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Michael S. Goldstein - Alternative Health Care: Medicine, Miracle, Or Mirage?

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Michael S. Goldstein Alternative Health Care: Medicine, Miracle, Or Mirage?
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In November of 1998 The Journal of the American Medical Association devoted an entire issue to alternative medicine for the first time in its publishing history. According to survey results reported in the journal, 83 million Americans used some form of alternative medicine to preserve and maintain their health in 1997, a sharp increase from the 61 million who turned to alternative forms of care in 1990. Michael S. Goldsteins Alternative Health Care is the first comprehensive account of the growing presence of alternative medicine in American society. Beginning with the basic premises of alternative medicine, Goldsteins book examines the clinical, economic, and political realities of the broad range of alternative care options and practices in the United States and explains why alternative medicine has become a viable choice for so many people who are ill or who seek to remain healthy. Bringing history, policy, practice, personal experience, and in-depth sociological analysis together into one comprehensive volume, Goldstein one of the first recipients of funding from the National Institute of Health for research on alternative medicine also studies the complexities of the relationship between spirituality and alternative medicine and the changing role of alternative medicine in the larger context of American health care. Probing such issues as the corporatization of medicine, the role of alternative medicine in managed care, and the dynamic relationship between conventional and alternative treatments, Goldsteins Alternative Health Care is more than the long-awaited introduction to the many forms of alternative medicine. It is also the measure of the implications of such care for practitioners, businesses, policymakers, and patients alike. Alternative Health Care is the definitive guide for the millions of Americans interested in alternative medicine and treatment, American health care, the sociology of medicine, and American social issues. Michael S.Goldstein is author of The Health Movement: Promoting Fitness in America and editor of 50 Simple Things You Can Do to Save Your Life. He serves as Professor of Public Health and Sociology at UCLA.

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The Emergence of Alternative Medicine
In 1983 when Joshua, my oldest son, was eighteen months old, a hot iron fell on his foot and remained there until the person watching him discovered it. Most of the skin on the top of his tiny foot was gone. The emergency room doctor, his pediatrician, and three or four physician friends who examined him all agreed this was a "third-degree burn." There was no way it could ever heal by itself. The only reasonable course of action was a skin graft. The well-known surgeon at a highly regarded bum center concurred. Laura (his mother) and I both felt lucky that the surgery could be scheduled very quickly. But our feelings changed when we found out that our son would have to be tied to his bed for the entire lengthy hospitalization to prevent him from scratching at the graft, and that the sight of this would be so upsetting that we would be restricted to a brief visit each day.
There had to be something else we could try before subjecting our little baby, no less ourselves, to such an ordeal. Laura's brother had a suggestion. He knew that in Japan, after the atomic bomb was dropped, the juice of the aloe vera plant had been used to treat people with much more severe burns. When we decided to try this ourselves, the Japanese proprietor of a nearby nursery offered helpful advice on which parts of the plant to use and how to start growing our own supply so as not to be dependent on him. Three times a day I carefully dripped the freshly cut aloe vera onto the wound. As I did, I drew on my
set of commonalties that justifies viewing alternative medicine as a single, if broad and diverse, phenomenon. It would be a mistake to think of alternative medicine as merely a name for a residual list of techniques omitted from the standard medical school curriculum.
To find that alternative medicine is a conceptually coherent category does not necessarily imply that there is a corresponding empirical or organizational reality. There is no doubt that a plethora of professional associations, conferences, publications, support groups, and commercial enterprises devote themselves to "alternative medicine." But it is still not clear to what extent "alternative medicine" exists as an empirically verifiable social reality and how it relates to mainstream medicine. Do the people who practice some form of alternative medicine, and those who utilize some facet of it for real health problems, see it as a cohesive entity? The answer here is not at all clear-cut. However, an organizational reality increasingly is emerging and gaining acceptance among the public, the government, and the health care establishment. The extension of thirdparty insurance coverage to alternative therapies, the decision of some HMOs to develop networks of alternative medicine practitioners, and the opening of the Office of Alternative Medicine at the National Institutes of Health all indicate that the climate in the late 1990s is far more open to alternative medicine than it was just a few years ago.
The central role of religion and spirituality in many forms of alternative medicine is one factor that complicates the future of alternative medicine in America. Many health professionals have a difficult time accepting spirituality as a core component of health and healing. Understanding this tension is vital to predicting the future relationship between alternative and mainstream medicine.
Another potentially pivotal characteristic of alternative medicine is that it draws on ideologies associated with both the political "right" and "left," thereby transcending common po-
our hope in nature and spirit, and adopt a secure recognition that life is purposive. In this view just as scientific "progress" is seen as inevitably leading to pollution and the despoliation of the physical and social world, medical "progress" inevitably results in iatrogenic illness, and the destruction of our natural ways of healing. According to Gross, Levitt, and many within the medical profession, such views are nothing more than superstitious nonsense that signifies a return to pre-scientific mentality.
Those who represent a conventional religious point of view have also been critical of much of the spirituality in alternative medicine. To many religious people, the very idea of "nonsecular" spirituality is offensive. Alternative medicine typically makes a "crucial presupposition" that "society is now secular and interpretations of spirituality shouldindeed mustreflect this." Alternative medicine offers a new "orthodoxy" that separates the spiritual from the religious and makes the former a personal search for meaning. ''The concept of God is generally excluded and so becomes marginal and virtually insignificant." In alternative medicine, a comparative religious perspective is dominant, with the assumption that all religions are equally valid. Individuals simply need to choose the one, ones, or bits and pieces of each that suit them best. Over the past few decades the voices of religion have sought to be more fully heard and recognized within the institutions of conventional medical practice. While on a superficial level alternative medicine would appear to be more responsive to these concerns, the institutional religious community remains, at best, ambivalent towards it.
Commentators such as Christopher Lasch and Ivan Illich, who advocate the progressive view that religion is a force to combat the savages of industrial capitalism, have raised a somewhat similar set of criticisms about the role of spirituality in alternative medicine. Such critics consider the overriding problem for modern societies to be the destruction of traditional
institutions by advanced industrial capitalism. The family and the church are two important institutions whose power to protect individuals from the onslaughts of industrialization have been largely emasculated. Each of these authors has seen medical institutions as providing a very weak substitute for the protection traditionally offered by the family or religion. Each has sought to imbue religion with a renewed sense of authority in order to help limit capitalism's destruction of crucial human values. From this perspective, the inclusion of spirituality and "nonsectarian" prayer or ritual as a part of medicine is most unwelcome. It exemplifies the ultimate triumph of what Illich calls the "medical nemesis," or the ability of medical terms and values to rob people of their humanity.
Spirituality's Impact on the Future of Alternative Medicine
Given its central and pronounced role, what impact will spirituality have on the future of alternative medicine? Will the immense pool of spiritual and religious feeling among the population facilitate the integration of alternative approaches into the medical mainstream? Or will the emphasis upon spirituality prove to be an unbridgeable gap with mainstream medical institutions in the context of a pluralistic, democratic, industrial society?
Clearly, the spiritual dimension that pervades alternative medicine is one of its great strengths and attractions. There is a widespread recognition that healing is facilitated by an clement of "magic," along with the application of knowledge about the body, mind, and techniques of therapy. Any healer, or type of healing, that can give a sense of hope and meaning to symptoms and illness will be more apt to succeed than one that cannot. At the very least, it will be well thought of by those who use it. Much of conventional medicine has failed in this regard. A large component of alternative medicine's success has been its ability to offer a sense of spirituality that,
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