrospect, what earned the label heroics-the therapeutics as applied by the physician or the effort to survive them by the patient-is debatable. The term has since evolved, thankfully, as have the techniques.) Names and naming were among the earliest issues tackled in the first NIH Working Group on Unconventional Medical Practices. Unconventional was simply unacceptable. Although they agreed that the public did have a good understanding of the term alternative, many participants were still unhappy with it. These representative practitioners felt that the term negatively implied a last resort. Many preferred the term complementary, but others found issue with that. Not able to agree among themselves, they came up with the following tentative names for their new organization: The Office of complementary and traditional, holistic and complementary, complementary, alternative and complementary, alternative and holistic and complementary, traditional ways, and integrated Medicine (or Medical Practice) (Meeting of the Working Group on Unconventional Medical Practices, 14-16 September 1992. National Institutes of Health Office of Science Policy and Legislation). Yet, regardless of what these leaders may choose, the public and the lay press have already settled the issue, and alternative they shall remain. The Other The art of medicine is my discovery. I am called Help-Bringer throughout the world, and all the potency of herbs is known to me. Ovid (Publius Ovidiou Naso, 43 BC-17 AD) Alternative medicine or alternative health care has come to be the term generally used by both the supporters (including Congress and the NIH) and the detractors of this type of medicine, but this is not the case for the name of the other medical discipline practiced by the more than 660 000 licensed physicians in the United States. Many terms are used for this method of healing; this probably reflects the continuing evolution of the practice itself. Scientific medicine is one term accepted by these physicians [9]. This name lays exclusive claim to a scientific foundation on a body of knowledge, derived from both research and observation, that is chronicled in peer-reviewed journals. It has a history of controlled, clinical studies; has a strong tradition of basic laboratory science; and is closely affiliated with medical schools and hospital research centers. But alternative practitioners, short on laboratory science but long on case reports, can also point to a historic collection of observations and data. With the NIH now enrolled as a sponsor, they will be soon publishing the results of more rigorous clinical studies, whatever their outcome, and may establish a stronger scientific foundation for their work. The term scientific medicine implies that other healing practices are not grounded in reality. It suggests, in a not so subtle manner, that alternative practices have no scientific or technological underpinnings, no systematization of facts, methods, or principles. It insinuates that alternative health care offers an alternative to the scientific laws that exist in the natural world. (This belief may indeed be held by those who support alternative medicine as well as those who attack it, but it belittles the legitimate debate that the subject demands.) The mantle of science cannot be claimed or exclusively worn by any one field of medicine. If not scientific, then what should we call the alternative to alternative medicine? Traditional cannot be used, because both types of medicine have long traditions and the actual historic edge goes to the alternative practitioners. Conservative? This term, also, carries too much political baggage, and its use is complet