Knowledge, attitude, and utilization of traditional medicine within the plural medical system in West Java, Indonesia.

BACKGROUND: The concept of 'medical pluralism' has become more popular among scholars in applied health science and prevalent in societies where one medical system alone cannot adequately meet the health care needs of the entire population. METHODS: The data collection is focused on the knowledge-belief-practice and the utilization of three medical systems in Kabupaten Bandung, West Java, Indonesia. Participants were purposively selected from households with at least one member experienced one of the listed diseases in the questionnaire. The extensive survey using a structured questionnaire has been undertaken to collect data on people's health care utilization behaviour. The dataset is further analyzed using multivariate analysis through non-canonical correlation, with the analytical data provided by Statistical Package for Social Sciences (SPSS). RESULTS: With regards to the total utilization by patients, the traditional medical system presents as the dominant medical system in the research area, accounting for 59.3% (n = 419) of total utilization, followed by the modern medical system (33.0%, n = 233), and transitional medical system (7.7%, n = 54). This study identified that village category, illness, illness duration, occupation, belief in traditional medicine, knowledge of modern medicine, accessibility, cost, proximity to the medical service, and insurance have significant (χ2 = 0.000) relationship with the utilization of medical systems. The results of the multivariate analysis show that the block of the predisposing socio-demographic factors and the block of the predisposing psycho-social factors correlate strongly with the utilization of medical systems. CONCLUSIONS: In general, people in Kabupaten Bandung, West Java, Indonesia seeks treatment from various sources, which in the context of the medical system, consists of the traditional, transitional, and modern medical system; therefore, it adopts the patterns of transcultural health care utilization. In terms of the knowledge, beliefs, and practices of traditional medicine in West Java, the inhabitants of the five research villages were commonly familiar with medicinal plants and speak profoundly about their knowledge of traditional medicine, which in the research area is perceived as accessible, efficacious, affordable and culturally appropriate with Sundanese community.

Medical pluralism, healthcare utilization and patient wellbeing: The case of Akan cancer patients in Ghana.

PURPOSE: As cancers increase in Ghana and in many low-and middle-income countries, healthcare utilization has become critical for disease management and patients' wellbeing. There is evidence that medical pluralism is common among cancer patients in Ghana and many other African countries, which results in lack of adherence to and absconding from hospital treatments. The objective of this study was to examine ways in which beliefs in disease causation influence medical pluralism among Akan cancer patients in Ghana. METHODS: A qualitative research approach was employed in this study. In-depth interviews were conducted for thirty (30) cancer patients who were purposively recruited from Komfo Anokye Teaching Hospital in Ghana. Thematic content analysis was used in analysing data. RESULTS: Our findings revealed that cancer patients ascribed both physical and spiritual causality to their illness. As such, they combined orthodox treatment with spiritual healing and herbal medicine. Regarding the order of therapeutic search, patients reported to herbal and spiritual centres before going to the hospital, a phenomenon which contributes to the late reporting and diagnosis as well as bad prognosis of cancers in Ghana. CONCLUSION: The findings of this research elucidate the relationship between culture and health care choices of cancer patients in Ghana. Increased awareness creation is crucial in eradicating myths surrounding cancers in Ghana.

Medicalisation and Ayurveda: the need for pluralism and balance in global health systems.

The current global economic and biomedical perspectives contribute content, strategy, and values to global health systems, like objectification and competition, which encourage the medicalisation of the system. Medicalisation overlooks our interdependence with other beings, the environment and biosphere. In contrast, ancient health traditions like Ayurveda, derived from Asian cultures, provide knowledge of the human being's composition of five basic states of nature that need to remain in constant equilibrium to ensure health (Svasthya). Asian health traditions encourage values like vulnerability and respect to facilitate an inherent relationship with the internal and external environment. The recent pandemic has revealed the fragile vulnerability in this nexus and the consequences to human health and well-being when that equilibrium is disturbed. Serious deliberations and discussions are needed between the modern economic and the Asian frameworks for healthcare which result in two different approaches to health and to health systems. This debate may encourage the creation of a philosophy and structure for a new global pluralistic health system more aligned to nature. These deliberations need to encourage the discussion of Svasthya (health), Soukhya (sustainable happiness), and the inner and outer ecological landscapes experienced by human beings that can be understood through mindful self-awareness. Global health systems need to evolve in the direction of a different, pluralistic philosophy of health that encourages a 'population's self-reliance in health' through an intimate and integrated connection with nature.

Hegemony versus pluralism: Ayurveda and the Movement for Global Mental Health.

Under the aegis of the World Health Organization, the Movement for Global Mental Health and an Indian Supreme Court ruling, biomedical psychiatric interventions have expanded in India augmenting biomedical hegemony in a place that is known for its variety of healing modalities. This occurs despite the fact that studies by the WHO show better outcomes in India for people suffering from schizophrenia and related diagnoses when compared to people in developed countries with greater access to biomedical psychiatry. Practitioners of ayurvedic medicine in Kerala have been mounting a claim for a significant role in public mental health in the face of this growing hegemony.This study examines efforts by ayurvedic practitioners to expand access to ayurvedic mental health services in Kerala, and profiles a rehabilitation center which combines biomedical and ayurvedic therapies and has been a key player in efforts to expand the use of Ayurveda for mental health. The paper argues for maintaining a pluralistic healing environment for treating mental illness rather than displacing other healing modalities in favor of a biomedical psychiatric approach.

The reluctant and the envious: Therapeutic subalternity and the practice of homeopathy in North America.

This work presents a neo-Gramscian theorization of therapeutic hegemony and subalternity, deployed with reference to the practice of homeopathy in North America by two increasingly-professionalized but unorthodox health occupational groups: Homeopaths and Naturopaths. Despite both occupations' contemporary sociopolitical subordination to dominant biomedicine, the continent's Homeopaths have been less successful in their professionalization efforts, owing partly to homeopathy-their primary therapeutic modality-being widely considered incommensurable with biomedical science. For Naturopaths, who increasingly align themselves with biomedical evidentiary norms, homeopathy represents but one among several central therapeutic modalities. Using survey (n = 588) and interview (n = 31) data from an empirical case involving Homeopaths and Naturopaths in Ontario, Canada-a jurisdictional outlier in which both groups are regulated by the state-the author employs the theory of therapeutic subalternity to illuminate the internal struggles faced by homeopathy-practising occupations in a biomedically-dominant context. Despite their regulated standing, Homeopaths' negative media characterization and ongoing lack of access to third-party insurance reimbursement contribute to ongoing frustration among practitioners, expressed as displaced envy toward the province's more elite, homeopathy-practising Naturopaths. However, while most Naturopaths express appreciation for homeopathy's clinical merits, many appear increasingly reluctant to use or discuss the practice to prevent compromise to their profession's therapeutic legitimation.

The Influence of Religious Participation and Use of Traditional Medicine on Type 2 Diabetes Control in Urban Ghana.

This study examined whether the frequency of participation in religious activities and seeking care from spiritual and other traditional medicine (TM) practitioners were associated with blood glucose (HbA1c) control among urban Ghanaians with type 2 diabetes mellitus (T2DM). Findings revealed that increased frequency of participation in religious activities was significantly associated with decreased HbA1c levels, whereas increased use of TM practitioners was significantly associated with increased HbA1c levels. These findings suggest that strategically integrating religious activities into disease management plans for Ghanaians with T2DM who identify as being religious may be a viable intervention mechanism.

Decolonizing health care: Challenges of cultural and epistemic pluralism in medical decision-making with Indigenous communities.

The Truth and Reconciliation Commission of Canada made it clear that understanding the historical, social, cultural, and political landscape that shapes the relationships between Indigenous peoples and social institutions, including the health care system, is crucial to achieving social justice. How to translate this recognition into more equitable health policy and practice remains a challenge. In particular, there is limited understanding of ways to respond to situations in which conventional practices mandated by the state and regulated by its legal apparatus come into direct conflict with the values and autonomy of Indigenous individuals, communities, and nations. In this paper, we consider two cases of conflict between Indigenous and biomedical perspectives to clarify some of the competing values. We argue for the importance of person- and people-centered approaches to health care. These value conflicts must be understood at multiple levels to clarify their personal, social, cultural, and political dimensions. Taking into account the divergence between epistemic cultures and communities allows us to understand the multiple narratives deployed in decision-making processes in clinical, community, and juridical contexts. Recognizing the knowledge claims of Indigenous peoples in health care can help clinicians avoid reinforcing the divides created by the structural and institutional legacy of colonialism. This analysis also provides ways to adjudicate conflicts in health care decision-making by disentangling cultural, political, medical, and pragmatic issues to allow for respectful dialogue. Insofar as the engagement with cultural pluralism in health care rights is conducted with reciprocal recognition, the medical community and Indigenous peoples can address together the difficult question of how to integrate different epistemic cultures in the health care system.

Sámi traditional medicine: practices, usage, benefit, accessibility and relation to conventional medicine, a scoping review study.

The Sámi Indigenous populations, who live in the arctic Sápmi area across four countries - Norway, Sweden, Finland and the Kola Peninsula of Russia - have practiced traditional medicine (TM) for millennia. However, today Sámi TM is unknown within the Swedish health care services (HCS). The aim of this study is to describe the nature and scope of research conducted on Sámi TM among the four Sápmi countries. This study covers peer-reviewed research published in the English language up to 8 April 2020. From 15 databases, 240 abstracts were identified, and 19 publications met the inclusion criteria for full review. Seventeen studies were conducted in Norway, one in Finland and one in Sweden, none in Russia. In northern Norway, Sámi TM is actively used by the local communities, and is claimed to be effective, but is not accessible within HCS. Holistic worldviews, including spirituality, prevail in Sámi TM from practitioners' selection criteria to health care practices to illness responsibilities. An integration of Sámi TM into HCS is clearly the desire of local communities. Comparisons were made between Sámi TM and conventional medicine on worldviews, on perspectives towards each other, and on integration. More studies are needed in Sweden, Finland and Russia.

When local phytotherapies meet biomedicine. Cross-sectional study of knowledge and intercultural practices against malaria in Eastern French Guiana.

ETHNOPHARMACOLOGICAL RELEVANCE: In French Guiana, traditional phytotherapies are an important part of self-healthcare, however, a precise understanding of the interactions between local phytotherapies and biomedicine is lacking. Malaria is still endemic in the transition area between French Guiana and Brazil, and practices of self-treatment, although difficult to detect, have possible consequences on the outcome of public health policies. AIM OF THE STUDY: The objectives of this research were 1) to document occurences of co-medication (interactions between biomedicine and local phytotherapies) against malaria around Saint-Georges de l'Oyapock (SGO), 2) to quantify and to qualify plant uses against malaria, 3) and to discuss potential effects of such co-medications, in order to improve synergy between community efforts and public health programs in SGO particularly, and in Amazonia more broadly. MATERIALS AND METHODS: This cross-sectional study was conducted in 2017 in SGO. Inhabitants of any age and nationality were interviewed using a questionnaire (122 questions) about their knowledge and habits regarding malaria, and their use of plants to prevent and treat it. They were invited to show their potential responses on a poster illustrating the most common antimalarial plants used in the area. In order to correlate plant uses and malaria epidemiology, all participants subsequently received a medical examination, and malaria detection was performed by Rapid Diagnostic Test (RDT) and Polymerase Chain Reaction (PCR). RESULTS: A total of 1566 inhabitants were included in the study. Forty-six percent of them declared that they had been infected by malaria at least once, and this rate increased with age. Every person who reported that they had had malaria also indicated that they had taken antimalarial drugs (at least for the last episode), and self-medication against malaria with pharmaceuticals was reported in 142 cases. A total of 550 plant users was recorded (35.1% of the interviewed population). Among them 95.5% associated pharmaceuticals to plants. All plants reported to treat malaria were shared by every cultural group around SGO, but three plants were primarily used by the Palikur: Cymbopogon citratus, Citrus aurantifolia and Siparuna guianensis. Two plants stand out among those used by Creoles: Eryngium foetidum and Quassia amara, although the latter is used by all groups and is by far the most cited plant by every cultural group. Cultivated species accounts for 91.3% of the use reports, while wild taxa account for only 18.4%. CONCLUSIONS: This study showed that residents of SGO in French Guiana are relying on both traditional phytotherapies and pharmaceutical drugs to treat malaria. This medical pluralism is to be understood as a form of pragmatism: people are collecting or cultivating plants for medicinal purposes, which is probably more congruent with their respective cultures and highlights the wish for a certain independence of the care process. A better consideration of these practices is thus necessary to improve public health response to malaria.

The emergence of new medical pluralism: the case study of Estonian medical doctor and spiritual teacher Luule Viilma.

Rather than the harmonious coexistence of different therapeutic practices and meaning systems, medical pluralism involves the contestation of norms and meanings related to legitimacy and authority. The implicit cultural norms that shape local understandings of health and legitimate healing methods become more during periods of social and cultural change. This paper demonstrates the contested nature of medical pluralism based on the case study of one significant figure, Estonian gynaecologist and spiritual teacher Luule Viilma. Well-known to the public as a trailblazer and prominent spokesperson for medical pluralism since the 1990s, Viilma's trajectory from doctor to healer reveals some implicit characteristics and mechanisms of power struggles as evidenced by the 'boundary work' carried out by biomedical specialists. By uniting and bridging biomedicine and spiritual self-help, Viilma became a figure whose presence and teachings gave responsibility and power to individuals and helped to legitimize pluralism in health practices. She had the ambition to redefine, in a fundamental way, perceived norms of legitimacy and authority, as well as the patient's position. From interviews with people who have used Viilma's teachings and material from internet discussion forums, it is apparent that the emergence of new forms of medical pluralism has brought several changes in health-related norms and understandings, including more active personal involvement in health-related information seeking and decision-making.

Medical pluralism, sorcery belief and health seeking in Vanuatu: a quantitative and descriptive study.

Set in Espiritu Santo, Vanuatu, this study explores the relationship between cultural knowledge and beliefs concerning illness and health-seeking behaviour within the context of medical pluralism. Concentrating on the nation's high rates of diabetes and non-communicable disease (NCD) risk factors, this research analyses the way in which understandings of disease aetiology and healing efficacy impact upon treatment-related decisions. Data were obtained through a mixed-methods community survey of 313 adult respondents developed in collaboration with ni-Vanuatu health experts, community leaders and survey enumerators, and comprised of open and closed-ended questions. As the results demonstrate, framed by cultural and religious beliefs, multifaceted indigenous conceptualizations of health and illness in Vanuatu are directly linked to pluralist health seeking practices, including the concurrent use of formal and informal health services. The interwoven identification of sociocultural, physical and clinical determinants of disease highlights the complex manner in which health is understood and maintained by ni-Vanuatu. In successfully addressing the rising burden of NCDs, it is integral that health interventions and service providers acknowledge the complex conceptualization of disease and ensure the provision of holistic care that embraces rather than ignores the steadfast role of local systems of belief, and of traditional, religious and other informal forms of healthcare provision.

Traditional Medicine and Help-Seeking Behaviors for Health Problems Among Somali Bantu Refugees Resettled in the United States.

Somali refugees have resettled in the United States in large numbers. The focus of this study was specifically on the Somali Bantu refugees, an ethnic minority group from Somalia. The goal of this study was to understand the following: (a) jinn (invisible beings or forces in Islamic theology) and related health problems resulting from jinn possession affecting Somali Bantu refugees, (b) types of traditional healing practices integrated into help-seeking behavior, and (c) pathways of care utilized to address health problems. In total, 20 participant interviews were conducted with Somali Bantu refugees resettled in the United States. Overall, participants described types of jinn and associated health problems. In addition, participants identified different pathways of care, including formal and informal health care. Participants accessed these pathways both concurrently and sequentially. Somali Bantu utilize complex and varied health care services based on their understanding of the causes of health problems and experiences with care providers.

Contextualizing geneticization and medical pluralism: How variable institutionalization of traditional, complementary, and alternative medicine (TCAM) conditions effects of genetic beliefs on utilization.

As genetic models are increasingly incorporated in medicine, health service users seem to accept these models to varying degrees. To appreciate these differences, this paper examines how health service users' genetic beliefs of health are associated with their use of traditional, complementary, and alternative medicine (TCAM) via responses from 31 countries in the 2011 ISSP survey. It finds an interesting contrast between East Asian countries and other countries in the world. The negative association between genetic beliefs and TCAM use is strong in the latter, whereas it is weak in the former. More intriguingly, the analysis demonstrates significant cross-national differences within East Asian countries. Chinese and Koreans reveal a negative relationship between genetic beliefs and TCAM use, while Japanese show a positive relationship. The paper provides an explanation to these cross-national differences by drawing on comparative studies of medical systems. When TCAM is institutionalized as valid and distinct medical resources, and when TCAM is practically available to everyday use, health service users who subscribe to genetic beliefs are likely to use TCAM as well. These findings contribute to revealing the pragmatic nature of health-seeking action and the institutional context in which geneticization and medical pluralism are conditioned to form.

[A biographical study of Bernard Rhodes S. J. (1646-1715), physician, surgeon and insignis pharmacopeus: deciphering medical itineraries in Qing China].

The itinerary of Bernard Rhodes S. J. (1646-1715), temporal coadjutor of the Society of Jesus and missionary in China, is of remarkable complexity. He was already a doctor before he was recruited by the Jesuit order and sent on various missions. During the nine years before his arrival in China, his route between Europe and Asia was largely determined by rivalries between European powers. When he eventually arrived in Beijing in 1699 and entered the service of the Kangxi Emperor, he became attached to the Imperial House, and this seems to have decisively determined the course of his itineraries in the Middle Kingdom henceforth. Following his movements in the capital and in the emperor's cortege during imperial tours gives us unique insights into the mobility of this Jesuit medical practitioner. In the service of the Manchu rule, he provided therapies-unknown to Chinese palace physicians and their medical traditions-to privileged patients belonging to the core imperial networks. In the medical pluralistic setting as it existed at the court and was instrumentalized by the Manchu ruler for ideological purposes, Rhodes was in competition not only with experts of the Imperial Academy of Medicine, but also with Mongolian doctor and Lama therapists. His career in the Qing empire illustrates that the presence in Beijing of doctors trained in Europe was not enough to ensure the transmission of the specific knowledge they held. Medical matters reveal to be an important case study in which Western language sources, combined with those in Chinese and especially in Manchu, provide us with a deeper understanding of courtly live and the function of medicine in consolidating Manchu rule during the Kangxi reign. Thus, the study of the biography of Rhodes, one of the marginal actors in the emperor's service, and the tracing of his itineraries is a complementary contribution to New Qing History, with its emphasis on exploring non-Chinese voices.

Beyond the orthodox/CAM dichotomy: Exploring therapeutic decision making, reasoning and practice in the therapeutic landscapes of elite sports medicine.

Elite athletes face extreme challenges to perform at peak levels. Acute and chronic musculoskeletal injuries are an occupational hazard while pressures to return to play post-injury are commonplace. Therapeutic options available to elite athletes range from novel 'cutting edge' biomedical therapies, established biomedical and surgical techniques, and physiotherapy, to a variety of non-orthodox therapies. Little is known about how different treatment options are selected, evaluated, nor how their uses are negotiated in practice. We draw on data from interviews with 27 leading sports medicine physicians working in professional football and cycling in the UK, collected 2014-16. Using idea of the 'therapeutic landscape' as a conceptual frame, we discuss how non-orthodox tools, technologies and/or techniques enter the therapeutic landscape of elite sports medicine, and how the boundaries between orthodox and non-orthodox therapy are conceptualised and navigated by sports medicine practitioners. The data provide a detailed and nuanced examination of heterogenous therapeutic decision -making, reasoning and practice. Our data show that although the biomedical paradigm remains dominant, a wide range of non-orthodox therapies are frequently used, or authorised for use, by sports medicine practitioners, and this is achieved in complex and contested ways. Moreover, we situate debates around nonorthodox medicine practices in elite sports in ways that critically inform current theories on Complementary and Alternative Medicine (CAM)/biomedicine. We argue that existing theoretical concepts of medical pluralism, integration, diversity and hybridisation, which are used to explain CAMs through their relationships with biomedicine, do not adequately account for the multiplicity, complexity and contestation that characterise contemporary forms of CAM use in elite sport.

Medical pluralism in the aftermath of cancer: health seeking actions and cancer patients' shaping of trajectories to healing.

Improved treatment methods for cancer are increasing the number of survivals in Norway. In turn, the group of people struggling with late effects after the treatment is growing. Late effects could be physical, psychological or existential conditions caused by treatment or the experience of illness. This qualitative study explores health-seeking actions among nine Norwegian people with cancer, and how they shape their trajectories to healing. Various health-seeking actions were identified through content analysis, and categorized as conventional, CAM, self-care, religious coping and traditional healing. Medical pluralism particularly flourished in the aftermath of cancer. We found that the phenomenon is characterized by: 1) implementation of contradicting models of reality and making pragmatic choices, 2) continuity and change of health seeking actions, 3) medical pluralism as a process, and 4) increased use of CAM and self-care to improve health and well-being in situations where the conventional care system has few available treatment options. To support people with long-term conditions, we need to know how they choose and make sense of their health-seeking activities. We argue that trajectories to healing are dynamic and shaped by people making choices. This process could be understood in greater depth by applying the concept of medical landscapes.

Doctors of Plural Medicine, Knowledge Transmission, and Family Space in India.

The transmission of traditional medical knowledge - either institutionally or through established lineages - is assumed to involve one single tradition or another. In India however, families of doctors often engage with multiple traditions, including Ayurveda, Unani, homeopathy, yoga, and biomedicine. Parents, children, siblings and spouses trained in different medical systems occasionally share knowledge and clinical space, producing versatile therapies. By exploring such cases, I challenge studies focused on single traditions and propose to examine "family space" as the physical and relational proximity that enables kin doctors to experiment with plural therapies while negotiating legitimacy and authority within the changing institution of the Indian family.

Drug adherence, medical pluralism, and psychopharmaceutical selfhood in postreform Vietnam.

This article examines drug adherence in relation to changing patterns of medical pluralism and neoliberal reforms among psychiatric patients in postreform Ho Chi Minh City, Vietnam. We conducted 39 in-depth interviews and 21 follow-up interviews with individuals prescribed psychiatric medication on an outpatient basis in 2016 to identify patterns of nonadherence, which was operationalized as taking medications according to doctors' prescriptions at the three-month follow-up interval. Patients adapt or reject their medication prescriptions due to (1) concerns about biomedical drugs and adverse drug reactions, (2) local concepts of psychic distress and selfhood, and (3) the social context of medicine taking. The dominant theoretical models of drug adherence focus on individual-level predictors. However, situating drug adherence in its political-economic context highlights the relationship between medicine and neoliberal modernity that underlies adherence. Examining the intersection of multiple medication regimens and political regimes, we argue that nonadherence is rooted in a complex layering of medical traditions and modernist projects of the self. The reception of new biomedical drugs in Vietnam is shaped by not only folk theories of illness but also a changing cultural politics of the self.

A National Survey of Complementary and Alternative Medicine Use for Treatment Among Asian-Americans.

Asian Americans (AAs) are more likely to use complementary and alternative medicine (CAM) compared to other race/ethnicities, yet previous studies have conflicting results. The 2012 National Health Interview Survey data was analyzed to investigate AA's (n = 2214) CAM use for treatment. AAs were divided into four subgroups: Chinese, Asian Indian, Filipino, and Other Asian. Only 9% of AAs reported using CAM for treatment, with 6% indicating CAM use specifically for chronic conditions. This could be a form of medical pluralism, a mixture of Eastern and Western health approaches. The "Other Asian" subgroup reported highest use of CAM for treatment. Significant predictors included age (≥ 65 years) and high educational attainment (≥ college degree). Sociodemographic factors were also significant predictors within Asian subgroups. Further investigation of this and other forms of medical pluralism among AAs are needed to explore potential cofounders and risks like underreporting, CAM schedules/dosages, cultural influences, and CAM's impact on one's health.

George Deacon and the circulation of homeopathic therapies in Lima (1880-1915) / George Deacon e a circulação de tratamentos homeopáticos em Lima (1880-1915)

Abstract Homeopathy arrived from the United States to Peruvian soil in the last decades of the nineteenth century, broadening the repertoire of existing medical knowledge, which included an emerging medical profession, Chinese herbalists, and indigenous practitioners. This article examines the circulation and use of homeopathic therapies and medicines in Lima from the time when the American homeopath George Deacon initiated his practice, in the 1880s, until his death, in 1915. Although homeopathy was not the most widely used medical therapy in the country, it nevertheless posed a threat to professional medicine and the School of Medicine's desired monopoly of the field of medicine.

Resumo A homeopatia originária dos EUA adentrou solo peruano nas últimas décadas do século XIX, ampliando o repertório de conhecimento médico existente até então, o qual incluía uma profissão médica em ascensão, herbolários chineses e médicos locais. Este artigo analisa a circulação e o uso de tratamentos e medicamentos homeopáticos em Lima desde o período em que o homeopata norte-americano George Deacon iniciou sua prática, nos anos 1880, até sua morte, em 1915. Embora a homeopatia não fosse o tratamento médico mais disseminada no país, ela representou uma ameaça à medicina profissional e ao monopólio do campo da medicina almejado pela escola tradicional.