American Anthropological Association

Wiley
Review: Social Scientific and Historical Studies of Complementary and Alternative Medicine in
Anglophone Countries: A Multi-Book Review
Author(s): Hans A. Baer
Review by: Hans A. Baer
Source: Medical Anthropology Quarterly, New Series, Vol. 19, No. 3 (Sep., 2005), pp. 350-356
Published by: Wiley on behalf of the American Anthropological Association
Stable URL: http://www.jstor.org/stable/3655368
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SOCIAL SCIENTIFICAND HISTORICALSTUDIES

OF COMPLEMENTARYAND ALTERNATIVEMEDICINE
IN ANGLOPHONECOUNTRIES:A MULTI-BOOK REVIEW

as the books covered in this review essay

indicate.Needless to say, otherrecenttitles
could have been addedto this listing. At any
rate,the firstthreebooks covered in this review essay aremonographs,andthe last two
A Diagnosis for Our Times: Alterna- are
anthologies.
tive Health from Lifeworld to Politics.
Although in the past terms such as "unMatthew Schneirov and Jonathan David orthodox" or
"irregular"medicine were
Geczik. Albany: State University of New bandied around to refer to
professionalYorkPress,2003 (paperandcloth), xi + 230. ized heterodox,
partially professionalized
heterodox,religious, and folk medical systhe terms that have appeared startBorderland Practices: Regulating Alter- tems,
in the early 1970s have included altering
native Therapies in New Zealand. Kevin
native medicine, complementarymedicine,
Dew. Dunedin,New Zealand:Universityof
holistic medicine, naturalmedicine, energy
OtagoPress,2003 (paperandcloth), 176 pp.
medicine, New Age medicine, and integraThe Politics of Healing: Histories of Al- tive medicine-the latterof which tends to
ternative Medicine in Twentieth-Century refer to the mergerof biomedicine and alNorth America. Robert D. Johnston, ed. ternativetherapiesin one form or other.As
New York:Routledge, 2003 (cloth and pa- biomedicine has come to incorporate, or
some would argue co-opt, alternativetherper), xiv + 388.
apies, there has been a tendency to use
Mainstreaming Complementary and Al- the term "complementaryand alternative
ternative Medicine: Studies in Social medicine"(CAM) in NorthAmericaandthe
Context. Philip Tovey,Gary Easthope, and United Kingdom, whereas the term "comJon Adams, eds. London:Routledge, 2004 plementarymedicine" is more common in
Australasia. It is important to note that
(cloth and paper),xx + 180.
CAM has become popular in other develHANSA. BAER
countries,such as Germany,Denmark,
oped
Universityof Arkansasat LittleRock
the Netherlands,Italy, and Japan, as well
When I first startedmy examinationof as developing countries aroundthe globe.
certainprofessionalizedheterodoxmedical It goes without saying that any discussion
systems in the United States and Britainin of CAM ultimatelyrequiresjuxtaposingits
the early 1980s, I was partof a small group relationshipwith biomedicine,regardlessof
of anthropologists,sociologists, historians, whetherthis relationshipis basedon compeand other scholars who were conducting tition, collaboration,cooption, absorption,
social scientific and historical research on or merger.
such systemsin NorthAmerica,Europe,and
In Orthodox and Alternative Medicine,
Australasia. Some 20 years later, I find British sociologist Mike Saks compares
myself in good company in this endeavor, and contrasts the routes by which regular
Orthodox and Alternative Medicine:
Politics, Professionalization and Health
Care. Mike Saks. New York: Continuum,
2003 (cloth and paper), 194 pp.

350
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BOOKREVIEWS

medicine or biomedicine and allied health

occupationsand variousCAM systems embarkedon professionalizationin Britainand
the United States since the 16thcentury.He
definesprofessionalizationin neo-Weberian
terms as a process "based upon the establishment of patterns of legally underwritten exclusionary social closure, gained by
some occupations in the politics of work"
(p. 4).
Whereas in the 16th and 17th centuries
healthcare in both nationalsettingswas extremelypluralistic,by the mid-20thcentury
biomedicine had achieved clear-cut,but incomplete, dominationover CAM systems.
British CAM practitionerstheoretically
have had a freer hand to function under Common Law in contrastto American
CAM practitioners,such as chiropractors
and naturopaths,who were forced to abide
by state licensing regulationsand basic science examinations. The differing political
economies of health care contributed to
greater biomedical domination in Britain
than in the United States because the
National Health Service, created in 1948,
provided biomedical practitioners with
greater state sanction than their American
counterparts who functioned in a more
laissez-fairesettingin which they competed
with CAM practitioners.Indeed,while Saks
does not adequatelyspell out the process,he
observesthatosteopathsin the UnitedStates
had achieved full practicerights in the majority of states by the late 1950s, whereas
they did not achieve statutoryrecognitionin
Britain until 1993. In large part, the divergent evolution of osteopathywas relatedto
the fact that whereasthe Britishhealthcare
system maintainedroughly a 50/50 balance
between hospital consultants and general
practitioners,the strong trend toward specialization in U.S. biomedicine and paucity
of primarycare physicians promptedlegislatorsand otherstrategicelites to give more
recognitionto osteopathicmedicine,particularly in the form of state-sponsoredosteopathic colleges.

351

Saks also discusses the emergence of a

medical counterculturein the 1960s and
1970s in both Britainand the United States
that initially posed a serious challenge to
biomedicine in both countries and contributed to the further professionalization
of certainalternativemedical systems, such
as osteopathy(which evolved into more of
a parallel than an alternativemedical system in the United States), chiropractic,and
acupuncture.Conversely, as it had done
with medical systems such as homeopathy
and eclecticism, particularlyin the United
States,biomedicinehas embarkedon a process of incorporatingalternativetherapies.
In A Diagnosis for Our Times, sociologists Matthew Schneirov and Jonathan
David Geczik elaborateon recent developments in the medical countercultureby focusing on two healthnetworksin Pittsburgh,
namely the Holistic Living Quest and the
Committee for Freedom of Choice. The
formerconstitutes an informalcoalition of
well-educated,left-leaningpeople who disseminate informationon alternativehealth
practices,grassrootsactivism,andNew Age
spirituality;the latter tends to be made up
of conservative Christian, rural, workingclass people who seek to acquaint their
audience with a range of alternativetherapies for cancer and other diseases. The
authors view alternativehealth as a new
social movement or site in which diverse
communitiesanddiscourseschallengewhat
Habermas terms the "colonization of the
lifeworld" by a health care system dominatedby high-technology,invasivemedical
procedures, and profit-drivenbureaucratic
institutions.
Following Habermas, Schneirov and
Geczik observe that alternativehealth encompasses both offensive new social movements that seek to create new social structuresand ecologically sustainablelifestyles
and defensive new social movements that
seek to defend traditional values and
lifestyles. Ironically,both progressivesand
conservatives in alternativehealth tend to

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352

MEDICALANTHROPOLOGY
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engage in an "incompleteholism thatfails to

appreciatethe social andclass dimensionsof
illness" (p. 23). Although alternativehealth
exhibitspatternsof resistance,it has increasingly become a "hothouse for small companies distributingnew products"(p. 142)
and is being co-opted by biomedicine in
the form of centers of integrativemedicine
and the creation of NIH's Office of Alternative Medicine in 1992, laterrenamedthe
NationalCenterfor ComplementaryandAlternativeMedicine.The authorssuggest that
HMOs will increasinglyfind ways to incorporatealternativetherapiesfor cost-cutting
purposes and the less holistic alternative
therapies that can meet the rigors of randomized controlledtesting will be adopted
by biomedicine while those "[b]ranchesof
alternativemedicinethatclaim fundamental
incompatibilitywith conventionalmedicine
will be marginalized"(p. 180).
Schneirov and Geczik posit three possible future scenarios for alternativehealth:
(1) its marginalizationas a result of a rejuvenation of biomedicine emanatingfrom
genetic engineering resulting from the
Human Genome Project;(2) a supplementary,subordinatedarrayof practitionersand
therapies incorporated into biomedicine;
and (3) an integrated medical system in
which alternativemedicineandbiomedicine
coexist as componentsof a new paradigm.
They neglect to note thatthe actualizationof
the last paradigm-one that has the potential of being authenticallyholistic-would
require the transcendenceof the capitalist
lifeworld.
In Borderland Practices, New Zealand
sociologist Kevin Dew offers yet another
example of the fluid boundaries between
biomedicine and alternativemedicine, but
from the perspectiveof a small countryfar
away from both the United States and the
United Kingdom.He distinguishesfive categories of practitionersfunctioning at the
boundaries of biomedicine. "Charlatans"
and"quacks"arepeople who purportto have
medical knowledgeor skills thatthey do not

actually possess. The "crank"is an eccentric practitionerwho follows his or her own
inclinations in carrying out medical treatment but is well intentioned, despite that
fact thathe or she deviatesfromvirtuallyall
other practitioners,orthodox or heterodox.
The "medicalheretic"is a practitionerwho
has been trainedin biomedicine but adopts
a therapyor therapiesthathe or she was not
taught in biomedical school. Finally, "deludedpractitioners"are"earnestpeople who
believe they are doing a good job and providing value, but who at best might be described as useless and at worst as harmful"
(p. 10). In reality,to a largedegree, who fits
in what categoryis subjectto the prevailing
medical norms of the historicalperiod and
social location, and Dew's choice of labels
appearsgroundedin anti-CAMbias.
Dew focuses on the ways that various
therapiesare validatedand regulatedwithin
the contexts of the larger the society and
biomedicaldomination.Despite the fact that
New Zealand,like Australia,exhibits "very
conformistmedicalestablishments"(p. 30),
many New Zealand general practitioners,
as well as their counterpartsin Australia,
have over the past few decades come to
express a strong interest in alternativeor
complementarymedicine, thus blurringthe
boundary between biomedicine and alternative practices.Dew discusses how chiropractyachievedstatutoryrecognitionbeginning with the recommendationsmadeby the
Commissionof Inquiryinto Chiropracticin
the late 1970s and overcame its marginality under Common Law. In the process of
achieving some semblance of legitimation,
the New Zealand ChiropracticAssociation
distanceditself from D. D. Palmer'sassertion thatsubluxationsarethe sourceof most
diseases and presented its practitionersas
musculoskeletalspecialistsratherthandrugless generalpractitioners.
Dew notes that the boundaries between biomedicineand acupuncturein New
Zealandhave become even more illusive in
that that the latterhas come to be practiced

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BOOKREVIEWS

by not only TraditionalChinese Medicine

(TCM)practitioners,many of whom are affiliatedwith the New ZealandAcupuncture
Society (est. 1975), but also biomedical
physicians belonging to the New Zealand
Medical AcupunctureSociety (est. 1981)
as well as physiotherapists.At any rate, he
observes that the existence of biomedical
acupuncturistshas served as a majorbarrier
in the efforts of the TCM practitionersto
obtain statutoryregistration.Although the
New Zealand Medical AcupunctureSociety became an affiliateof the New Zealand
Medical Association, at least one biomedical acupuncturist,namely Mat Tizard(who
used a form of electro-acupuncturein diagnosing chemical poisoning), was expelled
from the medical register in 1992, fined
$1,000, and ordered to pay $157,000 in
courtcosts, althoughthese were reducedby
the High Court to $100,000, exclusive of
General Sales Tax. In contrastto incompetent biomedical physicians who tend to be
treated relatively leniently for their transgressions, Tizard, as a biomedical heretic,
provokedoutrageby claimingto have found
a treatment for a serious health problem
that his colleagues could not easily diagnose or treat. Although alternativetherapies have become increasingly popular in
New Zealand, Dew argues that the growing emphasis on evidence-basedmedicine,
standardizationof procedures, quality assurance, and measurement threatens to
delimit both biomedicine and alternative

353

Indeed,the acronymCAM, in largepart,has

become a biomedical constructionthat reflects the absorptionof alternativetherapies.
Part I (Precursors: The Years in the
Wilderness)of the volume includes four essays that examine certain political struggles between biomedicine and alternative
systems in the decades prior to World II
and shortlythereafter.The essays by Nadav
Davidovitch and Anne Taylor Kirschmann
examine factionalism within the ranks of
homeopathy, namely between the provaccinationistsand anti-vaccinationistsand
the traditionalistsand the homeopathswho
had come to embrace much of biomedical
practice.In her essay, BarbaraClow examines the politics of alternativecancercare in
Canadabetween 1900 and 1950 andMichael
Ackermandiscusses the emergence of the
U.S. health foods movement, one in which
biomedical heretics and dentists played a
role, andthe Food andDrug Administration
that launched an attack on the movement
beginningin the early 1950s.
Part II (Intersections:Allopathic Medicine Meets AlternativeMedicine) includes
an essay by Otniel E. Dorr on the subject
of "voodoo death" as a trope situated at
the "boundariesbetween mainstreamand
fringe, alternativeand orthodox, and subversive and normative"(p. 71) and an essay
by WadeDavies thatchroniclesthejuxtaposition of biomedicine and Navajohealing.
Part III ("Contesting the Cold War
Monopoly") includes an essay by Naomi
medicine.
Rogerson SisterKenny,an Australiannurse
The Politics of Healing, edited by Robert who received far greater attention in the
D. Johnston,includes essays writtenby his- United States for her alternativeapproach
toriansand social scientists on the political to treatingcancer duringthe 1940s and the
battles that have ensued in North America 1950s, despite the opposition of organized
betweenbiomedicineandvarietyof alterna- biomedicine, than she did in her hometive healing systems and healthmovements land; an essay by Michelle M. Nickerson
over the course of the 20th century.The edi- on ultra-conservativeoppositionto passage
torarguesthatthe term"complementaryand of the Alaska Mental Health Bill of 1956;
alternative medicine" (CAM) is "sugges- and an essay by Gretchen Reilly on the
tive of how these alternativesare becoming campaign, beginning in the 1950s, against
a visible, and increasingly significant,cur- fluoridationof public drinking water, that
rent within the medical mainstream"(p. 1). includedMDs, dentists, researchscientists,

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354

MEDICALANTHROPOLOGY
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alternativepractitioners,health food enthusiasts, religious groups, political conservatives, and even some environmentalists.
The first two essays in PartIV (Contemporary Practices/ContemporaryLegacies)
touch on feminist health concerns. In her
essay, Amy Sue Bix examines the fascination of U.S. feministswith alternativetherapies betweenthe 19thcenturyandthe 1990s.
Georgina Feldberg explores the Women's
College Hospital in Toronto as an exemplarof the women'shealthmovementduring
the 1960s and 1970s. In other essays in
this section, Velana Huntingtonexamines
Orisha as Afro Cuban medical system in
the United States; Sita Reddy discusses
New Age Ayurvedaas a genre of "magazine medicine";anthropologistDavid Hess
analyzes the CAM cancer therapiessocial
movementin NorthAmericaoverthe course
of the 20th century;andMatthewSchneirov
and Jonathan David Geczik provide an
analysis of the two alternative networks
in Pittsburghthat they explore in greater
detail in a book reviewed earlier in this
essay.
In Section V (Conclusions), Robert
Johnstonoffersa historicaloverviewof antihistorical movements in the United States
in which he asserts that vaccine activism
transcendsthe left-right divide and James
C. Whortonexamineshow biomedicinehas
come to transformalternativemedicinefrom
a cult to CAM over the course of the 20th
century.
The other anthology in this review,
MainstreamingComplementaryand Alternative Medicine, incorporates sociological examinations of CAM in the United
States, Canada,Britain,Australia,and New
Zealand. In the Introduction,the editors
note that CAM has become a majorpartof
healthcarein all "advancedsocieties"(p. 1).
With regard to the first theme in the volume, namely consumptionin culturalcontext, Melinda Goldner in her essay asserts
that the CAM movement functions on two
levels: (1) as an interest group that lob-

bies for legislative reform, informing the

public, and developingcoalitions among its
multifariousactors and (2) in "submerged
networksof social movementcommunities
where activistsattemptto createand sustain
an alternativeway of life" (p. 12).
Goldner's study draws heavily from interviews conducted with practitionersand
patientsin the San FranciscoBay area and
the Albany CapitalDistrict.She arguesthat
consumershave played a significantrole in
the CAM movementin the UnitedStatesbecause of the strong presence of a marketdriven health care system, a fact that has
promptedinsurancecompanies to provide
coverage for CAM. Based on empiricalresearch with HIV patients and their CAM
practitionersundertakenin a local healthauthorityin West Yorkshire,KathrynHughes
indicatesthatrelianceon CAM has become
partand parcel of the emphasis on "patient
choice" in the United Kingdom-a policy
that seeks to shift more and more the responsibilityandexpense of healthcarefrom
the state sector to a self-care mode in which
the patientrelies on technologiessuch as the
Internetand digital TV for assessing his or
her health.
The next three essays address the impact of the state and the marketon CAM.
As CAM therapiesbecome more acceptable
to biomedicine, as Evan Willis and Kevin
White argue, the issue of subjecting them
to the rigors of evidence-based medicine
has moved the forefront,both as a means
to validate or discredit them. Randomized
controlledtesting(RCT)methodologyfunctions most easily when treatmentis fairly
straightforward,but becomes much more
difficult to administerin the case of many
CAMtreatmentsthatentaila combinationof
treatmentsdesigned for individualpatients.
They argue that the Australiangovernment
introduced the ComplementaryTherapies
FundingProgramin February2002 and exempted CAM practitionersfrom the Good
andServiceTaxmoreon the basis of clinical
legitimacy resulting from the continuing

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BOOKREVIEWS

patronageby consumers willing to pay for

services than from scientific legitimacy.
Based on my own examination of the
growing legitimation of complementary
medicine in Australia,including significant
support for the training of various CAM
practitionersin public tertiaryinstitutions,
the Australiangovernmentmay view CAM
as a cost-cutting measures because, with
the exception of acupunctureadministered
by GPs, it is not covered under Medicare,
the national health plan, and must be
paid for out of pocket or through private
health insurance.Kevin Dew, in his essay,
argues that RCTs in New Zealand and
elsewhere have the potential of providing
biomedicine with a mechanismto limit the
claims of competing CAM systems. Fran
Collyer discusses the corporatizationand
commercializationof CAM, particularlyin
Australiabut also elsewhere, noting that it
has evolved from a cottage industryinto a
corporateendeavor.She observes complementarymedicines have increasinglycome
to be manufactured by pharmaceutical
companies that produce biomedical drugs
and that CAM practitioners increasingly
are workingin corporate-ownedintegrative
medicine settings. Collyer asserts that the
mainstreaming of CAM will ultimately
increasecosts for consumers,governments,
and third-party payers and that CAM
has come to have "little relation to the
enhancementof well-being, patient safety,
altruismor the curingof disease" (p. 95).
The final four essays in the volume
address the issue of boundary contestation between biomedicine and CAM in the
workplace. Ian Coulter argues that most
efforts to develop an integrativemedicine
in the United States entail the addition of
CAM to "largely hospital-based medical
programmes"(p. 105), with the additionof
CAM providersin biomedical health clinics being the second most common strategy.
In their essay, HeatherBoon, Sandy Welsh,
Merrijoy Kelner, and Beverly Wellman
argue that an increasing number of CAM

355

practitionergroups, including naturopaths,

TCM practitioners,and homeopaths,have
been seeking statutory recognition in
Ontario.Based on focus groupswith various
CAM practitioners,they found thatmost of
them "felt thatregulationwould allow them
to achieve a measure of social closure by
institutingeducationand qualificationstandards" (p. 130). Conversely, some practitioners feared loss of clinical autonomy if
their group was regulated.In his essay, Jon
Adams reports on his interviews with 25
general practitioners(14 male, 11 female)
who use various CAM therapies (including acupuncture,homeopathy, hypnotherapy, and neurolinguisticprogramming)in
EdinburghandGlasgow.He foundthatthey
tendedto view "laytherapists"who practice
CAM as "deficient and potentially highly
dangerous"(p. 145) andarguesthatthe concept of complementary practice "implies
the domestication of unconventionaltherapies within the wider frameworkof conventionalmedicine"(p. 151). In theiressay,
Adams and Philip Tovey argue that nurses
in the United Kingdom have been at the
forefrontin the developmentof an integrative medicine, as evidenced by an increase
in the membershipof the Complementary
Therapies Forum of the Royal College of
Nursing from some 1,600 in 1997 to some
11,400 in 2000. Nurses,however,havebeen
selective in terms of the CAM therapies
that they choose to adopt, favoring therapies such as aromatherapy,reflexology,and
massage over others, such as chiropractyor
acupuncture.
Although medical anthropologistshave
been engaged in the study of indigenous
medical systems, folk and religious healing systems in complex societies, and professionalized heterodoxmedical systems in
SouthAsia, Japan,China,andIndonesiafor
decades, they have been somewhatslow in
examiningprofessionalizedheterodoxmedical systems in Anglophone and other developed societies, especially in comparison
to sociologists. Exceptions include Robert

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356

MEDICALANTHROPOLOGY
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Anderson and Kathy Oths, who have examined chiropractyin the United States;
Robbie David-Floyd, who has examined
direct-entrymidwifery in various national
contexts and holistic biomedicalphysicians
in the United States; David Hess, who has
examined CAM cancer therapies in the
United States; Tom Maretzki,who has examinednaturopathyin Germany;andClaire
Cassidy andLindaBarnes,who have examined acupunctureand TCM in the United

States. In contrastto sociologists who have

tended to rely on interviews and surveys
in conducting research on CAM systems,
it is hoped that anthropologistswill begin
to conduct participantobservation on integrative medical or CAM centers, CAM
schools, associations,conferences,the practices of solo CAM practitioners,healthfood
stores,and lay CAM networks,both professionalized and lay, more than they have to
date.

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