When doctors and health care practitioners post online about patients who’ve recovered successfully from COVID-19, their posts are consistently blocked and removed from public view. The Federal Trade Commission as well as other regulatory authorities and social media companies have persistently scrutinized content around COVID-19. Medical physicians and practitioners of any kind have been warned only to talk about evidence-based facts related to COVID and not to peddle a cure, as the world awaits a vaccine.
These tools of regulating information might help clamp down on misleading claims, but they can also create a hierarchy of legitimacy deciding which practices are considered credible, legitimate and real.
Real Change recently published a piece called “The Wisdom of Prevention” that examined how alternative medicine can harness principles of prevention and balance to mitigate the harms of disease. A common theme emerged in the reporting: Alternative medicine practitioners — many of whose practices come from philosophies and traditions of non-Western and non-conventional influences — have to struggle against regulatory, licensing and ideological powers to maintain legitimacy.
Using medicine for power
Medicine has been used as an instrument to gain power for centuries, conventional Western medicine from the establishment of Western civilization all the way up to present — including Western doctors’ abuse of Henrietta Lacks, a poor, Black American woman, to create a cell line now vital to medicinal research.
Western medicine has come part and parcel with missionary colonization and been used by European colonialists to take command of new territories the world over. This happened in India where, prior to British influence, there were schools for ayurveda and other medically complex procedures, such as plastic surgery that dates back to the surgeon Sushruta in 800 B.C. It also happened in the Americas, where Indigenous people were ravaged by diseases to which they were not immune. Six countries carved out African territory for themselves in the 19th and 20th centuries: Britain, France, Germany, Spain, Portugal and Belgium came to gain wealth and natural resources and grow their empire’s interests.
Northwestern University professor of history Helen Tilley examines the many impacts of European colonizers’ use of conventional western medicine on African colonies and how those attitudes continue even today in a 2016 article in the American Medical Association’s Journal of Ethics.
Inherent in Westerners’ conquests was rhetoric of superiority — think of Englishman Rudyard Kipling’s colonial-era poem “The White Man’s Burden,” which says it is the white man’s duty to civilize and take care of the world’s “uncivilized” (non-white) people.
In this context, according to Tilley, “health activities took on an exalted role given the ethos of improvement since they were a visible and seemingly uncontroversial way to address the needs of the continent’s people.”
Tilley says modern Western medicine was often invasive compared to what local tribes and communities had used for ages. Creating hospitals and medical administrations was a way to bring colonized subjects under their wing, while they simultaneously increased health risks by bringing disease and new infections with the destruction and exploitation of natural resources, such as mining.
Once medical infrastructure was put in place in African territories, European administrators wouldn’t allot reasonable budgets for medical needs in Africa. The people of various African colonies were also used as subjects for medical experiments and for the progress of science during this period. It was only after the Holocaust and World War II that Western powers in Europe and North America even created ethical standards for the practice of medicine.
Tilley’s work also shows that “African therapeutics’’ and Indigenous healing practices were marginalized through criminalization and policies. Tilley found parallels between the marginalization of traditional healing, which is cultural and place-based, and the oppression of people and communities who practice it. This aids in the delegitimization of the experiences, histories and knowledge of people and cultures who have been under the heel of colonial rule — a reality that is still fresh in the minds of many countries and generations, as much of the world has only gained independence within the last century.
The politics of legitimacy
Today, regulation and standards are a means to determine safety, and those guidelines are set by organizations with power, like the Food and Drug Administration, Centers for Disease Control and American Medical Association (AMA). In fact, health care providers must apply for a separate license to use the Current Procedural Terminology (CPT) code which is “set, created, and maintained” by the AMA. The code is used to report all healthcare services to insurance providers.
It can be a struggle for alternative health care providers to get the CPT-code license and, therefore, a seat at the decision-making table and limits their business and peoples’ access to services.
The AMA also engages in advocacy for the rights of physicians and patients to ensure the best health care. One of these advocacy categories is called Scope of Practice, where the goal is to “safeguard medicine” from “nonphysician professional attempts to inappropriately expand their scope of practice.”
In Washington state, naturopaths — some of whom also practice Traditional Chinese Medicine (which includes acupuncture) and ayurveda — can be licensed and be primary care physicians. To achieve licensure in naturopathy, one must graduate from four years or more at a federally-accredited naturopathic medical school, studying curriculum that incorporates Western medicine. Some naturopathy students, especially acupuncture students, use cadavers in their training, like conventional medical students. Finally, the licensure requires passing an overarching exam.
The AMA has specific language to deter naturopaths from organizing to prescribe controlled substances and pharmaceuticals. Naturopaths in Washington cannot prescribe controlled substances or opioids, but can prescribe antibiotics and other pharmaceuticals. The AMA’s advocacy handbook, which can be used as a tool when advocating for or against legislation, says this about Naturopathic medicine, glossing over the rigorous, and often integrative, studies naturopaths complete to become licensed practitioners:
“Indeed, naturopathic beliefs are rooted in vitalism, the pre-20th-century assertion that biological processes do not conform to universal physical and chemical principles,” states the AMA. “While naturopaths will point to minor pharmaceutical training included in curricula for schools of naturopathy, it is important to note that there is no naturopathic standard of care, and that many naturopathic therapies have not enjoyed the rigorous scientific study of those pharmacotherapies taught in osteopathic and allopathic schools of medicine. Granting naturopaths the right to prescribe is therefore a dangerous proposition. Moreover, naturopathy has long been considered by many state legislatures and the public as the natural practice of healthcare. To grant the right to prescribe any form of drug to the naturopath is not only dangerous, but also confusing to the public.”
Dr. Joshua Rubinstein, a professor at Bastyr University in Kenmore, Washington, says, “At some point, we have to come to peace with that — being questioned: ‘Are you a real doctor?’”
The politics of who can practice and what methods are credible are deeply entangled with what we consider to be “scientific” and “evidence-based.” While science in itself is an exploration of the world and an inquiry of knowledge, limiting what is “scientific” decides which knowledge does and does not have power.
Dr. Kathleen Lumiere has always been deeply curious about science and therapeutics, which led her to become a licensed acupuncturist and Bastyr professor. Lumiere says research methods and study design are rooted in a “pharmaceutical model” of double-blind studies and controlled experiments that don’t work well to measure the effects of massage or thoughtful, kind listening, for example.
“It’s hard for aspects of the current and most dominant model, the controlled randomized trial, to capture nuance and complexity. And a lot of things that have to do with quality of life and inner sense of well-being,” she said, adding that there are researchers working on qualitative (to enhance quantitative) data-analysis models.
Lumiere says the current model of medicine and science which is the nucleus of hospitals, pharmaceuticals and insurance systems begins to disintegrate as people start to hit the limits of the current medical universe. “They want more humanity, they want more interaction, they want more care, they need a multi-faceted approach,” she said.
Research methodology, Lumiere says, will inherently reflect the values and privileged worldview of the time. The messy politics around pharmaceuticals deserves an article all its own, but contributes to this heavily. Rubinstein says naturopaths use evidence-based therapies, yet because they use the medicinal properties of plants and naturally occurring materials, the medicine is accessible and, thus, not as lucrative as synthesized pharmaceutical products. A number of practitioners echo this sentiment citing that money and bottom lines drive pharmaceutical interests, so equal value and resources have not been given to alternative methods of healing.
Synergize instead of divide
The regulatory and legitimizing systems of Western medicine pit conventional and alternative medicine against each other. While they differ in approach, procedures and the valuation of holistic health, Lumiere says the two need not be in opposition and can work synergistically. Lumiere works at the intersection of biomedicine, acupuncture and naturopathy, often partnering with Harborview Medical Center’s integrated Pain Team.
“I don’t think it needs to be an either/or; I think it can be a both/and. The synthesis of traditional medicines and scientific inquiry make both of them better. And patients get better care when they have both together and they are not adversarial,” Lumiere said. She points to the number of patients she sees at Harborview “where unresolved trauma is at the root of so much suffering. And that is one of the things that acupuncture can begin to touch [to] help people and give them the tools to have a sense of agency.”
Integrative options get murky when insurance is added to the mix. In Washington, alternative medicine practitioners and acupuncturists are often covered by both private and public insurers, a luxury that is not widespread across the country. “A lot of the current challenge right now is around being paid fairly - around equity and compensation,” Rubinstein said.
Lumiere agrees. She said some insurance companies do not compensate alternative health providers with a “sustainable wage.” As a result, some practitioners choose a cash practice, but that limits patients to those who can afford to pay entirely out of pocket.
“Just think about all the parts of the country that are not well-served, where people are suffering needlessly from pain and they really are not going to get the help I know they can get,” Lumiere said, noting how acupuncture is very therapeutic for chronic pain and anxiety.
In fact, there is an opportunity to normalize more integrative approaches. The traditional roles of primary care physicians are increasingly unreplenished; younger doctors are opting to specialize since specialty medicine pays better, Rubinstein said. Rubinstein sees this as an opportunity for naturopaths to fill the chasm that will be left by retiring general physicians.
Approaching healthcare and medicine from a variety of methods suggests an opportunity to integrate well-being, lifestyle and healthcare. As many local institutions — like International Community Health Services and other culture-driven organizations in the Seattle area — have already done, recognizing other forms of medicine and care rooted in natural approaches and non-Western traditions would create a healthcare culture of accessibility and transformation that recognizes a coexistence of worldviews and the cultural knowledge they have to offer.
Reaching for an alternative | Second in a Real Change series
Kamna Shastri is a staff reporter covering narrative and investigative stories for Real Change. She has a background in community journalism. Contact her at firstname.lastname@example.org. Twitter: @KShastri2
Read more in the Aug. 5-11, 2020 issue.