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By Sumit Sarkar and Tracie Coble, North Carolina State University
What exactly is an alternative medicine? The American Heritage Dictionary defines the word, alternative as: "Noun. The choice between two mutually exclusive possibilities". Two mutually exclusive possibilities imply that both are alternatives to each other. Therefore, modern medicine in the United States is also an alternative medicine from a culture-free perspective. In the United States, the term medicine in the context of practice implies treatment with a scientific backing. What if the term medicine in a different country was understood to mean Homeopathy? Health care is as diverse as the many nations in the world. It seems that the western view has dismissed the widespread use of other treatments throughout the world. The western ideology is to disregard any non-scientific health practice and label it, alternative. Thus, it is important to study each type of health care from different cultural perspectives. To better understand a treatment and its degree of success, social factors must be considered. The two alternative treatments that will be researched are Homeopathy and Acupuncture. This research includes the origins and principle beliefs of the alternative medicine; where its use is prevalent and why; and where the treatment is scrutinized and why. Social factors will be used to further explain the answers to the questions posed. This research will present these medical practices through a non-biased view.
HOMEOPATHY: WHAT IT IS
Homeopathy is a system of medicine that is made from traces of plant, mineral, and organic ingredients. These medicines are prepared by a pharmacological process called potentization. This process involves consecutive dilutions of a natural ingredient in some medium, usually water. The strength of the potency is inversely proportional to the number of dilutions (Ullman 1995). There is no physical trace of the original ingredient after the process is completed. A single remedy has the name of the original ingredient. The remedy can be taken orally in a liquid base or as a sugar pill. Modern homeopathic companies also produce remedies as ointments, lotions, eye drops, syrups, and sprays.
ORIGINS
A German physician named Samuel Hahnemann (1755-1843) founded homeopathy. He derived the term from the Greek words "homoios" and "pathos". Homoios is Greek for similar and pathos is Greek for suffering. The principle theory of homeopathy was previously described by Hippocrates in ancient Greece. Mayans, Chinese, Greeks, Native American Indians and Asian Indians used this method of healing well before Hahnemann coined the phrase, homeopathy. Hahnemann was credited with making this principle theory into a systematic medical science (Ullman 1997).
PRINCIPLE BELIEFS
The principle belief of homeopathy is that like cures like, also known as the law of similars. This means that the same substances that cause illness and disease are used to cure it. The systematic provings of natural substances as homeopathic remedies are found in the Materia Medica. This literature is a detailed collection of reactions to substances in a healthy person. Therefore, homeopaths can prescribe remedies based on your symptoms.
Homeopathy is a highly individualized form of treatment. The homeopathic perspective is that there are no diseases, only diseased people. The basis of this perspective stems from the idea that we all experience disease in different ways. It is too limiting to diagnose a person with a specific disease and expect one form of treatment to work on everyone. Therefore, homeopaths prescribe medicines that take into account both physical and psychological symptoms each person experiences. Homeopathy individualizes treatment to a person's unique pattern of symptoms.
"Homeopathy has a highly systematic, rigorous method of investigating its medicine, using human subjects as the sounding board to understand the healing direction of various plant, mineral and animal substances" (Hershoff 2000). It is not known what the precise mechanism of healing is. It is difficult to prove its effectiveness through contemporary scientific methods. Researchers in the Lancet and British Medical Journal conducted studies that prove effectiveness of Homeopathy, however they cannot explain them through the views of current biology (Hershoff 2000). Researchers at CalTech have discovered magnetic particles throughout the human brain. They speculate that dilutions create a higher level of the electromagnetic field, thus triggering the defense mechanisms of the body (Ullman 1995). There is no direct scientific evidence to prove, or disprove, why homeopathy is effective.
"First, do no harm", was Hippocrates famous passage for medical practitioners. Homeopathy, as a system of medicine, is considered highly safe. Homeopathic theory states that taking random remedies will not cause any harm. It is hypothesized that only the correct remedy will interact with the brain to trigger the healing response. Modern medicine fails in this aspect with upwards of 200,000 deaths caused by prescription drugs according to the Journal of the American Medical Association in the early 90's.
WHO IS USING IT AND WHY?
Great Britain
Homeopathy is popular in Great Britain. It has been used to treat the Royal Family since the 1830's. Studies from the New York Times show that the number of visits to homeopathic physicians is increasing 39% per year. A questionnaire of 268 patients in England reported some insight into why they use Homeopathy. One of the responses included "positive valuation of complimentary treatment" (Furnham 1996).
The general attitude towards homeopathy is evident in their classification of homeopathy. They use the term complementary medicine, instead of alternative medicine (Hershoff 2000). Therefore, the terminology implies that it is accepted as a growing part of mainstream healthcare. On the other hand, alternative medicine implies that it is a separate entity from mainstream healthcare. Further homeopathy receives positive attention in the media. The Royal Family has been under its treatment for over a hundred years. Also, British Olympic Teams claimed that a homeopathic (Arnica) ointment was their secret weapon.
The attitude of British healthcare professionals towards homeopathy is more positive than in the United States. A British Consumer Organization survey concluded that 70% who had tried homeopathy were cured or improved by it. A study in the London Times showed that 42% of surveyed physicians refer patients to homeopaths. A survey published in the British Medical Journal noted that out of 100 recently graduated British physicians, 80% expressed an interest in being trained in homeopathy, acupuncture or hypnosis. This attitude may in part be due to the changes in organization of homeopathic doctors in Great Britain. They wanted to gain credibility in the general population, government and orthodox medical professionals. They acquired a number of professional properties in the process enhancing their legitimacy (Cant 1995).
Another study reported some motivations for using homeopathy. They included control over treatment, lack of personal care and waiting lists for treatment (Ernst 2000). The British National Health Service (NHS) has some features that correspond to the motivations for using homeopathy. The NHS suffered from underfunding and a lack of resources. This leads to limitations on treatments and patients turn to homeopathy for a sense of control. Also the limited resources lead to the waiting lists for treatment. Many seek homeopathy as an alternative to be treated at once. Also, studies reported regional inequalities and class differences in treatment. General Practitioners spend more time with upper class patients (Gabe 2001). Therefore, much of the population does not receive adequate attention. They may then seek homeopathic doctors for the individualized care that Homeopathy requires.
ATTACKS AGAINST THE PRACTICE
United States
Homeopathy was introduced in the United States in the late 1820's by German immigrants. It flourished for about a hundred years and by the turn of the century there were over 100 hospitals, 143 societies, and over 15,000 practitioners (Rogers 1997). After this period, the popularity of homeopathy begins to decline. Its decline is partly due to the American Medical Association. The theories of modern medicine and western views were contrary to the principles of homeopathy. The rise of scientific medicine eventually led to a single model of medical practice. "Medicine focused solely on the internal environment (the body), largely ignoring the external environment" (Conrad). The AMA successfully secured a monopoly and had an unrivaled professional dominance.
The attitudes of the United States government also reflect doubts in homeopathic treatments. The Food and Drug Administration (FDA) refused to acknowledge homeopathic remedies as effective drugs. Instead, they created standards listed in the Homeopathic Pharmacopoeia of the United States (HPUS). This was not a sign of acceptance by the government. It was instead a method to take action against possibly dangerous products masquerading as homeopathic medicine (Rogers 1997). The government passed licensing concerns to the states. There are only three states with homeopathic licensing boards. Therefore, there is no national standard for homeopathic practitioners. The ultimate decision is left up to the state, which is not always good for Homeopaths. North Carolina Board of Medical Examiners revoked the license of a homeopath concluding that he was "failing to conform to the standards of acceptable and prevailing medical practice" (NCAHF 1994).
The National Council Against Health Fraud in the United States issued a recommendation for consumers to avoid purchasing homeopathic products and avoid consultations with homeopathic doctors (NCAHF 1994). Similar organizations are skeptical because there is no scientific evidence of how homeopathy works. Studies from the British Medical Journal have proved rates of effectiveness through randomized, double blind placebo controlled studies (Taylor 2000).
The attitudes of American doctors are vastly different from British doctors. American doctors lead attacks against homeopathy. They have published several critical works on the practice of homeopathy. They attribute the alleged effectiveness of homeopathy to several reasons. They claim that they would have been cured anyway, diseases are cyclical, placebo effect, and false psychological perceptions (Barrett 2000). It is hard for consumers of medical care to ignore the attitudes of the highest regarded profession in the US, doctors.
ACUPUNCTURE: HISTORY AND ORIGINS
Acupuncture is a medical therapy in which specific points on the body are stimulated usually by manipulating very fine needles inserted in the body (Vickers, 1999). It is a form of Traditional Chinese Medicine which dates back to 1500 BC. Based on Taoist philosophy, it relies on the belief that a dynamic relationship exists between people and their environment; therefore, one's surroundings directly influence health and well being. The first written example of using needles for acupuncture was in fifth century BC, and the basic theories were established between 400 and 200 BC and recorded in the Yellow Emperor's Canon of Internal Medicine. During the Sui dynasty (589-618 AD), acupuncture became a stable system of medicine with the establishment of the Imperial Medical College (Leake, 1998).
PRINCIPLE BELIEFS
The main goal of traditional Chinese medicine is internal balance and harmony, and the main forces affecting this harmony are Yin, Yang, and the five phases: wood, fire, earth, metal, and water. Yin and Yang are opposingly equal forces of energy such as night and day that are believed to have originated from the primal energy source of creation. These five phases possess a rhythm that mirrors seasonal changes (Leake, 1998).
Qi, (pronounced "chee") another important force within traditional Chinese beliefs, is the natural energy circulating between the organs of the body that accounts for spiritual, physical, emotional, and mental processes (Vickers, 1999). Smooth flow of Qi throughout the body produces balance and harmony. Illness results when there is an excess or a deficiency of Qi, or if there is a blockage preventing the flow of Qi. Acupuncture is used to restore balance of energy of Qi, Yin, Yang, and the five phases (Leake, 1998).
WHAT IT IS
Acupuncture involves the placement of needles into the skin at specific points on the body. Bone, stone, or metal such as silver and gold were originally used to make the needles; however, modern needles are made of stainless steel (Cassileth, 1998). Smaller than hypodermic needles, these needles are solid, ranging in length from half an inch to four inches (Leake, 1998). The needles are inserted just deep enough to refrain from falling out, usually no more than three inches (Cassileth, 1998).
The placement of the needles is crucial to the practice of acupuncture. The acupuncture points are located along the twelve meridians, which correspond to twelve main organs of the body such as kidney, heart, and lung (Vickers, 1999). These twelve meridians are compared to the twelve main rivers of ancient China, and like rivers with tributaries, they are an internal communication and transport system for the human body. Each meridian connects to a specific organ system of the body, and by needling along the desired meridian, a distant problem in the body can be treated. Modern acupuncture involves more than 1,000 acupoints; however, most treatments only require needles placed in 10 or 12 of these points (Cassileth, 1998). Often, the needles are stimulated by either twisting or twirling manually or by electricity. Sensations of numbness, heaviness, and radiating paraesthesia result from the manipulation of the needles (Leake, 1998).
Modifications to the original acupuncture practice have occurred such as moxibustion, cupping, and acupressure. Moxibustion involves placing a smoldering piece of herb mugwort on the acupoints. Cupping, another ancient Chinese remedy, occurs when heated cups are placed on the skin. Sometimes this is done after puncture wounds are made at the precise location. Through this procedure, suction is produced which presumably enhances circulation improving health. Acupressure utilizes deep finger pressure on the acupoints rather than needles (Cassileth, 1998).
WHO IS USING IT AND WHY
Acupuncture is well established in China where it originated. Here, acupuncture is continually used to treat ailments and cure diseases despite a lack of experimental evidence supporting its effectiveness. It is used to correct abnormal fetal positions, cardiac problems, gynecologic disorders, and more. Research in acupuncture's effectiveness in these areas as a cure is disheartening though, and most experimentation has discovered no real benefit. Acupuncture is also used in modern Chinese hospitals as a secondary anesthetic for surgery (Cassileth, 1998).
Acupuncture is a growing healthcare trend in most industrialized nations. According to national surveys in 1998, during that previous year, an estimated 10% of the Denmark population, 33% of the Finland population, and 49% of the Australian population used alternative therapies including acupuncture. Europe and the United Kingdom also have high usage rates according to public opinion polls. In Canada, approximately 15% of the population saw a practitioner of alternative therapies during this same period (Eisenberg, 1998). According to a natural healthline article, in the past six years, the number of users of alternative medicine in Britain has doubled with acupuncture being the most popular. One in five Britons are now seeking aide from such therapies as acupuncture according to a recent BBC poll (Briton, 1999).
Acupuncture became particularly popular in New Zealand in the early 1970's after several Western Orthodox physicians returned from visiting China and witnessed the surprisingly marvelous results of this practice. These New Zealand physicians were mainly impressed by its anesthesia usage, not the diagnosis aspect of acupuncture which they deemed illogical (Dew, 2000). However, acupuncture has not yet become a fixed portion of New Zealand's healthcare system.
In the United States, acupuncture has been practiced on a small scale since 1876, however, it has only recently gained popularity among a bulk of the population (Nasir, 1998). Consumer spending on alternative therapies including acupuncture has surged 69% since 1989. The market for this form of healthcare is increasing as much as 30% yearly catching the attention of both the economic and healthcare worlds (Studdert, 1998). According to a study by Nancy C Elder, MD, MSPH, from Oregon, use of acupuncture and other alternative therapies is up from a third of the population to approximately one half of the American population (White, 1997). In addition, Eisenberg in 1997 found rates of usage ranging from 32% to 54% (Eisenberg, 1998).
Trends of using acupuncture also exist between different sociodemographic groups. According to the Eisenberg 1997 study, use was more common among women than men, less common among African Americans, and more common among people in the age range of 35-49. Those with a college education also had higher usage rates, and most patients had annual incomes above $50,000. Alternative therapies also seem more prevalent in the western United States than other parts of the country (Eisenberg, 1998). A study reported by Claire Cassidy also demonstrates similar results. In addition, she also reported that most patients were from urban or suburban backgrounds, and they were more likely to have professional or technical occupations. Interestingly, most were less likely to be married. These patterns of usage are not surprising because first users of new practices such as acupuncture tend to be those willing to take the risk and those able to afford it (Cassidy, 1999).
Many different reasons are given by patients for seeking alternative healthcare such as acupuncture. Once of the main reasons people choose this form of treatment is because they are looking for something that works since often this is a last resort when western medicine has failed as an effective treatment (Coulehan, 1999). According to Cassidy, many patients use acupuncture to keep them healthy (Cassidy, 1999). White reports that most patients truly believe in the practice and others believe it will improve the healing process when used with standard medical treatments. Others just want to take advantage of every medical tool at their disposal to allow for optimal health (White, 1997). Many users also report a resulting relaxed feeling as influencing them to continue with the practice (Briton, 1999).
Acupuncture in the United States is mainly used for the treatment of chronic or post-operative pain. Acupuncture has been found to be an effective treatment for pain, nausea, and vomiting. The FDA has also recently removed the "experimental" label from acupuncture needles and has placed their regulations under government control (Leake, 1998).
ATTACKS AGAINST THE PRACTICE
Acupuncture is not popular among everyone in the U. S. though, especially physicians. One of the main reasons traditional physicians distrust this practice is a lack of research (Udani, 1998). Since research in this field seldom leads to an economic benefit, little incentive exists for conducting studies. In addition, current medical regulations are not applicable to acupuncture; therefore, more research is needed to set individual regulations for this field of study (Eskinazi, 1998). Busy practitioners, however, do not possess the time, staff, or money to carry out the desperately needed research. Also, many of the acupuncture practitioners distrust the government and how their results will be portrayed (Vanchieri, 2000). Robert Patterson, a professor of medicine and rehabilitation at the University of Minnesota, expresses a concern at the impossibility of getting approval of research not adhering to Western medicine's traditional double-blind, placebo-controlled model (Majeski, 2001).
Another factor influencing the lack of active participation in acupuncture is the lack of insurance coverage for the procedure. Usually, most acupuncture treatment was paid for out of the patient's pocket. Only recently, major health insurance companies, like Keiser, have begun adding alternative therapies to their coverage plans (Studdert, 1998). Usually, however, the procedure is only covered if a physician recommends it, and even then the insurance company must deem it necessary (Grandinetti, 2000). This is an even bigger problem since an estimated 90% of patients are self-referred and do not consult a physician about receiving acupuncture (Studdert, 1998). In Duluth, Minnesota, St. Luke's Holistic Center was forced to close down because of the insurance companies refusal to provide coverage of alternative care (Evans, 2001).
One of the main factors keeping patients away from acupuncture, however, is the fear of needles and the risks involved with this practice. The main risks are the technical problems such as bent or broken needles, or the inability to remove needles. Stronger regulation for safer needles has reduced these problems, and usually a stuck needle is dislodged by relaxing the patient (Leake, 1998). Other adverse effects are lesions, fainting, and infection. Documented traumatic lesions have occurred during acupuncture treatments involving the heart, the lungs, the abdomen, and the spinal cord (Peuker, 1999). Infections such as endocarditis, septicemia, hepatitis B, HIV, osteomyelitis, myositis, peritonitis, and pleural empyema have all allegedly been contracted through acupuncture. Reports have also detailed psychiatric changes, insomnia, convulsions, and hypertension because of acupuncture treatment (Bensoussan, 2000). For the most part, however, when carried out in a safe and clean environment, acupuncture is fairly safe having only identified 193 adverse events in over 15 years (Vickers, 1999).
CONCLUSION
This research on Homeopathy and Acupuncture presents a non-biased view of these systems of alternative medicine. It is important to understand the origins of the treatments and the reasons different people approve or disapprove of the treatments. Given this evidence, we learn about social factors that might influence the availability and effectiveness of these alternative treatments. It is obvious that certain cultures or countries support treatments to varying degrees. We should not let the influences of one group determine whether a system of medicine is a legitimate form of treatment.
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