Views on what constitutes good medicine are, like the human race, wonderfully diverse. Something bothering you? Say, an upset stomach? Well wait no more, for a veritable feast of treatments is ready at hand! Why not suck on a licorice root or ginger? Or meditate? Or throw a leech on your abdomen? Or consult the village witch doctor? Or burn incense and recite some guttural chants? Heck, you could––if you so desired––even ask the nearest medical student what to do. (But give them time, they are probably still working on a differential diagnosis.)
Egad! So many options!
But options are good, right? Well, sometimes yes, sometimes no. But my purpose here isn’t to say whether or not I think it’s a good thing that there are so many approaches to medicine out there. Rather, I’ll be attempting to indicate what exactly separates mainstream medicine, which is the brand of medicine taught in American medical schools and practiced in the majority of U.S. hospitals, from alternative medicine, which, for our purposes, encompasses every form of medicine that isn’t mainstream (e.g., Ayurvedic medicine, chiropractic, acupuncture, folk remedies, tai chi, and the like). Drawing a line between mainstream and alternative medicine isn’t necessary for pondering the relationship between the two, but it should add clarity to our thoughts.
Let’s start by examining the conceptual roots of mainstream medicine. To do this, we have to take a trip to the distant past. It was roughly 14 billion years ago that our humble universe was thrust into existence by forces beyond our understanding. Following its sudden ontological extrusion, it . . . okay, perhaps we don’t need to go this far back. Let’s skip ahead to the 16th and 17th centuries A.D., which is around the time that Western science as we know it came into being. Galileo Galilei, Isaac Newton, Robert Boyle, Francis Bacon, John Locke, Rene Descartes, and the other architects of Western science were generally in agreement that to function optimally––to understand and predict natural phenomena––science needed to operate in a certain way. Specifically, it needed to make a number of assumptions about reality that would help it accumulate knowledge smoothly. When the scientist was to engage in scientific activities, he or she would need to make these assumptions for the duration of said activities. Without them, the activities could not be regarded as science.
I’ll briefly explain a couple of these assumptions. They are (1) that reality is fundamentally quantifiable, and (2) that scientific theories must be supportable by evidence derived from sense perception.
The first assumption basically stipulates that the universe and all of its constituents can be represented in a purely quantitative way. Thus, space is quantifiable (e.g., the air in my apartment occupies a certain volume), change is quantifiable (e.g., ice melts at a certain rate at room temperature), time is quantifiable (e.g., a second is defined as a certain number [9,192,631,770, to be exact] of atomic transitions in the caesium-133 atom), and even I’m quantifiable (e.g., my body is made of a certain number of atoms). At no point, says this assumption, are we unable to represent something in numerical terms.
The second assumption indicates that if we’re going to put forth a scientific theory––and I mean a truly scientific theory––there had better be some piece or pieces of evidence that we can physically point to in support of our theory. Take the theory that curare, a chemical derived from various plants in Central and South America, causes paralysis. Can this theory be supported by sense perception? Sure! If an unwary traveler accidentally ingests some curare while searching for edibles in the Amazon jungle, and becomes paralyzed shortly thereafter, that would constitute evidence for the theory that curare causes paralysis. So yes, there is definitely some evidence we can point to in this case.
What about the theory that Mary Cassatt is a better artist than Pablo Picasso? Can this theory be supported by sense perception? It’s hard to see how. An artist’s merits just don’t seem to be the sort of thing that can be measured by sense perception alone. We can look at some of Cassatt’s work and then compare its strengths and weaknesses with those of Picasso’s work, but then we’re merely throwing around opinions rather than collecting good, hard data. We could collect good, hard data about such variables as the total output of both artists, the variety of shapes and colors they utilized, their career earnings, and other such things, but then we’re mostly talking about the lives of the artists rather than their skill as artists. We could even consult well-renowned art critics for their opinions on the two, but then we’re back to reviewing opinions rather than data. On the whole, then, it seems that this theory cannot be verified by sense perception alone. To verify the theory, we would need some sort of standard of artistic excellence against which we could judge Cassatt and Picasso. But this is something that science, concerned as it is with objectivity, numbers, and precision, is not equipped to provide.
This raises the important point that these two assumptions of Western science are just that: assumptions. They aren’t meant to be claims about the way reality actually is; rather, they’re things that science presupposes in order to accomplish its primary task of understanding and predicting natural phenomena. Just because there are certain realities and topics that seem to resist full scientific understanding (e.g., beauty, love, ethics, logic, religion, the self) doesn’t mean that these things lack value or are devoid of truth and meaning; it only means that science doesn’t provide either the best or the only lens through which they can be examined.
But to return to the business of differentiating alternative from mainstream medicine. My proposal, in short, is that all medical ideas which adhere to the two aforementioned assumptions of Western science are part of mainstream medicine, whereas all medical ideas which break with either or both of the assumptions are part of alternative medicine. In other words, mainstream medicine is consistent with the methodology of Western science, whereas alternative medicine is not.
Let’s see how this proposal plays out with the example of acupuncture, which originated within traditional Chinese medicine. (I’m no expert on acupuncture, so please correct me if I get something wrong.) Acupuncture is based on the theory that health involves a balance between “yin” and “yang,” two opposing but inseparable forces at work within the body and the world at large. When the delicate relation between yin and yang is disturbed, so that there is an imbalance of these forces within the body, trouble ensues. Particularly, the flow of “qi,” or vital energy, through channels within the body called “meridians” is disrupted. Once the flow of qi is disrupted, the individual becomes ill. Hence, the purpose of acupuncture is to prevent illness by harmonizing yin and yang within the body while preserving the flow of qi.
Now, it’s my understanding that there are different metaphysical interpretations of yin, yang, qi, and other concepts of ancient Chinese philosophy, and this makes discussion of these concepts challenging. However, it seems fair to observe that, at a first glance, we are here dealing with things that are partly non-quantifiable and not verifiable via sense perception. Yin, yang, and qi are not like gravity, electromagnetism, or other forces of Western science. There may be some conceptual overlap between the two types of forces, but the Chinese forces have a more qualitative nature that resists numerical description. To assign numerical values to yin and yang would be similar to quantifying the activity and passivity inherent to a living creature, say, Garfield. (Let’s treat Garfield as a living creature for a moment.) It doesn’t make much sense to me to say that Garfield has 10,000 units (and what units, exactly?) of passivity and only 100 units of activity. That’s simply not how we characterize activity and passivity. It would make more sense if we used qualitative terms instead, for example, by describing Garfield as very passive and mildly active. Likewise for yin, yang, and qi: we need qualities to get a good grasp on these concepts.
Nor do yin, yang, and qi––considered as entities rather than mere concepts––appear to be verifiable through sense perception. Take qi. If qi exists, it’s hard to see how it could be wholly perceivable. Qi, as vital energy, would, in the context of the human body, be something like a hybrid of blood (which is perceivable and can flow) and the soul (which, if it exists, would be non-perceivable and incapable of flowing). It would somehow be causally related to the body (otherwise it couldn’t contribute to the body’s sustenance), but it would nevertheless have a non-perceivable component.
Of course, a Western scientist might come along (as many have) and attempt to discover components of the body that correspond to entities such as yin, yang, and qi. They might, for example, postulate that certain neural networks account for the symptoms traditionally ascribed to an excess of yin, and that acupuncture is capable of addressing these symptoms because it modulates the activity of the neural networks in question. But it seems that by doing this, the scientist is no longer working with yin, but rather with yin that has been stripped of its partly qualitative nature. Thus, the scientist in this scenario is not engaged in alternative medicine, since the partly non-quantifiable and non-empirical entity that is yin has been shorn of its full richness and replaced with a purely numerical and perceivable reality. (Interestingly, this is how the mainstream [but minimally substantiated] practice of “dry needling” came into being.)
To conclude this long-winded example: acupuncture, on the view proposed here, classifies as alternative medicine because it breaks with not just one, but both of the assumptions of Western science stated earlier.
In this way I could argue that Ayurveda, chiropractic, and all other approaches to medicine that are labeled as “alternative” differ from mainstream medicine. I could also expand my main argument by identifying other assumptions of Western science (e.g., that scientific theories must be falsifiable) and using them to differentiate alternative from mainstream medicine, but this post has gone on long enough. My primary task here was to differentiate alternative from mainstream medicine, and this I have hopefully accomplished.