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Introduction
- University of Michigan Press
- Chapter
- Additional Information
Introduction The Growth of Complementary and Alternative Medicine In the late nineteenth century, the rise of scientific medicine (or biomedicine ) brought ideological and professional coherence to health care; standards for safe, effective, and ethical practice; educational rigor; and recognized parameters for research into the validity of therapies . Biomedicine also provided a clearly articulated framework for understanding health, disease, and mechanisms of remedy in Western, scientific terms and excelled at treating infectious diseases and acute injuries.1 Biomedical practice followed Newtonian physics and Cartesian dualism in viewing human health largely in a mechanistic and reductionist fashion—for example, understanding the body as a physical system, objectively analyzable in terms of parts, and reducing the complex phenomenon of disease to a standardized set of physical symptoms and cures.2 As biomedicine gained political and economic ground in the latenineteenth -century world of competing medical sects, the biomedical community expelled providers such as homeopaths, naturopaths, and chiropractors from medical societies, prohibited professional association with them, and encouraged prosecution of such providers for unlicensed medical practice.3 In this way, biomedicine came to dominate not only the delivery of professional health care services in the United States but also legal and regulatory structures governing the delivery of health care.4 By the mid–twentieth century, a resurgence of popular interest in therapies such as chiropractic, naturopathy, massage therapy, acupuncture and traditional oriental medicine, nutritional and herbal medicine, folk medicine and spirituality in medicine, and mind-body therapies led to the growth of a recognized movement for “holistic 1 health care” or “alternative medicine.”5 The latter phrase initially was used to define therapies not commonly used in U.S. hospitals or taught in U.S. medical schools.6 However, as these therapies gained greater footing in U.S. hospitals and in medical school curricula and consumer use of such therapies dramatically expanded, complementary and alternative medicine gained recognition as a consensus term for these therapies , which historically had fallen outside of biomedicine.7 The term complementary and alternative medical therapies is also used to describe these modalities. Complementary and alternative medical therapies have been classified as involving at least seven major fields of practice: (1) mind-body interventions; (2) bioelectromagnetic applications in medicine; (3) alternative systems of medical practice; (4) manual healing methods; (5) pharmacological and biological treatments not yet accepted by mainstream medicine; (6) herbal medicine; and (7) treatments focusing on diet and nutrition in the prevention and treatment of chronic disease.8 The numerous subfields within these fields have been defined to include, for example, support groups, imagery, hypnosis, biofeedback, yoga, prayer, and mental healing (under “mind-body interventions”); traditional oriental medicine and acupuncture, Ayurveda, homeopathy , naturopathy, and Native American medicine (under “alternative systems of medical practice”); chiropractic and massage therapy (under “manual healing methods”); and European phytomedicine (under “herbal medicine”).9 By the end of the twentieth century, Congress had funded an Office for Unconventional Medical Practices, which later expanded into the Office of Alternative Medicine and then the National Center for Complementary and Alternative Medicine at the National Institutes of Health (NIH). At the birth of the millennium, the National Center had a $50 million (and growing) budget to stimulate research and enable it to serve as an information clearinghouse for scientists and the public. Congress also had enacted the Dietary Supplements Health Education Act (DSHEA), which allowed manufacturers to distribute dietary supplements without having to prove safety and efficacy, so long as they made no claims linking the supplements to a specific disease. The subsequent market growth of nutraceuticals—for example, the use of dietary supplements, including vitamins, minerals, herbs, and other botanical products—has made some therapies within “complementary and alternative” medicine a widespread part of everyday self-care. The 2 • Future Medicine [3.238.130.41] Project MUSE (2024-03-29 07:23 GMT) U.S. nutrition market alone reached $23 billion in 1997, consisting of $12.7 billion in dietary supplements, $7.7 billion in natural foods, and $2.7 billion in personal-care products and representing 31 percent of the $65 billion global nutrition industry.10 Questions involving potential liability for clinical recommendations of dietary supplements came to the forefront of mainstream practice. State legislation also increased the visibility and prominence of complementary and alternative medical therapies. By the twentieth century’s end, for example, chiropractors had found licensure in every state, acupuncturists and massage therapists in well over half the states, and naturopaths in perhaps a dozen states. Many states mandate insurance benefits for...