| Reviews / Comptes Rendus | Labour/Le Travail, 51

Reviews / Comptes Rendus

Hans A. Baer, Biomedicine and Alternative Healing Systems in America: Issues of Class, Race, Ethnicity, and Gender (Madison: University of Wisconsin Press, 2001)

NORTH AMERICANS have increasingly turned to a wide range of healthcare providers, and as they have done so, scholarly interest in "alternative" and "complementary" care has grown. That scholarship is deeply divided. Among some historians, medical doctors, and sociologists, osteopathy, homeopathy, naturopathy, and an increasingly wide array of alternative health systems, are precursors to scientifically grounded biomedicine (also known as allopathic medicine). Anthropologists, advocates, and others have attempted to understand why North Americans are dissatisfied with allopathic medicine, and they have promoted the virtues of natural alternatives.	1
Most of the scholarship is limited in its lack of attention to issues of race, class, ethnicity, and gender among providers and users of the wide range of "alternative" health systems that North Americans have used for many centuries. Written for, and from the perspective of, middle-class consumers, most books and articles are for a popular audience, and they focus on issues of choice, scientific validity, and lifestyle. They overlook the ways in which many of the types of healing that North Americans classify as alternative are traditional and fundamental to significant populations of immigrants and indigenous people. They overlook such issues as the cultural appropriation of healing that occurs when, for example, middle-class North Americans recast themselves as shamans.	2
Hans Baer's up-front acknowledgment of race, class, gender, and ethnicity promises a welcome relief. Baer, a professor of anthropology, became interested in osteopathy and chiropractic — systems of healing based primarily in the skeletal structure — almost twenty years ago. He describes Biomedicine and Alternative Healing Systems as the culmination of two decades of work and the outgrowth of his distinct but converging interests in alternative health professions, spiritualism and healing, and medical dominance as a reflection of social relations in American society. He has now published books in each of these areas.	3
The book's lengthy genesis and disparate roots have both positive and negative implications. Baer introduces Biomedicine and Alternative Healing as an "historical and socio-political overview of medical pluralism in the United States." Drawing on Vincente Navarro, he argues that "in capitalist societies, people in different class, racial, ethnic and gender categories tend to have different ideologies, which are reflected in cultural differences." Baer's book, an impressive summary of and synthesis of studies of alternative health, shows "how these groups have constructed distinctive medical systems to coincide with their diverse views of reality."(3)	4
The promise is only partly realized. Baer begins the book with two theoretical chapters. The first outlines the history of alternative healing. The second, derived from an earlier essay, explores "the rise of the American dominative medical system under corporate capitalism." These chapters set the stage for the rest of the work in more ways than one. Both are comprehensive reviews of the literature, but neither introduces much new or primary material. Baer's synthetic approach is both the great strength and primary weakness of the book. Biomedicine and Alternative Healing reads like a lengthy review essay, or literature review. It is thoughtful, if sometimes not entirely up to date, and raises interesting questions for further analysis. But this reader felt the absence of primary research and independent findings. Baer's approach made it difficult to discern any clear method. Was he writing as an anthropologist? If so, where was the ethnographic component? Had he been a participant-observant and if so where and when? Was he writing as an historian? If so, where was the archival research? Baer's open references to other studies and writers are refreshing in that they place this book squarely in the context of other studies of alternative medicine, but the result is that Baer's original contributions are sometimes lost. Too many paragraphs begin with sentences like, "A study by the Stanford Research Institute concluded that ..." (74); too few begin with a bold statement of Baer's own observations and research.	5
The greatest virtue of Baer's synthetic approach is that it allows him to take on the ambitious task of examining the history and evolution of multiple forms (otherwise known as modalities) of healing. While Baer clearly knows most about, and pays greatest attention to, chiropractic and osteopathy, he also explores the development and prevalence of acupuncture, naturopathy, holistic health, and folk medicine. Culling varied studies, Baer explores the internal structure and composition of these healing systems, and he compares and contrasts their professional memberships and structures to those of dominant biomedicine. However, the reliance on secondary sources and the comparative framework limits Baer's analysis. Inadvertently (and perhaps because this is the lens of the authors he relies on) Baer turns the dominant biomedical model into the norm. His analysis presents the other professions as either fighting against or emulating the professional and corporate structures of biomedicine, so that lay midwives and other alternative providers are seen as struggling to obtain a kind of professional status, akin to that of allopathic MDs.	6
Moreover, despite the place of gender in the title, Baer undertakes very little gender analysis of healing professions. The book captures sex differences in the composition of the healers, but there is little here of the varied ways in which "values" and practices developed by men structured healthcare. Despite his concern for ideologies and diverse realities, Baer fails to acknowledge the ways in which chiropractic and osteopathy grew from very male and medical models of care. Nor does his review of the literature encompass feminist critiques of healing. This reviewer is not an advocate of the literature that argues for women's special and distinctive modes of healing; nonetheless, a rich and varied literature exists that anyone who argues for diverse gendered ideologies must contend with.	7
Biomedicine and Alternative Healing Systems is consequently a very useful overview of the social science literatures on alternative healing systems in the United States. It provides a much needed first step to further research and analysis. However the absence of primary case studies and research leave the conclusions and analysis both vulnerable and wanting.	8
Georgina Feldberg York University

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