Saturday, 21 November 2009

Review of "Alternative Medicine? A History", by Roberta Bivins

I have to say, despite the promise of its title, this book was a disappointing read. Although the first chapter harks back as far as the 17th century and there is a nod to 20th century in the closing chapter the bulk of this work is an account of the challenges to the Western medicine of the 18th and 19th centuries from medical systems introduced from other parts of the world. The alternative medical systems addressed are mainly moxibustion and acupuncture but also include Traditional Chinese Medicine, Ayurveda, Unani Tibb, mesmerism and homeopathy (Europe's 'home grown' alternative medicine).

The history covered in the work is worthwhile, if limited. It is interesting to learn for example about the introduction of acupuncture into Europe and the reaction of the medical establishment to it in the 1700's or even earlier and how, as a practice it was confused by western doctors with a method of bleeding and so condemned as ineffective; similarly moxibustion was confused with cautery. It is interesting to hear that moxibustion as a treatment for the ubiquitous gout of the 18th century was highly praised in certain circles, not least because it avoided the brutal, painful and occasionally life threatening medical practices then current.

Following this however, no attempt is made to bring the subject up to date and discuss how scientific advances have allowed modern medicine to emerge from and leave behind earlier "mainstream" practices including bleeding, cupping, scarification, puking and purging which by and large made no more rational sense than the alternative practices under discussion. Instead, the author choses to portray the current medical establishment as if it were still of the dogmatic mind set of its predeccessors of 200 years ago. This approach provides a false, straw man, construct which will give encouragement and ammunition to those who currently practice and promote non-scientific medicine but has no basis in reality.

So, this book appears to be yet another work by an author versed in social sciences to conflate 19th century so called "heroic" medicine with modern science based medicine and, with a postmodern bent, present any and all alternative systems of medicine as simply "other ways of knowing" and allegedly equally as valid and effective as science based medicine. Very early in the work the tone becomes increasingly partisan and, turning against scienctific medicine, borders on the polemic at times with claims that orthodox medicine was "forged in the furnace of fear and loathing of homeopathy", Ether was promoted to combat Mesmerism and that anatomical study is a way of excluding women and non whites from "the franchise" (none of these claims are referenced so the reader is left guessing about their veracity).

Scientific medicine (or "biomedicine") is dismissed, without supporting evidence as impersonal and driven by the needs of the laboratory and technology and the "medical-industrial complex". Modern doctors are accused of being concerned only with dispassionate observation and measurement and of ignoring patient self reporting. The author is apparently unaware of the enormous part played in the conventional therapeutic relationship by history taking and has perhaps forgotten how often a doctor will open a consultation with the words, "how do you feel?".

From the outset, as the reader is told of the author's childhood, growing up alternately in various isolated African communities and urban New England, to the closing sentence when people are urged to see other cultures first hand and "judge for themselves if qi or prana are more or less credible, comprehensible, and intellectually attractive than neurotransmitters or the Krebbs cycle" this book is characterised by an apparent lack of understanding of science and of the importance of simply being able to decide whether a medical procedure works or not, something science alone, not tradition, not intuitive "ways of knowing", can tell us. Neurotransmitters and the Krebs cycle exist, whether Western intellects find them attractive or not is simply missing the point.

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