Back in the '60s, it was cool to be counter. Many baby boomers were against anything mainstream: the war and LBJ, corporate America, and most everything the older generation held dear. Even now, when it comes to unconventional medical approaches, I love the feisty label "alternative"--especially given the choices of the idealistic "holistic," the diplomatic "complementary," or the now fashionable "integrative."

After all, it was "alternative medicine" that skeptic Leon Jaroff targeted for his vitriolic attack in the November 8, 1999, issue of Time. "'Alternative medicine,'" he charged, "is merely a politically correct term for what used to be called quackery."

Would his blistering rant have had the same impact had he attacked "integrative medicine"? I don't think so.

In 1995, the National Institutes of Health (NIH) sponsored a Complementary and Alternative Medicine (CAM) Research Methodology Conference in which a panel was convened to ponder labels for non-mainstream medicine. The distinguished body identified segments of the population that use these forms of medicine. There are those, the panel declared, who view the terms "alternative" and "complementary" as accurate and value-neutral; others find the terms "offensive for implying the centrality of biomedicine." The panel also stated that there are those who flaunt the labels of "alternative" and "complementary" like "badges of honor to point out what's missing in biomedicine."

I fall squarely in the latter group. I'm still gripped by counterculture cachet, but these days my cohorts are known as the cultural creatives. We are the 44 million adults identified by sociologist Paul Ray as valuing, among other things, ecological sustainability, feminism, spirituality--and "alternative" medicine, perhaps valuing the label as much as the medicine. After all, haven't we also embraced "alternative music" and "alternative lifestyles"?

I concede to those offended by the "alternative" label that this term and the term "complementary" certainly imply the centrality of biomedicine, relegating other forms of medicine to peripheral roles. Something cannot be alternative or complementary unless it is alternative or complementary to something else, frequently, in this case, the politically dominant system referred to as "allopathy," from the Greek allo, meaning "opposite," and pathos, meaning "suffering." This form of medicine, in general, focuses on stamping out the disease or countering the symptoms. Some therapies that fall into the alternative category also operate in this way, such as the use of herbal remedies in place of antibiotics. Other alternatives, however, reflect perspectives rooted in very different philosophies, such as traditional Chinese medicine, ayurveda, homeopathy, and naturopathy. These philosophies might be labeled "holistic" because they focus not on disease but on body, mind, and spirit.

But the term "alternative" is intrinsically weak insofar as much of its support lies in anti-establishment feelings and because, by definition, it includes healing approaches that have not been proven by scientific methods. Thus, a treatment such as acupuncture, which is gaining ground and acceptance through research, probably can no longer be considered "alternative."

This whole linguistic sticky wicket began with the term "holistic," which was coined in the 1920s. While it grew in popularity among lay people, it remained on the fringes in medical and academic circles perhaps because it became too closely associated with the New Age movement in the '70s and '80s. Holistic medicine sought to treat not symptoms but the whole person, including his or her body, mind, and spirit.

In 1992, when Congress funded the Office of Alternative Medicine (OAM) at NIH, "alternative" was the more recognized term for unconventional treatments not taught in medical school. But on the one hand, "alternative" sounded adversarial, and on the other, some practitioners saw these approaches as adjuncts to Western treatment, not as separate medical options. So the label "alternative" gave way to the softer "complementary," preferred in European medical circles. One approach central to complementary medicine was nutrition, which had not garnered much attention in the medical community before the early 1980s.

But academicians--even the OAM itself--were reluctant to drop the word "alternative" entirely. Instead, they reduced it to secondary status by adopting the phrase "complementary and alternative medicine," widely known by its acronym CAM. As if to legitimize the new acronym, in 1998 Congress gave OAM substantially increased funding, conferred on it higher status in the NIH hierarchy, and rechristened it the National Center for Complementary and Alternative Medicine (NCCAM).

Meanwhile, the current buzzword "integrative medicine" was picking up steam, with its implication that non-mainstream medicine could actually partner with conventional approaches. Best-selling author and Harvard-trained physician Andrew Weil threw his weight behind this term of compromise and cooperation. As founder of the Foundation for Integrative Medicine and director of the Program in Integrative Medicine at the University of Arizona in Tucson, Weil has worked zealously to link a variety of healing systems with one another and with mainstream medicine.

The trend toward integrative medicine is one that satisfies consumers without threatening M.D.'s. It is even more mainstream than complementary medicine. But at the core of both complementary and integrative medicine is conventional medicine. A recent issue of Baltimore magazine, for example, featured a rundown of Baltimore-area hospitals that are "answering consumer demand for herbal medicine, acupuncture, and massage with new centers and specialists of their own." Pointing up the politico-semantic issues, writer Christine Demkowych noted, "For traditional physicians, and for some patients, too, nomenclature is important: Many hospitals have incorporated the words 'complementary' or 'integrative' or 'wellness' into the names of their new centers, suggesting cooperation rather than competition. Few hospitals use the word 'alternative.'"

Whereas various kinds of practitioners, including healers, shamans, and teachers of yoga, have been leaders in the alternative, holistic, and even complementary movements, one hallmark of integrative medicine appears to be that it is usually physician-led and physician-dominated. Take American WholeHealth, for example, "the nation's largest and fastest growing provider of integrative medicine." Founded in 1993 by David Edelberg, M.D., of Chicago, it boasts 3 operating divisions, 11 medical centers and affiliates in cities, and combined revenues of $40 million a year. Although a typical American WholeHealth practice incorporates chiropractic, acupuncture, massage, and other modalities, the keystone is clearly the multi-specialty group of board-certified physicians.

But every generalization has its exceptions. The start-up Association for Integrative Medicine is led not by an M.D. but by a chiropractor, and the organization invites "holistic, alternative, and integrated health practitioners" not only to join--but also to nominate themselves for positions on the board of directors.

In many ways, "holistic," "alternative," "complementary," and "integrative" appear to form less of a linguistic progressive dinner and more of a word stew. Promoters and practitioners may adopt one label, but they usually employ as many others as possible--as if to offer the largest imaginable menu. The American Holistic Medical Association, for example, states that the "practice of holistic medicine integrates conventional and alternative therapies to prevent and treat disease and, most important, to promote optimal health." And American WholeHealth combines "the best of conventional and alternative practices" and also describes itself as "one of the nation's leading network providers of complementary medicine."

In this time of medical revolution, we have a growing opportunity to take responsibility for our own health. Many of us will sample alternative, holistic, complementary, or integrative medicine. We can dip our spoons in the word stew, choosing from the changing lexicon, each according to our own tastes.

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