Weighing the Alternatives: Lessons from the Paradoxes of Alternative Medicine

The realization that at least 25% to 50% of adults in industrialized nations, including the United States, consult alternative medicine practitioners [1, 2] has prompted serious exploration of what makes alternative practices so attractive to patients [3]. In this issue, Kaptchuk and Eisenberg [4] contribute importantly to our understanding of that attraction.

Many conventional practitioners have responded to the emergence of alternative medicine by acquiring a new understanding of practices that they had previously considered to be “on the fringe” [5]. Others have incorporated “alternative” concepts and practices directly into their own daily patient care. Medical schools have opened their curricula to this previously forbidden area [6]; books, journals, and courses on the topic proliferate. But despite all this casting about, the simple fact that our patients are turning to alternative medicine remains baffling and disturbing, if only because it tells us that they need something that our much-vaunted scientific health-care system currently doesn't provide. Our distress echoes the feelings of parents whose children reject their advice and values: How can it be that alternative practices, shrouded in mystery, grow and flourish, while a century and half of effort by scientific medicine to demystify disease and its treatment-our spectacular success in defining pathophysiology, standardizing tests and treatments, and purifying drugs-is seen as inadequate, even dangerous? Where did we go wrong?

Alternative medicine is not, of course, a single coherent body of theory and practice, although, as Kaptchuk and Eisenberg point out, certain features are common to almost all of its many “schools.” As if the transcendent nature of many of these features were not paradoxical enough from the perspective of reductionist science, alternative medicine's “alternative” approach to several pragmatic issues-including the taking of responsibility, telling the truth, self-scrutiny, and commerce-are distinctly paradoxical from the conventional medicine point …