An Analysis and Comparison of Modern and Alternative Medical Models In the United

States and India

MA630 – The Cultures of Biomedicine

Spring 2022

Sargam Choudhury
Introduction

Alternative medicine is a counter to the modern medical model that is prevalent in the

world today. Modern medicine thrives in contemporary societies because of its emphasis on

“evidence-based” practice: replicable results, forthright solutions, and immutable data.

Alternative medicine is quite literally the opposite; with millennia of history, but an enormous

lack of experimental evidence confirming their efficacy as medical interventions, it is not often

taken seriously in modern medicine. Strikingly, concepts of evidence influence perceptions of

different medical models when proving the efficacy of alternative medicine in a world that

deems modern medicine to be the best-working medical system. Because of this, there are

conflicting attitudes towards the integration of alternative medicine and modern medical systems

in many contemporary societies, including the United States and India, two countries that I will

be discussing in this paper.

Why are there so many varying perceptions of evidence-based medicine and alternative

medicine in contemporary societies? How heavily does this affect accessibility to alternative

medicine in contemporary societies, specifically the United States, a leader in modern medicine,

and India, from where Ayurvedic healing practices originate? This is an important discussion to

consider, simply because patients’ needs continue to change over acute periods of time, and

medicine needs to change with it.

In this paper, I will be discussing differing attitudes towards alternative medicine in these

two countries, breaking it down to different branches of healthcare (medical professionals,

complementary practitioners, and patients), as well as how these differences come about due to

varying conceptions of evidence. A condensed list of what will be discussed includes the effects

of medical education on medical professionals and traditional practitioners, sociodemographic

variables of patients, and societal and cultural values on the emphasis of clinical vs. anecdotal

evidence. Specifically, I would like to consider how all of these factors are related to one another.

I will also discuss how medical authority affects accessibility to different medical models in both

of these societies. Lastly, I will argue that integration of alternative medicine with contemporary

biomedical systems needs to be seriously considered and debated, as modern medicine needs to

address more than the biochemical impact of healthcare delivery. This is especially true when

undertaking a holistic approach to health, which has been a growing movement within modern

medicine over the last several years.

Essentially, the varying conceptions of different medical practices and models do not

detract from the conception that integration between these medical models is required in many

populations across the world, which means that the current medical authorities must be

challenged.

Perceptions on “Evidence-Based” and Alternative Medicinal Models

While evidence-based medicine is the most highly regarded approach towards treating

patients amongst most healthcare professionals in both the United States and India,

complementary or alternative medicinal practices are gaining momentum and popularity.

However, there is a considerable amount of turmoil regarding the use of these alternative

practices, and whether they offer any health benefits or are risky to adhere to. In a clinical

setting, this may disrupt a multidisciplinary and holistic approach towards the common goal of

the patient’s health and wellbeing.

It is important to understand what evidence-based medicine means to people in different

branches of healthcare, from medical practitioners to patients, and how these differences come
about. Under the “western” biomedical model in the United States, multiple studies suggest that

the degree of exposure, both academically and clinically, to alternative medicine can alter a

health professional’s perception of alternative medicine in use, while socio-cultural influences

and traditions may influence the patient to regard alternative medicine on a higher pedestal. This

differs slightly in India; the understanding of complementary medicine is altered due to the

Ayurvedic traditions that remain prevalent even after thousands of years. While evidence-based

practice is the most common approach in India, Ayurvedic practices are not viewed as a separate

entity. Instead, there is an attempt to blend the two medical models to create a culturally relevant

form of medical practice.

There are clearly differing views on “alternative” medicine between not only healthcare

professionals and patients, but between Americans and Indians. This difference is a culmination

of both educational influences and exposures, and socio-cultural traditions.

Patients

For people all over the world, health is a cultural phenomenon, and not necessarily

described by a set of symptoms. Many cultures and populations refer to health differently, and

therefore health manifests differently in them (Fulder 1998, 147-149). This is the basis of

alternative medicine: to treat patients as part of a culture, rather than treating disorders. That is

what also makes it the complete opposite of the western biomedical model, which views health

as a phenomenon based on clinical evidence in which, as long as patients do not have disrupted

labs or testing, they are deemed healthy.

Alternative medicine is extremely popular in the United States, even amongst users of

conventional, western biomedicine. It has been shown that at least 70% of adult Americans have
used complementary medicine in conjunction with western biomedicine (Eisenberg, et al. 2001,

344). While this number was discovered towards the beginning of the 21st century, it has been

nearly two decades since then, and the fervor for complementary medicine is not likely to

decrease (Kessler, et al. 2001, 262). In fact, medical pluralism in the United States has been

around for centuries, since the birth of the United States (Goldstein 2004, 930). Essentially,

medicine in America is much more complex than what the western biomedical model portrays it

to be.

The endurance of alternative medicine within a system that promotes the western

biomedical model can be primarily attributed to the vast amount of information and resources

available on the Internet, as well as an emphasis on anecdotal evidence. With people constantly

using search engines and websites to obtain information without the need for specialists or

experts on hand, it is inevitable that they come across new and interesting ways for them to treat

issues that they may not have time to take to a physician or money to pay for treatments, or

issues that have not been successfully treated through clinical means. The Internet is a tool for

many patients to “demystify” and access specialized medical information that can then increase

the patient’s autonomy regarding treatment (930-933). When met with this new information,

usually with a lack of clinical data to support them, users turn to anecdotal evidence to provide

them with answers. In situations with increased “emotional engagement” including those

regarding health, anecdotal evidence holds much more meaning than statistical evidence

(Freling, et al. 2020, 51-52, 62-63).

With this constant stream of new information brimming with anecdotal evidence, and the

resulting increased autonomy, there is no wonder that alternative medicine, which is not often

practiced by American-trained physicians, is extremely popular. This may also be exacerbated by

a large amount of distrust that many American patients have in the current healthcare system. A

study performed using 961 adults in the United States concluded that there is a significant

amount of distrust for the healthcare system in the United States that is heavily associated with

poor health status, regardless of sociodemographic backgrounds (Armstrong et al. 2005,

294-296). This is consistent with the fact that while chronic illnesses are becoming more

prevalent in Americans, modern medicine limits itself to the treatment of “discrete symptoms”

rather than treating patients for their holistic well-being (Goldstein 2004, 939). Instead, this is

what complementary medicine and similar movements have been providing to patients. Patients

want autonomy and more ownership over the healthcare they receive, and combining

complementary medicine with western biomedicine does just that (Ben-Ayre, et. al. 2007,

398-401).

On the other hand, Ayurvedic practices that Americans view as alternative medicine is

perceived as a widely accepted healing tradition and way-of-life in India. India is Ayurveda’s

birthplace, from where it began as oral traditions. It spread throughout civilizations for thousands

of years until the British colonial rule over the Indian subcontinent put a stop to the spread of

Ayurvedic knowledge and medicine; Ayurveda was prohibited in medical school curriculums

until very recently after independence from Britain (Clements 2006, 215-217).

As a result of the “transcultural flow” of the western biomedical model, medical

pluralism is not as prevalent in India as one may think (Chopra & Quack 2011, 13). With more

emphasis on the western biomedical model, Indian patients are less likely to feel comfortable

with typically western therapeutics and courses of treatment, especially those who live in rural

areas or are in poverty (Sheehan 2009, 138). Chopra and Quack’s research on the use of western

psychiatric practices as a response to mental illness in India reveals many issues and the clear
mistranslation between India’s traditional medical model and the western medical model. First of

their many observations includes the difference in medical compliance between “western”

patients and Indian patients; in particular, Indian patients are less likely to continue taking

medications or performing treatments as directed, especially when ameliorating effects are not

immediate (Chopra & Quack 2011, 16).

While many Indian patients are used to the western biomedical model, efficacy of

western treatments are still judged based on how well it works for the patient and their current

lifestyle and traditions. There is also an emphasis on comprehensive health amongst Indian

patients, and the western biomedical model fails to adhere to that value (Khare 1996, 838 -840);

Ayurveda, on the other hand, accounts for the treatment of the mind, body, and spirit for the sake

of complete wellbeing (Clements 2006, 215-217), which is highly valued by the Indian people.

In fact, even when Indian patients understand and respect western biomedicine, many believe

that including Ayurveda in their treatment offers them the best possible option (Khare 1996,

838-841).

As mentioned before, Ayurveda is viewed as more than just reactive treatments to subpar

health to millions of people in India. For example, locals of the Tran Himalayas often drink an

herbal tea made with a native plant, Ephedra vulgaris, that has bronchodilatory properties and

helps with “easy breathing in the rarefied atmosphere of the Tran Himalayas” (Gangadharan &

Shankar 2009, 181). This is just one of many cases in which healthcare takes on an entirely new

meaning in the perspective of western biomedicine; this form of alternative medicine is done

proactively so as to prevent any future health issues as a cause of environmental conditions,

which is not often promoted in western biomedicine.

 While this will be discussed later, medical pluralism is incredibly necessary in a place

like India, where the western biomedical model begins to take precedence over the traditional

healing route and disregards the religious and cultural values of millions of people. Essentially,

the traditional biomedical model in India is one that many patients are willing to combine with

the western biomedical model, as long as certain religious, cultural, ethical, and moral needs are

met.

Medical Professionals

Boston University School of Medicine’s website is a little difficult to navigate, so it took

me a while to find the typical curriculum for medical students. The official curriculum is very

structured, similar to most medical schools, and does not contain much room for elective classes.

What is interesting is that there is also no option for an elective even remotely similar to

complementary, or integrative medicine. Conversely, Boston Medical Center’s Program for

Integrative Medicine indicates that importance is placed on complementary medicine within the

BUSM/BMC system. How does this program coordinate its care with the rest of the medical

center if BMC’s medical students and residents are not given the opportunity to learn about

complementary medicine? Given the increase in popularity of complementary medicine amongst

many patients, it is quite important that healthcare professionals have at least a foundational

background in order to care for patients the way they would like to be treated.

While there are several medical schools that offer electives in complementary and

integrative medicine, there is not enough emphasis placed on them for future medical

professionals. The process of becoming a physician requires enculturation, which is when one

“acquires the rules, norms, values, customs, and guidelines” of another culture (Surbhi, S.,
2022). When entering the role of a physician, one must leave behind their own values and beliefs

for the sake of taking on the cultures of biomedicine. Thus, if alternative medicinal practices are

not, at the very least, viewed as part of the culture of western biomedicine, it will become

increasingly difficult to integrate the two.

A cross-sectional study performed at the University of Western Ontario and University of

Toronto compared the general attitudes of final year medical, pharmacy, nursing, phsyiotherapy,

and occupational therapy students towards complementary and alternative medicine. The

researchers concluded that medical students, having had little to no exposure to

complementary/alternative practices, were the most likely to regard evidence-based medicine as

useful. Other health profession students were either moderate in their perspectives or heavily

leaned toward complementary medicine (Baugniet, Boon & Ostybe, 2000). This seems to be the

typical trend in many of the studies performed regarding attitudes towards complementary

medicine and it is made clear from many of these studies that the major factor in attitudes

towards complementary medicine is derived from educational opportunities and influences.

Most of the medical curriculum involves anatomical and physiological concepts

regarding the human body – rightfully so, given that their primary job is to be experts on the

human body. However, as a result of this enculturation, a large issue is accentuated; the

clinicalization of the human body and dehumanization of the patient is perpetuated with the

excessively objective view that the medical school curriculum supports (Leder 1992, 1-11). This

encourages the view that a person is a body with body parts that perform certain processes, and

when those processes are disrupted or malfunction, the doctor is there to fix it. It eventually takes

away from the complexities of the person that the physician is treating, including what makes up
who they are and the environmental conditions that can indirectly cause the disruptions in their

bodily processes.

In India, the medical education of physicians plays an even larger role in their

perspectives of the combination of western biomedicine and Ayurvedic practices. Physicians

place much emphasis on the misconceptions that patients have of western biomedicine on their

“lack of awareness” rather than the physician’s medical education and ability to gain patients’

trust. It is the “double socialization” that Indian doctors face that creates this gap in

communication between them and Indian patients (Chopra & Quack, 17). Physicians may not be

able to transfer the pedagogies in western biomedicine to the needs and traditions of the Indian

people, and this is made increasingly difficult due to the enculturation that is required of them; as

Chopra and Quack state in their analysis that even though physicians in India understand the

benefits of using Ayurvedic medicine, most physicians want to “stay true to their professional

training while on the other hand this stance sometimes conflicts with local realities,” making it

difficult to find a balance between the two medical models (18).

However, there are some physicians that manage to combine the two medical models in

order to create individualized treatment plans for patients. This includes a very complex process

of translation “between modern biomedical disease and classical Ayurvedic disease-entities,”

taking physiological symptoms that have cultural meanings and attempting to find an equivalent

in western biomedicine (21). While it makes it difficult to keep Ayurvedic diseases true to their

nature and defining factors, it makes it easier for patients to understand the relationship between

traditional medicine and modern medicine.

Medical professionals from both the United States and India have similar educational

backgrounds, but American physicians usually are not trained to integrate alternative medicinal
practices. On the other hand, Indian physicians, albeit rarely trained in terms of complementary

medicine, are required to integrate traditional practices with western biomedicine in order to

properly treat their patients. The medical systems that the two countries have are incredibly

different; even though the two medical systems have the western biomedical model in common,

the integration of different models by medical professionals leads to the production of different

cultures of biomedicine in these countries.

Complementary Practitioners

Complementary practitioners, those who practice alternative medicine as an occupation,

are the middle ground between alternative medicine users and medical professionals. They offer

the supplementary treatment that many patients seek in conjunction with western biomedicine.

As stated earlier, educational resources and academic curricula heavily influence a

healthcare professional’s perception of alternative medicine. While other healthcare professionals

(which includes nurses, occupational therapists, physical therapists, etc.) in the United States are

not considered complementary practitioners, they are still trained to implement or at least

acknowledge complementary medicine in their work, which is definitely an interesting difference

between the education of physicians and other healthcare professionals. However, the term

“complementary practitioners” in the western biomedical model primarily describes those who

practice traditional medicine and provide forms of healthcare that are unconventional when

compared to western biomedicine.

Contrary to popular belief, many complementary practitioners are proponents of

evidence-based modern medicine, and it has been found that educational exposure to

evidence-based practice is proportional to the value placed in it by complementary practitioners

(Leach & Gillham 2011, 131). In fact, many practitioners actively use it in their work, as they

heavily acknowledge the fact that making diagnoses and creating treatment plans in a clinical

setting involves several processes that need to be integrated, including evidence-based medicine

(134).

The issue with being a complementary practitioner that uses evidence-based medicine,

however, is the dependence on general practitioners and physicians; interviews with

complementary practitioners in the modern medical system have demonstrated that physicians

hold more dominance when providing care to patients, which takes away from many

practitioners’ ability to provide the comprehensive care that patients desire (Hollenberg, D. 2006,

738). This has the ability to affect their work, as well as their legitimacy and reputation as

providers of healthcare. This also makes it difficult to advocate for the integration of medical

models; while there is an obvious effort on their part to integrate different medical models with

western biomedicine, the medical authority of the western biomedical model prevents

complementary practitioners from allowing this to happen.

In India, practitioners of traditional medicine hold a much higher place in society

compared to those in the western medical system. In fact, anecdotal evidence is viewed as just as

important as clinical evidence in Indian society, as outlined by the clear emphasis of Ayurvedic

practices in government announcements and suggestions regarding public health issues. For

example, Ayurvedic practitioners suggested several practices for the general public’s well-being

as a proactive approach to the COVID-19 pandemic, appealing to the Indian peoples’

sociocultural beliefs in traditional medicine, that was regarded as important by the Indian

government (Panda et al. 2020, 101-103). Consistent with the complementary practitioners found

within western biomedical systems, Ayurvedic practitioners value clinical evidence in their work.
They also acknowledge the notion that in some fields, such as psychiatry, combining modern and

traditional medical models can produce more efficient and tailored treatment plans for individual

patients, on top of creating social impacts by “alleviating stigma” (Ramakrishnan, et al. 2014,

1807-1812).

Effects of Medical Authority on Accessibility to Alternative Medical Models

When discussing medical pluralism, medical authority plays an important role as it is a

defining factor in the distribution of healthcare and the use of certain medical models. Medical

authorities usually identify the dominant medical models used within a medical system, and its

regulatory aspects are influenced heavily by sociodemographic variables.

In the United States, there is no doubt that the western biomedical model is the most

dominant of all functional medical models within the American medical system. This is because

of the medical authorities that set the specific jurisdictions and standards of medical practice in

the country, and there is usually a hierarchy of authorities that set the stage for the prevalence of

the medical models within the system.

When people choose to pursue medicine, whether it is under the western biomedical

model or alternative medicine, they first must attend a school or training institution that allows

them to obtain enough knowledge and experience to treat patients on their own. Therefore,

schools can be considered institutions of medical authority. In the United States, students

wanting to practice within the western biomedical model must then ace the MCAT, which is

created by the Association of American Medical Colleges (AAMC), to enroll in medical schools

that are accredited by the AAMC. While in medical school, and then in residency training, they

must take the United States Medical Licensing Examination (USMLE) that is administered by
the Federation of State Medical Boards (FSMB) and National Board of Medical Examiners

(NBME), which determines their ability to deliver the form of medicine that they are now

ingrained to practice. All of these boards and associations hold medical authority over many

aspects of the healthcare system in America, patients and doctors alike. In fact, the quality of

healthcare, and the type of medicine that can legally be provided to patients in a healthcare

facility is primarily established by these groups of people. Similarly, the Indian healthcare

system is dependent upon the National Medical Commission (NMC) and the National

Commission for Indian System of Medicine (NCISM) to determine the quality and variety of

medical models that can be provided as options to patients by doing essentially the same thing as

all of the different boards and associations in the United States (Firstpost 2019; The National

Commission for Indian System of Medicine Act 2020).

The issue that arises due to medical authorities in contemporary societies like the United

States and India is that the legitimacy and opportunity as a medical option for patients is wiped

for many medical models. In the United States, there is little to no integration between the

medical models for the reason that many alternative medical models are not considered

legitimate when the ruling medical authorities do not promote it as such.

This situation differs in India because India as a national entity recognizes the value of

traditional medicine in its medical system, hence the creation of the NCISM, and integration of

medical models is attempted. However, the issue that lies within the Indian medical system is the

lack of coordination between the two national commissions that hold medical authority. The

western biomedical model, as regulated by the NMC in India, holds a lot of power. This is

reasonable; the global flow of information influences Indian society, and Indian society deems

western biomedicine to be more scientifically and technologically advanced than traditional

medicine. While the NCISM also holds a lot of power, it does not compare to the NMC. This is

primarily due to the dysregulation between the two commissions, and this leads to many

problems, one of which includes the amount of unqualified practitioners available to patients.

Unqualified practitioners reduce the legitimacy of traditional medicine, as they hinder the

“contributions that qualified practitioners may make to the healthcare system” and spoil the

reputability of the traditional medical model as a whole (Sheehan 2009, 138). This is just one of

many examples that demonstrate that when there is little to no regulation between the NMC and

NCISM, medical pluralism simply does not work as efficiently as it could and should in the

Indian medical system.

Integration of Medical Models

The integration of alternative medicine with contemporary biomedical systems needs to

be seriously considered and debated, as modern medicine needs to address the biochemical

impact and the role of sociocultural influences in treatment and healing practice. This is

especially true when undertaking a holistic approach to health, which has been a growing

movement in medical education over the last several years.

In the United States, it has been found that most patients prefer the use of complementary

medicine in conjunction with western biomedicine. However, several studies demonstrate that

many patients do not have conversations about alternative medicinal practices with their

physicians, which can increase harmful risks and reduce coordination between the patient and

physician regarding their treatment plan (Ge, et al., 2012; Laiyemo, et al., 2015). Physicians need

to stay knowledgeable and up to date on information that can help their patients. In a way, that is

their job, as it helps them prevent unnecessary harm to patients and is in favor of the ultimate
good for the patient, as described by the beneficence model (Zhang-Jiang & Tredwell 2020,

381). Integration of medical models simply allows for better treatment plans tailored to each

patient; a patient’s sociocultural values must align with the medical treatment they receive in

order to maximize health benefits.

In particular, India needs to work on the integration of the two major medical models that

are present in their medical system. It is understandable that western biomedicine has its own

stake in the Indian medical system; the world is developing and information flows rapidly across

nations and continents, and modernity in medicine is slowly becoming a common ground for

many populations. However, there is too much emphasis from Indian physicians on western

biomedicine due to the medical training that they receive, which simply cannot translate into

healthcare for people that do not understand the culture of western biomedicine. However, there

also needs to be a reduction in the amount of unqualified complementary practitioners, and this

can only be done with more regulation over the medical system; currently, the medical system

cannot meet the needs of the general public, as the distribution of healthcare is heavily divided.

For example, urban, upper- and middle-class populations have more access to both traditional

medicine and modern medicine, as well as the ability to combine both as much as possible. Rural

and lower-class populations, on the other hand, have less access to either, and typically only have

access to more unqualified practitioners (Sheehan 2009, 138-139). Therefore, an integrated

medical system cannot lean towards the betterment of only urban, upper-, and middle-class

populations, which does not even constitute the majority of patients in the country.

In order to combat this large problem, there should be guidelines available for medical

education that aids in tailoring medical treatment within the integrated models, as well as more

emphasis and opportunities to train in traditional medicinal practices. This will allow medical
professionals to incorporate more traditional medicine into their work, as well as reduce the

number of unqualified practitioners available.

Conclusion

Discussing the issues of current medical systems in both the United States and India tends

to become a cyclic argument, but the changes need to start somewhere. The current medical

authorities of contemporary societies must be challenged in order to allow for the integration of

socially and culturally relevant practices with modern medicine. Simply put, integration of

medical models will allow for better comprehensive healthcare delivery, but this constitutes

regulation between societal perceptions of alternative medical models as well. This can definitely

be altered through more comprehensive medical education, as well as more access to both

modern medical education and traditional medical education. There must also be an emphasis on

patient education in regards to the multiple options they have available to them.

Accessibility to healthcare is a fundamental human right, and people must have the

ability to choose the form of healthcare that fits them best. While this approach requires

consistency and long term efforts, it will only serve to improve and sustain the cultures of

biomedicine, the distribution and delivery of healthcare, and society as a whole.

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