As my readers know, I take a very hard line on alternative medicine, not because I just don’t like it, but because it harms, both actively with dangerous treatments, and passively by keeping people from effective science-based treatments. So what am I to think about a hospital in California that is now allowing Hmong shamans to perform healing rituals on patients?
There is a long history of religious and quasi-religious beliefs interfering with good health care. This interference comes in many forms.
Religion obviously has a strong influence on people’s health
decisions. Certain religions have, for example, specific ideas about end of life
care, mandating medically futile care in the name of preserving “life”.
This often means flogging the mostly-dead with painful, useless,
expensive care until they finally expire “naturally”. Most medical professionals who spend significant time in an
ICU know how much suffering is inflicted by this type of belief.
religions prohibit certain medical procedures such as abortion or blood
transfusion based not on medical facts but on moral or scriptural
Intrusion of mainstream religions into medical
decision making is not necessarily a bad thing, but it certainly can
be, given it’s reliance on the arbitrary mystical veneer it
uses to coat real, bloody medical facts.
Less mainstream religions often have very strong (and harmful) views
on health. Christian “scientists” eschew real medicine completely; Scientologists famously rob and abuse the mentally ill; and lesser known cults such as Nemenhah condone and abet the murder of children.
such as these need to be marginalized. There is no room for them in a
civilized society, and while a free society should of course not
prohibit them, we should make it clear that they lack any legitimacy in
the field of health care. Tacitly approving their actions through
silence is not “cultural sensitivity” but lunacy.
I have argued many, many
times that much of alternative medicine functions more as a cult than
as the practical application of scientific knowledge. Chiropractic,
homeopathy, and many other so-called alternative medicine practices
have revered founders, charismatic leaders, rely on faith rather than
evidence, and followers will not abandon their beliefs, no matter how
much evidence is presented. Vaccination as a cause of autism has been
soundly defeated as a hypothesis, but like any cult, the folks who
fetishize this idea simply find excuses to ignore the science—most of
these arguments boil down to, “but I believe it works.”
There is no difference between, for example, reiki and intercessory prayer. To believe that either act directly manipulates the real
world in any tangible, effective way is a misapplication of faith, and neither has a
place in medicine.
What of shamans? Shamans occupy different places in different
societies, but often serve an explicitly religious purpose. Since in
pre-scientific societies health was tied closely to religious belief,
shamans often function as healers. The Hmong, who until recently lived
in rural Southeast Asia, traditionally hold complex religious-medical
beliefs regarding souls, possession, and other mystical explanations
for illness. They may also carry some cultural baggage regarding
American authority figures, given their history of being used by
Americans during the Viet Nam War and then largely abandoned.
Doctors in Merced, California noted the trend of Hmong patients refusing health care and decided to try something. They
gave Hmong shamans clergy-level privileges at the hospital and
accommodated as much as possible their rituals. As far as I know they
haven’t formally studied the results, but the general feeling seems to
be that this is allowing Hmong patients to feel comfortable accepting
There is of course the danger that some will conflate acceptance of ritual with medical effectiveness of ritual but if they are able to keep clear the difference, they may be on to something. Shamans are being given classes in real medicine and appear to be interested.
This is what real integrative medicine is. So-called integrated medicine that takes fake medical treatments and blends them with real ones are dangerous. Allowing shamans to create a bridge between cultures to help people get the care they need is smart and compassionate.
Religion is a comfort
to many of my patients, and I don’t interfere with their beliefs. Not
only would it be wrong, but it also doesn’t work—a patient’s
beliefs always trump yours. Sometimes, religious beliefs create insurmountable barriers to proper care, but if we are able to understand our patients beliefs and work within them to provide science-based medicine, we not only serve our patients but co-opt them before the murderous woo-peddlers get to them. That seems like a good thing.