by Vinayak Sinha (Fall 2016) & Jenna Menefee (Spring 2015)
At its core, medical pluralism is the existence of multiple medical systems in a given society (1). Various cultures perceive and treat medical issues in different ways and the intersection of these methods allows for medical pluralism. The Western medical system is considered biomedicine and traditional medical systems, originating in other parts of the world, are labeled complementary or alternative medicine (CAM) (2). The Western approach is grounded in evidence-based studies and emphasis is placed on treating illness. Alternative medicine, such as Ayurveda and Chinese medicine, views health holistically, while treating an individual as a whole rather than their symptoms. Today, CAM therapies such as acupuncture and mindfulness mediation are becoming more integrated into Western health systems (3). As globalization spreads these ideologies to new areas, there is complementary usage of CAM and Western medicine together, particularly amongst immigrant populations (3). Medical pluralism is both an opportunity and a challenge for practitioners to better the health of the populations they serve through better integration, trust, and innovative thinking.
Medical pluralism has no specific origin. In early civilizations, the medical system used by individuals was based on their social and economic status within society, the poor used traditional medicine and wealthier used formalized medicine (4). In early colonial India, the introduction of the Western system by the British replaced Ayurveda treatments for the wealthy, but traditional medicine continued to persist with the poor (10). Throughout society medical pluralism became prevalent and combined practice developed (10).
Although biomedicine has emerged as the dominant form of standardized treatment, integration of traditional medicine practices, such as deep breathing and acupuncture, has become formalized (11). In the United States, it was not until the 1950s that complementary or alternative medicine practices began integrating into the formal health system (5). More specifically, in the last ten years, approximately 42% of the US population reported using CAM and roughly 80% of people in developing countries received health care from indigenous systems (2, 6).
In the nineteenth century, biomedicine emerged as the dominant form for treating individuals over traditional practices and remains the “superior” form of practice (4). In the United States, it was not until the 1950s that complementary or alternative medicine practices began integrating into the formal health system (5). More specifically, in the last ten years, approximately 42% of the US population reports using CAM and roughly 80% of people in developing countries receive health care from indigenous systems (2, 6).
An understanding of medical pluralism is important for public health practitioners both domestically and abroad, especially when working with immigrant populations and in developing nations. Recent efforts in the field have focused on the integration of conventional care and CAM in order to provide the best health outcomes (3). In the Ucayali region of Peru NGOs have focused on integrating indigenous shamanic practices with Western medicine’s sanitation requirements to drive down rates of stunting. Through the integration of shamanic practices and biomedicine principles there has been an 11% decrease in stunting in the region (12). This form of medical pluralism relied on shamanic practices to include guidelines established regarding sanitation to educate indigenous populations on nutrition and health. The inclusion of this important information in traditional medicine practices can better health outcomes and reduce healthcare costs while engaging patients. This example provides reasons for widespread understanding and acceptance of medical pluralism and explains real benefits of a patient-centered approach that respects the abilities of traditional practices.
When medical pluralism is adopted better health outcomes can result. However, there are limitations to this approach as many Western trained physicians view CAM as unscientific (7). One argument states that when biomedicine and traditional practices are used in conjunction, one cannot be certain which approach was effective in treating the individual. The efficacy of a wide variety of alternative medicine systems has not been studied therefore their inclusion is contentious. Safety and a lack of formal regulation of these therapies also prove to be limitations (8).
As the dominant healthcare system, biomedicine is prioritized above traditional systems leaving little room for collaboration. Yet there has been movement towards medical pluralism, by international organizations, as biomedicine practices can have low penetration rates in indigenous population regions, such as Ucayali in Peru (13). A new challenge in healthcare, both in the US and internationally, will be to address how alternative medicine can fit into a value-based system, particularly in regards to payment (9). The application of medical pluralism in this context will need to focus on value-adding activities across various medical systems to ensure appropriate treatment of individuals. A CAM activity such as yoga, is now favored as a value-adding practice for many practitioners of biomedicine as it is able to reduce use of medications and supplements (11). The need for medical pluralism is apparent in order to address the broadest needs of individuals while respecting diversity in health care choices and research regarding the use of alternative systems can strengthen this assertion.
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(4) Baer HA. Encyclopedia of Medical Anthropology: Health and Illness in the World’s Cultures Topics - Volume 1; Cultures - [Internet]. Springer Science & Business Media; 2004 [cited 2015 Mar 11].
(5) Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. Trends in Alternative Medicine Use in the United States, 1990-1997. JAMA [Internet]. American Medical Association; 1998 Nov 11 [cited 2015 Mar 16];280(18):1569. Available from: http://jama.jamanetwork.com/article.aspx?articleid=188148
(6) WHO | WHO launches the first global strategy on traditional and alternative medicine. World Health Organization; [cited 2015 Mar 16]; Available from: http://www.who.int/mediacentre/news/releases/release38/en/
(7) Maha N, Shaw A. Academic doctors’ views of complementary and alternative medicine (CAM) and its role within the NHS: an exploratory qualitative study. BMC Complement Altern Med [Internet]. 2007 Jan [cited 2015 Mar 16];7(1):17. Available from: http://www.biomedcentral.com/1472-6882/7/17
(8) Ernst E, Cohen M, Stone J. Ethical problems arising in evidence based complementary and alternative medicine. Journal of Medical Ethics. 2004;30:156–9. Availble from: http://jme.bmj.com/content/30/2/156.full.pdf+html
(9) Ananth S. CAM on America’s Main Streets. Hospitals & Health Networks. [cited 2016 Oct 16]; Available from: http://www.hhnmag.com/articles/5388-cam-on-america-s-main-streets?id=2350001399
(10) National Centre for Biological Studies. Overview of Indian Healing Traditions. [cited 2016 Dec 17] Available from: https://www.ncbs.res.in/HistoryScienceSociety/content/overview-indian-healing-traditions
(11) Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12. Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. 2008 Dec. [cited 2016 Dec 17] Available from https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm
(12) UNICEF |UNICEF Annual Report 2013 – Peru. [cited 2016 Dec 17] Available from https://www.unicef.org/about/annualreport/files/Peru_COAR_2013.pdf
(13) Borja A. Medical Pluralism in Peru – Traditional Medicine in Peruvian Society. 2010 May [cited 2016 Dec 17] Available from https://bir.brandeis.edu/bitstream/handle/10192/23882/Borja-MastersThesisFinal.pdf?sequence=1
A New Medical Pluralism: Complementary Medicine, Doctors, Patients and the State
Medical Anthropology Wiki
Medical Pluralism in India: Reconciling clinical practice and alternative medicine. https://www.youtube.com/watch?v=BUtRLbV08hU