Toward a meaningful alternative medicine.

In 1998, Phil Fontanarosa and George Lundberg declared, "there is no alternative medicine." They maintained there "is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which data is lacking." Fontanarosa and Lundberg continued: Regardless of the origin or type of therapy, the theoretical underpinnings of its mechanism of action, or the practitioner who delivers it, the critical questions are the same. What is the therapy? What is the disease or condition for which it is being used? What is its purported benefit to the patient? What are the risks? How much does it cost? And, perhaps most important, does it work? (1) The issue of the Journal of the American Medical Association in which this appeared contained six randomized clinical trials that evaluated various alternative interventions for the treatment of common clinical conditions. Now, more than ten years later, the enterprise of alternative and complimentary medicine boasts annual revenue in excess of sixty billion dollars, and visits to alternative practitioners outnumber visits to primary care providers. (2) But by no means should this be taken as an affront to Fontanarosa and Lundberg. Today, whole journals are devoted to evidence-based alternative medicine, and ancient practices are subjected to the rigor of randomized controlled trials. Sometime during medical school, I attended an alternative medicine conference in Chicago. The keynote address was by a general internist trained in several other modalities, and a critic of holding alternative medicine accountable by Western standards. His practice, however, was a hodgepodge of interventions. Some of the medicine he practiced was evidence-based--hypnotism for smoking cessation--and he emphasized the data for it. Some were therapies that were conceivably testable, but had not yet been verified, and some were interventions that ran contrary to the best large population evidence in medicine. He argued that he did not need evidence to know what worked--citing patients who simply "felt better" after acupuncture--though he had earlier basked in the level one evidence for hypnotism. His talk was philosophically confused. But most importantly, his practice did little to add richness to the way patients thought of health. It was aspiritual and faddish. At a time when medicine is increasingly pulled toward both evidence-based and alternative medicine, a number of philosophical issues arise, but they are all concerned with our conception of good health and the healthy life. I will argue that there is a unique way to think of alternative medicine, a way to preserve it in the midst of the evidence-based movement. We should move toward a rich and meaningful philosophy of meditative medicine. Looking to Heidegger The late works of the German philosopher Martin Heidegger were marked by recurring themes of poetry and technology as contrasting ways of making sense of the world (of "Revealing," as Heidegger put it). Heidegger used these terms not only in the concrete way we think of them, but also as placemarkers for their essence. The essence of technology for Heidegger is calculative thinking--the use of objects to achieve some purpose--while the essence of poetry and art is meditative thinking--reflecting on the beauty inherent in how things are. Heidegger believed that Man's nature was not restricted to either one of these modes of thinking; it encompassed both. So, though often described as antitechnology, Heidegger in reality was concerned that "The approaching tide of technological revolution in the atomic age could so captivate, bewitch, dazzle, and beguile man that calculative thinking may someday come to be accepted and practiced as the only way of thinking." (3) The issue then becomes "saving man's essential nature. Therefore the issue is keeping meditative thinking alive. …