ALLERGOL. ET IMMUNOPATHOL., 1998;26(6):257-259
EDITORIAL
OFFICIAL MEDICINE OR ALTERNATIVE MEDICINE
The concept of "official medicine", which refers to medicine as taught in medical schools and is developed in public health institutions and consecrated by the State, is equivalent to "scientific medicine". In the end, the aim of this type of medicine is the cure and prevention of disease based on knowledge acquired scientifically. This means gaining knowledge of the etiology and pathophysiology of each process by experimentation, and applying diagnostic techniques and therapeutic measures which have been developed using complex studies designed to confirm the results and compare them with those obtained by other researchers in order to evaluate the effectiveness of therapy and absence of risks.
Thanks to the investments of government agencies and public and private institutions in different countries and, notably, the dedication and sacrifice of many researchers, medicine has achieved major advances by means of a rigorous application of knowledge. Some diseases have been eradicated and many others have been cured or prevented. For the most part, these achievements were made in the last century and a half and coincide with the development of experimental physiology (Claude Bernat, Pavlov), biochemistry, bacteriology (Pasteur), radiology (Röentgen), surgery, and pharmacology. Aside from its contributions to the knowledge of anatomy, medicine before this period had practically no resources other than the description of symptoms, a careful clinical examination, and the use of remedies, based only on empirical knowledges.
Rigorous methods of research into therapeutic measures should be used within the context of a system including animal experimentation, administration to healthy volunteers, and, finally, administration to patients before the product is authorized for the market. Since this process can require many years to complete, the safety of medical prescriptions by physicians is very high. Even so, in some cases medications have to be taken off the market or their use must be restricted because of adverse effects that were not detected in the development phase.
Nonetheless, in spite of the guarantees that medicine currently offers, we are observing a phenomenon in which growing numbers of persons are showing interest in "alternative medicine", or "heretical medicine" to employ the term used in an interesting essay by the 1912 Nobel prizewinner for medicine, Alexis Carrel (1). From 1986 to 1991, the number of patients who consulted practitioners of these so-called "medicines" increased by 70% in the United Kingdom (2), where 25% of the readers of a popular magazine had seen such "practitioners". In the United States the figure is as high as 34%. This indicates that in the most developed countries for some reason a large part of the people mistrusts "official" or "scientific medicine" and is trying other forms of therapy.
The poor opinion or lack of confidence may arise, on the one hand, from public health care systems that require physicians to see too many patients, which allows only a few minutes to be dedicated to each patient to the detriment of the development of any physician and patient empathy (3). The patient with an organic disease also is affected mentally and has a fundamental role in assessing the disease itself, as well as the organic, family, or occupational problems that may derive from the disease condition when he or she suspects or knows that the disease is chronic or will produce impairment for daily activites (1). Medications and surgery can cure or alleviate the organic symptoms but the patients often needs more, for instance, an explanation of the disease and psychological and moral support, which usually can be achieved through long only, friendly conversations. This was once the bases of medicine and served at least to make the patient feel better, even if it didn''t do much more.
On the other hand, alternative medicines are free to advertise in a way that is considered inappropriate for other types of medical practice. Moreover, they are the focus of attention-seeking articles in the popular press. Scientific medicine generally only receives the attention of the press when spectacular events or major advances take place. Such advances often are only in the experimental stage and their discussion in the press generates unfounded hopes.
Above all, alternative therapies only contemplate a narrow aspect of medicine, therapy, although therapy undoubtedly is what all patients and, certainly, all physicians seek. This means that such disciplines pay little attention to diagnosis or clinical examination and limit themselves to the application of "therapeutic" procedures, although some variants use "pseudodiagnostic" practices. The indications usually are diseases in which pain is the dominant symptom, as well as anxiety, worry, etc., which affect the patient''s mood. These medicines provide what is missing from public care, sufficient time to address the patient''s psychological needs, sometimes with the support of the knowledge that some of these procedures have been practiced for thousands of years, as in the case of acupuncture. However, even after thousands of years, the "meridians" or "points", or other centers related with sickness and health, have not been visualized and are products of imagination, as also occurs in other alternative medicines. In contrast, in a short period of years scientific medicine, among other achievements, has come to know the organic and biochemical activities of the cell and has identified genes responsible for organic structure and also of many diseases, which should contribute much to future prevention.
It is noteworthy that some professional associations and official organizations include groups of physicians who practice these therapies, although they are not taught in medical schools. This means that knowledge of these fields has not been confirmed by exams and no implicit or explicit authorization of these practices exists. On the other hand, training courses for these practices are advertised in the daily press and specify that no university training is required.
The review by P. A. Davis et al. (4) published in this number of Allergologia et Immunopathologia demonstrates the lack of scientifically based studies supporting the veracity of the effectiveness of acupuncture in the treatment of asthma, which coincides with the conclusions of other authors (2, 3, 5).
F. Muñoz-López
REFERENCES
1. Carrel A. Medicina oficial y medicinas heréticas. Barcelona: Luis de Caralt; 1955.
2. Lewith GT, Watkins AD. Unconventional therapies in asthma: an overview. Allergy 1996;51:761-9.
3. Royal College of Physicians. Report of the Committee on Clinical Immunology and Allergy. Allergy: conventional and alternative concepts. Clin Exp Allergy 1992;22 Suppl 3.
4. Davis PA, Chang Ch, Hackman RM, Stern JS, Gershwin E. Acupunture in the treatment of asthma: a critical review. Allergol et Immunopath 1998;26:263-71.
5. Morton AR, Fazio SM, Miller D. Efficacy of laser-acupunture in the prevention of exercise-induced asthma. Ann Allergy 1993;70:295-8.
