The Persuasive Appeal of Alternative Medicine

The major presence of alternative medicine in western culture has been well documented [1, 2]. Discussion has focused on whether these practices have any biomedical efficacy and on potential adverse consequences. We examined the possibility that the cultural beliefs and contextual practices of alternative medicine frame a pathway of words, behaviors, and experiences that people find persuasive, compelling, and, ultimately, restorative. Shared cultural assumptions may provide a vehicle for an enlarged sense of self and a renewed sense of morality and purpose. This inquiry is not meant to advocate or debunk alternative medicine; rather, it describes cultural and epistemologic dimensions of alternative medicine, which are too often overlooked. Any generic discussion of alternative medicine is problematic. In the industrialized western world, many unorthodox medical therapies are readily available. Together, they represent a heterogeneous population promoting disparate beliefs and practices that vary considerably from one movement or tradition to another and form no consistent body of knowledge [3]. Despite this diversity, much of alternative medicine shares important underlying assumptions and themes that have allowed these movements to form a significant coalition in their historical tug of war with conventional medicine [4-7]. Although disagreement exists, the depth and consistency of common intellectual, emotional, political, and health care preconceptions have contributed to the strength of the alternative medicine alliance. The fundamental premises uniting the alternative community involve nature, vitalism, science, and spirituality. Taken together, these principles expand behavioral options, identity, experience, and meaning when illness (or its possibility) threatens a person's intactness and sense of connection to the world. We examined these four basic assumptions of alternative medicine in the hope of facilitating understanding and communication among physicians, patients, and providers of alternative therapies. Nature Alternative medical therapies provide patients with the generous rhetorical embrace of a benevolent nature. In alternative medicine, nature is innocent and wholesome and is the iconographic symbol of virtue [8]. Oliver Wendell Holmes (1809-1894) called this romantic view the nature-trusting heresy [9]. The belief encodes an unambiguous set of moral polarities: natural versus artificial, pure versus toxic, organic versus synthetic, low-technology versus high-technology, and coarse versus processed. Biomedicine automatically suffers in this bifurcation because of its association with sophistication and technology as opposed to the perceived simplicity of undeveloped nature. In this optimistic and hopeful view, any adverse aspects of nature (ranging from anthrax bacillus to deadly nightshade and snakebite) tend to be overlooked [10]. Nature is the defining metaphor for many alternative medicines. The preference for botanical medicine is rooted in this idea [11, 12]. The health food movement articulates the superiority of natural food [13, 14]. Even if it is not the central image, a belief in nature pervades other complementary medicines. The metaphor is pliable, relative, and honorific; anything in the alternative alliance is allowed this approbation. Thus, acupuncture needles, megavitamins, and meditation are all natural. By using natural treatment or changing one's life habits to conform to nature's norms, a person connects to what is perceived to be a less artificial version of personhood. Authenticity is immediately enhanced by purifying oneself of the toxic dimensions of civilization and their consequent diseases. Natural healing also implies ipso facto participation, even without conscious intention, in a wider reform movement for the regeneration of an overly developed technological society. Natural health takes on dual dimensions: personal healing and perfecting of the social order. The debility of disease (or the work of health maintenance) becomes an opportunity to save both the self and the world. Vitalism Alternative medicine offers a person threatened by illness or disease a connection with fundamentally benign, lawful, coherent, potent, and even meaningful powers [15]. When illness isolates, alternative health care allows a rescuing connection to life-supporting cosmic forces. This vital energy takes myriad forms: homeopathy speaks of a spiritual vital essence [16], chiropractic refers to the innate [17], and acupuncture is said to involve the flow of qi [18]. Ayurvedic medicine is based on the power called prana [19], and new age healing practices work with psychic or astral energies [20, 21]. The alternative alliance routinely claims that its methods rely on enhancing life forces as opposed to destroying them with artificial drugs and surgery [22]. Much of alternative medicine is also pervaded with a mental form of vitalism in which the force is not physical but is considered to stem from the mind or deeply held emotions [23-25]. In this belief system, consciousness or affective states are considered to be the primary arbitrators of health. Such best-selling books as Bernie Siegel's Love, Medicine and Miracles and Deepak Chopra's Ageless Body, Timeless Mind: The Quantum Alternative to Growing Old testify to the appeal of this form of vitalism. The threat of disease is greatly diminished as a person's imagination, will, and belief are empowered with healing consequences. Again, an optimistic perspective paradoxically manages to overlook any sense of fault or guilt generated from this enhanced autonomy and self-determinism [26, 27]. Science When people use alternative medicine, the scientific enterprise does not have to be abandoned. In fact, the label science in alternative medicine, as in biomedicine, is an important source of legitimating power, moral authority, and self-definition. Alternative medicine includes chiropractic science [28], homeopathic science [29], psychic science [30, 31], and even occult science [32, 33]. Academic science would undoubtedly call these approaches scientism and discuss the boundaries between science and pseudoscience [34-36]. However, for practitioners and their patients, these sciences are absolutely credible. Indeed, many of these disciplines have a long intellectual tradition and sophisticated philosophy [37-39], as does the broad notion of nature's healing power [40] and vitalism [41, 42]. Adding to the genuineness of the scientific label is the fact that training in alternative disciplines may involve years of study of complex knowledge bases and relations, intricate determinations of causality, and empirical testing of practice [43]. When debunkers or neutral scientists attack the nonscience of alternative medicine, participants are mostly perplexed or annoyed. Biomedicine has a set of epistemologic assumptions that differ radically from those of alternative medicine [44]. Alternative medicine's version of science lacks the recently adopted biomedical notion of clinical experiments carried out under artificially and deliberately controlled conditions, exemplified by the double-blind, randomized trial [45, 46]. Its version of science is observational and more closely resembles the modern sciences of paleontology and geology [47]. The science of alternative medicine is ultimately person friendly. Its language is one of solidarity, unity, and holism instead of the distant, statistical, and neutral conventions of normative science [48]. The person-centered experience is the ultimate verification and reigns supreme in alternative science. Because self-knowledge and simple observation are not deprecated, no placebo effect haunts and casts doubt on the validity of therapeutic outcomes [49, 50]. Alternative medicine makes no rigid separation between objective phenomena and subjective experience. Truth is experiential and is ultimately accessible to human perceptions. Nature is not separate from human consciousness. Instruments that extend the senses or objective diagnostic or laboratory tests that discern what cannot be felt never replace human awareness. A patient never has to fear that an illness will be branded as existing only in their head. A real cause will be found for any sensation. The science of alternative medicine, unlike the science component of biomedicine, does not marginalize or deny human experience; rather, it affirms patients' real-life worlds. When illness (and, sometimes, biomedicine) threatens a patient's capacity for self-knowledge and interpretation, alternative medicine reaffirms the reliability of his or her experience [51]. Alternative medicine science has no radical skepticism. In fact, alternative medicine science sometimes takes on the appearance of proving deeply held beliefs by selectively appropriating normative scientific studies. For example, consumer infatuation with and hope in self-prescribed vitamins is unshakable and is sustained by skewed attention to scientific knowledge; contrary evidence is often overlooked [52]. Spirituality Alternative medicine offers more than physical and mental health care. In the words of one observer, it comprises medical systems that dispense heavy doses of unconventional religion [53]. Through the patient's participation in nature, vital forces, and a human science, the quest for health takes on sacred proportions, allowing the patient to discern ultimate meaning and make profound connections with the universe. Conventional medicine more or less acknowledges a Kantian philosophical demarcation between science and religion. Science is exhaustively competent in the realm of causality in time and space, whereas religion is the domain of moral freedom and self-chosen values [54]. For many people, this dichotomy can be confusing and sterile. Many people want their truth with more unity and seamless-ness. In alternative medicine, the spiritual and physical domains provide different