integrative medicine and culture: toward an anthropology of cam
TRANSCRIPT
412 MEDICAL ANTHROPOLOGY QUARTERLY
SHELLEY R. ADLER
Integrative Medicine and Culture: Toward anAnthropology of CAM
Marc Micozzi's article drawsmuch needed attention to thefield of complementary and
alternative medicine (CAM), a signifi-cant topic that I believe holds unreal-ized research potential for medicalanthropologists. Why has such an im-portant subject remained understudied?Micozzi makes the point that contem-porary biomedical research is primarilyfocused on "the investigation of mecha-nisms of action and clinical outcomes"related to CAM. I agree that CAM re-search, as it is presently conducted inacademic medical institutions acrossthe United States, is revealing the in-completeness of a reductionist biomedi-cal paradigm. Anthropological researchis necessary both for the understandingof the limitations of our present modelsand, of potentially greater importance,for the construction of new ones. Weneed to offer our anthropological per-spectives on both the diachronic andsynchronic contexts in which this cul-tural phenomenon, frequently termedintegrative medicine, manifests itself.
I do not mean to imply that the voicesof medical anthropology have been ab-sent—only too faint. In the early daysof the National Institutes of Health Of-fice of Alternative Medicine (OAM;later elevated to the National Center forComplementary and Alternative Medi-cine), the impact of the participation ofanthropologists (and medical folklor-ists) was evident. For example, the ef-forts of the OAM Panel on Definitionand Description to circumscribe thefield were clearly culturally informed:
"Complementary and alternative medi-cine is a broad domain of healing re-sources that encompasses all health sys-tems, modalities, and practices andtheir accompanying theories and be-liefs, other than those intrinsic to thepolitically dominant health system of aparticular society or culture in a givenhistorical period" (1997:50, emphasisadded). It is high time that medical an-thropologists reintroduce this nascentcritical perspective, both historical andcultural, into a field in which theoreticaldebates remain largely unformed. Weneed to study the anthropology of com-plementary and alternative medicineand integrative medicine as culture.
CAM is neither a wholly new phe-nomenon nor has it "returned" from be-ing away. Alternative medicine has beena persistent presence in U.S. health care(Adler 1999). It is the recent increasedawareness on the part of researchersand the general populace, the "acknow-ledgment of postmodern medical diver-sity" (Kaptchuk and Eisenberg 2001:189), that merits investigation. Further-more, although the term integrativemedicine has only recently come intovogue, people have been practicing thistype of health care for quite some time.Individuals' personal healing systemsare frequently attempts at rendering dis-parate elements coherent. Patients' in-tegration of biomedical and CAMtherapies is, of course, not desperateand haphazard, as historically depictedin the biomedical literature; patients'health care practices are deliberate andcomplex. My research with women
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with breast cancer indicates that indi-viduals combine disparate elements—from what may appear to be mutuallyexclusive health traditions—into a syn-cretic whole (Adler 2001). Biomedicaland alternative health traditions mayonly appear to be irreconcilable: theirapparent inconsistencies are not viewedas such or are deemed insignificant bythose who engage in them, either con-currently or sequentially.
Micozzi concludes from his rich ex-perience as both a physician and an an-thropologist that "no one system ofmedicine alone can provide a formulathat will offer effective medical care forthe entire human family." In juxtaposi-tion to this pluralistic view stand asser-tions from within the field of biomedi-cine, such as the remarks in a 1998 NewEngland Journal of Medicine editorialthat "there cannot be two kinds of medi-cine—conventional and alternative.There is only medicine that has beenadequately tested and medicine that hasnot, medicine that works and medicinethat may or may not work" (Angell andKassirer 1998:841). The emerging fieldof integrative medicine is an attempt toresolve these issues by combining ele-ments of varied healing systems in or-der to eliminate the deficiencies of anysingle one. The term integrative is usedhere not as a substitute for alternative,but to indicate a collaborative, multidis-ciplinary approach that requires the ap-plication of the best options from dif-ferent healing systems—that is, expertsfrom a variety of biomedical and CAMfields focus the diagnostic and thera-peutic strengths of a combination ofsystems into a comprehensive and indi-vidualized treatment strategy that en-courages patient participation. Whatdoes medical anthropology make ofthis form of medical hybridity? Doesintegration mean the end of medicalpluralism?
Historically, folk medical and eth-nomedical research in the United Stateshas been conducted among marginal orperipheral communities, to the exclu-sion of more mainstream groups. Thelegacy of 19th-century social theoriesapplied to the study of "alternative"treatment use continued to affect (non-anthropological) research into CAMuntil quite recently. Over the past dec-ade, the focus has shifted dramatically.It is as if contemporary CAM research-ers are overcompensating for theirpredecessors' misconceptions. The factthat several large surveys have indi-cated that the use of CAM is most com-mon among relatively well-educated,well-off, "nonethnic minorities" re-mains a source of fascination—as evi-denced by myriad references to thesetypes of sociodemographic findings inthe biomedical literature. The result isthat CAM research, when approachedfrom a conventional biomedical per-spective, has become increasingly de-contextualized. Where's the culture?
There is a clear need for medical an-thropologists to integrate the study ofintegrative medicine. Many CAM stud-ies, from randomized, controlled, clini-cal trials to qualitative investigations,can benefit by being made truly inter-disciplinary. Let us not limit ourselvesto a preservationist approach but, rather,also apply our understandings of tradi-tional healing systems to the consumer-driven U.S. health care environment.Whereas traditional anthropologicalmethods can be engaged in the study ofemerging sites, for example, conduct-ing an ethnography of an integrativemedicine clinic, there is also a greatneed for the development of new,mixed methodological—that is, quali-tative-quantitative—approaches. Howcan studies be designed that are cogni-zant of biomedicine's and CAM sys-tems' unrelated diagnostic categories?
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How can clinical trials be developed toallow for CAM modalities' traditionsof individualized healing approaches or"subjective" outcomes?
Micozzi correctly notes that in theseparation between mind and body thatcharacterizes Western biomedicine'stake on Cartesian dualism, the mind,and by extension all aspects of "bioen-ergy," are given short (if any) shrift. Itis a given that many great biomedicaladvances will reveal that we havereached the limit of what our currentparadigms can contain, much as re-search into the human genome is serv-ing to debunk centuries-old "scientific"notions of "race" as a biologically validconstruct. As this new, integrativemedical dialog emerges and encouragesa paradigm shift in health and medicine,it is imperative that medical anthropol-ogy inform the discussion.
REFERENCES CITED
Adler, Shelley R.1999 Complementary and Alternative
Medicine Use among Women withBreast Cancer. Medical AnthropologyQuarterly 13:214-222.
2001 Integrating Personal Health BeliefSystems. In Healing Logics. ErikaBrady, ed. Pp. 115-128. Logan: UtahState University Press.
Angell, Marcia, and Jerome P. Kassirer1998 Alternative Medicine—The Risks
of Untested and Unregulated Reme-dies. New England Journal of Medi-cine 339:839-841.
Kaptchuk Ted J., and David M. Eisenberg2001 Varieties of Healing, 1: Medical
Pluralism in the United States. Annalsof Internal Medicine 135:189-195.
Panel on Definition and Description, CAMResearch Methodology Conference
1997 Defining and Describing Comple-mentary and Alternative Medicine. Al-ternative Therapies 3(2):49-57.
About the Contributors
Shelley R. Adler, Department of An-thropology, History, and Social Medi-cine, University of California, SanFrancisco, [email protected]
Hans A. Baer, Department of Sociol-ogy and Anthropology, University ofArkansas at Little Rock, [email protected]
Meredith B. McGuire, Department ofSociology and Anthropology, TrinityUniversity, [email protected]
Marc S. Micozzi, physician and author,marc_micozzi @ hotmail .com
Joseph E. Pizzorno Jr., President Emeri-tus, Bastyr University, and member,White House Commission on Comple-mentary and Alternative Medicine,drpizzorno@ salugenecists.com
David Reilly, Consultant Physicianand Honorary Senior Lecturer in Medi-cine, North Glasgow University Hospi-tals, [email protected]