Why all the debate?

'Both alternative and orthodox medicine will continue to co-exist at present'.  Sylvia Thompsonexamines the role played by orthodox medicine and alternative therapies in today's medicine.

The tensions between orthodox medicine and alternative and complementary therapies are not new.

So says Roberta Bivins, medical historian and author of the recently published Alternative Medicine - A History (Oxford University Press, £14.99).

In her book, Bivins chronicles the popularity of homeopathy in Europe in the 19th and early 20th centuries and examines how it only became an "alternative - or challenger to the medical system it had intended to reform - when it was squeezed out by orthodox hostility".

She also explains how despite such hostility, in countries such as Britain where there were once eight homeopathic hospitals, homeopathy continues to be the medicine of choice for significant numbers of people.

Similarly, Bivins describes how patients' interest in traditional Chinese medicine therapies such as moxibustion and acupuncture in the 18th and 19th centuries led to their inclusion in the repertoire of skills of some orthodox medical doctors in Europe.

A graduate in genetics and neurobiology, Bivins worked on the Human Genome Project before becoming a lecturer in the History of Medicine at Cardiff University in Wales.

"I wrote this book because I found that there were very few books which deal with more than one medical system at a time, yet in the marketplace we use orthodox medicine and alternative or complementary therapies all the time," she explains.

Bivins also has a personal interest in promoting greater understanding between what she describes as cross-cultural medicine and biomedicine or orthodox medicine.

As a child of academic American parents, she lived in Nigeria for some time and was successfully treated by a practitioner of classical Islamic medicine when western medical drugs failed to diagnose and treat her illness. It was a disease affecting predominantly poor, rural African children.

"Biomedicine did not even have a name for my village illness, much less a cure for it," she says.

Separately, while in the US, Bivins had an extreme reaction to the routine school vaccination for tuberculosis. After a battery of tests, it was discovered that she had contracted tuberculosis and was subsequently treated with orthodox medicine which returned her to full health.

"Today's debates between proponents of a biomedical monopoly and practitioners [ and consumers] of alternative healing practices continue a grand tradition in the modern medical marketplace," argues Bivins.

In her book, Bivins draws interesting parallels between earlier western medical systems (including humouralism) and Ayurvedic medicine and traditional and Chinese medicine.

Her historical research also looks at the changing involvement of patients in their own healthcare.

"In the 18th and 19th century, there was a high level of lay access to and participation in the medical press and the process of medical innovation," she writes.

However, as orthodox medical expertise evolved, Bivins says the experiential, subjective account of illness was replaced by practitioners' observations which were "gained increasingly through physical and technological mediated examination of the patient's body and exclusive knowledge".

Thus followed the rise of hospitals, laboratories, an increasingly urbanised population and, later, the state involvement in healthcare.

"The major innovations of the 19th century - surgical anaesthesia, germ theory and the weight of state intervention [ public health measures sought to fight the filth even if infectious diseases could not yet be cured] . . . tipped the balance in favour of orthodox biomedical monopoly," she writes.

Bivins explains how throughout the 20th century, hospitals moved from being places of last resort in medical care (and thus serving mainly the poor) to becoming the central institutions of medical practice, education and research sites.

Like many others, Bivins attributes the more recent rise of interest in alternative and complementary therapies in the West to the eradication of infectious diseases and the rise of chronic, degenerative conditions which don't always respond well to treatment by biomedicine.

"A new cultural focus on individualism also went against the grain of biomedical practice and the constantly decreasing time allotted to the doctor-patient encounter within orthodox medicine," she writes.

The time and attention that alternative/complementary therapists give to their patients has since begun to have an impact on orthodox medical doctors, according to Bivins.

"A new trend is emerging in biomedicine which is called 'activating the patient'.

"While not the same as treating the patient as an equal, it does engage the patient in his/her own care such as in diet and the rigorous regimes required for chronic disease management.

"This will become a central part of biomedicine in the future," she says.

Bivins also draws parallels between the state's involvement in the regulation and professionalisation of orthodox medicine in the 19th century and current state involvement in the regulation of complementary/alternative therapies.

"This month's announcement of the new regulatory body for complementary therapists in Britain [ the Natural Healthcare Council] which the department of health commissioned the Prince of Wales Foundation to set up is an example of this," says Bivins.

She also argues that complementary practitioners are also demanding regulation, "as they are concerned about the effects of competition, the widely variable levels of training and consequent damage to their own and their therapy's reputation," she says.

Alternative and complementary therapists (Bivins argues that both terms, alternative and complementary, are appropriate to use) are also, similar to their orthodox medicine colleagues, seeking funds from governments, industry and charitable foundations for research, education and services to patients.

Bivins argues that new research strands which "treat the person as an experimental instrument" could get some very interesting results.

"Both cost and consumer demand are encouraging the entities that foot the healthcare bills to look closely at alternative forms of medical provision," she writes.

"The perceived focus of many alternative therapies on self-healing behaviours sits well with contemporary public-health campaigns and, as long as chronic and degenerative illnesses are on the increase and intransigent to biomedical intervention, the cost-effectiveness of alternative therapies will remain appealing."

Bivins suggests that orthodox medicine is beginning to embrace, perhaps for the first time, medical concepts and theories (historically, western medicine only embraced the practices and products of medical systems such as traditional Chinese medicine and Ayurveda) of cross-cultural medicine.

She cites a recent study in Norway in which both medically and non-medically trained acupuncture practitioners used Chinese medicine concepts.

Many medical students also now have the opportunity to study alternative therapies within orthodox medical schools and universities.

Ultimately, Bivins argues that both alternative and orthodox medicine will continue to co-exist at present.

"Anything that engages the patient will attract the interest of the governments of the day and, at the moment, we're in a growth period.

"Many GPs are also using alternative therapies or sending patients to complementary therapy practitioners.

"It's not a synthesis as such but there is a better synergy than in certain other periods," she says.