Alternative medicine" is a broad term which encompasses all nontraditional therapies and treatments outside of the Western biomedical paradigm. Prominent examples include acupuncture, Chinese medicine, homeopathy, herbal medicine, Indian Ayurvedic medicine, tai chi and massage therapy.

Unlike Western medicine, alternative therapies can be extremely cheap, free of harmful side effects and, most important, successful in treating chronic illnesses. Moreover, many types of alternative medicine focus on holistic or preventive, instead of simply curative, approaches to health.

One of the first issues to be discussed regarding alternative medicine is the problem of quackery. It is undeniable that there is a great deal of corruption within alternative medicine and that certain practitioners may not have the most principled of intentions. It is important to be critical and cautious when evaluating the efficacy of these therapies. At the same time, if one professes loyalty to the rigorous standards of modern science, one cannot dismiss novel alternative treatments as fake without first subjecting them to serious scientific scrutiny. Everyone involved must keep an open mind and resist the tendency to summarily reject alternative treatments which may initially appear strange, startling or implausible.

Although skepticism is still prevalent, Western medicine is slowly beginning to accept its limitations and realize that some types of alternative medicine may be more effective in treating certain illnesses, especially chronic problems.

A recent study by the University of California at San Francisco found that 40 percent of Americans have some type of chronic illness, leading to $425 billion in direct health care costs every year. This explains why, despite annual health care expenditures of over 1 trillion dollars, the United States medical system was recently ranked 18th among developed countries by the World Health Organization (WHO). The WHO found that other developed countries that ranked higher than the United States encouraged a pluralistic health care system which incorporated nontraditional therapies, especially to treat chronic ailments. This strongly suggests that the over 100 million Americans with chronic illness would benefit from having access to alternative therapies.

The recent receptivity towards alternative medicine represents a return to ancient notions rooted in the history of both Eastern and Western medicine. The first step was a movement away from the reductionist philosophy of Western biomedicine which compartmentalized the body into separate systems. A greater emphasis was then placed on "new" more integrated views of the person, views that had been embraced by many alternative medical practitioners for millenia. A more holistic, interconnected medical paradigm, which led to the development of mind body medicine, was the result.

The more recent step has been to explore the medical properties of herbs and botanical extracts. Although modern Western medicine has only recently come to embrace the medicinal potential of herbs and botanical extracts, the fifth century Greek physician Hippocrates, considered the father of Western medicine, was the first to suggest this possibility. Hippocrates believed deeply in the healing power of nature. A strong advocate of the restorative powers of natural herbs, he once wrote, "Nature is the physician of diseases." This historical context attests to the long-term appeal alternative medical theory has had even to traditional biomedicine.

For those skeptical of the possibilities of alternative medicine, consider a well-known and accepted medical reality: the so-called placebo effect, which refers to changes in a patient's health in response to sugar pills. Understood as a psychological response to the expectation that medication will heal, and therefore a consequence of a patient's feelings and expectations, the placebo effect indicates clearly the power of the mind to help cure the body.

The placebo effect has been singled out by many as the main reason for the efficacy of alternative therapies. It is unreasonable to dismiss all alternative medicines as working through the placebo effect, because of the systematic and controlled scientific studies which have begun to demonstrate the validity of such treatments as acupuncture or herbal medicine. The pervasiveness of the placebo effect, which we must keep in mind when examining both conventional and alternative medicine, reminds us that controlled, double-blind studies are essential for assessing the efficacy of any type of therapy.

The increasing Western acceptance of alternative medicine has been reflected in a variety of institutional changes. In 1992, the National Institutes of Health (NIH), a pillar of the American biomedical research establishment, established an Office for Alternative Medicine (OAM). With an annual operating budget in 1997 of over 12 million dollars, the OAM provides a significant amount of research funding each year specifically for studies on alternative medicine. OAM also hosts international conferences to bring together researchers and scientists to further our understanding of alternative medicine.

Some HMOs and other insurance companies have begun to cover alternative treatments such as acupuncture or traditional Chinese medicine. In recent years, major insurers such as Mutual of Omaha Companies, Oxford Health Plans and PacifiCare have extended coverage to various nontraditional therapies. In fact, our very own University Health Services (UHS) has just hired Mr. Karl Berger, a licensed Shiatsu Massage Therapist affiliated with the Boston Shiatsu School.

This gradual shift has also been reflected in American medical schools, which will play a major role in determining the attitude of future physicians towards alternative therapies. At the end of 1997, over 30 medical schools were offering at least one course on some type of alternative medicine, and, like all other indices associated with alternative medicine, the classes are proliferating.

It is important to note that the use of the term "alternative medicine" although the most popularly used designation, is problematic for two reasons. First, it carries overtones of Western cultural hegemony by labeling all therapies and treatments outside the Western paradigm "alternative." In fact, most of these "alternative" practices constitute official, mainstream medicine in many other countries. The WHO estimates that more than 80 percent of population in developing countries use alternative therapies as a standard, everyday from of medicine.

Second, "alternative" implies that one system seeks to replace another. In reality, most supporters of alternative medical therapies do not consider them a substitute for conventional medicine but rather a valuable and essential complement to it. A term gaining ascendancy is "integrative medicine," popularized by Dr. Andrew Weil, one of the most popular public figures in this field.

Overall, there are many difficult questions in the context of alternative medicine which are just beginning to be explored. How do we begin a dialogue between practitioners from East and West who come from completely different paradigms of understanding health and the body? How do we develop a set of rigorous, systematic standards to evaluate the efficacy of alternative medicine? What will be the economic implications of the rapidly growing alternative medical market on traditional medicine and public spending on health? How do we resolve legal issues of licensure and malpractice liability in the current proliferation of alternative medical practices and practitioners?

The abysmal international ranking of American medicine among developed countries is a stark reminder of how much room for potential improvement there is in America's health care system today. If we are able to integrate effectively all of the successful and most valuable components of conventional and alternative medicine, the new system of health care which results would revolutionize cost, efficacy and most importantly, quality of patient care for all individuals.

Akilesh Palanisamy '98 is co-President of the Hippocratic Society. The society is holding a conference on Alternative Medicine in the Science Center, April 25-26, 1998.