Book Review

Alternative Medicine? A History

N Engl J Med 2008; 359:543-544July 31, 2008

Article

Alternative Medicine? A History
By Roberta Bivins. 238 pp., illustrated. New York, Oxford University Press, 2008. $35. ISBN: 978-0-19-921887-5

Whether acupuncture from China, Ayurvedic therapies from India, or homeopathy in Europe, in her scholarly book, Roberta Bivins presents the belief systems that gave rise to such ancient practices and then follows their subsequent problematic global voyages to other cultures. Neither an allopathic doctor nor an alternative practitioner, Bivins provides readers with a social examination of these “exotic” techniques, from moxabustion to mesmerism, and explains how each was introduced (and then studied, simulated, ridiculed, or rejected) by Western physicians in Europe and the United States. The nearly four-century transcontinental propagation was not always easy — especially when corresponding belief systems could not be transported along with the therapeutic techniques.

The basis of many premodern medical practices rested on the belief that the human body was a microcosm of the universe. For instance, without the benefit of anatomical dissection (which was then amoral and illegal) or microscopic analysis (which was then unavailable), the acupuncturists in ancient China believed there were 12 waterways in the body that mirrored the country's 12 great rivers and canals. Ayurvedic medical practitioners believed in a deep philosophical and cosmological spiritual world of reincarnation and karma. A person's balanced and healthy interactions with the environment were necessary not only for the body but also for the soul. The translation of these principles and techniques from East to West paralleled the interaction of the cultures themselves, with all the inherent stereotyping, superstitions, and feelings of racial and cultural superiority. Ultimately, despite British imperialism or the medical profession's turf wars, it was often the realities of — and the lack of therapies for — epidemics of cholera and the plague, or ailments such as gout, that encouraged quick investigation and resulted in rejection or eventual co-optation of the unfamiliar treatments. Of note, the authorities investigating and discounting alterative therapies were also often “borrowing” the practices for reintroduction as their own. One example was moxabustion, a therapy that uses heat and was apparently effective in the treatment of gout.

Argy Wormwood, a Leaf Extract, Burning on Top of Ginger Slices on a Man's Back at a Traditional Chinese Medicine Hospital in Fuzhou, China, 2006.

During the 18th and 19th centuries, the Western medical establishment was looking with a critical eye at the use of Chinese herbs and the practice of homeopathy while practicing what it knew as the best standards of care — cupping and bleeding. Some ancient practices were later “discovered” in the West. Centuries before Edward Jenner determined that mild cowpox exposure conferred immunity to smallpox, Asians practiced variolation — the controlled exposure to a carefully selected mild case of smallpox in one person to produce immunity in another. This same practice is followed today by some parents, who bring their unimmunized children to chicken pox or measles parties.

Early remedies paved the way for later advances. Acupuncture was not readily adopted by Western doctors, but Bivins speculates that acupuncture helped to familiarize them with needles, domesticating needles for later use in vaccines, drug delivery, and the drawing of blood. There are important lessons in this book for practicing physicians. For example, techniques such as homeopathy may have become popular not because of consistent efficacy but because the patients appreciated attentive clinicians and were attracted to the treatment's benign nature and affordability.

The Western physician, past and present, is made out to be mostly predatory and misguided. Bivins questions why researchers continue to assess treatments from other cultures in a Western framework. Admittedly, we do not have the technology to measure qi or to visualize prana (which of course does not disprove their existence), but we do have the tools to objectively evaluate clinical interventions. With 60% of U.S. medical schools now offering some instruction in alternative medicine, and the commitment to research being made by the National Institutes of Health's National Center for Complementary and Alternative Medicine, there is an effort under way to evaluate practices that may hold promise and bring them into our evidence-based world.

Bivins's book is a work of scholarship filled with thoughtful discussion, but it is largely devoid of colorful or memorable characters, a clear timeline or plot, or clinical discussions — all of which would have made the book more appealing. Bivins does ask one provocative question, illustrated in part by the use of a question mark in the book's title: Why do we continue to use the word “alternative” when the popularity and complementary integration of some of these therapies, especially for the treatment of chronic conditions, continues to increase? There are now more patient visits to alternative medical practitioners than to primary care physicians in the United States.

In the end, this book is about Western attitudes toward the non-Western world. It is a macroscopic analysis rich with philosophical reflection and historical observation that exposes the difficulty of exporting such therapies outside their original cultures and belief structures.

Teresa L. Schraeder, M.D.
Mount Auburn Hospital, Cambridge, MA 02138
tschraeder@nejm.org

Citing Articles (1)

Citing Articles

1. 1

   Cristine E. Berry, Robert A. Wise. (2009) Interpretation of Pulmonary Function Test: Issues and Controversies. Clinical Reviews in Allergy & Immunology 37:3, 173-180
   CrossRef