Worldwide, only an estimated 10 to 30 percent of human healthcare is delivered by conventional, biomedically oriented practitioners. The remaining 70 to 90 percent ranges from self-care, according to folk principles, to care given in an organized healthcare system based on an alternative tradition or practice.

Popular healthcare is the kind most people practice and receive at home, such as giving herbal tea to someone who has a cold. Community-based healthcare, which reflects the health needs, beliefs, and natural environments of those who use it, refers to the nonprofessionalized but specialized healthcare practices of many rural and urban people. Professionalized healthcare is more formalized; practitioners undergo more standardized training and work in established locations.

Professionalized Healthcare Systems

The professionalized healthcare practitioners often have conducted scientific studies about the causes of illness and explanations and results of treatment. Each of the major professionalized systems has certain characteristics: a theory of health and disease; an educational scheme to teach its concepts; a delivery system involving practitioners; a material support system to produce medicines and therapeutic devices; a legal and economic mandate to regulate its practice; cultural expectations about the medical system’s role; and a means to confer professional status on approved providers. These professionalized medical systems include traditional oriental medicine, acupuncture, ayurvedic medicine, homeopathy, anthroposophy, naturopathy, and environmental medicine.

Traditional Oriental Medicine

Traditional oriental medicine is a sophisticated set of many systematic techniques and methods, including acupuncture, herbal medicine, acupressure, qi gong, and oriental massage. The most striking characteristic of oriental medicine is its emphasis on diagnosing disturbances of qi, or vital energy, in health and disease. Diagnosis in oriental medicine involves the classical procedures of observation, listening, questioning, and palpation, including feeling pulse quality and sensitivity of body parts.

The professionalization of oriental medicine has taken diverse paths in both East Asia and the United States. Currently, the model in the People’s Republic of China, which was established after the 1949 revolution, involves the organized training of practitioners in schools of traditional Chinese medicine. The curriculum of these schools includes acupuncture, oriental massage, herbal medicine, and pharmacology, though the clinical style of making a diagnosis and then designing a treatment plan is the one traditionally associated with herbal medicine. The graduates of these colleges are generally certified in one of the four specialty areas at a training level roughly equivalent to that of a Western country’s bachelor’s degree.

In the United States, the professional practitioner base for oriental medicine is organized around acupuncture and oriental massage. There are about 6,500 acupuncturist practitioners in the United States. The American Oriental Body Work Therapy Association has approximately 1,600 members representing practitioners of tuina, shiatsu, and related techniques. Many American schools of acupuncture are evolving into "colleges of oriental medicine" by adding courses in oriental massage, herbal medicine, and dietary interventions. They also are offering diplomas, master’s degrees, and doctor’s degrees in oriental medicine. The legal sanctioning of oriental medical practice is most extensive in New Mexico, where the acupuncture community has established an exclusive profession of oriental medicine. Their legal scope of practice is currently similar to that of primary care M.D.s and D.O.s (doctors of osteopathy), and their State statute restricts other licensed New Mexico health professionals’ ability to advertise or bill for oriental medicine or acupuncture services.

Extensive research has been done in China through the institutions of traditional Chinese medicine, but only in the past quarter century have biomedical scientists in China characterized and identified active agents in much of traditional medical formulary. The use of traditional oriental herbal medicines and formulas in China and Japan has been studied for therapeutic value in the following areas: chronic hepatitis; rheumatoid arthritis; hypertension; atopic eczema; various immunologic disorders, including acquired immunodefiency syndrome (AIDS); and certain cancers. It would be useful to repeat these studies in the United States, assessing U.S. clinical populations according to high-quality research criteria.

Acupuncture

Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes. Puncturing the skin with a needle is the usual method, but practitioners also use heat, pressure, friction, suction, or impulses of electromagnetic energy to stimulate the points. In the past 40 years, acupuncture has become a well-known, reasonably-available treatment in developed and developing countries. Acupuncture is used to regulate or correct the flow of qi to restore health.

Modern theories of acupuncture are based on laboratory research conducted in the past 40 years. Acupuncture points have certain electrical properties, and stimulating these points alters chemical neurotransmitters in the body. The physiological effects of acupuncture stimulation in experimental animals have been well documented, and in the past 20 years acupuncture has become an increasingly established healthcare practice. An estimated 3,000 conventionally trained U.S. physicians have taken courses to incorporate acupuncture in their medical practices.

Acupuncture is one of the most thoroughly researched and documented of the so-called alternative medical practices. A series of controlled studies has shown evidence for the efficacy of acupuncture in the treatment of a variety of conditions, including osteoarthritis, chemotherapy-induced nausea, asthma, back pain, painful menstrual cycles, bladder instability, and migraine headaches. Studies on acupuncture also have shown positive results in the areas of chronic pain management and in the management of drug addition, two areas where conventional Western medicine has had only a modicum of success.

Ayurveda

Ayurveda is India’s traditional, natural system of medicine that has been practiced for more than 5,000 years. Ayurveda provides an integrated approach to preventing and treating illness through lifestyle interventions and natural therapies. Ayurvedic theory states that all disease begins with an imbalance or stress in the individual’s consciousness. Lifestyle interventions are a major ayurvedic preventive and therapeutic approach. There are ten ayurveda clinics in North America, including one hospital-based clinic that has served 25,000 patients since 1985.

In India, ayurvedic practitioners receive state-recognized, institutionalized training in parallel to their physician counterparts in India’s state-supported systems for conventional Western biomedicine and homeopathic medicine. The research base is growing concerning the physiological effects of meditative techniques and yoga postures in Indian medical literature and Western psychological literature. Published studies have documented reductions in cardiovascular disease risk factors, including blood pressure, cholesterol, and reaction to stress, in individuals who practice Ayurvedic methods.

Laboratory and clinical studies on ayurvedic herbal preparations and other therapies have shown them to have a range of potentially beneficial effects for preventing and treating certain cancers, treating infectious disease, promoting health, and treating aging. Mechanisms underlying these effects may include free-radical scavenging effects, immune system modulation, brain neurotransmitter modulation, and hormonal effects.

Homeopathic Medicine

Homeopathic medicine is practiced worldwide, especially in Europe, Latin America, and Asia. However, even in the United States the homeopathic drug market is a multimillion-dollar industry. Homeopathic remedies, which are made from naturally occurring plant, animal, or mineral substances, are recognized and regulated by the Food and Drug Administration (FDA) and are manufactured by established pharmaceutical companies under strict guidelines. Homeopathy is used to treat acute and chronic health problems as well as for disease prevention and health promotion. Recent clinical trials suggest that homeopathic medicines have a positive effect on allergic rhinitis, fibrositis, and influenza.

Basic research in homeopathy has involved investigations into the chemical and biological activity of highly diluted substances. Some homeopathic medicines are diluted to concentrations as low as 10-30 to 10-20,000. This particular aspect of homeopathic theory and practice has caused many modern scientists to reject homeopathic medicine. Critics of homeopathy contend that such extreme dilutions of the medicines are beyond the point at which any active molecules of the medicine can theoretically still be found in the solution. On the other hand, scientists who accept the potential benefits of homeopathic theory suggest several theories to explain how highly diluted homeopathic medicines may act. Using recent developments in quantum physics, they have proposed that electromagnetic energy in the medicines may interact with the body on some level. Researchers in physical chemistry have proposed the "memory of water" theory, whereby the structure of the water-alcohol solution is altered by the medicine during the process of dilution and retains this structure even after none of the actual substance remains.

Anthroposophically Extended Medicine

Anthroposophically extended medicine is an extension of Western biomedicine and also incorporates approaches and therapeutics from two alternative medicine movements: naturopathy and homeopathy. Anthroposophically extended medicine is most prominent in Europe, but there are an estimated 30 to 100 M.D.s in the United States who practice it also. Hundreds of uniquely formulated medications are used in anthroposophical practice, each seeking to match the key dynamic forces in plants, animals, and minerals with disease processes in humans to stimulate healing. Much research in anthroposophically extended medicine has been connected with attempts to understand the nature of disease, assess treatments qualitatively, and understand how the essential properties of the objects under investigation could be applied in therapy.

Naturopathic Medicine

Naturopathic medicine, as a distinct American healthcare profession, is almost 100 years old. It was founded as a formal healthcare system at the turn of the century by medical practitioners from various natural therapeutic disciplines. By the early 1900s, more than 20 naturopathic medical schools existed, and naturopathic physicians were licensed in most States. Today there are more than 1,000 licensed naturopathic doctors in the United States.

As practiced today, naturopathic medicine integrates traditional natural therapeutics — including botanical medicine, clinical nutrition, homeopathy, acupuncture, traditional oriental medicine, hydrotherapy, and naturopathic manipulative therapy — with modern scientific medical diagnostic science and standards of care. The medical research base of naturopathic practice consists of empirical documentation of treatments using case history observations, medical records, and summaries of practitioners’ clinical experiences.

At present, the two accredited naturopathic medical schools in the United States have active research departments. Naturopathic researchers have investigated the pharmacology and physiological effects of nutritional and natural therapeutic agents, and naturopathic physicians have been active in the investigation of new homeopathic remedies and in the natural treatment of women’s health problems. The most recently completed naturopathic study in women’s health tested the clinical and endocrine effects of a botanical formula as an alternative to estrogen replacement therapy.

Environmental Medicine

Environmental medicine, like anthroposophically extended medicine, also can be viewed as an extension of modern biomedicine. Environmental medicine traces its roots to the practice of allergy treatment and the work of Dr. Theron Randolph, in the 1940s, who identified a variety of common foods and chemicals that were able to trigger the onset of acute and chronic illness even when exposure was at relatively low levels.

Environmental medicine recognizes that illness in individuals can be caused by a broad range of incitant substances, including foods, chemicals found at home and in the workplace, and chemicals in the air, water, and food. Today there are 3,000 physicians worldwide practicing environmental medicine, and there are several environmental control units in the United States and one in Canada, where patients’ sensitivities are unmasked through fasting and complete avoidance of potentially incitant chemicals.

Research, in this field, has been directed at clinical treatment of patients and at evaluation of the diagnostic and treatment techniques used by practitioners. Other studies have supported the use of the approaches of environmental medicine in treating arthritis, asthma, chemical sensitivity, colitis, depression, eczema, fatigue, and hyperactivity.

The belief that humans can get sick from cumulative low-level environmental exposure to certain incitants is not well accepted by the conventional medical community. However, because "sick building syndrome" and other chronic conditions that cannot be explained by other phenomena are being seen with greater frequency, environmental medicine offers a theoretical groundwork for dealing with such phenomena. Indeed, environmental medicine is in a position to be a leading force in the investigation of ways to reduce the incidence of these and other disorders.

Community-Based Healthcare Practices

Community-based healthcare practices are varied and are found throughout the United States. Like other healthcare specialists, community-based healers may emphasize naturalistic, personalistic, energetic explanatory models or a combination. Traditional midwives and herbalists and, at the present time, pragmatic weight loss specialists are probably the best known of community-based practitioners who follow the naturalistic model. In addition, the Native American medicine man or medicine woman is a community-based traditional healer with primarily naturalistic skills, that is, the skills of an herbalist in particular. Some medicine people are also shamans, in which case they are often distinguished as holy men and women.

In contrast to professionalized practitioners, community-based healers often do not have set locations such as offices or clinics for delivering care but do so in homes, at ceremonial sites, or even right where they stand. Community-based healing of the personalistic variety can also be "distant," that is, it does not require that practitioner and patient be in each other’s presence. Prayers or shamanic journeys, for example, can be requested and "administered" at any time, and charm cures are sometimes delivered by telephone.

Meanwhile, community-based systems also thrive in urban areas. These systems include the popular weight loss programs and other 12-step programs. Often the practitioners rent office space and emphasize contact between client and practitioner, and they may charge considerable fees. Since these practitioners depend on their healing practice for their livelihood, they advertise and so may be easier to identify and contact for study purposes.

Native American

Native American Indian community-based medical systems have a number of rituals and practices: sweating and purging, usually done in a "sweat lodge"; the use of herbal remedies gathered from the surrounding environment and sometimes traded over long distances; and shamanic healing involving naturalistic or personalistic healing. Tribes such as the Lakota and Dineh (Navajo) also use practices such as the medicine wheel, sacred hoop, and the "sing," which is a healing ceremony rite that lasts from two to nine days and nights and is guided by a highly skilled specialist called a "singer."

Formal research into the healing ceremonies and herbal medicines conducted and used by bona fide Native American Indian healers or holy people is almost nonexistent, even though Native American Indians believe they positively cure both the mind and body. Ailments and diseases such as heart disease, diabetes, thyroid conditions, cancer, skin rashes, and asthma reportedly have been cured by Native American Indian doctors who are knowledgeable about the complex ceremonies.

Latin American

Latin American community-based practices include curanderismo, which is a folk system of medicine that includes two distinct components: a humoral model for classifying activity, food, drugs, and illness; and a series of folk illnesses.

In the humoral component of curanderismo, things could be classified as having qualitative (not literal) characteristics of hot or cold, dry or moist. According to this theory, good health is preserved by maintaining a balance of hot and cold. Thus, a good meal will contain both hot and cold foods, and a person with a hot disease must be given cold remedies and vice versa. Again, a person who is exposed to cold when excessively hot may "take cold" and become ill.

The second component, the folk illnesses, is actively in use in much of Mexico and among less educated Hispanic U.S. citizens. Studies have found that as many as 96 percent of Mexican-American households (more frequent in the less Americanized communities) treated members for Hispanic folk illnesses. Similarly, high use patterns among Mexican migrant workers have been found in Florida and Mexico.

Although no formal effectiveness studies seem to have been done on this system, its wide popularity and the research suggesting the relevance of the folk diagnoses, for biomedical practice, indicate the need for further demographic and effectiveness studies.

Alcoholics Anonymous

Alcoholics Anonymous (AA) is an example of an urban community-based healing system for helping people, whose lives are damaged by the consumption of alcohol, to stop drinking. Founded in 1935 by Bob Smith, M.D. and Bill Wilson, two alcoholics, it is a patient-centered self-help fellowship of men and women. AA has burgeoned and today is widely considered the most successful existing method for supporting sobriety.

In contrast to most community-based systems, a very large literature exists analyzing AA. Several models attempt to explain its success. One popular psychometric model interprets AA as a "cult" and the achievement of sobriety as a "conversion experience." Another model, however, asserts that members recover by integrating their own experiences with alcohol with those of others in the group and by learning and practicing some new ways to behave. Through these new ways, AA members feel as if they are living apart from the urban materialist norm; that the cause of alcoholism is not at issue; that people should share, not compete; and that the individual need not rise above the rest (spiritual anonymity).

Studies have concluded that active AA membership allows up to 68 percent of alcoholics to drink less or not at all for up to a year, and 40 to 50 percent to achieve sobriety for many years. More active or dedicated members (those who attend meetings more often) remain sober longer.