Throughout the nineteenth century, a variety of medical sects competed for professional supremacy in the United States. Allopaths used methods like bleeding, blistering or purging. Homeopaths prescribed “infinitesimal” amounts of substances to provoke symptoms of illness and stimulate the body’s natural defenses. Naturopaths employed botanical remedies. Osteopaths favored bodily manipulation. Other schools of thought, e.g. mesmerism, hydrotherapy, and chiropractic, were established in the later part of the century.
Of the different sects, allopathic medicine claimed to be the most scientific of the group, although at the time each subgroup was equally scientific. As the self-proclaimed winner, allopathic practitioners leveraged their “scientific supremacy” to dominate the medical field in the United States by eliminating the competition and aligning themselves with government organizations which then enacted restrictive legislation to remove licensing opportunities and funding for “irregular” practices.
With the competition removed, allopathic medicine bolstered its forces and built medical schools and hospitals, and established The American Medical Association [AMA] with the financial support of the US government. During this period, heavy promotion, legislative support, and industry alliances aiming to repurpose wartime technology into technology usable in civilian life provided allopaths with unparalleled influence that enabled them to practically eliminate their competition. They achieved this by either forcing the “alternatives” either join forces, as is the case with osteopaths and homeopaths or legislating them out of existence, as in the case of midwives and hydropaths.
However, complementary and alternative medicines [CAM] remained resilient, even in the most unfavorable of times. Chiropractic sought to offer patients an alternative to allopathic medicine and encouraged those dissatisfied with regular medicine to seek out its services. As their base grew, chiropractic sought licensing rights, a chance to set up its own educational programs and inclusion in government-funded health insurance programs. As chiropractic gained recognition and respect, other CAM groups, such as massage therapy, acupuncturists, naturopaths and homeopaths followed suit. However, allopathic medical groups remain reluctant to concede power and have only recently begun to acknowledge its usefulness.
The gradual acceptance of alternative medicine by the scientific medicinal community began in the 1970s after a period of introspection and the realization that several unaddressed were affecting the medical field. Such issues included poor patient satisfaction, limitations in conventional medicine, and a mounting crisis in health. Likewise, America’s economy shifted towards a more diverse, consumer-centered medical marketplace. These changes were eye-opening to medical professionals because patient satisfaction had previously been an afterthought to the industry which left those in the medical field with unchecked power and influence that often resulted in apathy and disinterest in the patient. Following this enlightenment, the medical community began incorporating journal articles about CAM into prestigious medical journals and began acknowledging the possibility that some alternative medical practices were valid treatment methods.
As CAM’s influence disseminated, demand rapidly accelerated, despite a lack of scientific evidence to support claims made by the practitioners. However, a lack of cohesion, regulation, and structure continues to limit its ability to gain credibility in the scientific medical community. To date, there are issues of credibility with the rise of unregulated supplement and quasi-medical procedures that cloud the more grounded aims of the classic alternatives. For example, after the illness of several people who took unregulated medical supplements, an editorial was posted in the New England Journal of Medicine:
“We have seen see a reversion to irrational approaches to medical practice, even while scientific medicine is making some of its most dramatic advances…Since these products have flooded the market, subject only to the scruples of their manufacturers. They may contain the substances listed on the label in the amounts claimed, but they need not…labeling has risen to an art form of double-speak…It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine-conventional and alternative. There is only one medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work.”
Former FDA Commissioner David Kessler also commented on the lack of regulation for the supplement market:
“The marketplace is awash with unsubstantiated claims….[W]e are literally back at the turn of the century when snake-oil salesman made claims for their products that could not be substantiated.”
However, such broad-stroke statements undermine the strides that CAM medicines have made, especially in terms of treating patients holistically. At present, there are still stigmas surrounding the use of non-conventional medical practices, limiting patient options. Some reason for a lack of collaboration include:
- Allopaths are not well disposed to co-operation with practitioners of CAM. Their approach has been the “Gold Standard” for decades and conceding power and control is an uninviting prospect.
- Many CAM modalities have not gone through the same clinical and scientific testing to meet the rigorous standards of bio-medicine so they are implemented based more on patient demand than practitioner recommendation.
- Many doctors do not believe in the efficacy of CAM on its own, rather they see it as a form of relief that can be used in conjunction with scientific medicine.
However, the varying sectors of the scientific medical community view CAM differently. Senior physicians are less likely to use, accept, or recommend CAM because their work tends to deal with the acute and bio-medical manifestations of a problem more than their community-based counterparts. Senior physicians also spend less time with patients, so they are not as in-tune with the psycho-social aspects of medical problems. This can be a problem because senior physicians are often involved in policy-making decisions.
Primary-care physicians, however, are more likely to treat patients on an ongoing basis. Therefore, they are more in-tune with the psycho-social needs of their patients which makes them more likely/willing to refer their patients to CAM practitioners. This is often a result of their wish to offer their patients with long-term coping strategies. This is especially true for sufferers of chronic ailments. Unfortunately, there has been limited research into the views of non-senior hospital physicians.
At present, the following approaches to CAM have established nationally accredited organizations accepted by the United States Department of Education:
- Chiropractic: The Council on Chiropractic Education, The National Board of Chiropractic Examiners
- Acupuncture: Accreditation Commission for Acupuncture and Oriental Medicine, National Certification Program for Acupuncture and Oriental Medicine
- Naturopathy: The American Association of Naturopathic Physicians
- Massage Therapy: National Certification Board for Therapeutic Massage and Bodywork
Congress has also established the National Center for Complementary and Alternative Medicine [NCCAM] to conduct rigorous research into the efficacy of various CAM treatments to ultimately remove ineffective/unsafe treatment methods from the market and/or encourage the integration of effective CAM practices into the healthcare system. However, the NCCAM is not currently responsible for credentialing CAM practitioners and there are no federal policies in place to regulate CAM practitioners. Instead, regulation varies greatly from state to state.
- Familiarity breeds discontent: senior hospital doctors’ attitudes towards complementary/alternative medicine.
- From Quackery to “Complementary” Medicine: The American Medical Profession Confronts Alternative Therapies
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