Power Politics and the Takeover of Holistic Health in North America: An Exploratory Historical Analysis - Farah M Shroff, PhD
Allopathic medicine, while it is well entrenched in North America, has only held this influential position for approximately one century. Dispelling myths that allopathic dominance was gained exclusively through evidence based health outcomes using scientific diagnostic and treatment protocols
, this paper demonstrates that two systems of healthcare were overturned in North America, using primarily financial, military, and political tools
. In analyzing these social forces, this paper is in no way a wholesale critique of allopathy. Indeed, allopathy has tremendous value in improving population health, particularly in acute and emergency care.
Holistic systems of medicine were ascendant in the past and their decline was less about “the progress of science”
and more about power and politics
. Despite this decline, holistic health is re-emerging. Medical pluralism is experiencing a renaissance.
Indigenous Holistic Health Care Practices in North America: a Brief Overview
While not romanticizing indigenous systems of medicine, it is clear that this genius emanates from societies that were deeply connected to all forms of life and accepted few limits on the capacity of the human being for excellence and self-fulfillment.
Indigenous systems of medicine generally focus on returning people to a state of harmonious balance both internally and in relationship with the outer world. The holistic approach
of many indigenous systems of medicine worked to create changes in (ill) people’s self knowledge, their relationships with the world around them, and ultimately move them back to health transformed
. Behavioural changes were often expected by those guiding the healing (Continuum Centre for Health and Healing, 2003). Illness is thus an opportunity for growth and learning despite the suffering.
Colonial Influences on Indigenous Systems of Medicine: A Brief Overview
With the colonizers came extreme trauma in many forms — genocide, war, removal from ancestral lands, relocation, forced labour, religious conversion
, and more. Residential schools were an attempt to convert indigenous children to Christianity, stripping them of their own culture, language, and belief systems
“Humanitarianism” and colonial medicine
were used to pathologize indigenous peoples and a regime of doctors, hospitals, and field matrons was established to encourage assimilation (Kelm, 2005). Nonetheless, many indigenous peoples have been able to resist and alter these forces to preserve their own cultural understanding of their bodies, disease, and medicine (G. Oleman, personal communication, April 25, 2007).
Annie Guno, a First Nations holistic health care practitioner and teacher, for example, states that much of the holistic health care she practices, such as therapeutic touch and energy medicine
, stem from ancient traditions that, in her words, “tap into the Universe.
” These practices survived, and some, such as therapeutic touch, have now been established within Canadian hospitals, practiced by nurses (personal communication, January, 2007).
European Holistic Medicine in North American History: A Brief Overview of Homeopathy
Samuel Hahnemann (1755–1843), a German physician, is credited with coining the word “homeopathy
” (“homoios” in Greek means similar, “pathos” means suffering, so homeopathy is a system of medicine which induces a condition that mimics the disease in order to treat illness) to refer to the pharmacological principle, the law of similars
, that is its basis. This law was previously described by Hippocrates and Paracelsus and was utilized by many cultures, including the Mayans, Chinese, Indians, Greeks, and indigenous peoples (Ullman, 1991), but it was Hahnemann who is thought to have codified the law of similars into a systematic medical science. Homeopathy’s principles were in direct contrast to those of allopathy
. Homeopathy posed a philosophical, clinical, and economic threat to orthodox (allopathic) medicine
as will be explained below.
External challenges to homeopathy: The formation of the AMA and its alliance with early capitalists
, the American Medical Association
(AMA) was formed to represent allopathic medicine. Allopathy was informed by the thought of Rene Descartes, Francis Bacon, and others. It was largely, but not entirely, defined by a reductionist and dualist Cartesian scientific base.
In Greek, “allo” means different and “pathy” means suffering, so allopathy is a system of medicine that creates a different illness in order to treat illness.9 As part of its code of ethics, the AMA specifically prohibited its members from professional consultation with homeopaths (Solberg, 2009). From its inception, the AMA advocated educational reforms to establish its type of medicine as the only legitimate one and itself as the only legitimate medical association
(Loop, 2008). For example, the AMA lobbied to strike down the licensure law, which allowed different sects to have their own licensure boards and the right to examine their own candidates. The abolishment of the licensure law
played an important role in losing homeopathy the power to govern itself (Barzansky and Gevitz, 1992; Edlin and Golanty, 2009).
By the late 1890s an alliance between the AMA and large industrial capitalists was formed, assisting the AMA in gaining the political influence and influential friends it sought. This initiated the sociopolitical hegemony of allopathy which continues today
. The modern medical sector is a reflection of socioeconomic hierarchies in society (Navarro, 2007) which are based on race, class, gender, and other categories of difference. Corporations and the upper classes who dominate society in general also direct the functions and structures of medical industrial complexes.
The Flexner Report
A Council on Medical Education
was established in 1904
by the AMA and was composed solely of representatives from universities which followed the Johns Hopkins’ model.
The Council then applied, through the AMA, to the Carnegie Foundation
to commission an independent report to verify its work. Abraham Flexner
, an educator whose brother was an allopath, was selected for the task. He was accompanied by Nathan Colwell, MD
, Secretary of the Council, and a participant in all the site visits. They visited all the medical schools in North America.
, the Flexner Report
, Medical Education in the United States and Canada
was released by the Carnegie Foundation for the Advancement of Teaching
. The report marked a turning point in medical education. It suggested new guidelines for medical schools to make them more scientific (in the reductionist and dualist tradition)
. Approved schools
were to provide full-time research faculty as well as a solid, technological base — the modern research laboratory (Barzansky and Kenagy, 2010) — which required a large amount of funding
Flexner (1930, p. 189) wrote: “the influence of the board of trustees determines, in the social and economic realms, an atmosphere of timidity which is not without effect on critical appointments and promotions.” He stated that the first and final voice is theirs, concerning the highest decisions. An “atmosphere of timidity
” thus helped to shape medical education about one hundred years ago. Their first goal
was to ensure that “the aims of higher education, of course, are to be attuned to the needs of the industrial (corporate) system”
(Galbraith, 1967, p. 370). In the process, Flexner rebuked homeopathic schools along with other holistic schools for their poor standard despite their successful establishment and many were excluded from the reconstruction of the medical system.
Funding was the chief distinguishing factor between the Flexner report and the innumerable other reports which were published in the same era as several foundations financed its implementation. By 1934, large foundations had donated $154 million to reform medical education along Flexnarian lines. The Rockefeller General Education Board
supplied $83.3 million to nine medical schools (Fedunkiw, 2005). Other schools lost their funding and many were forced to close down, including schools of natural medicine and the only medical schools which admitted African Americans and women (Hiatt and Stockton, 2005). Amongst the medical schools that were heavily funded by many corporations in order to meet the high expectations set by the Flexner report and the AMA, only two homeopathic schools could stay open with the help of devoted alumni and local benefactors.
A reform movement at the turn of the 20th century, commonly called progressivism
, posited that scientific knowledge could be applied beyond medicine and public health to politics, law, labour relations, industrial production, and so forth. Proponents believed that science combined with capitalism would solve the problems of rapid industrialization
. Alexander Peter Reid, a Canadian allopath born in 1836, was a leader in this movement. He firmly believed that science could solve social problems (Petrou, 1998). These kinds of social elements created a stronger foundation upon which allopathic medicine could flourish, particularly as prominent allopaths were in leadership positions.
One such prominent allopath was Morris Fishbein
who became the editor of the Journal of the AMA in 1924. He became well known when Time Magazine referred to him as the nation’s most ubiquitous and perhaps most influential medico.
The rise in allopathic medicine was also influenced by the needs of the battlefield. Most notably, the “world” wars made rapid research in acute care necessary; approximately 39,488 Canadian soldiers were killed in action during World War I
and approximately 12,048 died of wounds (Salisbury and English, 2003). It was considered a “medical miracle” that approximately 154,361 were injured yet survived and approximately 4 out of 5 of these soldiers returned to active military service (Salisbury and English, 2003).
World War II
catalyzed the rapid research and development of high technological approaches to medicine and resulted in clearly visible successes. The necessity for crisis surgical intervention techniques for battlefront wounds also encouraged use of morphine, sulfa drugs, and penicillin. The introduction of “heroic
” medicine and “wonder
” drugs during the war had lasting effects. This type of medicine produced instantaneous results which awed the general public. People’s faith in allopathic medicine grew tremendously during this time period
People of varying socioeconomic positions continued to turn to practitioners of holistic health care. Treatments offered by holistic practitioners were not always cheaper than allopathic treatments. People turned to holistic treatments partly because they were less painful than allopathic treatments but some holistic treatments were not painless. Both ill and healthy people sought out holistic practitioners based on sound information and experience, not fear and ignorance
. While those who sought treatment from holistic practitioners may have been critical of some aspects of allopathic care, they were not interested in mounting collective social challenges to allopathy in general (Clow, 2001).
As long as we accept the premise that doctors monopolized health care in the last century, we will continue to believe that criticism of and opposition to conventional medicine is a recent phenomenon. And as long as popular disenchantment with the medical profession is seen as a product of the 1960s counter-cultural revolution, we will continue to formulate solutions to the current health care crisis that ignore enduring traditions of independence, self-help, and anti-authoritarianism.
(Clow, 2001, p. 7)
North Americans thus have a strong tradition of working towards medical pluralism.
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