Baer Multi-Book Review of CAM

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Review: Social Scientific and Historical Studies of Complementary and Alternative Medicine in Anglophone Countries: A Multi-Book Review Author(s): Hans A. Baer Review by: Hans A. Baer Source: Medical Anthropology Quarterly, New Series, Vol. 19, No. 3 (Sep., 2005), pp. 350-356Published by: on behalf of the Wiley American Anthropological AssociationStable URL: http://www.jstor.org/stable/3655368Accessed: 10-10-2015 22:51 UTC

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SOCIAL SCIENTIFIC AND HISTORICAL STUDIES OF COMPLEMENTARY AND ALTERNATIVE MEDICINE IN ANGLOPHONE COUNTRIES: A MULTI-BOOK REVIEW

Orthodox and Alternative Medicine: Politics, Professionalization and Health Care. Mike Saks. New York: Continuum, 2003 (cloth and paper), 194 pp. A Diagnosis for Our Times: Alterna- tive Health from Lifeworld to Politics. Matthew Schneirov and Jonathan David Geczik. Albany: State University of New York Press, 2003 (paper and cloth), xi + 230.

Borderland Practices: Regulating Alter- native Therapies in New Zealand. Kevin Dew. Dunedin, New Zealand: University of Otago Press, 2003 (paper and cloth), 176 pp. The Politics of Healing: Histories of Al- ternative Medicine in Twentieth-Century North America. Robert D. Johnston, ed. New York: Routledge, 2003 (cloth and paper), xiv + 388.

Mainstreaming Complementary and Al- ternative Medicine: Studies in Social Context. Philip Tovey, Gary Easthope, and Jon Adams, eds. London: Routledge, 2004 (cloth and paper), xx + 180. HANS A. BAER University of Arkansas at Little Rock

When I first started my examination of certain professionalized heterodox medical systems in the United States and Britain in the early 1980s, I was part of a small group of anthropologists, sociologists, historians, and other scholars who were conducting social scientific and historical research on such systems in North America, Europe, and Australasia. Some 20 years later, I find myself in good company in this endeavor,

as the books covered in this review essay indicate. Needless to say, other recent titles could have been added to this listing. At any rate, the first three books covered in this review essay are monographs, and the last two are anthologies.

Although in the past terms such as "un- orthodox" or "irregular" medicine were bandied around to refer to professionalized heterodox, partially professionalized heterodox, religious, and folk medical systems, the terms that have appeared start- ing in the early 1970s have included alternative medicine, complementary medicine, holistic medicine, natural medicine, energy medicine, New Age medicine, and integrative medicine-the latter of which tends to refer to the merger of biomedicine and alternative therapies in one form or other. As biomedicine has come to incorporate, or some would argue co-opt, alternative therapies, there has been a tendency to use the term "complementary and alternative medicine" (CAM) in North America and the United Kingdom, whereas the term "complementary medicine" is more common in Australasia. It is important to note that CAM has become popular in other devel- oped countries, such as Germany, Denmark, the Netherlands, Italy, and Japan, as well as developing countries around the globe. It goes without saying that any discussion of CAM ultimately requires juxtaposing its relationship with biomedicine, regardless of whether this relationship is based on compe- tition, collaboration, cooption, absorption, or merger.

In Orthodox and Alternative Medicine, British sociologist Mike Saks compares and contrasts the routes by which regular

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medicine or biomedicine and allied health occupations and various CAM systems embarked on professionalization in Britain and the United States since the 16th century. He defines professionalization in neo-Weberian terms as a process "based upon the estab- lishment of patterns of legally underwrit- ten exclusionary social closure, gained by some occupations in the politics of work" (p. 4).

Whereas in the 16th and 17th centuries health care in both national settings was ex- tremely pluralistic, by the mid-20th century biomedicine had achieved clear-cut, but incomplete, domination over CAM systems.

British CAM practitioners theoretically have had a freer hand to function under Common Law in contrast to American CAM practitioners, such as chiropractors and naturopaths, who were forced to abide by state licensing regulations and basic sci- ence examinations. The differing political economies of health care contributed to greater biomedical domination in Britain than in the United States because the National Health Service, created in 1948, provided biomedical practitioners with greater state sanction than their American counterparts who functioned in a more laissez-faire setting in which they competed with CAM practitioners. Indeed, while Saks does not adequately spell out the process, he observes that osteopaths in the United States had achieved full practice rights in the ma- jority of states by the late 1950s, whereas they did not achieve statutory recognition in Britain until 1993. In large part, the diver- gent evolution of osteopathy was related to the fact that whereas the British health care system maintained roughly a 50/50 balance between hospital consultants and general practitioners, the strong trend toward spe- cialization in U.S. biomedicine and paucity of primary care physicians prompted legis- lators and other strategic elites to give more recognition to osteopathic medicine, particularly in the form of state-sponsored osteopathic colleges.

Saks also discusses the emergence of a medical counterculture in the 1960s and 1970s in both Britain and the United States that initially posed a serious challenge to biomedicine in both countries and contributed to the further professionalization of certain alternative medical systems, such as osteopathy (which evolved into more of a parallel than an alternative medical system in the United States), chiropractic, and acupuncture. Conversely, as it had done with medical systems such as homeopathy and eclecticism, particularly in the United States, biomedicine has embarked on a process of incorporating alternative therapies.

In A Diagnosis for Our Times, sociologists Matthew Schneirov and Jonathan David Geczik elaborate on recent develop- ments in the medical counterculture by fo- cusing on two health networks in Pittsburgh, namely the Holistic Living Quest and the Committee for Freedom of Choice. The former constitutes an informal coalition of well-educated, left-leaning people who dis- seminate information on alternative health practices, grassroots activism, and New Age spirituality; the latter tends to be made up of conservative Christian, rural, working- class people who seek to acquaint their audience with a range of alternative therapies for cancer and other diseases. The authors view alternative health as a new social movement or site in which diverse communities and discourses challenge what Habermas terms the "colonization of the lifeworld" by a health care system domi- nated by high-technology, invasive medical procedures, and profit-driven bureaucratic institutions.

Following Habermas, Schneirov and Geczik observe that alternative health en- compasses both offensive new social movements that seek to create new social struc- tures and ecologically sustainable lifestyles and defensive new social movements that seek to defend traditional values and lifestyles. Ironically, both progressives and conservatives in alternative health tend to

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engage in an "incomplete holism that fails to appreciate the social and class dimensions of illness" (p. 23). Although alternative health exhibits patterns of resistance, it has increasingly become a "hothouse for small companies distributing new products" (p. 142) and is being co-opted by biomedicine in the form of centers of integrative medicine and the creation of NIH's Office of Alter- native Medicine in 1992, later renamed the National Center for Complementary and Al- ternative Medicine. The authors suggest that HMOs will increasingly find ways to incorporate alternative therapies for cost-cutting purposes and the less holistic alternative therapies that can meet the rigors of randomized controlled testing will be adopted by biomedicine while those "[b]ranches of alternative medicine that claim fundamental incompatibility with conventional medicine will be marginalized" (p. 180).

Schneirov and Geczik posit three possi- ble future scenarios for alternative health: (1) its marginalization as a result of a re- juvenation of biomedicine emanating from genetic engineering resulting from the Human Genome Project; (2) a supplemen- tary, subordinated array of practitioners and therapies incorporated into biomedicine; and (3) an integrated medical system in which alternative medicine and biomedicine coexist as components of a new paradigm. They neglect to note that the actualization of the last paradigm-one that has the potential of being authentically holistic-would require the transcendence of the capitalist lifeworld.

In Borderland Practices, New Zealand sociologist Kevin Dew offers yet another example of the fluid boundaries between biomedicine and alternative medicine, but from the perspective of a small country far away from both the United States and the United Kingdom. He distinguishes five cat- egories of practitioners functioning at the boundaries of biomedicine. "Charlatans" and "quacks" are people who purport to have medical knowledge or skills that they do not

actually possess. The "crank" is an eccen- tric practitioner who follows his or her own inclinations in carrying out medical treatment but is well intentioned, despite that fact that he or she deviates from virtually all other practitioners, orthodox or heterodox. The "medical heretic" is a practitioner who has been trained in biomedicine but adopts a therapy or therapies that he or she was not taught in biomedical school. Finally, "de- luded practitioners" are "earnest people who believe they are doing a good job and providing value, but who at best might be de- scribed as useless and at worst as harmful" (p. 10). In reality, to a large degree, who fits in what category is subject to the prevailing medical norms of the historical period and social location, and Dew's choice of labels appears grounded in anti-CAM bias.

Dew focuses on the ways that various therapies are validated and regulated within the contexts of the larger the society and biomedical domination. Despite the fact that New Zealand, like Australia, exhibits "very conformist medical establishments" (p. 30), many New Zealand general practitioners, as well as their counterparts in Australia, have over the past few decades come to express a strong interest in alternative or complementary medicine, thus blurring the boundary between biomedicine and alternative practices. Dew discusses how chiropracty achieved statutory recognition beginning with the recommendations made by the Commission of Inquiry into Chiropractic in the late 1970s and overcame its marginal- ity under Common Law. In the process of achieving some semblance of legitimation, the New Zealand Chiropractic Association distanced itself from D. D. Palmer's asser- tion that subluxations are the source of most diseases and presented its practitioners as musculoskeletal specialists rather than drug- less general practitioners.

Dew notes that the boundaries between biomedicine and acupuncture in New Zealand have become even more illusive in that that the latter has come to be practiced

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by not only Traditional Chinese Medicine (TCM) practitioners, many of whom are af- filiated with the New Zealand Acupuncture Society (est. 1975), but also biomedical physicians belonging to the New Zealand Medical Acupuncture Society (est. 1981) as well as physiotherapists. At any rate, he observes that the existence of biomedical acupuncturists has served as a major barrier in the efforts of the TCM practitioners to obtain statutory registration. Although the New Zealand Medical Acupuncture Soci- ety became an affiliate of the New Zealand Medical Association, at least one biomedical acupuncturist, namely Mat Tizard (who used a form of electro-acupuncture in diag- nosing chemical poisoning), was expelled from the medical register in 1992, fined $1,000, and ordered to pay $157,000 in court costs, although these were reduced by the High Court to $100,000, exclusive of General Sales Tax. In contrast to incompe- tent biomedical physicians who tend to be treated relatively leniently for their trans- gressions, Tizard, as a biomedical heretic, provoked outrage by claiming to have found a treatment for a serious health problem that his colleagues could not easily diag- nose or treat. Although alternative therapies have become increasingly popular in New Zealand, Dew argues that the growing emphasis on evidence-based medicine, standardization of procedures, quality as- surance, and measurement threatens to delimit both biomedicine and alternative medicine.

The Politics of Healing, edited by Robert D. Johnston, includes essays written by historians and social scientists on the political battles that have ensued in North America between biomedicine and variety of alternative healing systems and health movements over the course of the 20th century. The edi- tor argues that the term "complementary and alternative medicine" (CAM) is "sugges- tive of how these alternatives are becoming a visible, and increasingly significant, cur- rent within the medical mainstream" (p. 1).

Indeed, the acronym CAM, in large part, has become a biomedical construction that re- flects the absorption of alternative therapies.

Part I (Precursors: The Years in the Wilderness) of the volume includes four essays that examine certain political strug- gles between biomedicine and alternative systems in the decades prior to World II and shortly thereafter. The essays by Nadav Davidovitch and Anne Taylor Kirschmann examine factionalism within the ranks of homeopathy, namely between the pro- vaccinationists and anti-vaccinationists and the traditionalists and the homeopaths who had come to embrace much of biomedical practice. In her essay, Barbara Clow examines the politics of alternative cancer care in Canada between 1900 and 1950 and Michael Ackerman discusses the emergence of the U.S. health foods movement, one in which biomedical heretics and dentists played a role, and the Food and Drug Administration that launched an attack on the movement beginning in the early 1950s.

Part II (Intersections: Allopathic Medi- cine Meets Alternative Medicine) includes an essay by Otniel E. Dorr on the subject of "voodoo death" as a trope situated at the "boundaries between mainstream and fringe, alternative and orthodox, and sub- versive and normative" (p. 71) and an essay by Wade Davies that chronicles the juxtapo- sition of biomedicine and Navajo healing.

Part III ("Contesting the Cold War Monopoly") includes an essay by Naomi Rogers on Sister Kenny, an Australian nurse who received far greater attention in the United States for her alternative approach to treating cancer during the 1940s and the 1950s, despite the opposition of organized biomedicine, than she did in her home- land; an essay by Michelle M. Nickerson on ultra-conservative opposition to passage of the Alaska Mental Health Bill of 1956; and an essay by Gretchen Reilly on the campaign, beginning in the 1950s, against fluoridation of public drinking water, that included MDs, dentists, research scientists,

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alternative practitioners, health food enthu- siasts, religious groups, political conservatives, and even some environmentalists.

The first two essays in Part IV (Contem- porary Practices/Contemporary Legacies) touch on feminist health concerns. In her essay, Amy Sue Bix examines the fascina- tion of U.S. feminists with alternative therapies between the 19th century and the 1990s. Georgina Feldberg explores the Women's College Hospital in Toronto as an exem- plar of the women's health movement during the 1960s and 1970s. In other essays in this section, Velana Huntington examines Orisha as Afro Cuban medical system in the United States; Sita Reddy discusses New Age Ayurveda as a genre of "maga- zine medicine"; anthropologist David Hess analyzes the CAM cancer therapies social movement in North America over the course of the 20th century; and Matthew Schneirov and Jonathan David Geczik provide an analysis of the two alternative networks in Pittsburgh that they explore in greater detail in a book reviewed earlier in this essay.

In Section V (Conclusions), Robert Johnston offers a historical overview of anti- historical movements in the United States in which he asserts that vaccine activism transcends the left-right divide and James C. Whorton examines how biomedicine has come to transform alternative medicine from a cult to CAM over the course of the 20th century.

The other anthology in this review, Mainstreaming Complementary and Alter- native Medicine, incorporates sociologi- cal examinations of CAM in the United States, Canada, Britain, Australia, and New Zealand. In the Introduction, the editors note that CAM has become a major part of health care in all "advanced societies" (p. 1). With regard to the first theme in the volume, namely consumption in cultural context, Melinda Goldner in her essay asserts that the CAM movement functions on two levels: (1) as an interest group that lob-

bies for legislative reform, informing the public, and developing coalitions among its multifarious actors and (2) in "submerged networks of social movement communities where activists attempt to create and sustain an alternative way of life" (p. 12).

Goldner's study draws heavily from interviews conducted with practitioners and patients in the San Francisco Bay area and the Albany Capital District. She argues that consumers have played a significant role in the CAM movement in the United States because of the strong presence of a market- driven health care system, a fact that has prompted insurance companies to provide coverage for CAM. Based on empirical research with HIV patients and their CAM practitioners undertaken in a local health au- thority in West Yorkshire, Kathryn Hughes indicates that reliance on CAM has become part and parcel of the emphasis on "patient choice" in the United Kingdom-a policy that seeks to shift more and more the re- sponsibility and expense of health care from the state sector to a self-care mode in which the patient relies on technologies such as the Internet and digital TV for assessing his or her health.

The next three essays address the im- pact of the state and the market on CAM. As CAM therapies become more acceptable to biomedicine, as Evan Willis and Kevin White argue, the issue of subjecting them to the rigors of evidence-based medicine has moved the forefront, both as a means to validate or discredit them. Randomized controlled testing (RCT) methodology functions most easily when treatment is fairly straightforward, but becomes much more difficult to administer in the case of many CAM treatments that entail a combination of treatments designed for individual patients. They argue that the Australian government introduced the Complementary Therapies Funding Program in February 2002 and ex- empted CAM practitioners from the Good and Service Tax more on the basis of clinical legitimacy resulting from the continuing

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patronage by consumers willing to pay for services than from scientific legitimacy.

Based on my own examination of the growing legitimation of complementary medicine in Australia, including significant support for the training of various CAM practitioners in public tertiary institutions, the Australian government may view CAM as a cost-cutting measures because, with the exception of acupuncture administered by GPs, it is not covered under Medicare, the national health plan, and must be paid for out of pocket or through private health insurance. Kevin Dew, in his essay, argues that RCTs in New Zealand and elsewhere have the potential of providing biomedicine with a mechanism to limit the claims of competing CAM systems. Fran Collyer discusses the corporatization and commercialization of CAM, particularly in Australia but also elsewhere, noting that it has evolved from a cottage industry into a corporate endeavor. She observes complementary medicines have increasingly come to be manufactured by pharmaceutical companies that produce biomedical drugs and that CAM practitioners increasingly are working in corporate-owned integrative medicine settings. Collyer asserts that the mainstreaming of CAM will ultimately increase costs for consumers, governments, and third-party payers and that CAM has come to have "little relation to the enhancement of well-being, patient safety, altruism or the curing of disease" (p. 95).

The final four essays in the volume address the issue of boundary contesta- tion between biomedicine and CAM in the workplace. Ian Coulter argues that most efforts to develop an integrative medicine in the United States entail the addition of CAM to "largely hospital-based medical programmes" (p. 105), with the addition of CAM providers in biomedical health clin- ics being the second most common strategy. In their essay, Heather Boon, Sandy Welsh, Merrijoy Kelner, and Beverly Wellman argue that an increasing number of CAM

practitioner groups, including naturopaths, TCM practitioners, and homeopaths, have been seeking statutory recognition in Ontario. Based on focus groups with various CAM practitioners, they found that most of them "felt that regulation would allow them to achieve a measure of social closure by instituting education and qualification stan- dards" (p. 130). Conversely, some practitioners feared loss of clinical autonomy if their group was regulated. In his essay, Jon Adams reports on his interviews with 25 general practitioners (14 male, 11 female) who use various CAM therapies (including acupuncture, homeopathy, hypnother- apy, and neurolinguistic programming) in Edinburgh and Glasgow. He found that they tended to view "lay therapists" who practice CAM as "deficient and potentially highly dangerous" (p. 145) and argues that the con- cept of complementary practice "implies the domestication of unconventional therapies within the wider framework of conventional medicine" (p. 151). In their essay, Adams and Philip Tovey argue that nurses in the United Kingdom have been at the forefront in the development of an integrative medicine, as evidenced by an increase in the membership of the Complementary Therapies Forum of the Royal College of Nursing from some 1,600 in 1997 to some 11,400 in 2000. Nurses, however, have been selective in terms of the CAM therapies that they choose to adopt, favoring therapies such as aromatherapy, reflexology, and massage over others, such as chiropracty or acupuncture.

Although medical anthropologists have been engaged in the study of indigenous medical systems, folk and religious healing systems in complex societies, and professionalized heterodox medical systems in South Asia, Japan, China, and Indonesia for decades, they have been somewhat slow in examining professionalized heterodox medical systems in Anglophone and other de- veloped societies, especially in comparison to sociologists. Exceptions include Robert

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Anderson and Kathy Oths, who have examined chiropracty in the United States; Robbie David-Floyd, who has examined direct-entry midwifery in various national contexts and holistic biomedical physicians in the United States; David Hess, who has examined CAM cancer therapies in the United States; Tom Maretzki, who has examined naturopathy in Germany; and Claire Cassidy and Linda Barnes, who have examined acupuncture and TCM in the United

States. In contrast to sociologists who have tended to rely on interviews and surveys in conducting research on CAM systems, it is hoped that anthropologists will begin to conduct participant observation on integrative medical or CAM centers, CAM schools, associations, conferences, the practices of solo CAM practitioners, health food stores, and lay CAM networks, both professionalized and lay, more than they have to date.

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Article Contentsp.350p.351p.352p.353p.354p.355p.356

Issue Table of ContentsMedical Anthropology Quarterly, Vol. 19, No. 3, Sep., 2005Front MatterAmerican Acupuncture and Efficacy: Meanings and Their Points of Insertion [pp.239-266]The Challenge of Cross-Cultural Clinical Trials Research: Case Report from the Tibetan Autonomous Region, People's Republic of China [pp.267-289]The Politics of Recognition in Culturally Appropriate Care [pp.290-309]Explaining a Complex Disease Process: Talking to Patients about Hansen's Disease (Leprosy) in Brazil [pp.310-330]Doubling the Cloak of (In)Competence in Client/Therapist Interactions [pp.331-347]Book Reviewsuntitled [pp.348-349]Social Scientific and Historical Studies of Complementary and Alternative Medicine in Anglophone Countries: A Multi-Book Review [pp.350-356]untitled [pp.357-359]untitled [pp.360-363]

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Baer Multi-Book Review of CAM

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