Although cancer specialists have recently challenged the corporate opportunism of the world of alternative health care, many GPs remain sympathetic to the drive to integrate these anachronistic methods within primary health care.1
While advocates of alternative medicine claim that it offers a more compassionate mode of health care, scientific medicine's claim to be more humane rests on its unparalleled record of achievement in the treatment of disease and the relief of suffering. Alternative healers raise unrealistic expectations and provide therapies whose effectiveness (and safety) have rarely been objectively confirmed. The worst medical doctor can cure diseases and save lives; the best alternative healer can only offer false hopes.
Alternative practitioners proclaim a ‘holistic’ approach, which takes account of the patient's body, mind, and spirit. They condemn orthodox medicine for its mechanistic conception of the body, for its reductionist attempts to understand its function (and malfunction) in biochemical terms and for its interventionist style of therapy. By contrast, alternative therapists regard disease as a disturbance of the harmony between the individual, nature and the cosmos; their treatment aims to assist the purposeful attempts of the body to restore its natural balance.
If the fundamental principles of the alternative health movement sound familiar, this is because they are the same as those of the Hippocratic tradition, which dominated orthodox medicine from antiquity until the beginnings of scientific medicine in the 17th century (a period in which almost all treatments were useless, if not dangerous).
Alternative health schools claim three sources of wisdom. Some are based on revelation, either divine or secular. Others rely on speculation, theorising human health and disease in terms of elements or humours, or energy flows. Others still use empirical methods, observing patients and classifying the clinical features of disease.
Although empiricism proved the most productive approach, the activities of pre-scientific doctors were constrained by the speculative theories that guided their selection of data. As Louis Pasteur observed, ‘without theory, practice is but a routine born of habit. Theory alone can bring forth and develop the spirit of invention’.2 Scientific medicine emerged out of the empiricist tradition, but crucially advanced through the methods of induction and experimentation, developing theory by arguing from the particular to the general, elaborating hypotheses and testing them in practice.
Traditional healers turn ancient insights into laws of nature with eternal validity. For scientific medicine what was previously thought to be true has often been superseded by new discoveries. Whereas traditional healers express humility in the face of nature and deference towards authority, practitioners of scientific medicine are sceptical and insubordinate, challenging divine and secular authority, questioning the evidence of the senses and the passive reflections of the human mind. ‘Why think?’, surgeon John Hunter famous challenged GP Edward Jenner, ‘why not try the experiment?’3 The historic innovation of scientific medicine was that it was open to critical evaluation and revision. Whereas alternative systems arrive in the world fully formed, medical science is in a constant state of flux.
Just as reason cannot be reconciled with irrationality, so orthodox medicine cannot be integrated with alternative medicine. For Bruce Charlton, ‘fringe therapies are a kind of cultural fossil, preserving a pre-scientific and pre-critical mode of reasoning about medicine’.4 Furthermore, ‘their survival depends upon either ignorance or double-think (a deliberate bracketing off of skepticism) — which explains why such practices can never be disproved’. This is why the project of subjecting alternative therapies to randomised controlled trials and other scientific methods is doomed.
Given that the general trend of medicine up to the late 20th century was to move away from superstition, it is sad that the new millennium has brought a return to mysticism. Given the backward-looking character of the vogue for alternative medicine it is remarkable that an openness towards such practices is today regarded as a progressive, even radical, outlook.
- © British Journal of General Practice, 2007.