Scientific and Social Problems and
Perspectives of Alternative Medicine:
Analysis of a Dutch Controversy
by Joseph Keu/artz, Chung/in Kwa and Hans Radder
Introduction
Ever since the mid-1970s, the Western world has seen growing public and polltical interest in alternative medicine. The
main reason has been a feellng of dissatisfaction with
regular, science-based medicine, which gained a monopoly
position for itself in the course of the last century. The
feellng of dissatisfaction is caused by a number of mutually
reinforcing developments, the most important of which we
should llke to outline here.
First, a sh!tt has taken place in current mortaHty and
morbidity patterns. As a result of the rlsing average age of
the population, urbanisation and the tendency to overfeed in
most Western countrles, the morbidity pattern is at present
dominated there by chronic-degenerative affllctions, . functional disorders and psycho-social complaints. On the whole,
the way in which diseases are handled in regular medical
science is st111 based on the way in which in the past infective diseases such as cholera, smallpox, typoid and diphther ia were conquered. This approach has not proved very
successful in combating the complaints and diseases that
prevad in modern morbidity patterns.
Secondly, as a result of technological developments and
increased specialisation, there is a considerable stress in the
interhuman relationship between physician and patient,
especially where semi- and intra-mural care are concerned.
An impersonal approach is used in which the attention is
mainly focused on somatic aspects and symptom fighting by
means of surgical and chemical methods. The contact between physician and patient is also made more difficult by
the bureaucratic methods that result from the growing influence of the state on the health services which occupy an
ever more important place in the national economies of the
West.
Thirdly, the importance of liberation and democratisation movements of the ’60s and ’70s should be pointed out.
The self-image of these movements can be explained in
terms of the need for self-determination and self-reallsatlon,
for involvement and participation, for a mimetic contact
with nature (both internal and external) and a loyal attitude
towards others. Within the new health movements, such as
the self-help movement, the psycho-therapeutic movement,
the psychiatric counter-movement and the movement in
favour of alternative therapies, this re-orlentation leads to
a different angle on views concerning health and morbidity,
diagnosis and therapy, as well as the physician-patient relationship.
The three developments mentioned above are interlocked
and culminate in heated debates on the scientific and social
problems and perspectives of alternative therapies in the
press, political parties and national parliaments.
Within the framework of the discussion of holism and
the movement for holistic health care, there have been
repeated discussions of alternative therapies in the United
States in recent years. The interest taken in different
therapies and new approaches in health care came to the
fore, for instance, during a congress of the National Institute for Mental Health, as well as at a congress of the
American Medical Students’ Association, in 1977. Another
proof of interest is the foundation of the American Holistic
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MCJtcdl Assoc.iation in 1978, and the widespread establishment of new holistic health centres and clinics (1). In
AustraHa and New Zealand a parliamentary and ministerlal
committee respectively, have investigated alternative therapies, and chiropractic in particular. In 1977, the Australian
committee published a voluminous report (2): the New
Zealand committee followed in 1979 (3).
In Great Britain attempts are being made at establishing
a lobby in parliament in favour of natural therapies (the socalled ‘Action for Natural Therapies’). In 1980, a number of
scientists were invited to investigate the status, quality and
remedies of alternative therapies in the United Kingdom, as
well as the need felt by the British people for alternative
medicine (4). In Belgium an ‘Action Committee for Therapy
Freedom’ has been in existence for some time; its aim is to
establish the patients’ rlght to choose the therapy or therapies of their preference.
In the Netherlands a similar committee exists) ‘Equal
Rights for All Therapies’. In January 1977, this committee
organised a congress in Amsterdam, attended by 1500
people, which sent a request to the then government, asking,
on behalf of the medical consumer, to be given the freedom
to choose one’s own therapy and therapist, and the rlght to
obtain alternative care on the same conditions as regular
medical care. In t1ay, 1977, the government instituted the
Commissie Alternative Geneeswijzen (CAG) (‘Commission for
Alternative Therapies’), the Chairman of which was P.
Muntendam. In January 1981, the Commission submitted a
report (5). When the report came under discussion on 5 September 1983, a comfortable majority in parl!ament expressed
the wish to have alternative therapies included in the services offered by the Dutch National Health Service. The
right-of-centre Lubbers government adopted an extremely
cautious attitude, being afraid that official recognition of
alternative medicine would lead to rising costs.
The CAG – a body of experts in the field of both
regular and alternative medicine – limited itself in its work
to those branches of medicine in which there is most interest in the Netherlands, i.e. acupuncture, therapies involving
extra-sensory perception, natural therapy, anthroposophical
therapy, homoeopathy and manual therapy.
The summary of the reports submitted by working groups
constitutes the main body of the CAG report. It is preceded
by a short historical-philosophical exposition and definitions
of the concepts ‘alternative’ and ‘therapy’, as well as a discussion of matters such as reductionism and holism, quacks
and quack methods, suggestion and placebo in therapy, and
the differences and similarities between regular and alternative medicine. Using the CAG report as our guidellne, we
intend to investigate in this article the scientific and social
aspects connected with an official approval of alternative
medicine.
The CAG report does not contain any concrete scient!tic analyses or evaluations of the various alternative therapies in the Netherlands. This does not mean, however, that
the scientific aspects are not considered. As we shall see,
the CAG did pay a good deal of attention to the question
whether or not alternative medicine has, generally speaking,
a scientific basis. In fact, the very strategy of the CAG
rests on the assumption that the problem of the official
approval of alternatIve medicIne IS essentIally of a sCIentific
nature. SOCIal factors and prioritIes play negative parts
only, preventing a thorough scientific evaluation of alternative medicine from being started at all.
With regard to the social aspects, the CAG limited itself mainly to establishing the social relevance of alternative therapies in terms of the number of contacts between
patients and alternative therapists, the motives for consulting an alternative therapist, etc. In doing so, it reached the
not very surprising conclusion that public interest in alternative mediCIne can hardly be overestImated, and that,
therefore, the authorities cannot afford to ignore the alternative group any longer. However, this approach implies an
obVIOUS limitation of the problem. The CAG devotes no more
than five pages out of a total of approximately three hundred to the general problem of the relevance of alternative
medicine seen in the light of more general social developments. It IS not surprising, therefore, that the CAG does
little more in those few pages than circumspectly offering a
brief outline of the problem: ‘One might, perhaps, say that
the rise of (at least some) alternative therapies should be
regarded as an attempt on the part of (a section of) the
community to look for, and sometimes even find, better ways
of dealing with health care’ «5), p. 169). Unfortunately, the
CAG fails to elaborate this point, which is central to the
issue: ‘Time will show whether the interest in alternative
medicine is a passing phenomenon or whether alternatIve
medicine will be the starting-point for the development of a
new kind of health care’ «5), p. 170). Answering these crucial questIons would, it IS said, necessitate an extensive
sociological anslysis which the CommIssion did not consider
itself capable of makIng, partly as a result of the lack of
research data. However, unless the phenomenon of alternative medicine is explicitly placed in a wider social perspective, it IS impossible, for us at any rate, to endorse the
plea in favour of alternatIve medicine, which IS what the
CAG report does, after all.
Part I: Scientific Aspects
The CAG’s scientific strategy
In the CAG report, the problem of the (non)scientific basis
of regular and alternative mediCIne plays an Important part.
The CAG’s opInions on this score may be summarised in
three poin ts.
First, the CAG assumes that there is only one form of
mediCIne, and only one medical science: ‘Naturally many
diverse views can exist within science, but there can be no
question of alternative conceptions of science outside the
one medical science’ «5), p. 22; see also (5), appendix H, p.
6 and pp. 12-14).
Medicine, it IS stated, owes its unIty to the existence of
an unambiguous scientific method: rational discussion and
evaluation WIthIn the so-called ‘forum’ (6). This forum is not
a concrete social InstItution, but an abstract body to which
in principle every scientist belongs. Ideally it shuld apply a
number of impersonal, objective methodological rules which
make it possible, in the course of time, to separate true
from untrue statements, or, to put it somewhat more carefully, statements that are more true from those that are less
true. One example is the rule that scientific discourse
should be consistent. From a forum-view of science the gap
caused by the differences between regular and alternative
medicine which, according to the Commission, are often
exaggerated, is not unbridgeable. After all, to the realm of
science belong all those forms of knowledge that can be
subjected for discussion and evaluation to the universal rules
of the forum. There is nothing to indicate a priori why
alternative medical knowledge should be downright unacceptable in all cases as a result of these rules. The CAG
expects that, in fact, the contrary wlll prove to be the
case.
Secondly, the notion of the forum offers the CAG a for-
mal and procedural criterion for separating science from
non- or pseudo-science. However, as to the content of regular and alternative medicine, fundamental differences may
occur, since ‘each form of medicine can offer only a limited
view of reality as a result of its epistemological principles.
Within different forms of medicine, different lines of
thought can be detected, which depart from different paradigms’ «5), p. 27). In this context the CAG differentiates
between two types of approach: the analytical and the contextual «5), pp. 231-232). These can be roughly characterised as follows. In the analytical approach human beings,
organs etc. are first divided into their separate components
– whether literally or conceptually – and next an effort is
made to understand how these entities function in terms of
the action of, and the interaction between, their components. The contextual approach, on the other hand, departs
from the idea of the entity as a whole and tries to explain
occurring phenomena with the help of factors from the
wider social and environmental context in which this entity
has been placed. According to the CAG, the two views, the
analytical and the contextual, are complementary. It is precisely because of their differences that they are both
needed to provide an adequate and satisfactory view of the
reality of illness and health.
A th1rd 1mportant po1nt 1n the CAG’s op1n1on 1s that the
scientific community of (regular) medical practitioners does
not exercise as it should its forum funct10n with respect to
alternat1ve medicine. The fact is that really very 11ttle good
research has been done into the sc1entific tenabllity of alternative therapies. Instead of a dogmatic denunciation of
alternative therap1es, a (real) scIentific approach 1s called
for, in the form of a differentiated and finely graded ‘evaluation of their truth content measured by objective standards’ «5), p. 238; cf. p. 20).
The fact that th1s k1nd of scientifically justified evaluation has not, or not sufficiently, taken place is due not so
much to any unscientific qualities of alterncttive therapies,
as to ‘interfering’ factors within the scientific community of
regular physicians, such as influence by pressure groups,
personal interest, avallabllity of funds, status of alternative
medicine, etc. The Commission assumes that this is, in fact,
an anomalous situation which can and should be ended. The
only legitimate cond1tions for an official approval of alterna t1ve med1cine are to be found, according to the Commission, through scientific justification: ‘In general the process
of argumentation and counter-argumentation wlll be the
most 1mportant: he who has the best argument shall w1n’
«5), p. 276).
Criticism
There is one thing that strikes one immed1ately in this vision
of science as it is propounded by the CAG. It is that the
forum-view on which the CAG bases its theoretical expositions in fact dates back to 1971 (6). And the problem is that
since at that time stormy developments in the theory of
science have led to completely new 1deas on the sc1ences
. It stands to reason that these developments have not
bypassed the CAG altogether. However, the way in which it
tr1es to combine or even reconclle the new ideas with a
forum-view is nothing less than shabby. We shall try to
prove our point by offering comments on the CAG standpoints outlined in the previous section, from the point of
view of modern theory of sc1ence.
The problem with the scientific forum is that it does not
exist. This problem is admitted as such by the CAG when it
states that the notion of a forum is an idealisation which
never has been completely realised and which, in practice, it
w1ll never be possible to realise. The point is, however, that
introduc1ng and work1ng w1th ideal1sations of th1s k1nd 1s
useful only when real scientific communities satisfy the
demands that are made of a scientific forum to some degree
at least. However, th1s is not the case by a long chalk.
Wishing to be brief, we shall limit ourselves here to one
example, viz. the rule that a newly proposed idea or fact
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‘should not be incompatible with other already accepted or
simultaneously offered claims, unless accompanied by arguments which would make the new claim considerably more
true than the existing one’ «5), p. 236). If this kind of rule
were heeded, scientific innovation would soon come to an
end. After all, as was shown by Kuhn in particular, in scientific innovations (revolutions) a new theory or a new paradigm generally merely holds the promise of finding ‘greater
truth’; first the new paradigm must be accepted before the
‘greater truth’ can possibly be found. Therefore we may say
that an evaluation of alternative medicine on the basis of a
forum-view is impossible. There is, however, another objection to the notion of a forum. It is this: even if a forum
existed in medical science (whether or not approximately),
the forum-view would stl11 offer a demarcation criterion for
marking the terr itor ies of science and non- or pseudoscience that is far too broad. In fact it would cover all socalled rational argumentation (such as jurisdiction, but also
less formal forms occurring in everyday discourse). It is
hardly surprising, therefore, that from this point of view the
differences between regular and alternative medicine seem
relatively small.
This leads us to criticism of the second point, concerning a difference in content between alternative and regular
medicine. We feel that a combination or a peaceful co-existence of different approaches to illness and health (such as
the analytical and the contextual approaches) will be far
more difficult than the CAG thinks it is, for the following
reason. Fundamental differences in therapies (as regards
underlying concepts of illness, for instance; cf. (12), Chapter
1), generally speaking imply different methods of testing the
efficacy of these therapies (by means of an experimental
rather than a casuistic test, for example: we shall come
back to this later). The CAG report contains a long list of
specific difficulties that may arise in effect research with
regard to alternative therapies. It is remarkable, however,
that the Commission does not go on to mention that the
problem of the acceptability of arguments raised in the
forum concerning the efficacy of therapies is largely dependent on the acceptability of the testing methods for that
particular therapy. Determining the correctness of scientific
arguments is not a matter of formal logic. Specific theoretical considerations, in particular with regard to the question
‘what counts as sound evidence?’, play an important part.
The considerable fundamental differences throughout the
wide range of regular and alternative therapies necessarily
make a scientific evaluation in the way envisaged by the
CAG highly problematic. All this criticism leads, in fact,
directly to the conclusion that the idea of the truth value
of alternative therapies being determined by a forum using
objective standards is very dubious. To say the least, it
defies comprehension that the CAG should use notions that
are highly disputed in the modern theory of science, such as
‘objectivity’ and ‘truth’, completely gratuitously (13), (14).
However, the CAG really goes too far when it argues at the
same time in terms of Kuhnian paradigms – which, after all,
are incommensurable according to Kuhn – and in terms of
universal criteria in order to test the truth of all existing
paradigms by applying objective criteria from the point of
view of one all-encompassing standpoint (the ‘one and only’
medical science)! «5), appendix H, pp. 34-35).
According to the CAG, the only really true conditions
for official approval concern the matter of the scientific
basis of alternative medicine. Socio-historical aspects are
regarded as no more than inconvenient obstacles hindering
the process of official approval «5), pp. 243-244). In the
modern theory of science, howeve,r the socio-histor ical context of science is frequently – and rightly – considered one
of its essential and inseparable aspects. Socio-historical influences are not simply deemed ‘deviations’ from the ideal
or ‘wants’ of rationality. The CAG expresses the opposite
opinion: ‘These forum rules are not, however, always applied
in the proper way as a result of fundamental human shortcomings and voluntary (sic!) limitations in the minds of some
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or several forum members’ «5), p. 25). We feel that in this
way, as is clear from the CAG report, the full social signlficance of the current debate between regular and alternative
therapists is bound to stay in the dark. As a result, the usefulness of the report for progressive perspectives and actions in the field of health and politics remains very vague.
2 The strategy of the ‘regulars’
The ‘Royal Dutch Society for the Advancement of Medicine
(KNMG) represented ‘regular medicine’s’ point of view. The
scientific strategy of the KNMG physicians and theOir philosophers can also be classified in a number of sections according to main lines of thought. In doing so, we shall base ourselves mainly on the ‘Commentary of the working group for
the preparation of the KNMG reaction to the CAG report in
the Netherlands’, which we shall refer to as ‘the KNMG
working group’ (15).
First, it is assumed that an explicitly acceptable criterion for separating science from non- or pseudo-science
exists. The CAG is reproached for not distinguishing ‘between science and pseudo-science. The two can be separated,
however, for two reasons, viz. (1) that scientific theories
and hypotheses can be tested, and (2) that science has a
cumulative character’ «(15), pp. 1676-1677; cf. also (16), pp.
1629-1630). However, it appears that the second criterion the accumulation claim – does not play an independent part.
The idea behind it is that only accumulation of knowledge
that has been tested and found correct is acceptable. To
this way of thinking accumulation is, therefore, the consequence of testing: knowledge that has once been tested and
found correct will be valid forever, so that testing will
automatically lead to accumulation «(16), p. 1630).
Secondly, the KNMG, like the CAG, holds the opinion
that there is, and can be, only one medical science. Unllke
the CAG, however, this one medical science is associated a
priori with regular medical science. The ·KNMG working
group considers the growing interest in alternative therapies
as a sign that there are lacunae in regular medicine, and
makes recommendations to eliminate the origins of this interest. This optimistic way of reasoning is in sharp contrast
with the idea of the CAG which points out the fundamental
nature of the problems with which regular medicine has to
deal, particularly with regard to the chronic-degenerative
diseases.
As a consequence, the KNMG loses no time in expressing
rejection of alternative therapies: ‘a large part of the alternative therapies must .•. be characterised as pseudo-science’
«(15), p. 1677; cf. also (16), p. 1630). On the other hand, the
scientific character of regular medicine is strongly emphasised. Medicine is an applied empirical science that IJses the
results of many other sciences (biology, chemistry, physics,
mathematics, sociology, psychology).
According to the
KNMG, it is possible as a result of its scientific character,
‘to draw up a long list of investigations which irrefutably
prove the usefulness of particular regular therapies’ «(15), p.
1676).
Criticism
It is remarkable to see in the KNMG standpoint a striking
resemblance with the CAG: both emphasise the crucial role
that is, or should be, played by science when evaluating
(regular and alternative) therapies. More particularly they
both assume the postulate of the unity of Cnedical} science.
Part of the conflict, then, is caused by the fact that the
content of the postulate illeans different things to the two
groups. In this section we shall consider the KNMG’s criticism of the CAG report point for point.
First of all there is the idea that a practically applicable, general criterion exists (testability), by means of which
science may be separated from pseudo-science, as the corn
is separated from the chaff. This is the notorious problem of
demarcation. It is a fact, however, that for contemporary
theory of science the demarcation problem is an unsolved, or
even an un solvable, problem. At the moment there is no such
thing as a generally accepted and universally applicable
demarcation crlterion (see (17), for example). What we do
have are numerous proposals, but all of those are arguable,
and in any case they are not generally applicable, as becomes clear when testing with the help of historical and
sociological case studies. That is why, particularly in the
modern sociology of science, the demarcation problem of
science and pseudo-science is often considered unsolvable or
is disregarded as being a pseudo-problem (for an example,
see (18». Naturally, this can be regarded as arguable. It is
not possible, however, to ignore all these views and to give
the impression, by carelessly dropping a term like testablllty
without further explanation, that the whole problem is
simple and has already been solved.
On the other hand, we feel that the idea of testability,
so long as It is not regarded as an unambiguous demarcation
criterion, does underline an important fundamental aspect of
the matter, which should most certainly not be left out of
the discussion.
All this automatically leads us to a criticism of the
second point, viz. the idea of the unity of the (medical)
scientific method on the basis of notions such as testability
and testing. We do not wish to invent the wheel all over
again and shall limit ourselves to presenting KNMG advisor,
Mellenbergh’s curious standpoint. He quotes Suppe’s book,
The Structure of Scientific Theories, for ‘a survey of the
current state of affairs’ «(16), p. 1630), but he ‘forgets’ to
mention that this current state of affairs in the theory of
science, as it is presented in Suppe’s book, is in sharp contrast with his own ideas!
The third point in the KNMG’s evaluation concerns the
rejection of the major part of alternative therapies and the
defence of the ‘irrefutably useful’ regular medicine. Measured by the KNMG’s own standards, their opinion on alternative medicine is, to say the least, ‘unscientific’, as it is
not the result of thorough testing of this branch of medicine. Mellenbergh even mentions having ‘the impression’ that
many alternative therapies are pseudo-scientlfic «(16), p.
1632). On this point there is more to be said for the CAG’s
opinion that it is time that a systematic evaluation of alternative therapies should be undertaken, although we feel that
what such an evaluation should be like is still a point for
discussion.
3 Testablllty and testing
As we have seen, the general strategy of both the CAG and
the KNMG is aimed at proving the (un)scientific basis of
alternative medicine. In doing so, however, an important
aspect of the matter is ignored or incorrectly represented.
That is, that the aim of therapy is ‘curing’ rather than the
acquisition of theoretical-scientific knowledge. Naturally,
knowledge is used in every branch of medicine in some form
or other. The KNMG,”‘and to a lesser extent the CAG also,
harbours the – unexpressed – presupposltion that scientific
knowledge which has been produced under speclfic conditions, is ‘simply’ applicable in actual therapeutic practice.
Of course, subsidiary problems wlll have to be dealt with,
but they do not detract from the usefulness of the necessary
medical-scientlfic knowledge as such, nor do they make it
superfluous. This way of thinking ignores” an important
aspect, however, something which every general practitioner
will have experienced. This is the fact that the conditions
under which scientific knowledge is produced can be radically different from the sltuations in which this knowledge
would have to be used. Thus the whole notion of the ‘application’ of scientific knowledge in actual therapeutic practice
becomes doubtful (and it is the practices that concern us in
this debate, after all). One exa mple is the discovery of the
antibiotic effect of penicillin on a colony of bacteria in” a
petri-dish. In this environment the situation can be kept
completely under control, but in using penicillln to fight in-
fectious diseases new problems arise, such as the growing
resistance of the bacteria. In view of this consideration, it
would seem to us much more useful when evaluating alternative (and regular) medicine, not to make a ‘detour’ by way
of medical science, but to try and develop concepts of testability and ways of testing that are directly applicable to
these practical situations.
Testing and control
One problem to be explored can be stated as follows. In any
test, the tester should be acquainted with the relevant condltions which make possible a particular treatment and be
able to control them. This holds good for both regular and
alternative therapies. If the fact that the patient takes
three pills after dinner is an essential part of the therapy,
we must – if the case in question is to be a good test of a
particular therapy – be acquainted with the relevant conditions and in a position to manipulate them, so that we can
be sure that the patient does not take six pills before
dinner. Also, if someone has been given a biological-dynamic
diet by a natural therapist, we shall have to know or find
out whether the food sold as such really is biologicaldynamic. In other words, when testing, we aim at closing
systems by trying to speclfy and control the relevant conditions.
As is clear from the above examples, more is required
than just theoretical knowledge, viz. social knowledge and
power to be able to effect the closing of systems in practice. It must be possible for the physician to call in the help
of social workers to ensure that the patient in the example
takes the right number of pills at the right time. And the
natural therapist who recommends breast feeding to increase
a baby’s resistance is acutely aware of his lack of social
power when mother’s milk is shown to be so badly polluted
by PCBs that the wholesome effect becomes doubtful (19).
In testability and testing we are concerned therefore
with the posslblllties for closIng systems in sl.lcha way that
It becomes possible for us to make predictions or pronounce
expectations with regard to the expected course of lllness
and treatment. Essential to this way of thinking is that testability and testing of therapies will always have both cognitive and social aspects. The social aspects are of quite a
different nature from the social aspects that play a role in
scientlfic testing in laboratories or clinics. As a result, testing therapies is not just a matter· of applying scientlfic
theoretical knowledge. The aspect of social knowledge and
control is not an addltional problem, but an essential part of
testing alternative and regular therapies.
Let us give an example to illustrate our point. Beatrix
suffers from chronic frontal sinusitis. Three (or more) possible hypotheses and suitable ways of testing can be imagined.
(a) The nasal septum is in an oblique position, which hinders
an adequate abduction of waste matter. Test: Operate and
put the septum straight.
(b) As a result of Beatrix’s hablt of smoking too much and
eating bad quality food she has a low resistance and cannot
therefore cope with the inflammation herself. Test: Psychotherapy to help her get rid of her nicotine addiction, instruct and motivate her to adopt different food hablts,
based, for instance, on a natural therapy, plus a financial
allowance to cover the higher cost of this kind of food.
(c) Beatrix works in a hospital and the affliction is caused
by the profusion of bacteria present in that environment.
Test: She leaves the hospltal and takes a dlfferent job.
How do these possibillties for testing work out in practice?
For (a): This therapy is undoubtedly testable in present-day
society (the costs will be paid for by the national health
insurance scheme); in the meantime the test has been
carried out, wlth a negative result.
For (b): This therapy has not yet been considered, as it is
not part of regular medicine. Therefore: not testable for
practical reasons.
For (c): It has been suggested that Beatrix give up her job
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In the hospltal. However, In practice thls Is Imposslble, slnce
there Is no other work to be found and the money Is badly
needed. Therefore, for social and personal reasons (c) Is not
testable In practlce.
Concluslon
It wlll be clear that the Ideas on testabllity and testlng are
as yet sweeplng and sketchy. However, we feel that our
exposltlon does show that the problems concernlng the testIng and testablllty of theraples are much more complex than
the KNMG would have us belleve In Its comment on the
CAG report. At the same tlme the contours of an alternatlve approach to the problem start emerglng.
As we have seen, testlng a therapy not only Involves
scientlfic knowledge and technical-scientiflc control, but
also, at the same time, soclal knowledge and social control
of the conditlons that are necessary for effectlve medical
measures. Closlng open systems In a soclal force-fleld Is an
essentlal aspect of testlng alternative (and regular) theraples. It Is thls aspect that has not received nearly enough
attentlon In the CAG report.
What we have sald so far In thls artlcle wlll make It
posslble to gauge more accurately the soclal slgnlficance of
the alternative theraples. Now we can wonder if we wlsh to
submlt ourselves to the social control necessary for an
effective applicatlon of alternatlve therapies, and if so,
whose control we are willlng to submlt ourselves to. We feel
that the scientific strategy pursued by the CAG leads far
too easlly to Increased soclal control by the medical professlons, the state bureaucracy, the pharmaceutlcal Industry,
etc., In other words: to an Increaslng medlcalisation of man
and society. Our condltlon for an offlclal approval of alternatlve theraples Is, therefore, a more open and more democratlc form of ‘soclal control’, leading to alternatlve therapies that wlll not disregard the soclal causes of dlsease. For
thls purpose, it wlll be necessary to formulate differentiated
and speclfic counter strategles and to form soclal counter
forces. But in fact we shall have to go even further. In general it Is by no means always deslrable to close open’ systems and put up wlth the necessary soclal control to render
testlng the therapy posslble. Patients/clients may declde, on
grounds of personal and soclal analyses and prioritles, not to
cooperate In effectlng therapies. In thls case agaln the
avallablllty of counter strategles and counter forces wlll be
a prerequlsite.
In the second part of thls article we shall show that and how – it Is possible to analyse and evaluate thls same
set of problems from a soclal polnt of vlew by using the
notlon of (regular and alternatlve) medlcallsation.
PAR T 11: SOCIAL ASPECTS
What contrlbutlon can the alternatlve theraples make In
brlnglng the process of contlnulng medlcalisatlon of soclety
to a halt or even to reverse It? Thls cruclal polnt is mentloned only Indirectly by the CAG. On the one hand, the
CAG Is of the oplnlon that ‘some alternatlve theraples can
be sald to offer In any case a certain counter force to medlcalisatlon as a result of the attentlon pald to matters such
as llfe-styles, the Indlvldual’s relatlonshlp wlth hls environment, food and food habits, etc.’ «5), p. 44). On the other
hand the CAG says that It realises that a particular use of
alternatlve theraples also harbours the danger of medicallsatlon. In thls part of our artlcle we shall try to reach a more
tanglble vlew of medlcallsatlon and demedicallsatlon tendencles wlthln alternative mediclne. We shall start by analysIng the concept of medicallsatlon Into three elements: the
concept or label of dlsease, the slck role and, connected
wlth it, the mechanism of soclal control.
6
Medicallsatlon
Untll qulte recently, troublesome chlldren who cannot be
made to slt stlll, have problems wlth concentratlng and are
prone to sudden changes of mood were slmply troublesome
chlldren. Slnce 1966 a medical label Is avallable for these
chlldren: ‘hyperklnesls’ or ‘mlnlmum braln dysfunctlon’. To
the Immense satlsfactlon of parents, teachers as well as the
pharmaceutical Industry, troublesome chlldren are now a
medlcal problem. Other well-known new labels are to do
wlth female sexuality and procreatlon – such as the ‘postnatal depresslon’ and the ‘pre-menstrual syndrome’ – and
wlth certaln food habits, such as ‘obesltas’ and ‘anorexla’.
These are a few examples of ‘regular’ medicallsation, which
we want to dlstlngulsh from ‘alternatlve medicalisatlon’.
The concept of medlcalisatlon origlnated withln the
framework of the sociology of devlant behaviour «20), p. 1).
Accordlng to the Interactlonlst devlance sociologlsts, devlance arlses not on the basls of Indlvldual factors such as
motlvatlon and physlque, but Is caused by soclal reactlons to
a partlcular way of behaving. Behavlour Is devlant only
because It Is labelled as such. In thls way the emphasls Is
shlfted from the person who has been labelled devlant to the
Instltutlon attrlbutlng the ‘devlant’ labels. The theoreticlans
of the labelllng approach In no way mean to deny that the
above examples may cover sltuatlons that can be measured
objectlvely and descrlbed In sclentiflc terms. However,
whether thls sltuatlon should be regarded as healthy or slck
Is not a cognltlve-theoretical questlon, but a moral-practical
one, even though it Is not always recognised as such In our
science-orlented society «21, p. 343).
Once people accept the judgment of thelr envlronment,
the label wlll brlng about a reorganlsatlon of thelr behavlour, and they wlll adopt the correspondlng slck role. The
domlnant sick role Is the regular one. In It, slck people are
made not to feel morally responslble for thelr devlant behavlour: they ‘cannot help It’ and must, therefore, be helped.
The legltlmacy of the sick role, however, Is llmlted: sick
people are relleved of the fulfllment of thelr normal duties
only on the conditlon that they regard thelr slckness as undeslrable and accept the obligatlon to get ‘well’. To thls end
they need to call In the competent help of a physlclan and
to obey strlctly the latter’s orders. As a result the sick person Is In fact powerless agalnst the doctor’s decislons. The
regular slck role also offers patlents few posslbllltles for
reslstlng prescribed theraples and thelr posslble slde effects,
hospital treatment, applicatlon of advanced medlcal technology, etc.
At the same tlme, the slck role functlons as a mechanIsm of soclal control. By means of the system of prlvlleges
and obllgatlons outlined above, the regular slck role manages
to channel devlant behavlour In such a way that the existlng
soclal order and stablllty Is not endangered. The mechanlsm
of soclal control ‘lsolates’ the sick person from the healthy
one, and In doing so the former’s legitimacy of belng 111 Is
restrlcted, whlle strengthenlng the latter’s motlvatlon not to
become 111. At the same tlme the slck person Is forced to
enter professlonal instltutlons where he or she is made dependent on those who are not III «22), pp. 428-480).
In sum, we see that three elements are dlstlngulshable In
the medicallsatlon process. It Is a process In which the
labels ‘healthy’ and ‘111’ are belng made to bear on an ever
Increaslng part of human llfe. The process Is accompanled by
an extenslon of the slck role to new areas. From a social
perspectlve, thls means an Increase In the posslblllties for
soclal control. The three elements also play a part In testlng
theraples. As we made clear In Part I, testing presupposes
the possiblllty of closlng systems In such a way that we are
able to make predictlons and pronounce expectations on the
course of the dlsease and the treatment. In order to effect
the closlng of systems In practice, not only theoretical
knowledge – and especlally a concept of dlsease – Is requlred, but also soclal control over the condltions necessary
for successful treatment. The sick role is, therefore – In
terms used by Foucault – the point of intersection of the
technologies of the body, the representations of knowledge
and the mechanisms of power.
2 Drawbacks of the regular model
What the theoreticians of the labelling approach have done,
in fact, is to describe the regular medicalisation process.
According to them a shift has taken place in the course of
time, from the religious and legal definition of deviance as a
sin and crime, to a medical definition of it as a disease. At’
the same time, penance and punishment have increasingly
been replaced by treatment and care. The hospital has succeeded the church and the law court as the most important
institution of social control: ‘The gowns remained but
changed in colour, from red and black to white’ «23), p. 15).
The labelling theoreticians generally tend to emphasise the
negative aspects of the shift from the role of sinner or
criminal to the role of patient – a shift which in slightly
older literature is regarded as a ‘more humane’ attitude
towards social intercourse with deviant behaviour.
They point out the iatrogenous (side)effects of medicalisation. In doing so, they distinguish clinical from sodal
iatrogenesis. Cllnical iatrogenesis refers to any harm done
by a medical technology. Sodal iatrogenesis refers to the
far-reaching dependence of the layman in comparison with
the medical expert, which decreases the health stimulating
and curing aspects of the social and natural environment and
in this way diminishes the physical and mental fighting spirit
of ordinary people «24), pp. 40-41).
The medicalisation of sodety also leads to an obscuration of the sodal etiology of many diseases. As soon as
something is labelled a ‘disease’, it has by definition become
an individual problem; generally speaking, the level of intervention will then also be individual. The label ‘disease’,
therefore, has a depollticising effect and a strong conflictsuppressive power. The result is that medical expert knowledge is called upon more and more frequently to mask explosive sodal oppositions, when taking controversial measures concerning labour relations (for instance, matters like
the legIslation concerning disability allowances, etc.), when
assIgnIng scarce commodities (such as flats and houses),
selecting personnel (medical examinations, etc. for admittance into the army or a variety of jobs), estimating collective risks (toxidty of food), etc. In thIs way the medical profession is collecting a steadlly increasIng number of managerial positIons. ThIs entalls, on the one hand, an Increase
in Individual physicIans’ chances of a decent Income and
consIderable socIal status. But it is also threatening to
undermine to a considerable extent the position of authority
occupied by the regular medical profession as a whole. It is
the alternative therapists who are gaining by the loss of
authority by a rapid rise in status «28), pp. 208-224).
We should like to point out that the model of the sick
role as outllned above is valid only in acute cases. People
suffering from chronic allments and handicaps have an unconditional legitimacy in the sense that they are excused
permanently from certain obligations. This also means, however, that their privlleges are curbed very clearly. Their
needs are always the last thing to be considered, especially
in times of economic crisis: they must not be too demanding
and should be satisfied with what is considered ‘sufficient’
by others . The rise of alternative therapies undoubtedly
is also connected with the attempts made by large groups of
patients who are considered incurable, and have been given
up by the regular physician, to (re)gain the status of acute
patient «21), pp. 224-244).
3 ‘Alternative medicalisation’
The alternative therapies do not constitute a unIty. They
differ widely;n underlying phllosophy and consequent forms
<?f rii;:-':;'losing and therapy. The CAG report shows, however,
that they also have substantial features in common; it is
possible, therefore, to speak here of an alternative medicallsation type, the contours of which we should like to sketch
brIefly.
WithIn the alternatIve therapIes a new concept of dIsease was developed. Illness should no longer be regarded as
a completely negative phenomenon, as a devIation from some
establlshed norm. PaIn, dIsease and death are essential experiences with which each of us shall have to learn to live.
The alternatIve therapIsts agree wIth Illich’s hypothesis that
tradltlonal cultures derlved thelr health-stlmulatlng function
precisely from the ability to teach human belngs that pain
can be bearable, illness understood and the encounter wlth
death meaningful «24), pp. 40-41). Modern medical civilisation has eroded this ability by regarding pain, illness and
death as nothing more than acddents which require medical
treatment. Not until human beings have learned to go
through illness, pain and suffering agaln, will a regeneration
of people’s self-healing power occur. Health, according to
alternative therapists, also needs to be formulated in positive terms – that is, in terms of an optimal sense of wellbeing or comfort – rather than In excluslvely negative terms,
as the absence of complaints and ailments. As a result, the
emphasls shifts from the curative to the preventive level:
rather than combatting dlsease it Is the stimulation of
health that should come first. It is also withIn the alternative therapIes that a new sick role was conceIved. In it, the
patient’s personal responsiblllty for the state of his or her
health is stressed. He or she Is encouraged to adopt an actIve role Instead of belng passlve and dependent. Heallng,
according to the alternative therapists, always is selfhealing. The point is that the ‘inner doctor’ who is present
in every human being should be activated. It is easier to
achieve this when the healing process is based on the
patient’s personal experiences rather than on concepts formulated by the medical profession. Changin& the concept of
disease and the sick role involves changmg the form of
social control which now will no longer be imposed from
above: the patient gets a say in the way in which it should
be exercised. In short, the alternative medicallsation type is
characterised by a positive concept of disease, a moralised
sick role and a democratised form of social control.
In this type of medicalisation, the iatrogenous (slde)effects are diminished or even abolished altogether. In order
to prevent clinical iatrogenesis, alternative therapIsts prefer
limiting medical intervention by means of medicines or surgery to a minimum. When necessary, they make use of sImple
and ‘natural’ techniques, partly derived from Eastern and
traditional therapies, and partly from modern forms of
psycho-therapy that stress ‘body-work’. Most important of
all, however, are the so-called ‘life-style’ recommendations,
concerning eating and sleeping habits, work, pain, grief, etc.
As the above techniques and recommendations can, in general, be understood and applied by anyone, they tend to
have a de-professionalising effect. This leads us to the issue
of sodal iatrogenesls. To prevent this happening, a larger
degree of equality between physician and patient is aimed
for, which is expressed by such things as the use of the
same sort of language, wearing the same clothes, openness
with regard to the diagnosis, therapy and prognosis. There
are no medical secrets to make patients dependent and insecure, and it is not assumed that they know nothing about
their own health or illness or the functioning of their own
body. The obscuring of the social etiologyis also avoided to
a large extent by alternative therapies. This results from
the hollstic principle on which these therapies are based.
Alternative therapists assume that illness and health should
be placed within the context of people’s total functioning.
They resolutely reject the body-mind dualism that for a long
time was a central philosophical theme in Western thought,
and also pay attention (to some extent, at least) to the spiritual dimension of human life. Health and illness should,
according: to the alternative therapists, be seen in terms of
harmony and disharmony between the somatic, mental and
7
spiritual aspects, all of which form a fundamental and integral whole. However, humans should be in harmony not only
with themselves, but also with their natural and social environment. That is why alternative therapists wlll take eco··
logical and social factors into account when making their
analysis of the origins and development of illness.
4 Dangers of alternative medicalisation
‘Too good to be true’ the patient reader will say at this
point. And quite rightly, seeing that dally practice is often
in shri11 contrast with the rose-coloured self-image fostered
by alternative therapists, as is clear from the CAG report.
Three dangers in particular are connected with the alternative medicallsation model, which we shall examine in more
detall: the positive approach to health and illness may lead
to an unprecedented expansion of accompanying labels; the
moralised sick role may lead to quite new forms of ‘victim
blaming’; and finally, attempts at preventing iatrogenesis
may lead to ‘secondary iatrogenesis’.
Healthism
Crawford accuses the proponents of the new health movements (to which alternative therapists and their patients and
supporters should also be considered to belong) of a onesided preoccupation with personal health as the highest aim
in Hfe and as the main source of well-being. This obsession,
labelJed ‘healthism’ by Crawford, may clear the way for
total medica!lsation, in which the labels ‘lli’ and ‘healthy’
will gradually be app!led to practically all phenomena and
activities of daily Hfe. The labelllng process w1ll no longer
llmit itself to manliest sickness behaviour, but will extend
to all risk-bearing behaviour, i.e. to all ways of behaviour
and all habits that are regarded as being bad for one’s
health. The result will be that we shall all of us become
deviants in our daily lives – ‘when we llght up a cigarette,
when we consume eggs at breakfast, and when we are unable to express fully our emotions’ «26), p. 380). We should
alJ of us be aware of our duty – as potential patients – to
diminish health risks by correcting ‘bad’ habits.
Crawford’s criticism of the new health movements did
not fall to excite a response. Putting the individual’s health
first must not, according to Katz and Levin, be regarded as
a ‘sollpsistic trap’ which a generation of disillusioned activists walks into with its eyes open (as Crawford would have
us believe). The growing consciousness of the dangers that
threaten our health, it is said, should be seen as a condition
rather than an impediment for social action. Participation In
the new health movements has, therefore, nothing to do wIth
narclss1sm or social escapIsm; on the contrary, it 1s ‘a specific antidote to passivity, apathy, and dependency in the
health care area, and has potential extension to other areas
of !lving as well, including the polltical sphere’ «27), p.
333). The increased health consc1ousness that is indicated by
the term ‘healthlsm’ by Crawford cannot therefore be simply
explained in terms of increasing medicallsation.
To prevent ‘health1sm’ from deteriorating into medicalisation, the power to define what counts as ‘lli’ and
‘healthy’, which is now held unilaterally by the medical profession, will have to be spread. After all, the question what
should be called ‘ill’ and ‘healthy’ is a moral-practical one,
not just a cognitive-theoretical one, to answer which the
medical profession does not possess any special competence.
In order to achieve this, a certain amount of openness is
required in the relationship between physician and patient,
and between the medical profession and the public. Among
alternative therapists in the Netherlands this relationship
leaves much to be desired. Instead of openness, a certain
amount of obscurantism can be seen. This is partly due to
the monopoly posItion of academically trained physicians, as
it was laid down in 1865 in the ‘Act on the Execution of
Medical-Practice’. The science-based approach to illness and
health was elevcaed by the Act to the only ‘regular’ approach. The alternative therapies, which were practised
8
largely by unqualified practitioners, were reduced to the
status of quack remedies and clandestine status. This aura
of taboo wIll not dIsappear until the 1865 Act is replaced.
In a proposed new Act, the exclusive monopoly of medicai
practitioners is changed into a partIal monopoly, whlle the
professional protection is replaced by protection of the title
to create room for the application of therapies by nonquallfled practitioners.
Another important cause of lack of openness is to be
found in the fact that alternative therapists in the Netherlands tend towards a certain amount of sectarism. This can
be explained from the fact that a number of alternative
therapies arose in the context of a particular life phllosophy
– usually one with rellgious overtones.
Victim Blaming
Another danger mentioned by Crawford concerns the moralised sick role. He points out that the holism of alternative
therapists is of a very limited character: although it is true
that the ecological and social context is not ignored or
denied, it is, as a rule, reduced to the immediate environment and area of personal relationships. As a result, the
problem of illness and health is still, just as in orthodox
medical science, largely formulated and dealt with at the
individual level. Combined with the strong emphasis on personal responsibllity typical of the alternative sick role, this
reduction will inevitably lead to all kinds of ‘victim blaml!:!.&’. The diseased wlll then be made responsible for matters
and circumstances that from the nature of things are out of
their control and which they cannot possibly manipulate on
their own. Disease is (once again) turned into punishment for
moral decline and lack of wlll-power. We want to add to
Crawford’s critique that this state of affairs may lead the
patient to a sltuation that is comparable in all respects to
the situation in regular medicine. A patient who is gUllty of
hIs own illness is not in a position to question the views and
actions of his or her physician or therapist: In th1s way one
kind of intimidation may lead to another, so that the dependency relationship is continued rather than abol1shed.
The dangers that are pointed out by Crawford can no
doubt also be detected in the development of alternative
therapies in the Netherlands. Although it 1s true that fa1rly
recently the importance of good – ‘stable and warm’ – interhuman relationships was discovered and a certain amount of
ecological awareness can be said to exist, as is apparent
from the mounting avers10n to technology and ‘chemicals’,
nevertheless there is nothing substantial to be found in the
CAG report on the pollution of the environment, inner city
decay, the mllitarisation of society, the nuclear threat,
alienated labour, racism or paternalistic attitudes as (co-)originators of disease. Moreover, it is far too often the sick
individual who is blamed for his or her disease (seen as a
result of disharmony in the person-environment relationship).
It is not the environment that needs changing, but the
patient’s llfe style.
Patients who are not sufficiently motivated or capable
of discarding certain habits and making quite drastic
changes in their IHe styles are, therefore, not accepted.
Some alternative therapists want to extend the patient’s
personal responsibllity to the financial sphere by asking for
a private contr1bution and a retr1bution system: ‘li the
patient is not aware of the costs he himself is causing, and
does not, in the first instance, have to pay for them himself,
he will not be fully conscious of his personal responsibility’
«5), appendix F, p. 30).
Secondary 1atrogenesis
The final danger that we should llke to discuss is pointed
out by Illich. He argues that health service reforms, although aimed at fighting clin1cal and social iatrogenesis, will
generally only lead to secondary iatrogenesis. ‘Acupunctur1sts, homeopaths, and witches can be assigned departments
in a worl~-wide hosp1tal for IHe-long patients. In a ther-
apy-oriented society, all kinds of Aesculapians can share the
monopoly of assigning the sick role, but the more different
professional cl iques can exempt the sick from their normal
obllgations, the less people on their own define how they
wish to be known and treated’ «24), p. 79). According to
this view, alternative therapists would do better to shut up
shop, if they want to do us a favour.
Illich undoubtedly is right in saying that within alternative medicine there is a tendency towards professionalisation. Over the past decade especially all kinds of professional organisations of alternative therapists have been founded,
which concern themselves with drawing up rules for admission, fee charging and disciplinary measures. The CAG
report focuses on the demarcation problems with respect to
regular medicine resulting from this process of professionalisation. However, it is not a matter of course at all that
this rise of an alternative profession side by side with the
regular medical profession will lead to increased dependence
on the part of the average patient, as I111ch would have it
. This danger would arise only in a situation of complete
‘regularisation’, i.e. in case of a frictionless incorporation of
alternative medicine within the framework of the existing
health service, without any changes in the framework itself.
It is by no means impossible that those therapies that regard
themselves as ‘additive’ rather than ‘alternative’ will be
allotted a place in the social system of health care, their
main function being to assist in streamlining existing medical
treatment. In that case there will, indeed, be secondary
iatrogenesis: for the problems caused by regular medicalisation a new medical channel will have been created. The
problems will simply repeat themselves at a higher level, by
creating new, more subtle forms of making people dependent. In this way alternative therapies may well become the
end of the line for all hopeless, chronic and/or terminal
cases that have gone the full round of the (regular) medical
profession.
According to the CAG report, natural therapists and although to a lesser extent – ESP therapists are the only
ones who recognise the dangers connected with complete
regularisation, such as limitations on the consultation duration, large-scale practices, profit making and conformity
demands «5), pp. 93 and 112; (5), appendix D, p. 35).
Since the recent foundation of the ‘Organisation of
Alternative Therapists in the Netherlands’ (NOVAG), all
warnings with respect to these dan~ers seem to have died
(1) Ferguson, M. The Aquarian Conspiracy, Granada Publishing Limited,
New York, 1982.
(2) Webb, E.C. et ai, Report of the Committee of Inguiry into Chiropractic,
Osteopathy, Homeopathy and Naturopathy, Australian Parliamentary
,
Paper 102, April 1977.
(3) Inglis, B.D. et ai, Chiropractic in New Zealand, 1979 (quoted in (5),
Bijlage 13, pp. 15 and 19).
(4) Fulder, 5., The Threshold Survey of Alternative Medicine, quoted in (5),
appendix B, p. 15.
(5) Rapport van de Commissie Alternatieve Geneeswijzen, Alternatieve
geneeswijzen in Nederland, Staatsuitgeverij, Den Haag, 1981.
(6) Groot, A.D. de, Methodologie, Mouton, Den Haag, 1961 (English translation: Methodology, Mouton, The Hague, 1969).
(7) Kuhn, T.S., The Structure of Scientific Revolutions, 2nd edition, The
University of Chicago Press, Chicago, 1970.
(8) Feyerabend, P., Against Method, New Left Books, London, 1975.
(9) Lakatos, I. and Musgrave, A. (eds.), Criticism and the Growth of Knowledge, Cambridge University Press, Cambridge, 1970.
(10) Shapin, S. ‘History of Science and its Sociological Reconstructions’,
History of Science 20, 1982, pp. 157-211.
(11) Knorr-Cetina, K.D. and Mulkay, M., Science Observed, Sage Publications, London, 1978.
(12) Rotschuh, K. Konzepte der Medizin, Hippokrates Verlag, Stuttgart,
1978.
(13) Pekelharing, P., ‘Cykopiese filosofie’, Krisis 2, No. 4, 1982, pp. 28-52.
(l4) Hesse, M., Revolutions and ReconstrUCtIons in the Philosophy of
Science, Harvester Press, Brighton, 1980, pp. 61-164.
(15) Commentaar van de werkgroep ter voorbereiding van de KNMG-reactie
op het r’-ipport van de Commissie Alternatieve Genceswijzen in Nederland, Medisch Contact, No. 51/52, 1982, pp. 1672-1680.
(l6)Mellenbergh, G.J., ‘Wetenschapsopvattingen en alternatieve
geneeswijzen’, Medisch Contact, No. 51/52, 1982, pp. 1629-1632.
(17) Koningsveld, H. Het verschijnsel wetenschap, Boom, Meppel, 1976.
(18) Latour, B. and Woolgar, S. Laboratory Life, Sage Publications, London,
1979.
down. The organisation, ‘the alternative KNMG’, is an offshoot of an organisation in which patients as well as therapists were represented. Whlle the patients have found a
place in a ‘National Consultative Organisation for Patients
of Alternative Therapies’, the therapists have joined forces
in NOVAG. NOVAG is trying to win complete official approval by cutting off all offshoots. Since 1 January 1984, a
stop has been issued in all subsidiary organisations for members who do not come up to the standards – stricter now
than before – with regard to training, the organisation of
their practices and experience. They are hoping for money
for ‘real’ effect research and have given matters such as
cooper a tion with regular medicine high priority.
The question is whether the patients will be prepared
and able to offer some kind of resistance and call the alternative therapists back. When we see what motivates the
average patient to go and see an alternative therapist, there
does not seem to be much chance of this happening. As is
clear from the CAG report, users of alternative therapies
may be divided into three categories: frustrated patients
(frustrated by regular medicine, that is), pragmatic patients
(using now regular, now alternative therapy) and high principled patients (choosing an alternative therapy as part of
their life philosophy or religion) «5), p. 59). A section of the
high principled patients, who number no more than twenty
percent of the total number of patients, received its preference for alternative therapies as part of its upbringing,
one might say «5), appendix F, p. 57), e.g. many patients of
homeopathic therapists traditionally belong to the Dutch
Calvinist Church. It seems reasonable to assume that another section of ideologically motivated patients stems from
the countermovement. Two indications for this assumption
may be found in the CAG report. First, a number of patients’ organisations have seen a marked increase in the number of young patients who have ‘a new way of looking at
things’ «5), appendix F, p. 48). Secondly, we find that alternative therapists not only have a large foHowing among adherents of small right-wing parties but also among those of
small left-wing parties. The fact that the alternative therapists – with the political victory in sight – have been able to
move so easlly in the direction of total regularisation may
well be connected with the fact that the counter-movement
has been able to develop so little strength up to now among
patients of alternative therapists.
Translated by Thea Sumrnerfield
(19) Pros tier , E., Moedermelk in een vervuild milieu, Stichthing Ekologie,
Amsterdam, 1983.
(20) Conrad, P. and Schneider, J.W., Deviance and Medicalization, Mosby &:
Co., St. Louis, 1980.
(21) Freidson, E., Profession of Medicine, Dodd, Mead &: CO., New York,
1973.
(22) Parsons, T., The Social System, Tavistock, London, 1952.
(23) Zola, I.K., De medische macht, Boom, Meppel, 1973.
(24) Illich, I., Medical Nemesis: the Expropriation of Health, Calder and
Boyars, London, 1975.
(25) Swaan, A. de, De mens is de mens een zorg, Meulenhoff, Amsterdam,
1982.
(26) Crawford, R., ‘Healthism and the Medicalization of Everyday Life’, Int.
J. of Health Services 10, 1980, pp. 365-388.
-(27) Katz, A.H. and Lowell, S.L. ‘Self-care is not a Solipsistic Trap’, Int. J.
of Health Services 10, 1980, pp. 329-337.
–From approximately 1960 a ‘historical wave’ can be detected in the
theory of science with which the names of Kuhn, Feyerabend and
Lakatos especially are connected. See (7), (8) and (9). At a later stage,
from approximately 1975, an important ‘sociological wave’ came into
be ing; see (10) and (11).
2 People with a disease that is stigmatised by society, such as many
venereal diseases, AIDS, epilepsy, leprosy, dementia and psychic disorders, have an even harder time. These diseases are frequently regarded as completely illegitimate: the patient is, admittedly, discharged
from a number of responsibilties, but he/she is forced to contract new
responsibilities and enjoys few, if any, privileges.
3 Even if IlIich were proved right on this point, only half of his statement
will have been proved, and he will still have to make credible that the
sparing use made of soft and natural techniques by alternative therapists will lead to secondary clinical iatrogenesis, which it is very hard
indeed to imagine.
—
9