Humanities are the Hormones

Transforming the Art of Healing through Diversity was the theme of the 12th International Congress of Traditional and Indigenous Medicine (Albuquerque, August 1998). The series of congresses (the 8th of which was held in St. John's in 1994) serve, in part, to bring under-represented and divergent voices into the greater conversation about health care. If the Albuquerque congress did not succeed entirely in bridging the gap between scientific knowledge and traditional approaches, it underscored the complexity of the gap in consequence of diverse ideologies, cultures, politics, economics, as well as approaches to knowledge.

We hear much about creating integrated health care these days. In the U.K. the Prince of Wales promotes the Foundation for Integrated Medicine (launched October 1997). This explores how orthodox and complementary medicine might work more closely together. Perhaps the real value of the foundation is placing the subject of integration in the limelight. Presently, if integration occurs, it is generally dependent on local personalities and circumstances. At least this is so in Canada where some hospitals are responding to the view that "If you believe in the primacy of patients making their own decisions and you believe in the fundamental of informed consent you cannot deny them access to the [alternative] treatment."

That developments are piecemeal is reflected in a recent Canadian Family Physician editorial, Two solitudes of complementary and conventional medicine. Where are we going? This complained that "both physicians and patients are frustrated by the fragmentation [of alternative and conventional medicine] they experience." Such fragmentation partly reflects the existence of two cultures in health care: those who want to change the world to a better and more natural way of health, and those who believe health care must be based strictly on scientific approaches and evidence.

Can the gap between the two cultures be bridged? Is integration (or, as some prefer, collaboration) a realistic goal or a mirage? The answer has to be "It all depends." In western societies, it all depends on many factors that include the results of future rigorous research undertaken on complementary/alternative medicine, on the experiences of the growing numbers of physicians who are participating in complementary/ alternative care, on the collective views (subjective and objective) of patients' experiences, on whether the theoretical and other gaps between the two cultures can be bridged, on the health care policies of governments and of insurance companies, on the needs of an aging population, on changing views about team care, and so on. Additionally, there are influences such as promotion by many members of the nursing profession of, say, therapeutic touch, massage and certain mind-body treatments. Moreover, commentators view therapies that do not threaten physicians’ territories as more likely to be integrated.

In developing countries, where traditional medicine (as distinct from much western complementary alternative care) remains a mainstay of health care, situations are different. Traditional practitioners often worry about the policies of the World Health Organization in fostering the scientific evaluation of traditional medicine with the thought of assisting in the eventual rational use of traditional medicine through science and international standards. The worry is that the policy may disembowel aspects of traditional medicine not amenable to scientific study at the present time. As in western complementary/alternative medicine there is also concern about loss of choice in health care.

At least one issue seems certain, that discussion on integration will be with us for the foreseeable future, and that it will become more public. It is one component of an International Conference on Healing to be held next year in Newfoundland, on the Conne River, Miq'maq Reserve, from June 30 to July 3, 1999. For details contact Dr. John Crellin, History of Medicine, 709 (737-6592 or email jcrellin@morgan.ucs.mun.ca