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• Alternative Medicine is a Useful Concept
  Harri Hemila
  Published on: 5 December 2017

• Published on: 5 December 2017

  Alternative Medicine is a Useful Concept

  • Harri Hemila, Adjunct professor University of Helsinki, Finland

  Pekka Louhiala argues, "there is no alternative medicine" because "it escapes a meaningful definition, and 'alternative medicine' cannot be clearly differentiated from conventional medicine" [1]. I do not consider that his arguments are valid.

  Louhiala does not mention the definitions that have been proposed for "alternative medicine". For example, Eisenberg defined alternative medical therapies as "interventions neither taught widely in medical schools nor generally available in US hospitals" [2]. Cochrane collaboration defined: "Complementary and alternative medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and that of the dominant system are not always sharp or fixed" [3]. These definitions are not exhaustive, but they capture what I think is the most essential.

  These definitions consider that the relevant factor for setting up the boundary around alternative medicine is by the lack of social acceptance within mainstream medicine. Thus, alternative medicine consists of i...

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  Pekka Louhiala argues, "there is no alternative medicine" because "it escapes a meaningful definition, and 'alternative medicine' cannot be clearly differentiated from conventional medicine" [1]. I do not consider that his arguments are valid.

  Louhiala does not mention the definitions that have been proposed for "alternative medicine". For example, Eisenberg defined alternative medical therapies as "interventions neither taught widely in medical schools nor generally available in US hospitals" [2]. Cochrane collaboration defined: "Complementary and alternative medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and that of the dominant system are not always sharp or fixed" [3]. These definitions are not exhaustive, but they capture what I think is the most essential.

  These definitions consider that the relevant factor for setting up the boundary around alternative medicine is by the lack of social acceptance within mainstream medicine. Thus, alternative medicine consists of interventions that are outside of the "conventional" or "medical school" medicine. The definitions above do not consider whether a treatment is effective or not. Effectiveness is located on a different dimension and is not part of a relevant definition for alternative medicine.

  Louhiala formulated numerous arguments that do not teach us anything about the usefulness of the concept of "alternative medicine". Although I agree that often "modern medicine is much more varied in its approaches than the propagandists for alternative medicine usually imply", this statement does not imply any conclusions about the concept of "alternative medicine".

  I do not agree with Louhiala's statement "alternative medicine means that the other option is rejected". For example, some of my own patients describe that they use forms of alternative therapies, but they do not reject me therefore.

  I disagree also with the statement that "if a genuine alternative medicine did exist, it should produce results that are similar to those of ordinary medicine". There is great treatment variation within mainstream medicine, and there is no uniform "treatment result" to which the results of alternative therapists might be compared unambiguously. Furthermore, when we accept the large treatment variation within mainstream medicine, why should we not accept variation between mainstream medicine and alternative medicine. This issue is not relevant to the question whether the concept of "alternative medicine" is useful.

  I agree with the statement "alternative medicine cannot be clearly differentiated from conventional medicine". However, there are numerous cases where the border between neighboring concepts is fuzzy. Internal medicine cannot be clearly differentiated from general practice medicine (e.g. both treat hypertension). Children cannot be clearly differentiated from adults (e.g. teenagers are biologically adults but psychologically children). However, the lack of a clear differentiation does not imply that "internal medicine" or "child" are useless concepts.

  Louhiala states, "bundling all the so called alternative therapies under one heading is misleading. It is hard to see common features between, say, healing using prayer and healing using megadoses of vitamins." If alternative medicine is defined by the lack of social acceptance as described above, that provides an unambiguous justification to put prayer and megavitamins under the same heading. Furthermore, there is great variation within the mainstream medicine from surgery to pharmacology to psychiatry. If Louhiala's argument is valid, we should not bundle such different methods under the one heading of "medical school medicine".
  While Louhiala criticizes the vague definition of "alternative medicine", he does not consider the options to define, for example, "homeopathy". When I was young, I studied biochemistry and got a PhD degree. As a biochemist, I defined homeopathy as "diluting a substance to such an extent that there are no molecules left in a spoonful". Thereafter I studied medicine.

  When I started to work as a GP, I realized that there is a fundamentally different second definition for homeopathy: "a person goes to a homeopath and stays there for some time and then leaves". If we ask whether homeopathy is beneficial for a patient, we should first define what we mean by "homeopathy". This was not done by Louhiala.
  In catholic countries, sometimes people go to see a priest for a confession. I believe that the confession often decreases the anxiety of a person, and in that respect, it can lead to positive health effects. This health benefit has nothing to do whether we think that there is evidence for God. Similarly, homeopathy as an encounter can be beneficial for a patient because visiting a homeopath is much more than biochemistry.

  While working as a GP, I have realized that a large part of the positive health effects that I am generating on my patients are caused by listening and speaking. Why should we assume that a priest or a homeopath is incompetent at such an activity? I have seen many physicians who are poor in their communication with patients. Compared with them, an average priest or homeopath may generate greater improvements in health if the major problems of the patient are anxiety and depression. On average, alternative therapists may have better bedside manners than physicians [4].

  The purpose of my commentary is not to increase the social acceptability of alternative medicine. I point out that the lack of social acceptability seems to be a reasonable basis for defining alternative medicine. I do not hope that the use of homeopathy increases; instead, I hope much the contrary. Nevertheless, the question about, for example, homeopathy is much more complex than whether it is absurd from the biochemical point of view. I think that it is much more fruitful to contemplate on the nature of alternative medicine [2-4], instead of trying to argue that such a field does not exist.

  1.https://doi.org/10.1136/jmh.2010.004358
  2.https://doi.org/10.1001/jama.280.18.1569
  3.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116545
  4.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1296162

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  Conflict of Interest:
  None declared.

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