Traditional or Biomedical Knowledge?

Modern life is imagined as world that profits from the achievements of enlightenment and modern science. The field of modern medicine is probably one of the most striking examples. Where else was the triumph of modern science over religious, esoteric or ancient belief systems more life prolonging than in the realm of health? But things are always more complex than they seem.

Scholars from anthropology as well as history show that neither traditional nor biomedicine are stable entities. Traditional medicine was invented with the birth of the institutionalization of modern biomedicine. It is only since modern biomedicine gained momentum as standardized, analytical and universal that traditional medicine was constituted as holistic, individual and contextual. The difference between traditional and biomedicine is powerful in everyday life, because it reiterates in policies, standards, curricula, scientific research and myriad healing practices every day.

In this small intervention I show how actors in the field of traditional medicine in Thailand enact a medicine that diffracts the taxonomies of the seemingly separate worlds of hard bioscience and traditional belief systems in scientific world-making practices. Mapping these diffractions enables me to tell a story about the making of scientific facts and worlds that crisscross global space and to decentre the geopolitics of biomedical knowledge.

In my research project on ‘worlding medicine’ I followed the genesis, enactment, and circulation of scientific facts in the field of traditional medicine in Thailand. The research is based on months of fieldwork in Thailand, where I did participatory observation and interviews with experts who engage in the production of knowledge on traditional medicine. In this multi-sited ethnography, I observed how scientific knowledge is made in situ. Therefore, I went to forests with traditional healers and ethnobotanists. They documented plants and notated their local names. They exchanged stories about recipes, fields of application and modes of action. I followed the plants on their way to botanical gardens or to scientific herbariums, where they were dried and provided with scientific names. It takes a number of further steps until a safe and effective medicine will be available in the market. In the end, I reconstructed a comprehensible trace of scientific references from forest over labs to market.

But what kind of scientific fact is it that develops here? Is it traditional medical knowledge? Or is this biomedical knowledge? The questions that I want to answer here are: How is traditional medicine transformed into scientific facts? How are scientific categories transgressed in this process?

I call my research strategy “worlding as ethnographic theorizing”, following the famous medical anthropologist João Biehl: “Ethnographic theory emerges from and in conversation with people and world-making practices, with various ways of knowing and relating. It is a way of staying connected to open-ended social processes and unknowns – a way of counterbalancing the generation of certainties and foreclosures by other disciplines” (Biehl 2016: 136). Worlding for me meant drawing together stories from different contexts, different places and different scales in order to destabilize a “narrative of globalization” (Biehl 2016: 132) that grants biomedicine a gold standard.

In the following, I show how world-making practices in traditional medicine diffract the taxonomies of the seemingly separate worlds of hard bioscience and traditional belief systems. Therefore, after a brief introduction to Traditional Medicine in Thailand, I will tell approach how traditional medicine became a scientific fact in Thailand in two different ways.

Traditional Medicine in Thailand

Traditional Medicine in Thailand is heterogeneous and has roots in China, Burma, Laos and Cambodia. It is influenced by Ayurveda, Traditional Chinese Medicine, Khmer traditions and locally diverse folk medicines. In the early 20^th century, modern biomedicine became the dominant medical paradigm in Thailand. Practicing traditional medicine was finally prohibited by national legislation. However, during the last 40 years, Traditional Medicine has experienced a renaissance and become a political project. The reasons therefore are complex: Pharmaceutical companies have an increasing interest in traditional medical herbs, since in the 1990ies international free-trade agreements such as TRIPS have paved the way to internationally enforce intellectual property rights. Some civil society groups criticize insufficient access to modern pharmaceuticals due to WTO agreements and patent laws. They call for greater independence from transnational pharmaceutical companies. The state has passed a law to protect traditional medical wisdom (Kingdom of Thailand, 1999). The king promotes a ‘sufficiency economy’. The promotion of traditional medicine has become part of this strategy. “Traditional Thai Medicine” – as it is taught at Thai universities today – is much more homogeneous than the mundane traditional ways of healing 40 years ago.

First Approach

Traditionally, recipes for herbal medicines contain about 30 to 40 ingredients that are individually composed for the needs of the patient. The problem is, traditional doctors in Thailand are only permitted to use, prescribe, buy or sell these traditional herbal medicines, if their safety and efficacy is biomedically proven. I learned from a specialist in ethnopharmacy in Prachin Buri that “it is impossible to biomedically proof the safety and efficacy of recipes with so many ingredients, [because] these ingredients all interact with each other” (Interview with the Head of the International Relations Office of Abhaibhubejhr Hospital, Prachin Buri, February 2017). This is why traditional recipes are reduced to a maximum of 5 components. Mostly, they are reduced to even only one. During this process, a new traditional medicine emerges that misses core qualities: Only plant components are tested. Metals and animal components are excluded due to safety and efficiency as well as wildlife protection regulations. The individualization for one person gets lost. The interactions of ingredients are neglected. The medicine loses it magic. The spiritual part of healing is excluded.

At the same time, the proof of safety and efficacy provides the opportunity to patent an innovation. Currently, traditional medicine promoted by the state. This process is called ‘biomedicalization’ of traditional medicine (Ijaz and Boon 2018). Through labs, national and international biomedical standards, the Food and Drug Administration, Good Manufacturing Practices, international free trade agreements and national law traditional medicine becomes part of globalized biomedicine: But, there are always two sides to every story and this is why I will reverse my argument now.

Second Approach

Numerous research institutions in Thailand test the efficacy of traditional medicine with biomedical research methods. They range from smaller clinical trials to the biomedical gold standard: the randomized controlled trial. I met the Head of the Department of Developmental and Alternative Medicine, a research department of the Ministry of Public Health in Bangkok. In her view there is no lacking of evidence-based biomedical research on traditional medicine in Thailand. She and her team analyzed hundred-sixty academic studies that explore the impact of traditional medicine on human beings. “We found, none of the studies has been a study that starts from the diagnosis in traditional medicines” (Interview with the Head of the “Department of Developmental and Alternative Medicine” of the Ministry of Public Health, Bangkok, February 2017, Par. 71). What she stresses is that the current “biomedical research does not achieve the standards of traditional medicine” (Interview with the Head of the “Department of Developmental and Alternative Medicine” of the Ministry of Public Health, Bangkok, February 2017, Par. 50).

I want to illustrate this with an example. A clinical trial has tested the efficacy of a traditional medicine for chronic obstructive pulmonary disease (COPD). COPD is characterized by long-term breathing problems and poor airflow. Until today it is incurable. Biomedical treatment can only alleviate symptoms. In contrast, traditional medicine in Thailand conceives of health as balance between the four elements earth (din), water (nahm), wind (lom) and fire (fi). Illness is caused by imbalance. The wind element controls the energy flow within the body and regulates blood and pulmonary circulation. In traditional medicine the aforementioned treatment is applied to balance the earth-element.

But how can you test the efficacy of a traditional treatment for curing COPD, if it is originally designed to treat ‘wind-disorder’? What the reference system of biomedicine labels a ‘disease’, is a ‘symptom’ in traditional medicine. So, whose diagnostic and scientific categories are suitable for the clinical trial? “You cannot jump directly to the intervention and try to prove the intervention itself. First, you have to see where these kinds of things come from and what is their traditional or cultural value […]” the Head of the Department of Developmental and Alternative Medicine argues (Interview with the Head of the “Department of Developmental and Alternative Medicine” of the Ministry of Public Health, Bangkok, February 2017, Par. 50). “The parameter that you measure and the intervention must be reciprocal: In conventional medicine for the fever, you use the thermometer, that's why. But for the traditional one, what do you measure? That you need to think” (Interview with the Head of the “Department of Developmental and Alternative Medicine” of the Ministry of Public Health, Bangkok, February 2017, Par. 50). That means, instead of testing the efficacy of wind-disorder-treatment against COPD, a trial tests the efficacy of wind-disorder-treatment against wind-disorder first. And second, it investigates the interrelation between traditional wind-disorder and COPD.

Why do I tell this story in such great detail? What I find striking is, that during this process wind-disorder becomes a category of biomedicine. On the one hand, traditional medicine transforms into biomedicine as I have shown in the first part of this essay. But on the other hand, traditional medicine also transforms biomedical classifications. The concept of ‘diffraction’ seems suitable for explaining what happens here. Donna Haraway (2004: 70) describes it as “interpenetration of boundaries between problematic selves and unexpected others and […] the exploration of possible worlds in a context structured by transnational technoscience.” In my case, diffraction characterizes the reconfiguration of traditional medicine through biomedical gold standards as well as the inscription of categories from traditional medicine into the biomedical mainstream.

Conclusion: Worlding Traditional Medicine

The medical anthropologist Mei Zhan reminds us that worlding is “not a replacement for globalization, but […] a heuristic device to think through the multiple spatiotemporalities in and of knowledge production” (Zhan 2009: 23 f.). Drawing on the concept of ‘worlding as ethnographic theorizing’ I have shown how actors in the field of traditional medicine in Thailand enact medicine in their scientific world-making practices. This enactment diffracts the classifications of the seemingly separate worlds of hard bioscience and traditional belief systems.  

Acknowledgment

All empirical findings as well as the case study originated from the research project “Worlding Medicine – Negotiating Knowledge Regimes and Practices between Alternative and Biomedicine” [grant number: 392750976]. The project is funded by the German Research Foundation between 2018 and 2022. I thank the German Research Foundation for its generous support of the project.

References

Biehl J (2016) Theorizing Global Health. Medicine Anthropology Theory 3(2): 127–142. DOI: 10.17157/mat.3.2.434.

Haraway D (2004) The Promises of Monsters: A Regenerative Politics for Inappropriate/d Others. In: Haraway DJ (ed) The Haraway reader. New York, London: Routledge, pp.63–124.

Ijaz N and Boon H (2018) Statutory Regulation of Traditional Medicine Practitioners and Practices: The Need for Distinct Policy Making Guidelines. The Journal of Alternative and Complementary Medicine 24: 307–313. DOI: 10.1089/acm.2017.0346.

Kingdom of Thailand (1999) The Protection and Promotion of Thai Traditional Medicine Knowledge Act B.E. 2542. Available at: http://thailaws.com/law/t_laws/tlaw0294_3.pdf (accessed 01 August 2018).

Zhan M (2009) Other-worldly: Making Chinese Medicine through Transnational Frames. Durham: Duke UP.

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Iris Dzudzek is Professor in Critical Urban Geography at the University of Münster, Germany. In her research she engages with questions of power and knowledge, urban and planetary health and environmental justice.