In Part 2, the terms medicine and medical treatment refer to conventional medicine and conventional medical treatment. This avoids the redundant use of conventional. Part 2 is concerned with clarifying the meanings of alternative and conventional, about which there is considerable confusion. They are sometimes used interchangeability, as if they both have the same meaning. For example, "Alternative (also known as complementary," "unconventional") medical therapies encompass a broad spectrum of practices and beliefs. Functionally defined, these are medical interventions neither taught widely in the U.S. medical schools nor generally available in U.S. hospitals. Examples include chiropractic, acupuncture, homeopathy, massage and herbal therapies."4
Specifically, what does alternative … medical therapies in the previous paragraph mean? Doctors may examine, diagnose, and provide a patient with information, but not necessarily treat that patient. Examination, diagnosis, and advice are medical procedures, but not medical therapies because they are not medical treatment.
The meaning of alternative is restricted to medical therapies in the penultimate paragraph. However, the term alternative in the National Institutes of Health (NIH) Office of Alternative Medicine5 obviously means alternative to medical treatment. Because alternative health care modalities are not all medical, it is incorrect to categorize them all as alternative medicine. (I shall say more about this later.) An alternative modality may not be medical treatment although, as pointed out in Part 1, medical treatment may be an alternative health care modality.
Restricting all alternative health care modalities to the category of alternative medicine also makes no sense from the point of view of state laws that regulate the practice of medicine. These laws obviously do not apply, for example, to chiropractic and massage which are regulated by their own their state laws. If something is not conventional medical treatment, calling it alternative medicine does not, ipso facto, make it medicine. In some cases, the term alternative medicine is therefore an oxymoron. It makes no sense.
The term alternative medical therapies4 is also ambiguous because therapies include medical as well as non-medical (i.e., alternative) modalities. The term therapy may also refer to treatment of conditions involving the soul, independently of the body.2 The terms alternative health care and alternative health care modalities are more appropriate than alternative medicine and alternative medical therapies.
"Let there be light."
To understand the differences between the terms alternative and complementary requires that we differentiate between definitions of treatments and the treatments themselves. Definitions of treatments exist independently of patients who receive the treatments. But treatments do not exist independently of patients who receive them. Treatments may differ from their definitions when doctors use the treatments for purposes for which they are not ordinarily prescribed; i.e., defined. We therefore cannot decide whether medicine or some other health care modality is alternative or complementary without knowing what treatment(s) each individual patient is receiving, when, and under what conditions.
It is therefore not a matter of simply adopting one or the other of the two terms - alternative or complementary - for general use a priori or in vacuo; that is, independently of each particular treatment situation to which one or the other term may apply. Neither term can replace the other because they may have different meanings under different circumstances.
To understand the differences between the terms alternative and complementary also requires that we identify different roles doctors play. Doctors may provide patients (a) with medical treatment without providing them with medical information, (b) with medical information without providing them with medical treatment, and (c) with both medical information and medical treatment. Information per se is not medical treatment.
When the same doctor treats patients with alternative health care modalities, alone or in conjunction with medical treatment, alternative and/or complementary is not an issue. It becomes an issue when people pay providers of alternative health care, who are not physicians, billions of dollars.6 Doctors become concrned because they are not getting that money.
This article focuses on clarifying the terms alternative and complementary as they are used to describe the relationship between medicine and alternative health care modalities. However, even within alternative health care itself, independently of medicine, the terms are also applicable. For example, Swedish massage is a useful complementary modality for chiropractic treatment. Doctors are much less concerned about what these terms mean in professions other than medicine because much less money is involved..
The fact that many patients use doctors only as a source of medical information is recognized by the cardiologist Dr. Bruno Cortis. He described "exceptional heart patients who kept the reins of health care in their own hands. They wanted their doctors to serve as advisors and consultants, not as authorities. They resented it if their doctors attempted to run the show. They insisted on making the final decisions themselves." Some of these patients "made use of alternative and experimental methods of which their doctors knew very little. In short, they insisted on doing things their own way… Many of these patients confounded their doctors by getting well when they were supposed to get worse. They thrived when they were supposed to weaken. They lived when they were supposed to die."7 In these cases, doctors served only as "advisors and consultants."
These considerations clearly reveal that treatment with alternative modalities may be complementary to or completely independent of medical treatment. It is impossible for alternative modalities to be complementary to medical treatment when people are not receiving any medical treatment. Conversely, medical services may be complementary to alternative health care. This occurs when doctors only monitor or provide information to patients who are being treated only by alternative health care practitioners.
However, many people don't want doctors even as "advisors and consultants." This is reality, and medicine knows it because "one in three U.S. patients routinely uses alternative therapies, and seven in ten users do not discuss the practices with their primary physicians."4 That is one reason why The Department of Continuing Education at the Harvard Medical School and the Department of Medicine at the Beth Israel Hospital are jointly presenting the course Alternative Medicine: Implications for Clinical Practice in Boston on March 27 - 29, 1996.4
Two different solar models for health care
Doctors tend to place themselves in a central position of health care providers, like the sun in our solar system, with alternative modalities rotating around them like planets around the sun. I call this model heliocentric. It seems to fit the view of Joseph J. Jacobs, M.D., former director of the National Institutes of Health (NIH) Office of Alternative Medicine. For him, "the term alternative medicine is a misnomer." "It's not an alternative to conventional treatments. It's supplemental,"5 which is another way of saying complementary. For this reason, some individuals want the Office of Alternative Medicine to be renamed the Office of Complementary Health Care.
This proposed change raises the question - complementary to what? The assumption by doctors that all alternative health care is or should be complementary to their medicine is, as has been shown, a denial of present-day reality. Many people who are being treated by practitioners of alternative modalities reject medical care. For them, medical treatment is unacceptable. The alternative treatment these individuals get is truly alternative health care because it is an alternative to medicine. It is not complementary to medical treatment because they are not getting any medical treatment. A heliocentric model of health care that is more realistic than the one described above has the patient, not the doctor, in the center of the health care system, with medicine and alternative health care modalities, all equally and independently available, rotating around each patient who decides which one(s) he wants.
Dr. Jacobs is correct in concluding that the term alternative medicine is a misnomer. But he is wrong in implying that alternative health care is "not an alternative to conventional treatments. It's supplemental."5 That's only one side of the coin. Alternative health care may be supplemental to conventional medical treatment, just as conventional medical treatment may be supplemental to alternative health care.
To summarize, alternative modalities are not always supplemental to conventional medicine. They cannot be supplemental to medical treatments when people are treated only by alternative modalities. They are also not associated with conventional medical treatment when patients use doctors (a) only to monitor their progress and (b) only to provide information by answering questions while they are on alternative modalities. Under these circumstances, doctors provide only information, not medical treatment.
Doctors' limited view of reality
"In light of evidence that one in three U.S. patients routinely uses alternative therapies, and seven in ten users of alternative therapy do not discuss these practices with their primary physicians, there is a need for professional education and improved patient-provider communication in this area."4 This alleged need reflects doctors' limited view of reality. The greatest need is for doctors to understand that alternative health care is now mainstream, and why more and more people are using less and less medical treatment.
The medical establishment has unsuccessfully tried to suppress homeopathy, naturopathy, and chiropractic because they are economic competitors. If the medical establishment tries to do that with present-day alternative health care modalities, it will clearly reveal its economic motive.6 That will lower the credibility of medicine which many people already look on as a business and industry whose primary objective is profit.
What's wrong with conventional medicine?
One reason why so many people have given up on conventional medicine is that too many doctors are death-oriented or negative in other ways. This was pointed out by Andrew Weil, M.D., who considers "voodoo death" as the ultimate example of a negative placebo effect." These curses, which Weil calls "a kind of medical 'hexing'", are doctors' comments to their patients, such as:
"They said I would just have to live with it."
"They said there was nothing more they could do for me."
"They said I'd be dead in six months."
"They told me it would only get worse."
Fortunately, Weil found that he could break these medical hexes by administering humor. "When I can get patients to laugh," he wrote, I feel that the curses are dispelled."8
People have also given up on convention medicine because they do not want what Weil calls "antimedicine" which "in essence is counteractive and suppressive." Antimedicine consists of "antispasmodics and antihypertensives, antianxiety agents and antidepressants, antihistamines, antirhythmics, antitussives, antipyretics, and anti-inflammatories, as well as beta-blockers and H2-receptor antagonists."
People want medicine which has a health-oriented philosophy instead of a "disease focus." With respect to this, Weil directs attention to "our National Institutes of Health. Really," he writes, "they are National Institutes of Disease: The National Cancer Institute, The National Institute of Allergy and Infectious Disease, the National Institute of Arthritis and Skin Diseases, The National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke, and so on. Where is the National Institute of Health and Healing?"8
Finally, the practice of medicine has become impersonal to the extent that many describe it as a dehumanized assembly line where the bottom line is profit for doctors, hospitals, the pharmaceutical industry, and insurance companies.6 To avoid this, many people seek alternative health care, because it is personal, humane, non-interventive, has less adverse side effects, and is effective. Moreover, they personally pay billions of dollars annually for alternative health care because their health insurance usually does not cover the fees of primary health care providers who are not doctors.
Doctors too often heliocentrically assume that they are or should be the only ones who provide primary health care, and that alternative modalities, with which people choose to be treated, should be complementary to conventional medical care; that is, under the direct or indirect control of doctors. This would, of course, enable them to get fees sometimes for little if any service.
Health care would cost much less if alternative health care providers were paid directly by insurance companies. However, the medical establishment is opposed to this for obvious reasons.
1. Schatz, A. Why the Church for Spiritual Healing and Health was established. Spiritual Massage Ministry Newsletter. 1(4): 1-3, 1995.
2. Schatz, A. The Church for Spiritual Healing and Health. Spiritual massage healing. Journal of Spiritual Bodywork. 1(1):1-53, 1995.
3. Schatz, A. Massage therapy and spiritual message healing are legally different modalities. Spiritual Massage Ministry Newsletter. 1(10):1-2, 1995.
4. Alternative Medicine: Implications for Clinical Practice. A course sponsored by the Harvard University Department of Continuing Education and the Department of Medicine, Beth Israel Hospital. Boston, MA. March 27-29, 1996
5. Time for new head, new approach at OAM. Jour. Amer. Med. Assoc. 272:1806-1810, 1994.
6. Schatz, A. and Carlson. K. We need a new kind of national health care. More of the same won't work. Journal of Well Being. 9(4):19-27, 1994.
7. Cortis, B. Heart & Soul. A Psychological and Spiritual Guide to Preventing and Healing Heart Disease. Villard Books. New York. 1995.
8. Weil, A. Spontaneous Healing. How to Discover and Enhance Your Body's Natural Ability to Maintain and Heal Itself. Alfred A. Knopf. New York. 1995.