Alternative Therapies
Zinberg, Norman E. 1984. Drug, Set, and Setting: The Basis
for Controlled Intoxicant Use. New Haven, CT: Yale
University Press.
Robin Room (1995, 2004, 2014)
Director, Center for Alcohol Policy Research, Turning Point
Professor, Melbourne School of Population and
Global Health, University of Melbourne
ALTERNATIVE THERAPIES
This entry consists of the following:
I. SOCIAL HISTORY
Robert C. Fuller and Justin Stein
II. ETHICAL AND LEGAL ISSUES
James F. Drane
I. SOCIAL HISTORY
Healing is a profoundly cultural activity. The very act of
labeling a disease and prescribing treatment expresses a
healers commitment to a particular set of assumptions
about the nature and structure of reality. These assump-
tions not only help specify the agents thought to cause
disease but also contain implicit understandings of what
health optimally or normatively enables humans to do.
Because rival medical systems typically subscribe to
differing philosophical and cultural outlooks, the notion
of orthodoxy pertains to medicine as surely as it does to
religion or politics. What makes a therapy orthodox is
its adherence to a belief system that, for intellectual and
sociological reasons, informs the practice of the dominant
members of a cultures medical delivery system. A therapy
is therefore unorthodox to the extent that its diagnoses
and treatments are not deemed legitimate by the
dominant belief system.
The philosophical and professional differences that
separate orthodox and unorthodox therapies give rise to
complex ethical questions. How, for example, are we to
understand medical legitimacy when this notion is the
product of ever-changing philosophical, cultural, and
social factors? What does it mean for a medical treatment
to be unethical? Must it in some way bring about negative
results, or is it unethical even if it is merely a harmless
fraudsuch as vitamin placebo treatment? What con-
stitutes a therapeutic benefit? Is it solely determined by
improvement in a persons physical well-being, or does it
also include consideration of a persons mental or spiritual
well-being?
First, the sheer diversity of alternative therapies
hampers attempts to generalize about the kinds of ethical
issues that unorthodox treatments present. There is an
almost bewildering array of alternative therapies, ranging
BIOETHICS, 4TH EDITION
from chiropractic, osteopathy, and acupuncture to shiatsu,
herbal medicine, and religious faith healing. Further
complicating this task is the fact that these alternative
therapies find themselves labeled unorthodox for quite
different reasons. Some, for example, are practiced by
healers committed to an alternative belief system or
worldview that grants reality to causal forces that differ
greatly from those specified by medical orthodoxy. Such is
the case with Ayurveda and Chinese medicine, which
describe fluids in patients bodies that have no direct
correlates in biomedicine. It is also true for religious
therapies such as faith healing traditions and New Age
medical systems that invoke overtly metaphysical explana-
tions of the causes of physical illness and depict human
health in terms of adherence to specific spiritual or moral
outlooks on life.
Second, healing systems may become unorthodox
when they employ therapies that, though they are
predicated upon the consensus worldview, have not yet
been validated or confirmed as efficacious by orthodox
medical standards. Many of the treatments suggested for
combating cancer or acquired immunodeficiency syn-
drome (AIDS) are considered unorthodox for this reason.
Third, healers find themselves outside the medical
mainstream when they provide services that are typically
ignored or deemed of secondary importance by a cultures
dominant medical practitioners. This has been the case,
for example, with dentists in the nineteenth century,
podiatrists in the early twentieth century, and midwives
throughout most of modern history.
The case of midwifery is instructive. While it was
never as widespread in the United States as in other parts
of the world, midwives provided the only obstetrical
assistance available to many women until early in the
twentieth century. As obstetrics became a recognized
medical specialty, primarily under the control of male
physicians, hospitals equipped with surgical facilities
supplanted the home as the normal site for giving birth.
Increasingly the last resort of those who could not afford
hospital births, midwifery generally fell into disrepute.
Midwifery, then, became an unorthodox form of
medical care not because it employed an alternative
worldview or because it could not be validated as a
treatment but because the dominant providers of medical
services decided that the home and the assistance of other
women at childbirth were not of primary importance.
Interestingly, midwifery has witnessed a modest resur-
gence as part of a general cultural trend toward natural
medicine and woman-centered health care. From 1980 to
2010, births attended by certified nurse-midwives went
from just over 3 percent to about 8 percent of total births
and 12 percent of all vaginal births (Declercq 2012).
These numbers are roughly the same in Western Europe,
with the exception of the Netherlands, where roughly
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one-third of all births are home births monitored by
midwives and where midwives monitor almost 70 percent
of hospital births (DeVries 2001).
What alternative therapies have in common is
economic, legal, and cultural disenfranchisement from
the socially empowered institution of scientific medicine.
Any attempt to reflect upon the ethical questions raised by
these alternative approaches to healing requires sensitiv-
ity to the historical and philosophical roots of this
disenfranchisement. Regular physicians coalesced into
state and local medical societies during the nineteenth
century, securing an institutional power base for what was
to become medical orthodoxy in the United States. This
emerging corps of physicians shared a more or less
common approach to medical practice, and they were
eventually able to institutionalize this approach through
the influence they exerted over licensure laws enacted by
state and federal governments, the accreditation of
medical schools, and access to technologically equipped
hospitals.
The American Medical Association (AMA) (founded
in 1847 but lacking strong organization and sufficient
membership until the early twentieth century) eventually
succeeded in organizing and promoting the interests of the
nations dominant medical practitioners. The AMA
encouraged state and federal agencies to enact stricter
licensing regulations and to restrict hospital access to
graduates of AMA-accredited medical schools. These
efforts undoubtedly furthered the cause of scientific
medicine and surely protected the public from potentially
harmful forms of quackery. They also, however, forced to
the margins of the medical marketplace those whose
approaches to healing utilized a nonscientific worldview or
whose medical services did not fit with dominant
approaches to medical care.
Medical orthodoxy aligned itself with the worldview
spawned by the Western scientific tradition. Its approach
to therapeutic intervention has been firmly rooted in the
evolving body of information that has emerged from
advances in physiology, chemistry, and pharmacology.
Accompanying this reliance upon the Western scientific
tradition has been an implicit endorsement of a secularist
and rationalist ontology (i.e., a worldview skeptical of
claims concerning the supernatural or other unquantifi-
able influences). What has given scientific medicine its
public character is its insistence that theories concerning
the etiology and treatment of disease specify causal forces
that are physical, as opposed to spiritual or metaphysical.
Its theories and strategies for therapeutic intervention are
thus more susceptible to empirical verification, and
disputes can at least potentially be resolved by an appeal
to observable and quantifiable sets of data. This is also
why scientific medicine found itself more amenable than
many of its alternative counterparts to the economic and
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legal institutions of modern Western governments.
Rejecting the private claims to truth made in religious
arguments, Western democracies have required that all
civic discourse be advanced according to rationalistic and
public grounds of argumentation.
To the extent that scientific medicines academic and
experimental foundations facilitate such public argu-
mentation, it has largely merited its enfranchisement
within the legal and economic institutions that make
judgments about the allocation of medical resources. Any
consideration of the ethical status of these judgments and
their effect upon the practice of alternative medical
systems in the modern West must take into account the
important role that such rational and public discourse has
had in the development of Western culture.
EARLY CHALLENGES TO REGULAR MEDICINE
The Thomsonian System. One of the first challenges to
the orthodoxy of regular physicians occurred in the
early 1800s. Samuel Thomson (17691843) was a poor
New Hampshire farmer whose mother and wife had
suffered from the bleedings and mercurial drugs forced
upon them by regular physicians. Thomson believed that
better treatments must be available, and he began
studying the therapeutic value of herbs. He soon
developed his own system of botanical medicine predicat-
ed upon the assumption that there is only one cause of
disease, cold, and one cure, heat. Thomson believed that
by restoring heat to his patients systems, he could cure
any ailment. Using botanics such as cayenne pepper,
supplemented with steam baths, Thomson sought cures
without the incessant bloodletting or mercurial drugs
utilized by the eras orthodox physicians.
The Thomsonian system reached the height of its
popularity in the 1820s and 1830s. Some estimate that its
methods were employed to varying degrees by as many as
a million Americans. One obvious reason for its appeal
was that its treatments were generally more benign than
the aggressive arsenal of bloodletting, alcohol, opium,
mercury, arsenic, and strychnine that many regular
physicians used to stimulate their patients systems.
Perhaps more important, Thomsonianism could be
studied relatively inexpensively (although the official price
for the right to use his methods was a substantial $20) and
practiced by family members. During the early days of
medical professionalization in the United States, Thom-
sonianism strengthened the role of parents and especially
mothers in caring for family members.
Thomsonianism also fit nicely with the periods
moral and religious climate, which urged individuals to
take responsibility for their own moral and spiritual
regeneration. It endeavored to make every man his own
physician and encouraged individuals to take responsi-
bility for restoring their rightful relationship to the
BIOETHICS, 4TH EDITION

divinely decreed laws of nature. Of lasting significance is
the fact that Thomsonianism was the first system to take
on the issue of licensing of medical practitioners and to
assert the publics right to free choice of healers.
Thomsonians led the successful campaign to repeal
medical licensing legislation in the mid-1800s and drew
public attention to the somewhat predatory tactics with
which orthodox physicians sought to restrict the right of
would-be healers to practice whatever system they wanted.
Homeopathy. A second form of sectarian medicine,
homeopathy, emerged more or less concurrently with the
publics gradual loss of enthusiasm for the Thomsonian
system. The homeopathic system of medicine was the
creation of the German physician Christian Friedrich
Samuel Hahnemann (17551843), who grew increasingly
critical of the indiscriminate prescription of drugs by
contemporary physicians. He coined the term allopathic to
refer to orthodox medicines alleged overreliance upon
invasive therapeutic treatments (e.g., bloodletting, sur-
gery, or the administration of strong pharmacological
agents). In contrast to allopathic medicine, Hahnemann
enunciated a medical theory that he thought relied more
upon the bodys natural powers to bring about recovery.
The first principle of homeopathic medicine is like cured
by like. By this Hahnemann meant that physicians
should treat symptoms by prescribing drugs that produce
similar symptoms in a healthy individual. The second
fundamental principle of homeopathic medicine is the
doctrine of infinitesimals. It was Hahnemanns conviction
that the greatest therapeutic benefit was to be achieved by
administering diluted doses of a drug, sometimes only
1/1,000,000 of a gram.
Homeopathy spread quite rapidly in the United
States. It was introduced by Hans Gram (17861840),
who opened an office in New York after studying the
homeopathic system in Europe. By 1835 a homeopathic
college had been formed, and in 1844 the American
Institute of Homeopathy was organized. Throughout
the second half of the nineteenth century, 10 to
12 percent of the countrys medical schools and medical
school graduates were adherents of homeopathy.
In contrast to Thomsonianism, which was practiced by
nonprofessionals, homeopathic practitioners were educat-
ed professionals who often came from the ranks of
regular physicians. Moreover, while those who received
Thomsonian treatment tended to be rural and poor,
homeopathy thrived among the urban upper and middle
classes. This latter fact led to direct economic competition
with the regular system and proved an important catalyst
in the formation and success of the AMA as economic
motives joined with scientific ones to rally regular
physicians in opposition to their now irregular
competitors.
BIOETHICS, 4TH EDITION
Alternative Therapies
As the most popular of the centurys alternative
systems, homeopathy raised a number of important
ethical questions. For example, could allopathic physicians
consult unscientific practitioners? (The AMAs original
code of ethics included a consultation clause that
prohibited such interactions.) Or should homeopathic
physicians be allowed to practice in publicly supported
hospitals or in the military? Even in the late twentieth
century there was debate about whether pharmacies
should be required to stock homeopathic medicines.
Hydropathy and Dietary Regimens. In the mid-1840s
another alternative therapy, hydropathy (water cure),
began to attract a following in the United States. Based on
the theories of Vincenz Priessnitz (17991851) of Austria,
hydropathy was based on enhancing the bodys inherent
vitality and purity. Priessnitz believed that pure water
could be used to flush out bodily impurities and stimulate
the bodys inherent tendencies toward health. Water-cure
treatments emphasized drinking large amounts of water
and applying water externally through baths, showers, or
wrapping wet sheets around the body. Most American
adherents of water cure advocated an eclectic approach to
health based on the curative powers of fresh air, diet,
sleep, exercise, and proper clothing. The philosophy of
water cure also had a decidedly moral tone.
Hydropathy equated disregard of the laws of healthful
living with defiance of Gods will. Systematic efforts to
promote healthful living were not only the means to
physical well-being but also the key to the spiritual
renovation of Earth. The hydropathic cause naturally
attracted many of the periods moral and religious
reformers. William Alcott, Lucy Stone, Amelia Bloomer,
Susan B. Anthony, and Horace Greeley visited major
hydropathic retreat centers, where they circulated reform-
ist agendas ranging from vegetarianism to utopian
socialism. Critical of the alleged superiority of official
medical authorities, advocates of hydropathy had a natural
affinity with the feminist thought of the time. Hydropa-
thy looked to nature, not credentialed male physicians, as
the ultimate source of healing; in so doing, it provided a
vehicle for those seeking to redress what they thought
were faulty notions of social and political authority.
Another nineteenth-century forebear of contempo-
rary alternative therapy in the United States was Sylvester
Graham (17941851), who combined conservative reli-
gious beliefs with zealous concern for health reform. An
ordained Presbyterian minister and itinerant evangelist,
Graham believed that human physical, moral, and
spiritual well-being required scrupulous adherence to the
natural order established by God. Graham admonished
his followers that avoiding alcohol and the overstimulation
of the sexual organs could help them maintain moral and
physical health. His advice for a healthful diet included a
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Alternative Therapies
coarse bread, which was later produced in the form of a
cracker that (in modified forms) still carries his name.
Grahams dietary principles, widely circulated throughout
the nineteenth century, served the cause of keeping the
souls bodily temple free from impurities.
Ellen White (18271915) occasionally visited a
hydropathic resort in Dansville, New York, where she
became a convert to Grahams dietary gospel. White
thereafter had a series of mystical visions in which God
revealed to her that he expected humans to follow the
divinely given laws governing health and diet as faithfully
as his moral laws. The Seventh-day Adventist denomina-
tion founded by White has since then adopted Grahamite
principles and a vegetarian diet as essential parts of
purifying themselves in expectation of the Second
Coming of Christ. Seventh-day Adventists, one of the
largest religious groups to originate in the United States,
combine their evangelical religious faith with a strong
emphasis on healthy dietary practices. This emphasis
upon a healthful diet does not in and of itself constitute an
alternative medical practice. Their dietary concerns are,
however, closely connected with their belief in the efficacy
of petitionary prayer. Furthermore, the Adventist church
opened health sanitariums, including the renowned
Battle Creek Sanitarium overseen by John Harvey
Kellogg (18521943) of breakfast cereal fame. These
sanitariums stressed hydrotherapy and nutrition but have
since developed into a system of hundreds of biomedical
hospitals and clinics around the world.
THE RISE OF MENTAL HEALING PRACTICES
Mesmerism. The introduction of Franz Anton Mesmers
science of animal magnetism, commonly known as
mesmerism, in the 1830s and 1840s popularized a belief
in the power of the unconscious mind to draw upon an
invisible healing energy. Mesmer (17341815), a
Viennese physician, believed that he had detected the
existence of an almost ethereal fluid that permeates the
universe. This fluid, called animal magnetism, flows
continuously into and is evenly distributed throughout a
healthy human body. If for any reason an individuals
supply of animal magnetism is thrown out of equilibrium,
one or more bodily organs will begin to falter. Mesmer
proclaimed, There is only one illness and one healing.
The science of animal magnetism revolved around the
identification of techniques for restoring a patients inner
receptivity to this mysterious, life-giving energy.
Mesmer held magnets in his hands and repeatedly
passed them over the heads and bodies of his patients in
an effort to induce the flow of animal magnetism into
their systems. His followers later dispensed with the
magnets, finding that oral suggestions from the healer
could induce patients into a trance, ostensibly heightening
166
their receptivity to the influx of this metaphysical healing
agent. Mesmerized patients claimed to feel prickly
sensations running up and down their bodies, which they
attributed to the influx and movement of animal magne-
tism. Awaking from their sleeplike trance, they reported
feeling refreshed, invigorated, and healed of such disorders
as arthritis, nervousness, digestive problems, liver ailments,
stammering, insomnia, and the abuse of coffee, tea, or
alcohol. Some patients even claimed that the mesmerizing
process enabled them to open up the minds latent powers
for telepathy, clairvoyance, and precognition. These claims
contributed as much or even more to mesmerisms growing
popularity than its reputation for healing.
A good many of those drawn to mesmerism were
middle- and upper-class individuals who styled themselves
progressive thinkers and were interested in uniting science
and religion in a single philosophical account of human
nature. Mesmerism struck them as an important step in
this direction. The phenomena surrounding mesmeric
trances were thought to provide empirical proof that each
human is inwardly connected with higher, metaphysical
planes of reality. Adherents of mesmerism believed that
under certain conditions of psychological receptivity,
humans are able to open themselves to an influx of energy
or guidance from these higher realms. American mesmer-
ists borrowed terminology from transcendentalism, spiri-
tualism, and Theosophy to provide their middle-class
reading audience with a new vocabulary for understanding
the interconnection of their physical, mental, and spiritual
natures.
Mind Cure and Christian Science. A popular philosophy
known as the mind cure, or New Thought movement,
grew out of the mesmerists healing practices. Mind-cure
writers in the United States published books and
pamphlets describing how thought controls the extent
to which we are able to become inwardly receptive to
spiritual energies. From Phineas P. Quimby and Warren
Felt Evans in the 1800s to Norman Vincent Peale,
Norman Cousins, and Bernie Siegel in the 1900s,
to Rhonda Byrne in the early twenty-first century,
Americans have displayed a remarkable enthusiasm for
this power of positive thinking literature. The mind-
cure movement gave rise to a novel form of religious piety
based on the belief that the deeper powers of our minds
control our access to a metaphysical power that can
instantly help us to achieve peace of mind, improved
health, and a never-ceasing flow of energy. The holistic
health movement of the late twentieth century relied
heavily upon this cluster of metaphysical ideas.
Mesmerism was also instrumental in the formation of
Christian Science. In 1862 Mary Baker Eddy, in great
physical and emotional distress, arrived on the doorstep of
the famous mesmerist healer Phineas P. Quimby.
BIOETHICS, 4TH EDITION

Quimbys treatments gradually cured her of her ailments;
they also gave her a new outlook on life, based upon
the principle that our thoughts determine whether we
are inwardly open to or closed off from the creative
activity of a spiritual energy (animal magnetism). Soon
after Quimbys death, Eddy transformed his mesmerist
teachings into the foundational principles of Christian
Science. Her principal text, Science and Health with Key
to the Scriptures (1875), reveals her intention to shift
the science of mental healing away from the categories
of mesmerism to those that bear more resemblance
to Christian scripture, albeit her own unique inter-
pretation of it.
The basic theological postulate of Christian Science is
that God creates all that is and all that God creates is
good. Sickness, pain, and evil are not creations of God,
and therefore they do not truly exist. They are simply the
delusions produced in an erring, mortal mind that has lost
a firm hold on the belief that only those things created by
God have true existence. For Christian Scientists the
universe is spiritual. What we call matter (e.g., bacteria,
viruses, and so on) consequently does not really exist and
therefore has no causal power. Christian Science healers,
known as practitioners, help individuals to overcome their
faulty thinking and to elevate their mental attitudes above
the delusions of the senses. Healing occurs as the
individual learns to function on a metaphysical rather
than a physical plane. Healings are understood not as
miracles or faith healings but as the lawful consequence of
exchanging false conceptions for true ones, which center
solely on the higher laws of Gods spiritual presence.
Both Christian Science and the holistic philoso-
phies that emerged from the mind-cure tradition teach
that our thoughts control the degree to which we avail
ourselves of the higher spiritual source from which health
proceeds. As a consequence, illness or disease is under-
stood as something the sufferer has brought upon himself
or herself through failure to sustain a correct mental
posture toward life. Any ethical analysis of these forms of
alternative therapy must take seriously their built-in
skepticism about whether a medical system really needs
to attend to material causes of illness (bacteria, viruses,
and others). The issue is not as acute for holistic healing
practices that do not deny that there are physical and
material causes of illness but simply maintain that mental
and spiritual factors are entailed in the etiology of most
illnesses and must be taken into account in any
comprehensive medical system. Although they insist that
a patients mental outlook often is a significant factor in
the creation and cure of illness, they generally do not
espouse a medical theory that puts all the blame for
illness or credit for recovery upon the patient.
Christian Science, by contrast, goes much further in
challenging the empirical and rational foundations of
BIOETHICS, 4TH EDITION
Alternative Therapies
Western science. By denying the ontological reality of
matter, and hence the causal power of viruses or bacteria,
Christian Science is clearly at philosophical loggerheads
with both medical orthodoxy and the legal systems of
most Western, democratic nations. Although the courts
allow Christian Scientists and others to avoid immuniza-
tion, concern over the medical well-being of children has
prompted judicial action to limit Christian Scientists right
to prevent minors from being denied medical treatment. In
1990 the US courts decided that two Christian Science
parents were guilty of child neglect when their sole reliance
on Christian Science methods was deemed responsible for
their childs death Such cases draw attention to the
important ethical distinction between private religious
belief and actions that have consequences in the public
domain regulated by the legal system.
CHIROPRACTIC AND OSTEOPATHIC MEDICINE
Osteopathic and chiropractic medicine provide interesting
examples of the fate of alternative philosophical, religious,
and ethical interpretations of healing in an age dominated
by scientific medicine. Osteopathic medicine emerged
from the healing philosophy of Andrew Taylor Still
(18281917). A former spiritualist and mesmeric healer,
Still developed techniques for manipulating vertebrae
along the spine in ways that he thought removed
obstructions to the free flow of the life-giving current
that promotes health throughout the body. Still explained
the healing principles of osteopathy (a term derived from
two Greek words meaning suffering of the bones) in
overtly metaphysical terms that described the origin and
nature of the life-giving current ultimately responsible
for human well-being. His followers largely discarded the
occult-sounding dimensions of Stills philosophy and
instead insisted that osteopathic medical education be
grounded in anatomy and scientific physiology. Thus,
although osteopaths originally relied only upon manual
manipulations of the spine as a means of restoring health,
they soon added surgery and eventually drug therapy to
their medical practice.
By the 1950s, so few differences existed in the
training or practice of osteopaths and medical doctors that
their two national organizations agreed to cease the rivalry
that had existed for several decades and to cooperate in
such matters as access to hospitals, residency programs,
and professional recognition. Having jettisoned the
alternative worldview of its founder, osteopathy no longer
bore any overt signs of unorthodoxy and finally found
itself within the medical mainstream. Interestingly, during
the 1960s many osteopaths were concerned about being
absorbed into allopathic medicine and gave renewed focus
to osteopathys philosophical origins. Their commitment
to osteopathys historical concern with enhancing the
bodys natural powers for recuperation made them
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champions of holistic medicine long before the term
holistic became commonplace among alternative healers.
As of 2012, there were over 82,500 osteopathic physicians
in the United States, with the number estimated to top
100,000 by the end of the decade (American Osteopathic
Association 2012, 2).
The case of chiropractic medicine is more complex.
Chiropractic medicine originated in the work of Daniel
David Palmer (18451913), a mesmerism-inspired mag-
netic healer in Iowa. Palmer, who knew of Stills
osteopathic techniques, theorized that dislocations of the
spine are able to block the free flow of the life force, which
he called Innate (his nomenclature for animal magnetism).
Palmer and his son, B. J. Palmer, explained that Innate
Intelligence is a part of the Divine Intelligence that fills
the universe, bringing full physical health whenever it
flows freely through the human body. Chiropractic
medicine represents the Palmers art and science of
adjusting the spine in ways that remove obstructions to
the free flow of Innate Intelligence within the body.
Over the years, chiropractic physicians began playing
down the movements metaphysical origins and empha-
sized its scientific approach to the treatment of musculo-
skeletal disorders. In this way, they minimized their
theoretical unorthodoxy and identified an area of medical
practice largely ignored by most medical doctors.
Chiropractic physicians sustained attention to this void
in the orthodox medical system has earned them a
viable niche in the medical marketplace. In 1990 more
than 19,000 chiropractic physicians in the United States
were treating more than 3 million patients annually; a
survey by the National Institutes of Health estimated that
by 2006 osteopathic and chiropractic physicians were
treating over 18.7 million Americans through manipula-
tive treatments (Barnes, Bloom, and Nahin 2008, 10).
Even though most medical insurance companies have
come to recognize the medical functions performed by
chiropractic medicine, medical doctors are still largely
wary of chiropractic medicine because it has failed to
elucidate an empirically validated theory that would
substantiate its therapeutic claims. This professional
tension provides a fascinating example of a continuing
theme in the history of alternative medicine: the clash
between orthodox medicines rationalism (its insistence
on an acceptable scientific explanation for all methods)
and alternative medicines pragmatism (discovery of
therapies that produce results regardless of whether they
are proved with rational theories).
ALTERNATIVE MEDICAL SYSTEMS
Around the world, a wide variety of therapies exist
alongside those based on medical science. An estimated 80
percent of the world considers alternative medicine their
168
primary health care option, while biomedical care is
unavailable or is prohibitively expensive. Within the
United States, variations of pow-wow, an eclectic tradition
using charms, prayers, and rituals to prevent and cure
disease, continue to be practiced by Pennsylvania Dutch;
curanderismo still flourishes among Mexican-American
communities in the American Southwest; and immigra-
tion from the Caribbean has rekindled African-American
folk medicine practices. The continued presence of such
ethnomedical treatments may represent attempts to
preserve cultural identity, economic disenfranchisement
from the nations more expensive conventional medical
system, or the revival of genuine medical pluralism. The
contemporary medical landscape is not, however, one that
ensures even ground for all competing systems. The very
notion of conventional versus alternative reveals
enduring discrepancies in legal status, institutional
funding, and access to insurance coverage. Furthermore,
conflicts between multinational pharmaceutical corpora-
tions and indigenous peoples and their advocates over the
intellectual property rights to medicinal plants point to an
ideological chasm between biomedicine and ethnomedi-
cine. In any case, both legal and economic attitudes
toward alternative therapies must be philosophically and
culturally nuanced.
Immigration from Asia has increased the presence of
Ayurveda and Chinese medicine in the West, and, in the
case of the United States, use of these therapies
dramatically increased immediately following the immi-
gration reforms of 1965. The National Institutes of
Healths National Center for Complementary and
Alternative Medicine (NCCAM) classifies these as
alternative medical systems or whole medical systems because
they are complete systems of theory or practice that have
evolved over time apart from conventional or Western
medicine. NCCAM distinguishes such systems, which
also include homeopathy and naturopathy, from biologi-
cally based therapies, such as supplements and diets;
manipulative therapies, such as chiropractic and osteopath-
ic manipulation; mind-body therapies, such as meditation
and breathing exercises; and energy-healing therapies, such
as Reiki and therapeutic touch. The fact that the
alternative medical system of Chinese medicine includes
therapies from the other four categories (e.g., herbs,
massage, and internal and external qigong) demonstrates
the arbitrariness of this delineation. Orthodox medicines
relationship with these systems lies somewhere between its
acceptance of osteopathy and its continued mistrust of
chiropractic: therapies like acupuncture are considered
efficacious, although practitioners explanations of how it
works are still largely rejected.
Ayurveda. The best known of Indias indigenous medical
systems, Ayurveda is founded on ancient (c. 500 B.C.E.
600 C.E.) Sanskrit texts that emerged from the
BIOETHICS, 4TH EDITION

heterogeneous religious traditions of Brahmanism, Bud-
dhism, and Jainism and circulated in translation across
premodern Eurasia, from Italy to China. These texts
outline Ayurvedic physiology, etiology, and diagnosis as
well as surgical techniques and the preparation and
dispensation of plant- and mineral-based medicines.
Despite some similarities to biomedical procedures,
Ayurvedic practices operate under different models of
the body than biomedicines aggregate of anatomical
structures and physiological systems. Ayurveda describes
the body as a series of seven layers (dhatu), animated by a
vital energy (ojas) and circulating three fluids (doshas):
wind (vata), bile (pitta), and phlegm (kapha). While one
or two of these fluids dominates each individuals
constitution, good health relies on a balance of the three,
and Ayurveda tends to stress prevention over cure.
Even though biomedicine has achieved orthodoxy
in postcolonial India, receiving the majority of state
funding, indigenous practices like Ayurveda continue to
thrive, partly through their adoption of the discursive,
institutional, and technological practices of scientific
medicine. In the West, however, where interest in Asian
medical systems grew dramatically at the end of the
twentieth century, it is precisely Ayurvedas difference
from biomedicine that makes it attractive to medical
consumers.
Traditional Chinese Medicine. Since the second half of
the nineteenth century, waves of migration have brought
Chinese medical practices, including herbalism, acupunc-
ture, massage, cupping and moxibustion, to the Americas,
Australia, and Europe. Like Ayurveda, Chinese medical
discourse describes the body as a microcosm of the
universe, through which courses a series of channels that
carry the fluid called qi (or chi). Blockages, excesses,
deficiencies, and imbalances of qi are considered to be the
root of disease, and these are treated through diet, herbs,
acupuncture, and other therapies. Several types of
imbalances can occur, the most important being those
between heat and cold; damp and dryness; and the five
phases (wuxing) of wood, fire, earth, air, and water,
which each correspond to one of five viscera.
There have been many competing schools of thought
and practice in Chinese medical history, but massive
standardization efforts in twentieth-century China
resulted in what is called Traditional Chinese Medicine
(TCM). This standardization is the result of professional
unification by practitioners in the face of competition by
Western biomedicine in the first half of the century as well
as the state control of education and health care after the
establishment the Peoples Republic in 1949. While other
Chinese practices, such as taijiquan (or tai chi) and
qigong, have also received international attention for their
health benefits since the second half of the twentieth
BIOETHICS, 4TH EDITION
Alternative Therapies
century, the NCCAM classifies them as mind-body
therapies rather than part of the alternative medical
system of Chinese medicine.
HOLISTIC MEDICINE
During the last few decades of the twentieth century, the
holistic healing movement led a surge of popular interest
in therapies based on an explicitly religious, or quasi-
religious, interpretation of the healing process. The precise
meaning of the term holistic medicine varies among healing
systems. Among its meanings are emphasis upon natu-
ral therapies, patient education and responsibility,
prevention, and treating patients as whole people. Also
common to holistic healing is the basic assumption that,
as one handbook put it, every human being is a unique,
wholistic, interdependent relationship of body, mind,
emotions, and spirit (Belknap, Blau, and Grossman
1975, 18). The term spirit, alongside body, mind, and
emotions, carries holistic healing beyond psychosomatic
medical models; it also represents commitment to a belief
in the interpenetration of physical and nonphysical
spheres of causality. Even holistic healings exhortations
concerning reliance on the bodys own regenerative and
reparative processes are typically laden with references to
opening individuals up to the inflow of a divine healing
energy. Persons who call themselves holistic health
practitioners typically operate according to a worldview
that is incompatible with the naturalistic framework of the
modern Western scientific heritage.
One example of such a holistically oriented healing
movement and its methods is Alcoholics Anonymous
(AA) and its twelve-step program, which has influenced
many other self-regenerative therapies. Founded in the
1930s, AA has well over 1 million members, with about
35,000 groups meeting weekly in over ninety countries.
The principal founder of the movement, Bill Wilson, was
an alcoholic who became aware of his inability to
overcome his addiction. A mystical experience of a great
white light (Kurtz 1979, 19) convinced him that a loving
presence surrounds us and is capable of healing our
broken inner lives. Wilson maintained that we need only
cease relying upon our own willpower and surrender to
this Higher Power. Wilson was wary of institutional
religions moralism. From psychologists such as William
James and Carl Jung, he pieced together a spirituality
based upon opening the unconscious mind to a higher
metaphysical reality. AA counsels its members that in
order to recover, they must acquire an immediate and
overwhelming God-consciousness followed at once by a
vast change in feeling and outlook (Alcoholics Anony-
mous 1955, 569). AAs mystical, nonscriptural approach
to personal regeneration sets its doctrines apart from most
of the United States religious establishment; its denunci-
ation of both material and psychological/attitudinal
169
Alternative Therapies
factors in favor of an overtly spiritual view of healing sets
its practices apart from the American medical and
psychological establishments. But its open-minded and
eclectic sense of the presence of spiritual forces in the
determination of human well-being made it one of the
most powerful mediators of wholeness in twentieth-
century America.
The various religious and healing groups that
constitute the New Age movement also endorse a holistic
approach to health and medicine; they envision every
human being as a unique combination of body, mind,
emotions, and spirit. Central to New Age piety is the
conviction that each person exists simultaneously on both
the physical and the metaphysical (i.e., the astral and
etheric) planes of reality. Many New Age therapies seek to
channel healing energies from higher metaphysical planes
into the physical body. Energy healing, for example,
maintains that illness in the physical body is frequently
caused by a disruption or disharmony of energies in the
part of the body that extends into the metaphysical plane,
called the etheric body or the subtle body. Healing
consequently requires techniques to achieve harmony
between the physical and metaphysical bodies.
Crystals are thought to have unique properties that
enable them to serve as receptors and capacitors of
energies from the metaphysical planes. Used properly,
crystals are assumed to be capable of transmitting these
energies in ways that bring the individuals physical,
moral, and spiritual natures back into harmony. To this
extent, New Age adherents do not reject the efficacy of
established medical science (though they do condemn
what they perceive to be an overreliance on drugs and
invasive surgical techniques) so much as its secularist,
materialistic worldview, which fails to take into account
our spiritual potentials. Healing, for New Agers, is a by-
product of the more fundamental goal of expanding their
spiritual awareness. Many Westerners attraction to Asian
practices, including yoga, tai chi, and Reiki, is bound up
with agendas left over from such nineteenth-century
movements as mesmerism, spiritualism, and Theosophy.
Even acupuncture is embraced by many Americans not
only for its obvious physical benefits but also for its
connections with Eastern mystical philosophies.
THE CHALLENGE TO BIOETHICS
Persons with life-threatening diseases who have not been
helped by conventional treatments understandably be-
come interested in pursuing alternative therapeutic
strategies. The highly publicized debate in the late
1970s over the effectiveness of laetrile for retarding
cancer drew attention to the potential risks of the
regulation of medicine by the US Food and Drug
Administration. At stake was the unresolved issue of
whether a drug should be restricted only when it is known
170
to cause harm or only when laboratory testing has failed to
reveal measurable physical benefits. This debate continued
in the 1980s and 1990s over various treatments for AIDS.
Persons given a bleak prognosis by medical doctors sought
immediate access to experimental drugs that had just
entered the slow and laborious regulatory processes
mandated by US federal law. Although much has been
done to try to speed up the evaluation of experimental
treatments for AIDS and other prevalent diseases such as
cancer, there is always a subset of the population that finds
itself barred from access to innovative scientific treatment.
The central ethical question raised by alternative
therapies is whether genuine medical treatment can be
distinguished from various forms of quackery. Except for
isolated instances in which individuals engage in deliber-
ate medical fraud, quackery is difficult to identify or
prove. Any reliable definition of therapeutic benefit
requires being able to define the factors known to
affect human well-being and what optimal health consists
of. The practitioners of many forms of alternative
medicine criticize the assumptions they believe underlie
contemporary medical science. They argue that alternative
therapies better understand human well-being and are
cognizant of mental, moral, and spiritual factors that go
well beyond the physiological considerations on which
scientific medicine relies. To those who say that their
practices or those who utilize them are irrational, they
respond that every therapy is rational insofar as its
methods of treatment are logically entailed by its
fundamental premises or its assumptions about the nature
of disease.
Establishing criteria with which to mediate between
competing medical systems is complicated by the fact that
the plausibility of the beliefs or assumptions that underlie
them are every bit as dependent on sociological factors as
on intellectual proofs. What we consider valid evidence,
whom we consider expert authorities, and how we should
go about separating relevant from irrelevant information
turn not on objective, rational criteria but on the ways we
were socialized into one belief system or another. Who,
then, is in a position to decide what is an irrational
medical choice? With what degree of confidence or
philosophical integrity can orthodox physicians seek to
dissuade persons from seeking alternative treatments? Do
persons have a right to what seems, to adherents of
accepted forms of Western medicine, to be an utterly
ineffective therapy simply because it conforms to their
personal belief system?
Alternative therapies may reasonably be expected to
demonstrate their benefits to patients and to substantiate
the claim that their distinctive healing practices directly
cause these therapeutic results. Medical ethics is con-
cerned with protecting persons from intended or inadver-
tent harm. Well-intentioned tolerance of alternative
BIOETHICS, 4TH EDITION

therapies should not preclude their undergoing rigorous
scrutiny. Governmental agencies, health care facilities, and
insurance companies are forced to allocate limited
resources and to ensure the welfare of the general public.
They must be prepared to make reasonable assessments of
alternative medical systems that are based on belief
systems at considerable variance with modern Western
science. Because quackery poses an inherent threat to both
personal and public well-being, those who make ethical
and policy-related judgments must exercise caution and
strive for the unrelenting application of public (openly
demonstrable and subject to empirical scrutiny) standards
of evidence. Perhaps the most important consideration
in assessing scientifically unvalidated therapies is that
contemporary medicine differs from its predecessors not
because we have become more rational but because we
have learned to use the controlled trial to determine the
relative merits of competing treatments.
Medical systems that are labeled alternative because
their concerns or treatments are at the periphery of
mainstream medicine are reminders that dominant
professional groups tend over time to employ predatory
tactics to ensure their continued supremacy and keep
potential competitors at a distance. These medically
peripheral systems alert us to the fact that medical science
has philosophical and institutional blinders that may close
off, rather than open, innovative approaches to human
health. The presence of alternative health professionals in
the wider system of health care helps safeguard against the
kinds of complacency and narrowness of vision that
frequently creep into economically entrenched profes-
sions. By providing a range of services that address both
curative and preventive issues typically neglected by
biomedical physicians, many of these alternative therapies
potentially contribute to a comprehensive understanding
of human health and well-being.
The twenty-first century is perhaps no closer to
adjudicating the scientific, economic, and ethical contro-
versies surrounding alternative medicines than previous
eras. In 1991 US Senator Tom Harkin spearheaded the
effort to create a special division of the National Institutes
of Health dedicated to the research of promising
unconventional therapies. The Office for Alternative
Medicine was initially launched with a budget of $2
million and, by 2010, had grown into NCCAM with an
annual budget of about $120 million. The centers use
of the descriptive phrase complementary medicine
seemingly endorses the view that alternative medicines
might be used in combination with conventional medical
treatments, as is also implied with other phrases such as
integrative medicine. The creation of NCCAM coin-
cided with the United Kingdoms decision to fund
homeopathic hospitals under the National Health Service.
Governmental support for these alternative medicines
BIOETHICS, 4TH EDITION
Alternative Therapies
predictably generated considerable criticism from physi-
cians, scientists, and public policy analysts. Critics note
that the use of public funds to research and promote
complementary and alternative medicine (CAM) gives the
misleading impression that these treatments have been
clinically validated in addition to diverting research funds
from the most scientifically promising treatments (Bausell
2007; Ernst 2008; Singh and Ernst 2008). Debates about
whether NCCAM is driven more by scientific method or
ideological agendas reflect the continuing public dilemma
about how to assess the clinical and economic merits of
alternative medicine.
SEE ALSO America, Bioethics in: I. United States; Bioethics:
VIII. Sociology of; Health and Disease: III. Anthropo-
logical Perspectives; Medicine, Anthropology of; Medi-
cine, Philosophy of
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Barnes, Linda L., and Susan S. Sered, eds. 2005. Religion and
Healing in America. New York: Oxford University Press.
Barnes, Patricia M.; Barbara Bloom; and Richard L. Nahin. 2008.
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and Children: United States, 2007. National Health Statistics
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Belknap, Mary; Robert Blau; and Rosaline Grossman, eds. 1975.
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Robert C. Fuller (1995, 2014)
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Justin Stein (2014)
Doctoral Candidate, Department for the Study of Religion,
University of Toronto
II. ETHICAL AND LEGAL ISSUES
Alternative medicine covers a dizzyingly heterogeneous
group of medical theories and practices that are not part of
mainline conventional medicine. Alternatives range from
the different forms of folk medicine to more scientific
systems such as homeopathy, chiropractic, acupuncture,
and naturopathy. Also included under the term alternative
are hypnotherapy; herbalism; iridology; the traditional
medicines of India, China, Japan, the Philippines, and
indigenous peoples; yoga; diet; meditation; music therapy;
massage therapy; and reflexology. Certain shared negative
elements justify lumping together such diverse medical
theories and practices. These include marginal social
standing or fringe status in advanced cultures; exclusion
from mainline professional journals; little public funding
for research; exemption from mainline licensing require-
ments; and conflict (but sometimes cooperation) with
mainline medicine. The essential ethical and legal
considerations raised by alternative medicines are scientific
objectivity, veracity, and beneficence and nonmaleficence.
Because false claims of healing efficacy can cause direct
and indirect harms to patients, such claims violate the
essential ethical obligation of all medical practice, whether
alternative or conventionalthat is, to help and not to
harm. On the other hand, there is an ethical issue that
supports many alternative medicines: the frequent failures
of mainline conventional scientific medicine to connect
personally with the patient, to establish and then continue
a personal relationship, and to pay primary attention to
the patient rather than to technologies. Into the ethical
vacuum in mainline medicine, created by the loss of
personal relationship with patients, step many different
forms of alternative and unconventional medicines.
THE MEANING OF ALTERNATIVE AND
CONVENTIONAL
Once the Flexner Report (Medical Education in the United
States and Canada: A Report to the Carnegie Foundation for
the Advancement of Teaching) commissioned by the
American Medical Association (AMA) was published in
1910 in order to improve medical education in the United
States and bring quality controls to medical curricula,
BIOETHICS, 4TH EDITION