Between Heaven and Earth

Originally written as an introduction for:

Between Heaven And Earth :
An Introduction To Various Philosophies And Approaches To Medical Care

A journal of the American Medical Students Association National Project on Alternative and Complementary Medicine

There exists more between heaven and earth, Horatio, than is dreamt of in one single philiosophy.
— Hamlet, Act I, Sc. 5

Copyright 1999 Ariana Vora and Eliot Tokar

In his 1993 New England Journal of Medicine article, Dr. David Eisenberg of Harvard University brought to the attention of the medical establishment the extent to which Americans were seeking unconventional medical care1. In order to best understand the phenomenon he depicted, we must first realize that the growth of the alternative medicine field is the result of a thirty-year grassroots movement in the United States. Regrettably, Dr. Eisenberg’s article was focused on economics and demographics. Now, it is vital that future physicians begin to understand with the true meaning and depth of this movement.

It is clear, that over a period of decades, economics has come to increasingly dominate the practice of medicine in America. Alliances with the insurance and pharmaceutical industries have come to define the medical profession. As a result, the physician’s work environment has become increasingly litigious, and the healthcare industry has neglected its primary responsibility to devote itself toward each patient’s best interest. Doctors’ and patients’ relationships to insurance companies have become more dominant in medicine than their relationships to each other. Rather than being trapped by the past, medical students and physicians should work to correct the mistakes which created this legal and economic morass. Inquiring into the nature of the alternative medicine movement is one means of making such progress.

What are the benefits of such an inquiry? By cooperating with colleagues in the various fields of alternative medicine, physicians can integrate new concepts and approaches into allopathic medicine. They can benefit their patients vis-a-vis quality of life, the ability to view patients as unique individuals, and the use of non-toxic interventions when possible. Doctors can also benefit personally from embracing tenets of traditional natural medicine which assert that they should be examples, not just experts, in the field of health. In the ancient medical traditions, doctors were taught to practice their understanding of what is meant by ‘leading a healthy life’, rather than merely preaching about it to their patients. In other words, the least doctors can gain from inquiring about the alternative medicine movement is an enhancement of clinical care. At best, all the qualitative and quantitative aspects of our health care system as it impacts physicians as well as patients can be greatly improved.

As scientists, we can not be afraid of affirming the full breadth of human knowledge and experience with regard to health care. We might like the touchstone of all medical care to be verified by randomized, controlled, double-blinded trials. However, at a 1997 NIH conference Dr. Alan Trachtenberg, former head of the NIH Office of Alternative Medicine, asserted that “a majority of interventions recommended to Americans by their physicians are not based on randomized and blinded trials…[but] on the clinical experience of those physicians and their teachers”. He made the point that such interventions are used not on the basis of research but because they have “stood the test of time in American medicine.”2 The test of time for many traditional forms of natural medicine is counted in centuries. By pursuing an understanding of alternative medicine, we will sometimes be able to find mechanisms to scientifically explain ideas existent in those disciplines. Drawing inspiration from what we find, we can also direct the inquiry toward the field of allopathic medicine, thereby creating new paradigms of practice such as psychoneuroimmunology.

As we engage new ideas, we must be careful and critical about the concept of “complementary” medicine. Whereas the term “integrative medicine” is currently in vogue in discussions about the future of alternative medicine, its implications and results must be examined seriously at each step of the process. Some might think that the best way to make alternative kinds of healthcare available to the general public is to institutionalize them in the same manner as allopathic medicine. However, as physicians and patients become increasingly dissatisfied with a medical system determined by economics and consumerism, is it useful to anyone for alternative medicine to be pulled into this brave new world of healthcare?

Simply seeking for verification, westernization and integration does not allow for the preservation and the best use of ancient traditional systems of healing or of more modern or western natural healthcare approaches. As future physicians we must seek to improve medicine. As such, we must be aware of the growing “gold rush” occuring in the field of unconventional medicine. As such, we must be aware of the growing “gold rush” occuring in the field of alternative medicine. We must realize that because allopathic medicine is rushing forth to find ways to integrate some use of unconventional approaches, the grassroots alternative medicine movement is being forced aside with the building of a new Complementary and Alternative Medicine industry. The same pharmaceutical companies that send their salespeople to wine and dine doctors are an integral part of the new Nutriceutical industry. This industry is mainly directed toward product development, marketing and sales, and is supplanting the ecological and traditional ethic of long standing groups such as the American Botanical Council and the Herb Research Foundation.

Our responsibility as doctors is to protect our patients, but we need not define this role in a paternalistic manner. After all, it was patients who, in massive numbers, forced our field to take a serious look at alternative medicines–the same medicines that allopathic physicians declared as “quackery”, banned, and then ignored for more than half a century. In a new movement to improve medical care, doctors can begin eliminating ignorance through working together with colleagues in alternative medicine to share information and increase education for the public at large. Respect is the key. We first must respect the diverse ethnic backgrounds of citizens of our country, including the natural and folk medicine traditions which people bring when they immigrate to the United States. Increasing the sophistication we all have regarding health is the first step in creating a safe system of preventative medicine.

By coming to terms with the scientific value and the underlying depth of various fields of natural medicine, we can begin to develop a new humanistic approach to medicine. We can begin to once again give central value to important medical technologies such as compassion, which will revive the true spirit of the Western medical tradition as depicted in the Oath of Maimonides, the great physician of natural medicine and spiritual teacher, which is taken by graduates of many medical schools.

Our objective is to initiate a dialogue among future physicians about the cultural context of various medical traditions, the wishes of patients in their interaction with their doctors, and the broader questions that lie behind this movement. By asking these questions with a sense of open-mindedness proceeding from a true scientific ethic, we can help to facilitate a renaissance in medical care in this country.

Ariana Vora is a student at the Mount Sinai School of Medicine and originated the Project on Alternative and Complementary Medicine in 1997 as a part of the Task Force on Humanistic Medicine.

Eliot Tokar, a NYC based practitioner of traditional Asian medicine (Tibetan, Chinese, Japanese), and writes and lectures on the field of alternatives in healthcare


1. Eisenberg D. et al. Unconventional medicine in the united states; prevalence, costs, and patterns of use. New England Journal of Medicine. 1993;328: 245-252.

2. Trachtenberg, A. American acupuncture: primary care, public health, and policy. NIH Consensus Development Conference on Acupuncture: Program and Abstracts. 1997;137.