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Modernity, premodernity and traditional medicine

28 February 2008

In a comment on an earlier post of mine, on Religion, spirituality and politics, Nic Paton said “Thats an interesting distinction between the post/modern “neopagan” and the premodern “paleopagan”… Do you see a role for the paleopagan in contemporary culture / spirituality?”

I referred to the recent comments of the Minister of Health on the possibility of clinical trials for traditional medicine:

clipped from www.iol.co.za
African traditional medicines should not become “bogged down in clinical trials” when being subjected to research and development, Health Minister Manto Tshabalala-Msimang said in Pietermaritzburg on Saturday.

She later explained that she was not against clinical trials per se. “But some of the medicines have been used by traditional healers for thousands of years. Clinical trials need protocols for traditional medicine.”

It is also expected to discuss the naming of traditional medicines and patent and ownership rights.

“This lack of documentation (in traditional medicine) sometimes creates serious legal challenges,” said Tshabalala-Msimang.

  blog it

What the Minister was talking about was the modernisation of traditional medicine, and the recognition that there are two different cultures meeting: premodern and modern.

Traditional medicine and modern medicine come from cultures with different cultural assumptions, different notions about disease and sickness and their causes. In Africa, traditional medicine originally existed in societies that could be described as paleopagan, or premodern. One of the characteristics of premodern societies is that they do not compartmentalise things in an analytic way, as modern society does. There are no rigid distinctions between “religion”, “politics” and “science”, for example. So traditional medicine is not necessarily “religious” or “pagan”, in the modernist “Western” sense. Nor is it necessarily divorced from “religion”.

But today the societies that developed “traditional” medicine are modernising, and the boundaries are blurred. There is no clear dividing line, and premodern and modern ideas get mixed up in people’s minds, and postmodernity, which is, at least in part, a reaction against modernity, finds premodern ideas more acceptable, but it is also different from premodernity. Premodern ideas are holistic, part of a holistic worldview, whereas postmoderns tend to be eclectic and fragmented, borrowing a little from here and a little from there, according to taste, so that there is not the integrated worldview that one finds in either premodernity or modernity.

One can see the reaction of modernity to the health minister’s remarks in blog comments like the following:

And then, the coup de grace of evidential reasoning, she quantifies why african medicine is so special that it does not need to be tested… because it has been used for thousands of years. Wow. Really? Under that logic, perhaps we should revert to slavery, forced marriage, human sacrifice and colonialism… all practices with thousands of years of tradition behind them. Perhaps we should go back to other traditional forms of healing: bloodletting, amputation, trepannin and electroshock therapy? Perhaps we should throw out the whole court system and bring back trial by combat? And perhaps we should bring back that wonderful old-time tradition of women not being allowed to hold public office?

Get a few things straight, Manto: traditional does not mean right. There is no such thing as ‘western’ clinical trials, there are only clinical trials, performed everywhere in the world. And there is no such thing as western medicine, chinese medicine or african medicine: there is only medicine, which is the stuff that has been tested objectively and found to work, and all the other stuff that people claim is medicine, which is the stuff that may well be helpful, harmful or placebo, but which we don’t know until we test it.

That’s modernity speaking unequivocally. It is also clear from that that while modernity places a high value on “evidential reasoning”, there is little “evidential reasoning” actually evident in the post – amputation, electroshock therap, trepanning are linked without any reasoning at all. The assumption is that what we do now is better than what anyone did in the past. If Manto assumes that tradition is right, that poster assumes, unequivocally and without evidence, that tradition is wrong. New=good, old=bad. That is not evidential reasoning; it’s a priori reasoning. That shows that modernity is as much a cultural attitude as premodernity. It is not so much “scientific” as scientistic. I took one blog post as an example, but you can find plenty of others.

But there are several things that should be noted: if something has been used for thousands of years, then it has been clinically tested. It it’s been used on patients for thousands of years, then it’s been more thoroughly clinically tested than something released by a pharmaceutical company a couple of months ago. Consider a drug like thalidomide, which caused defects in unborn children. It took a long period of clinical trial before that side-effect emerged. The longer a medicine has been used on patients, the longer the clinical testing period has been.

But there are other considerations about the interaction between modern and premodern thinking and culture.

The health minister alluded to one of them: pharmaceutical companies have taken traditional medicines and tried to patent them. Patenting is something that exists in modern, or dare one say it, “Western” law and culture. But in effect the pharmaceutical companies have stolen traditional knowledge. Something similar happened when an American company tried to trademark rooibos tea a few years ago.

But there is something else that the Health Minister does not seem to have acknowledged (or if she did, it wasn’t reported) — that modernity has affected traditional healers as well. Yes, you can go to a herbalist’s shop and find all kinds of bark and roots and other ingredients on sale. There are also concoctions given by some herbalists and diviners that are not traditional, and if analysed in a laboratory can be shown to contain household chemicals that can be bought in a supermarket, things like bleach and brake fluid. Nothing premodern about those!

Traditional medicine has adapted to modernity, but sometimes in strange ways. And there are no simple answers to this.

4 Comments leave one →
  1. 28 February 2008 11:10 am

    Steve – a sane and helpful analysis.

  2. Gift permalink
    28 February 2008 12:11 pm

    Actually the blog you cite does not say traditional medicine is wrong. You misrepresent the author’s position, they actually said we shouldn’t assume something works because it’s been around a while. Nothing was dismissed out of hand, except trying to dodge legitimate testing. Even the excerpt you quote makes this position clear:

    “Get a few things straight, Manto: traditional does not mean right.”

    and

    “…we don’t know until we test it.”

    So the author is actually arguing for objective testing. There’s nothing wrong with that, after all why should there be a double standard when licensing medicines? Indeed, proper scientific investigation of traditional medicine can actually improve upon it by isolating active ingredients and quantifying an effective dose (artimesin for example).

    Oh and generations of use does not equate to a clinical trial, unless of course you can point to the placebo groups or double blinds used?

  3. Paul Putter permalink
    28 February 2008 12:35 pm

    Khanya
    You wrote: “if something has been used for thousands of years, then it has been clinically tested”.
    Something is only clinically tested when it is tested in an objective manner in controlled circumstances. The fact that something has been used for however long, does NOT imply that it works. Medical science is not concerned with the origin of medicines, only with their effectiveness and side-effects which can easily be determined experimentally.
    Secondly, there is no such thing as “Western science”. THE scientific method has been developed by thousands of scientists from all over the world.
    The waffle you write is not to be confused with science or even scientific philosophy – it’s just waffle.

    Cheers
    Paul

  4. 1 March 2008 6:46 pm

    Something you wrote sparked a thought later on

    “postmoderns tend to be eclectic and fragmented, borrowing a little from here and a little from there, according to taste, so that there is not the integrated worldview that one finds in either premodernity or modernity.”

    Is this really the case? On ground level? Or just in a theoretical sense?

    I agree that on a philosophical level their is not (yet?) an integrated version of postmodernity, but I wonder if the average person from any worldview do have an integrated worldview?

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