The United States

Based upon historical and ethnographical research, Baer has written an overview of medical pluralism in the United States (Baer, 2001). He argues that medical pluralism has historically reflected and continues to reflect class, racial/ethnic, and gender relations in U.S. society. U.S. medicine during the nineteenth century was highly pluralistic in that regular medicine shared the stage with a wide array of competing and sometimes alternative medical systems, including homeopathy, botanic medicine, eclecticism, hydropathy, Christian Science, osteopathy, and chiropractic. Although regular medicine constituted the most widespread medical subsystem, it did not completely dominate its rivals economically, politically, or socially.

As U.S. capitalism evolved from competitive to a monopoly form after the Civil War, the corporate class found it necessary to exert control over an increasingly restless populace. Along with the state and education, medicine became another hegemonic vehicle by which members of the corporate class indirectly came to legitimate capital accumulation and to filter their view of reality down to the masses. The corporate class acquired an effective tool around 1900, with the development of a germ theory and the transition to "scientific medicine," or biomedicine, a medical system based on systematic research and controlled experimentation. With its emphasis upon pathogens as the cause of disease, biomedicine provided corporate leaders with a paradigm that allowed them to neglect the social origins of disease while at the same time, in some instances, restoring workers back to a level of functional health essential to capital accumulation. Consequently, the emerging alliance between the American Medical Association, which consisted primarily of elite practitioners and medical researchers in prestigious universities, and the corporate class ultimately permitted biomedicine to achieve dominance over rival medical systems. Biomedicine quickly co-opted most homeopaths and eclectics by admitting them into their state medical societies.

The U.S. dominative medical system consists of several layers that tend to reflect class, racial/ethnic, and gender relations in the larger society. In rank order of prestige, these include: (1) biomedicine; (2) osteopathic medicine as a parallel medical system focusing on primary care; (3) professionalized heterodox medical systems (namely chiropractic, naturopathy, and apuncture and Oriental medicine); (4) partially professionalized or lay heterodox medical systems (e.g., homeopathy, massage therapy, herbalism, and midwifery); (5) Anglo-American religious healing systems (e.g., Spiritualism, Christian Science, Unity, Pentecostalism, and New Age healing); and (6) folk medical systems (e.g., Appalachian herbalism, African-American folk medicine, curanderismo, Native American healing systems).

As a result of corporate support for biomedicine, its practitioners came to consist primarily of white, upper-and upper-middle-class males. As professionalized heterodox medical systems, osteopathy, chiropractic, and naturopathy held out the promise of improved social mobility for thousands of white lower-middle- and working-class individuals, most of whom were males, who were denied access to biomedicine due to the structural barriers created by the Flexner Report of 1910. Osteopathic medicine eventually evolved into a parallel medical system with full practice rights as a result of the paucity in primary care physicians created by the increasing trend toward specialization in biomedicine. Anglo-American religious healing systems provided outlets for white women seeking therapeutic roles. Whereas Christian Science served this role largely for upper-middle-class women, Spiritualism and Unity did so for lower-middle-class women and Pentecostalism did so for lower-class women. Finally, folk medical systems have enabled working-class people from various ethnic groups, particularly people of color, to provide low-cost and culturally appropriate therapy for individuals at the lowest echelons of U.S. society.

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