A pluralist challenge to "integrative medicine": Feyerabend and Popper on the cognitive value of alternative medicine

Medical Pluralism as a Matter of Justice

Culture, health, and medicine intersect in various ways-and not always without friction. This paper examines how liberal multicultural states ought to interact with diverse communities which hold different health-related or medical beliefs and practices. The debate is fierce within the fields of medicine and bioethics as to how traditional medicines ought to be regarded. What this debate often misses is the relationship that medical traditions have with cultural identity and the value that these traditions can have beyond the confines of the clinical setting. This paper will attempt to bring some clarity to the discussion. In so doing, it will delve into some controversial areas: (1) the debate around whether liberal states ought to embrace multiculturalism, (2) the existence and nature of group-differentiated rights, (3) the question of whether healthcare systems ought to embrace medical pluralism, and (4) what this would entail for policymakers, clinicians, and patients. Ultimately, I argue that liberal democratic states with multicultural populations ought to recognize medical pluralism as a matter of respecting group-differentiated and individual human rights.

A Human Right to What Kind of Medicine?

The human right to health, insofar as it is widely recognized, is typically thought to include the right to fair access to adequate healthcare, but the operating conception of healthcare in this context has been under-defined. This lack of conceptual clarity has often led in practice to largely Western cultural assumptions about what validly constitutes "healthcare" and "medicine." Ethnocentric and parochial assumptions ought to be avoided, lest they give justification to the accusation that universal human rights are mere tools for Western imperial agendas. At the same time, a right to healthcare that is not also explicitly the right to effective healthcare rapidly loses meaning. This paper strives to provide an account of medicine with the flexibility to accommodate cultural difference in forms of practice, while also aiding in the articulation of a minimum for medical systems to meet the standards set out in a human right.

Evidence-Based Medicine and the Potential for Inclusion of Non-Biomedical Health Systems: The Case for Taijiquan

Many traditional and complementary and alternative healthcare systems or practices, such as Traditional Chinese Medicine, taijiquan, or acupuncture, are easily found in many North American and European cities. For the most part these practices are not accredited, and their validation remains limited. This is primarily the result of the lack of modern scientific research. Additionally, the studies that are performed rely on evidence and research designs that often negate the true features of these practices with a loss of authenticity. Is it possible or even desirable for these systems to acquire accreditation and inclusion? If so, given the apparent, subjective nature of these practices, can a pluralistic approach to healthcare that retains the Western values of science and medicine be developed that yet respects the diversity of different concepts about life, health and services while permitting these practices to maintain their authenticity? And is it possible to develop a regulatory framework that practitioners can use? The current paper examines questions concerning the uses of non-Western healthcare practices without the loss of their authentic nature. The process of integration is here examined using the inclusion of taijiquan as a health-promoting martial art as the model.

Práticas integrativas e complementares no Sistema Único de Saúde do Brasil: disputas político-epistemológicas

Resumo Este artigo apresenta um estudo de Epistemologia Política sobre a implementação de Práticas Integrativas e Complementares no sistema de saúde do Brasil. O objetivo foi analisar a controvérsia existente entre as recomendações da Organização Mundial da Saúde, as Portarias do Ministério da Saúde do Brasil e as cartas públicas de instituições científicas. Evidenciamos as visões epistêmicas e os interesses políticos subjacentes presentes em cada um dos documentos.

Fakes and chemicals: indigenous medicine in contemporary Kenya and implications for health equity

BACKGROUND

Access to effective biomedical treatments for humans and livestock in Kenya is far from universal. Indigenous healing has a significant role to play in contemporary society in Kenya, yet access is not the only reason for this. Beliefs surrounding the composition of biomedicines, people's experiences of biomedical care, and issues of counterfeit biomedicines sold over the counter have led to patients seeking care outside of biomedical institutions.

METHODS

This study explores local realities of treatment seeking in one rural and one urban study site, for both humans and their livestock, including when, where and how people access certain types of medicines. Using an ethnographic approach to interviews, focus groups and observations, I explore the role that indigenous healing, both herbal and occasionally spiritual, plays within this context with healers and community members.

RESULTS

Indigenous healing remains important for many people due to their mistrust and suspicion of biomedicine and big pharma. Their interactions with the healer or doctor, and the equity of these interactions, influence their decisions whether to access herbal or biomedical care, or a combination of the two. Indigenous healing bridges the gap many people experience when they are unable to access biomedical treatments and effectively creates a broader, more equitable coverage for healthcare. The plurality of reasons surrounding decision making is complex, but it is clear that many people often use indigenous healing, improvements in the regulation of both formulas and practice would assist people to access more effective treatment.

CONCLUSIONS

Indigenous healing is an important way in which Kenyans in rural and urban areas access healthcare for themselves and their animals. Issues of counterfeit biomedicines have led to broad mistrust and people favour indigenous healing, depending on the illness or severity of symptoms. Indigenous healing is a vital way in which people in underserved rural and urban populations access care. Herbal medicines and indigenous healing are trusted due to the greater transparency in their creation, and the more equitable relationship between indigenous doctor and patient. The study demonstrates that a pluralistic system is appropriate to increasing equity in access to healthcare in both urban and rural settings, as well as the importance of biomedical care providers respecting indigenous healing and viewing it with legitimacy. By taking a One Health perspective to understand the intersection of humans, livestock and the environment, we can better understand critical aspects affecting decision making for treatment and implications for healthcare equity in a rapidly changing world.

The abundant world: Paul Feyerabend's metaphysics of science

The goal of this paper is to provide an interpretation of Feyerabend's metaphysics of science as found in late works like Conquest of Abundance and Tyranny of Science. Feyerabend's late metaphysics consists of an attempt to criticize and provide a systematic alternative to traditional scientific realism, a package of views he sometimes referred to as "scientific materialism." Scientific materialism is objectionable not only on metaphysical grounds, nor because it provides a poor ground for understanding science, but because it implies problematic claims about the epistemic and cultural authority of science, claims incompatible with situating science properly in democratic societies. I show how Feyerabend's metaphysical view, which I call "the abundant world" or "abundant realism," constitute a sophisticated and challenging form of ontological pluralism that makes interesting connections with contemporary philosophy of science and issues of the political and policy role of science in a democratic society.

Introduction: Reappraising Paul Feyerabend

This volume is devoted to a reappraisal of the philosophy of Paul Feyerabend. It has four aims. The first is to reassess his already well-known work from the 1960s and 1970s in light of contemporary developments in the history and philosophy of science. The second is to explore themes in his neglected later work, including recently published and previously unavailable writings. The third is to assess the contributions that Feyerabend can make to contemporary debate, on topics such as perspectivism, realism, and political philosophy of science. The fourth and final aim is to reconsider Feyerabend's place within the history of philosophy of science in the light of new scholarship.

Feyerabend, truth, and relativisms: Footnotes to the Italian debate

There is a substantial literature on Feyerabend's relativism-including a few papers in this collection-but fewer specific studies of the ways that his writings and ideas have been taken up among the non-academic public. This is odd, given his obvious interest in the lives and concerns of persons who were not 'intellectuals'-a term that, for him, had a pejorative ring to it. It is also odd, given the abundance of evidence of how Feyerabend's relativism played a role in a specific national and cultural context-namely, contemporary Italian debates about relativism. This paper offers a study of how Feyerabend's ideas have been deployed by Italian intellectuals and cultural commentators-including the current Pope-and critically assesses them.

Between relativism and pluralism: Philosophical and political relativism in Feyerabend's late work

Relativism is one of the most problematic terms associated with philosophical discourse, with Feyerabend considered among the most important twentieth century theorists subscribing to it. This paper provides a detailed overview of relativist positions advanced in Feyerabend's mid-to-late work and investigates the associated epistemic and political applications. Emphasis is placed on how Feyerabend supported certain aspects of relativism, and at what stage he rejected others. It is noted that Feyerabend had already imposed limitations on relativism in Farewell to Reason, in which he entertained the possibility of epistemic definition within stable contexts, and advanced the notion that opportunities and equality associated with political and cultural units could only be valid within a democratic system. In Conquest of Abundance, political relativism is largely discarded, while epistemological relativism is increasingly treated as an appeal for diversity in all areas. In this re-reading of his work, it becomes clear that Feyerabend was already advocating a moderate form of epistemic and political relativism in the middle of his career, which he subsequently developed in the direction of "ontological pluralism" in his later work. This paper thus shows that Feyerabend's relativism should not be completely rejected, but rather that it continues to offer interesting food for thought.

Feyerabend on politics, education, and scientific culture

The purpose of this paper is to offer a sympathetic reconstruction of the political thought of Paul Feyerabend. Using a critical discussion of the idea of the 'free society' it is suggested that his political thought is best understood in terms of three thematic concerns-liberation, hegemony, and the authority of science-and that the political significance of those claims become clear when they are considered in the context of his educational views. It emerges that Feyerabend is best understood as calling for the grounding of cognitive and cultural authorities-like the sciences-in informed deliberation, rather than the uncritical embrace of prevailing convictions. It therefore emerges that a free society is best understood as one of epistemically responsible citizenship rather than epistemically anarchistic relativism of the 'anything goes' sort-a striking anticipation of current debates about philosophy of science in society.

Epistemic injustice in healthcare: a philosophial analysis

In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker (Epistemic injustice. Power and the ethics of knowing. Oxford University Press, Oxford, 2007). Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services--the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice.