Medical Pluralism


The existence of multiple healing systems and options within a society.
Pluralism has always existed in health care systems; there have always been multiple practitioners to choose from and multiple ways of understanding health and healing. While the ideal pluralism suggests multiple healing options competing on a level playing field, in modern societies this is often not the case.


Origins and development in the United States
In the west, orthodox medicine (biomedicine) has enjoyed a hegemonic position for over a century, but "before the early 19th century, U.S. medicine was a shifting collection of coexisting options not rigidly or permanently defined: A broad spectrum of practitioners, diverse in social background and intellectual attainment" (Kaptchuk & Eisenberg 189 ). Professional care was not limited to today's mainstream biomedicine. Rather, botanical healers, midwives, apothecaries, bonesetters, inoculaters, and ethnic practitioners, such as Native American and slave doctors, provided to their immediate communities through alternative and complementary practices. Even with the Enlightenment’s goal of universalizing the benefits of science, the democratic fervor of the post-Revolution United States allowed alternative therapies to thrive with biomedicine looming.

In the early 19th century, "U.S. medical pluralism was a war zone" (Kaptchuk & Eisenberg 190). In 1847, the American Medical Association (AMA) was founded, in an attempt to protect orthodox medicine from "other" alternative therapies, combating any deviance with their Committee on Quackery (ref). Until recently, one of the medical community's main concerns was combating alternative therapies. An alliance with the government through the U.S. Food and Drug Administration secured biomedicine's elite status for years to come. Though the elitism of the modern U.S. medical system is exclusive, Charles Leslie, in his essay Medical Pluralism in World Perspective , reminds us:

"The triumph of modern medicine has been to improve
care by applying scientific research and new
forms of professional organization to biomedical
problems. Since the last quarter of the 19th century
this has led to effective knowledge for controlling and
curing infectious diseases. and to the complex technology
that characterizes the modern hospital. Efforts
to increase the scope and to improve the quality of
health care have sought to eliminate or severely restrict
“irregular practices”, so that ideally local medical
systems will simply become extensions of a nationally
and internationally standardized medical system." (191).

In the 1960s, alternative medicines (anything other than mainstream biomedicine) started regaining respect after the period of "eclipse" that began when organized biomedicine's relationship with the state became stronger (Cant and Sharma, 1999). Medical professionals "no longer uniformly categorizes alternative medicine as deviant, marginal, fringe, fraudulent, and of little consequence. Rather, the profession has begun to realize that it is a cohabitant in what seems to be a postmodern medical network in which consumer preferences dictate
the service profile" (Kaptchuk & Eisenberg, 189). The results of a survey conducted in 1990 and 1997, assessing the use of and expenditures for alternative medicine, showed an increase from 34 to 42 percent, confirming the increasing respect for "alternative" therapies.

Case Studies


"In recent years reformers have drawn heavily on
the example of the People’s Republic of China, where
traditional Chinese medicine has been incorporated in
the state sanctioned medical system. The idea is to
consider “irregular medicine” in a more objective
sociological manner. All medical systems can then be
conceived of as pluralistic structures in which cosmopolitan
medicine is one component in competitive
and complimentary relationships to numerous “alternative
therapies”. This way of conceiving the medical
system opens the door to serious practical studies on
how these therapies and their practitioners provide
resources for health care planning. The argument is
especially strong for developing countries where local
medical systems are largely composed of indigenous
practices and the immulation of costly institutional
planning from industrial countries is culturally and
economically inappropriate" (Leslie, 191).



Cant, Sarah, and Ursula Sharma. A New Medical Pluralism?: Alternative Medicine, Doctors, Patients, and the State. London: UCL, 1999. Print.

Kaptchuk, Ted J., and David M. Eisenberg. "Varieties of Healing. 1: Medical Pluralism in the United States." Annals of Internal Medicine 135.3 (2001): 189-95. Print.

Leslie, Charles. "Medical Pluralism in World Perspective." Social Science & Medicine 14.B (1980): 191-95. Print.