Alternative therapies and public health: crisis or opportunity?

Abstract

In 1994, Jennifer Jacobs, MD, MPH, contacted the national office of the American Public Health Association (APHA) about procedures to start a new organizational component of the association and to schedule time for an organizational business meeting at the 1994 annual meeting. The result was a new Special Primary Interest Group (SPIG) that, after much discussion at the annual meeting, was eventually named Alternative and Complementary Health Practices (A. Trachtenberg, oral communication, 2002). The term “health practices” was chosen to reflect a neutral stance on whether such practices might be therapeutic, preventive, or even harmful. At the 1994 meeting, about 30 members elected the new SPIG’s first cochairs, Jennifer Jacobs and Alan Trachtenberg, MD, MPH, who at that time was also directing the National Institutes of Health (NIH) Office of Alternative Medicine. Lawrence Kushi, ScD, was elected the SPIG’s first program chair. From 1995 to the present, the SPIG has presented an interesting and well-attended scientific program at every annual meeting and has grown to over 200 primary members. The public health imperative for the study of these health practices was their sheer prevalence, which had been brought to major public attention by the survey by Eisenberg et al. in the New England Journal of Medicine.1 Members of the new SPIG assumed that some practices would be helpful, some harmful, and some merely an unnecessary expense, and that sound clinical research was required to separate the wheat from the chaff. However, we recognized that a public health approach to alternative health practices would also require a larger view, one that incorporates cultural competence as an important value in primary health care. For instance, if a health center was providing community-oriented primary care for a particular community, the health practices, beliefs, and traditions of that community might need to be addressed to ensure adequate medical utilization and compliance by members of the community, as well as to provide for community input, participation, and self-governance of health care. The new SPIG was aware of the World Health Organization’s (WHO) traditional medicine initiative,2 which sought to incorporate traditional tribal healers into the public health infrastructure around the world, as well as the practice at many Indian Health Service units of finding creative ways to provide space and even positions for tribal healers.