Documente Academic
Documente Profesional
Documente Cultură
1562 | Editorials American Journal of Public Health | October 2002, Vol 92, No. 10
EDITORIALS
This system of classification is be used to prejudice judgment the parallel medical system of os- best, reflect a long history of ar-
one of several that have been against potentially effective treat- teopathy to professionalized het- rogance, exploitation, and colo-
proposed. However, the intellec- ments led to the expansion of the erodox systems such as chiro- nialism.10 At worst, it represents
tual point of departure, and the very idea of what is scientific. Or practic, acupuncture, and a continuing legacy of intellec-
standards by which these thera- rather, it could be argued that naturopathy to national and re- tual, emotional, and spiritual vio-
pies are judged, remains that of the German approach marked a gional folk healing systems such lence committed in the name of
conventional biomedicine. return to the term’s more inclu- as Appalachian folk medicine to the very public we have sworn to
sive meaning as a system of self-care and home remedies protect. Can one claim that a so-
THE SCIENCE OF CAM knowledge, and not necessarily used outside of these profession- ciety is healthy that finds its
the one and only received system alized and semiprofessionalized worldview under automatic as-
He who wants to recognize what is of knowledge held by a biomed- systems. While, for instance, Na- sault, and the integrity of its cul-
alive and describe it, seeks first to drive ical scientific establishment. Per- tive American health systems are ture called into question? This is
the spirit out of it. Then, he holds the haps from the land that gave the easily understood to fall into a not a call for cultural relativism
parts in his hands. But, he is missing world Martin Luther, one should separate system of ethnomedi- so much as a call for cultural tol-
the spirit’s band. expect nothing less. The compro- cine, it is indeed helpful to un- erance and humility. We may, in-
mise solution involved alternative derstand that movements such as deed, have much to learn from
Goethe, Faust, Part 1, Scene 4 criteria for the proof of the effect Christian Science, chiropractic, one another.
and effectiveness of herbal drugs and spiritualism may also be in- How may we decide on the
A second consideration in ad- apart from randomized clinical digenous ethnomedical systems health of a culture itself? This
dressing the role of CAM in pub- trial data. In effect, the “scientific in the United States. has been a vexing theoretical
lic health is determining effec- standard” by which the efficacy This type of framework not and pragmatic question con-
tiveness and efficacy. Merely of herbal drugs could be as- only leads to interesting social, fronting anthropology since
hosting a special issue on the sessed could now be other ra- political, and economic questions Henry Lewis Morgan essentially
topic of complementary and al- tional systems and models in ad- but also helps us to understand founded the discipline in the
ternative public health will not dition to the ethnomedical that the tapestry of care re- 19th century by trying to salvage
magically resolve the thorny is- system known as biomedicine. sources for public health is in- what he saw as the disappearing
sues that have plagued debate in deed rich. Such a broad recon- culture of the Iroquois. Healthy
this area for the past several CONVENTIONAL, ceptualization of the public societies are composed of
years. However, to shy away ALTERNATIVE, AND health system offers many poten- healthy individuals, but they are
from this debate may be pro- COMPLEMENTARY tial opportunities to improve, ex- not simply the sum of these
foundly debilitating to public ETHNOMEDICAL pand, and refine what we do, parts. Nor can the health of indi-
health in the long term. The SYSTEMS where we do it, for whom we do viduals be maximized in the con-
complex ontological and episte- it, and to what end. This is as text of ailing social systems or
mological issues involved strike The cultural diversity of com- true in the developing world, cultures. What role does public
to the very core of our “scien- plementary and alternative such as in western Africa,8 as it is health play in promoting and
tific” approaches to public health, health practices and systems can in the industrial world, such as in maintaining the health of soci-
and our ability to avoid concep- indeed be daunting. Kleinman6 the American South.9 The oppor- eties and cultures, particularly in
tual stagnation and continue to suggests that we understand a so- tunity to increase the power and the era of globalization?
gain new knowledge. There can ciety’s health care resources as reach of the public health sector Whether it is an integrated
be no question that social and belonging to 3 sectors: popular, through integration of CAM or model of holistic health care for
political considerations of estab- folk, and professional. For public indigenous practitioners is ig- Native American women,11 the
lished biomedicine have often health practice and research, nored only at our own detriment. role of the Black churches in the
masqueraded as “scientific” just there is much to be gained in un- South in providing mental
as surely as there have been derstanding these health sectors, CAM, CULTURAL health services,9 or drawing
charlatans or others blindly sup- including scientific biomedicine, DIVERSITY, AND upon the lessons of shamanic
porting untenable beliefs and as ethnomedical systems within CULTURAL HEALTH healing in providing brief psy-
practices at the expense of the society. Baer7 has suggested that chotherapy for Latino immi-
public health. the American landscape is best One final consideration must grants,12 the works collected in
An interesting compromise understood as a pluralistic con- be raised. The past (and present) this special issue represent a
was reached in Germany with tinuum of alternative or comple- insensitivity of public health snapshot of complementary and
the passage of the German Drug mentary ethnomedical systems. workers and scientists to comple- alternative approaches that can
Act in the 1970s.5 Concerned by This continuum ranges from pro- mentary, alternative, or indige- play a vital role in the health of
the very idea that “science” could fessionalized biomedicine and nous systems of health may, at the public. Although the stan-
October 2002, Vol 92, No. 10 | American Journal of Public Health Editorials | 1563
EDITORIALS
dard of positivist biomedical sci- tices represent a vast and as yet About the Author 6. Kleinman A. Patients and Healers
ence may not always be a fair unrealized sector of the public Vincent M. B. Silenzio is with the Center in the Context of Culture: An Exploration
for Family Medicine, Columbia University, of the Borderland Between Anthropology,
point of departure, it is nonethe- health systems of developed and New York, NY. Medicine, and Psychiatry. Berkeley: Uni-
less the framework within which developing nations. Moreover, Requests for reprints should be sent to versity of California Press; 1980.
we decide truth. It can be a the limits of our current bio- Vincent M. B. Silenzio, MD, MPH, 630
7. Baer H. Biomedicine and Alterna-
W 168th St, VC 12-217, New York, NY
purely reductionist model of sci- medical knowledge and capabil- tive Healing Systems in America: Issues of
10032.
Class, Race, Ethnicity and Gender. Madi-
entific reason, with its linear ities cannot be denied. We do This editorial was accepted June 26,
son: University of Wisconsin Press;
model of causality and attempts not, as yet, have all the answers, 2002.
2001.
at objectivity. It can also be a or even, for that matter, know 8. Green E. Engaging indigenous Af-
less reductionist approach, all the questions. There are References rican healers in the prevention of HIV
1. World Health Organization
where causality may be under- more things in heaven and earth and STDs. In: Hahn R, ed. Anthropology
(WHO). WHO launches the first global
and Public Health: Bridging Differences in
stood more as a web rather than than can be dreamt of in our strategy on traditional and alternative
Culture and Society. New York, NY: Ox-
medicine. Available at: http://www.who.
a thread, and the subjectivity of current biomedical philosophies. ford University Press; 1999:63–83.
int/inf/en/pr-2002-38.html. Accessed
lived experience once again as- Stagnant biomedical orthodoxy May 20, 2002. 9. Blank M. Alternative mental health
sumes a prominent role in un- cannot achieve the fullness of 2. McNeil D. With folk medicine on services: the role of the Black church in
rise, health group is monitoring. New the South. Am J Public Health. 2002;
derstanding health and well- public health’s potential and has
York Times. May 17, 2002:A8. 92:1668–1672.
being. With this less reductionist no role to play in human prog-
3. National Center for Complemen- 10. Helman C. Culture, Health and Ill-
approach, the interrelationships ress. Maintaining an openness to tary and Alternative Medicine. Major ness: An Introduction for Health Profes-
between cultural and personal, this reality may serve to help domains of complementary and alterna- sionals. Oxford, England: Butterworth-
public and individual health marshal the resources of indige- tive medicine. Available at: http:// Heinemann; 1997.
nccam.nih.gov/nccam/fcp/classify. Ac-
begin to become clearer. nous, complementary, and alter- 11. Napoli M. Holistic health care for
cessed June 7, 2001.
native women: an integrated model. Am
The works collected here rep- native health practices in the 4. Green LA, Fryer GE Jr, Yawn BP, J Public Health. 2002;92:1573–1575.
resent the beginning of an im- service of public health, now Lanier D, Dovey SM. The ecology of
12. Dobkin de Rios M. Lessons from
portant dialog for public health. and in the future. medicine revisited. N Engl J Med. 2001;
shamanic healing: brief psychotherapy
344:2021–2025.
Although in different ways, with Latino immigrant clients. Am J
5. Weiss R, Fintelmann V. Herbal Public Health. 2002;92:1576–1578.
complementary and alternative Vincent M. B. Silenzio, MD, MPH Medicine. New York, NY: Thieme;
health care and healing prac- Guest Editor 2000.
The remarkable accuracy of Wal- involved in linking emotions, death and, second, what that
Walter B. ter B. Cannon’s 1942 article such as fear, with illness. physiological basis might be.
“ ‘Voodoo’ Death,” excerpted in If submitted to a scientific The dramatic suddenness of
Cannon and this issue of the Journal,1 propos-
ing a scientific basis for “voodoo”
journal today, this paper would
not make it beyond the review
the illness following the threat,
coupled with a lack of any appar-
“ ‘Voodoo’ death is at once surprising and
not surprising. Voodoo death, as
process, as it would be described
(probably with some disdain) as
ent injury, exposure to toxins, or
infection suggested to Cannon
1564 | Editorials American Journal of Public Health | October 2002, Vol 92, No. 10