Alternative Medicine, National Institutes of Health, Bldg The use of complementary and alternative medicine (CAM) has grown dra …
S/A 4071: Social/Cultural Aspects of Health and Illness: Class 29: Complementary Alternative Medicine 2 Today we look at health care restructuring in light of alternative approaches to medicine Health Health Determinants: WHO 1947: health a state of complete physical, mental social well being, not merely the absence of disease infirmity Consistent with alternative approaches as goes beyond mere disease state to consider feelings behaviors This holistic definition also considers wider determinants of health than traditional medicine eg SES, environment, lifestyles, social support Yet somewhat idealistic potentially justifies intrusion of medical experts into ever expanding areas in name of health promotion This definition has also tended to be ignored in practice by mainstream allopathic medicine, though alternative approaches more sympathetic Medicine the Health Care System: Medicine is a broad term, includes both alternative allopathic practice: all persons, procedures
things committed to dealing with health problems promoting health Health care system includes conventional alternative medicine, institutions, mechanisms of payment aspects of government
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The Conventional Health Care System: Different assumptions underlie conventional health care alternative approaches The conventional approach: Emphasizes: - biological causation - separation of mind/body - bodya machine - fixing broken parts - science -efficiency/cost reduction Downplays: - psychosocial aspects of illness - the persons voice - alternative approaches - interpersonal care esp since cutbacks/rationalization
Alternative Approaches to Health Medicine: These are hard to define given: - diversity of therapies - funding variations - the fact that some are offered by conventional practitioners - some remedies available over the counter - extensive use by the public despite traditional allopathic hostility Alternative health care a diverse, plurality of therapies in 7 categories:
1 Medication homeopathy, naturopathy herbal remedies 2 Manipulation chiropractic, osteopathy, acupuncture, acupressure, therapeutic massage 3 Devices that provide various treatments 4 Mind cures meditation, visualization
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5 Supernatural cures magic 6 Folk medicine traditional Aboriginal or Ayurvedic 7 Diagnostic techniques eg iridology Many of these are becoming increasingly conventional widely used People often pragmatically use alternative conventional medicine together, not exclusive to one another This cuts across social categories Alternative approaches ideally tend to be more holistic, treating the individual as a biological, psychological social whole, also placing a greater emphasis on health promotion Most widespread alternative practices: chiropractic, naturopathy, midwives, herbal medicine Specific alternative approaches: 1 Chiropractic: - history of antipathy with allopaths, but increasingly legitimated - widely used paid for by government health insurance -
professionalized as a limited specialization in the conventional system dealing with neuromuscular problems - most practitioners mixers that recognize causes besides spine 2 Massage therapy: - emerging profession increasingly prescribed by conventional practitioners - regulated paid for under some health plans - potential to also become a limited specialty
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3 Naturopathy: - focuses on uniqueness of individual/illness - emphasizes healing power of nature - utilize eclectic treatments such as diet, nutrition, lifestyle counseling, vitamins, herbs, homeopathy, acupuncture, physiotherapy, hydrotherapy, etc - growing in Canada, licensed in several provinces paid for in BC Yet, may be overtaken as allopaths move in same direction 4 Homeopathy: - utilizes natural remedies producing similar symptoms to illness like cures like - utilized by other alternative practitioners - some remedies available over the counter 5 Herbal remedies: - a substantial, growing industry, increasingly entered
by drug industry - much concern over unsubstantiated claims, product safety, side effects unwarranted usage - once science used to evaluate in same way as drugs, these become indistinguishable from drugs ie no longer alternative - Federal government has begun regulation through Health Canada, encouraging such convergence 5 Midwifery: - a more personal, holistic empowering approach to birthing - has a long history, marginalized in 20th century, but making a comeback legal recognition in many provinces
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- legitimation/professionalization may undercut claims to being an alternative approach If integrated into conventional system, could they be co-opted? 6 Acupuncture: - a component of traditional Chinese medicine - increasingly incorporated into conventional model 7 Aboriginal traditional medicine: - focuses on holistic healing using herbal remedies, listening talking, loving accepting with humility, respect humor - emphasis on harmony with ones environment community - not
necessarily antithetical to conventional medicine The Use of Alternative Health Care: 1997 Fraser Institute-Angus Reid Poll: 73 of Canadians had used at least one alternative therapy Most common in descending order: chiropractic, relaxation techniques, massage, prayer, herbal therapies, special diets, folk remedies, acupuncture, yoga, homeopathy, lifestyle diet, self-help groups 40 added that such costs should be covered by medicare 1997 CTV-Angus Reid Poll: 42 of Canadians had used alternative health care most commonly chiropractic, herbology, acupuncture homeopathy Almost half of users had started within past 5 years 70 of respondents said medicare should cover costs 66 felt governments should advocate alternative medicines to reduce health costs 67, however, also felt regulation necessary to ensure safety efficacy
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Health Care Restructuring Alternative Health Care: While alternative therapies often criticized for anecdotal support, many conventional therapies themselves
lack clear, consistent scientific evidence Even those that do work may not for certain individuals, or result in severe side effects Alternative therapists, however, also rely on assumptions As time goes on, conventional medicine is becoming more in tune with individualized treatment the complex interplay of biological, psychological, sociological factors impacting health Alternative conventional medicine becoming more similar in that: - they seek effective therapies tailored to patient - they seek proof of efficacy - they emphasize a holistic approach - they promote wellness in addition to treating illness Health care in Canada is becoming increasingly pluralistic as a result of both consumer demand integration of philosophies/practices across the conventional/alternative divide eg conventional medicine stealing the fire of alternative approaches Meanwhile, alternative practitioners are attempting to professionalize, become legitimated, etc Recognition in legislation adds to
this Many willing to exchange increased regulation for recognition though funding doesnt necessarily follow This convergence/increasing acceptance/breakdown of old hostilities makes it harder harder to distinguish alternative approaches as time goes on even more so specific varieties
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Umbrella legislation in Ontario Alberta places many health professions including many once considered alternative on equal footing Could this be an attempt to put pressure on/undermine the power of allopathic practitioners in an era of escalating costs? Are we headed towards an increasingly integrated system, or a serious power struggle in health care?
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Source:bioethics.nih.gov
