Alternative Paths to Wellness a Political Act With Winners, Losers

Who benefits when governments appeal to UNESCO to endorse a traditional medicine as intangible cultural heritage? Who loses and who gains when the FDA determines what can and cannot be called a "medicine"?
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Have you ever reached for a bottle of Echinacea to stave off a cold? Called on an acupuncturist as well as pain medications to manage lower back spasms? Consulted an herbalist, of the Chinese or American variety, after being handed a conventional diagnosis for lupus or fibromyalgia, say, that left you nowhere, fast?

Nearly 40 percent of Americans do the same thing, routinely, according to the National Center for Complementary and Alternative Medicine. Other scholars put the number as high as one in three Americans. These numbers are arguably higher globally -- from Berlin to Beijing. However, what you might feel to be a highly personal path to wellness is also a political act, though perhaps not in obvious ways.

In this era of evidenced-based medicine, we have become more sophisticated in our efforts to question the value of medicines, both conventional and alternative varieties. Consider the recent Canadian study that questions the value of mammograms, ongoing concern over the safety of Indian-made pharmaceuticals or recent stories about the enigma of Chinese medicine. Efforts such as those by Dr. Paul Offit to debunk alternative medicine as nothing more than placebo magic further contribute to public debate, albeit in ways that conflate thousands of years of empirical medical history with the latest consumer-driven pitch about the health benefits of coffee enemas or emu oil. Even Prince Charles recently weighed in through his advocacy against the poaching of rhinos, elephants and other charismatic megafauna, the creatures of Disney movies and panacea myths.

However, using traditional, complementary or alternative medicine is not just about rejecting chemotherapy and eating Chinese herbs, mixing Reiki with SSRIs to deal with depression or pursuing the latest fad in slimming supplements. We must ask questions not only about what works -- a scientific Pandora's box of evidence and tricks of the trade to measure efficacy -- but also about what the cultural, economic, environmental and political stakes are in these transactions.

Using traditional therapies and their "complementary and alternative" derivatives pulls us into a web of connection that demands we ask different kinds of questions about what makes for "good" health care and what global health inequity looks like. Beyond entering into the "kingdom of the sick," as Susan Sontag calls illness, when the search for a coveted formula may contain endangered species or hinge on threatened forms of knowledge, we are entering into another kind of kingdom: a place of culture and commodification, politics and profit.

Consider the following examples:

Every summer across the Tibetan Plateau, tens of thousands of people, many of them children, spend weeks on their hands and knees digging up yartsa gunbu ( ophiocordyceps sinensis). This freak of nature, part caterpillar moth, part fungus, translates as "summer grass, winter insect." It is renowned as a kidney tonic, used to treat various autoimmune problems, and is also known as Tibetan Viagra. The stuff has been traded for centuries across high Asia, but today it is literally worth more than its weight in gold (about $40k/kilo). However, the Tibetans who gather yartsa gumbu rarely use it for medicine, indeed, they can't afford to use it as medicine. Instead, the money they earn from its collection pays for basic needs, including whatever medical care they can afford to access, which may include traditional Tibetan formulas and Western-style pharmaceuticals.

We are left to weigh the ironies: Even as a cosmopolitan woman in Shanghai with Prada on her shoulders and Blahnik on her toes shells out $500 for a small vial of high-quality yartsa gunbu for her husband, somewhere else in this great country a rural Tibetan, perhaps suffering from tuberculosis or rheumatoid arthritis, is hooked up to an antibiotic IV drip at the local underresourced township clinic because the drip offers a most expedient and affordable (if not the most effective) treatment for his suffering -- and an infusion of modernity, to boot.

Elsewhere high in the Himalayas, a Tibetan doctor stoops down to inspect a snow lotus (sassurea spp.), a species he knows well. This man has spent half a century collecting and processing medicinals -- plants, animal products, minerals. He carries his laboratory on his tongue. His body is a fine-tuned diagnostic instrument, uncovering patterns of illness through pulse analysis. He treats patients (usually for free) with a combination of individualized insight and a great deal of compassion, a currency of care conventional doctors in the West now seek to cultivate.

The doctor examines the flower. His brow furrows. His well-trained eyes see what ecological studies also confirm: The plant is becoming rarer, smaller, more difficult to find. In this tiny ivory-colored bloom the doctor glimpses the impact of something he plainly calls greed but that others dub a "growth industry," overharvesting fed by the multimillion dollar trade in commercialized traditional Tibetan and Chinese formulas. As he considers this flower, a species that defies cultivation, that resists scaling up, he recounts tales of smarmy sandalwood merchants, back alley dealers in musk, and the ways he his being priced out of the market for making high-quality medicines.

In the same breath, the doctor also speaks in his own terms about climate change. They don't call the highest mountain range on earth the "third pole" for nothing. Summer comes in torrents now, he says; glaciers at whose skirts plants like the snow lotus bloom recede each year, and with them water sources not only for the communities this doctor treats but also ecologies of healing on which people have relied for centuries.

Then there is the matter of knowledge politics. As highlighted by a new exhibit at the Rubin Museum of Art in New York, what happens when a traditional practice, in all its complexity, becomes distilled into a simplified if still exotically packaged "alternative" pill, powder, or pressure point? Who benefits when governments appeal to UNESCO to endorse a traditional medicine as intangible cultural heritage? Who loses and who gains when the FDA determines what can and cannot be called a "medicine"?

The growing global turn toward consuming traditional, complementary and alternative medicines is not just a choice against Big Pharma. This embrace of nonconventional medicine is also radically transforming and at times endangering not only tigers and blue poppies but also forms of deep, place-based medical knowledge and communities' abilities to care for themselves in a very pragmatic sense.

Sienna Craig is an associate professor of anthropology at Dartmouth College, where she teaches courses on health and illness, global health, Asian medical systems, Tibet and the Himalaya. She is also a contributor to Bodies in Balance: The Art of Tibetan Medicine, an exhibit that opened this week at the Rubin Museum of Art in New York.

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