Discussion and Conclusion
This study focused upon a
specific practice, Qigong, within the larger and growing phenomena
of alternative and complementary health care in the United States.
Qigong and the "field" of alternative and complementary medicine are
increasingly becoming powerful influences on the belief systems of
the contemporary health care consumer and to a lesser extent Western
scientific health care providers. The research of Qigong has
expanded from China to the U.S. and now includes the NIH's Office
of Complementary and Alternative Medicine and a growing number of
various national and international organizations and individuals all
across the world.
Alternative and complementary
health care has much to offer in examining the past development of
the United States' health care system, the current restructuring of
the health care system, and the future direction of the system.
The focus is moving from treatment to preventive health care and health
education. This changing focus is created by the changing structure
of the healthcare system from the traditional fee for service to several
other reimbursement options, including the capitated health maintenance
organizations (HMO's) and preferred provider organizations (PPO's).
This change is resulting in changes in health behavior; and health
care consumer's behavior, as a driving economic force, can offer much
insight into the successes and failures of such restructuring.
Modern American scientific
medicine began in response to the Flexner Report written in the early
20th century (1910 Flexner). From this report the standardized
curriculum taught in medical schools was established and remains today
largely unchanged. This educational model, a dualistic, organ
system approach has left much to be desired as "[t]he current process
is lengthy, costly, and has produced an overabundance of specialists
and too few primary care physicians" (1995 Kovner 63). Modification
of this situation is a difficult problem as all states require licensed
physicians to be graduates of approved schools. The accredation
process is regulated by the Liaison Committee on Medical Education,
which is jointly controlled by the American Medical Association (AMA)
and the Association of American Medical Colleges (AAMC) (87).
Thus, as physicians are the leaders of the health care field and responsible
for the educational development of the schools, change is slow to
Health care provider behavior
can be instrumental in insuring a high quality of health care.
The way and form in which care is provided can have extreme implications
for the difference between life and death. The care provider
should have a working knowledge of the culture of those they are caring
for in order to properly communicate vital information. As well,
education about culturally different forms of health care and care
providers should become a part of the framework of overall care.
Alternative forms of health care, such as chiropractic and the traditional
health systems of India and China, have demonstrated remarkable health
benefits that should not be ignored because they originated outside
of the traditional Western bioscientific approach.
Many physicians believe the only medicine worth writing
the highly scientific medicine sometimes practiced
hospitals, but such medicine is in fact the exception
rather than the rule. Most of our
encounters with the doctor are about everyday
problems such as fatigue, panic attacks, high blood
infections, and birth control that don't always have
"scientific solutions." (1988 Payer 19)
Many practices called "alternative" are mainstream treatments
in other Western medical traditions such as in Germany and France.
As well, many "mainstream" practices in America are not "...the result
of scientific progress but rather outgrowths of American cultural
biases that in some cases harmed more than helped our health and well-being"
(1988 Payer 16). The behavioral practices of healthcare providers
have a direct and often measurable effect on health, as can be seen
in the many malpractice suits brought in our society.
At present one of the prime
movers of the healthcare system is the drive to control cost.
Among the many reasons are "[t]he combined effects of prospective
payment (PPS), managed care and capitation (HMOs) and limits to Medicare
reimbursements (DRGs) began to squeeze income and cut into paid patient
days" (1997 Press 2). The result being that our health care
system is attempting to do more with less. The solution that
appears to be developing is that health and prevention rather than
treatment is being emphasized. "As more hospitals and physicians
participate in capitated health plans, it will be in their best financial
interests to keep patients healthier and away from formal providers
and institutionalized care" (1997 Press 3). This trend has resulted
in many insurance companies and other health management organizations
to increasingly provide coverage for such "alternative" treatments
as chiropractic and acupuncture. On the downside of this movement
are examples of "...nitpicking 'utilization reviews' of doctors' bills
by insurance-company bureaucrats; patients hustled out of a hospital
within hours, even after surgery as traumatic as breast removal; gag
orders forbidding doctors to tell a patient about an expensive treatment"
and being billed for an expensive emergency room visit for a perceived
emergency that turns out to be a false alarm and the HMO will not
cover it (1997 Church 32). On the upside many detection and
preventive health practices are now being covered that were previously
For the future, patient behavior
is one of the most likely sources to have an extreme impact on individual
health and the health care system. Certain behavioral and cultural
practices can be harmful to the human organism. Culturally defined
definitions of disease and pain can have great impact on both prevention
and treatment of disorders. Behavioral practices and non-practices
are important for health outcomes. Eating and exercise habits
are prime movers in the maintenance or non-maintenance of health.
Most of the major health problems in our society today are a direct
result of patient behavior or lifestyle choices. Examining consumer
behavior and culture can be a useful tool to find ways to modify human
behavior to a healthier and better quality of life.
Another factor which will greatly
impact the future of health care is technology. Technology brings
both great benefits and numerous problems as it constantly and ever
more quickly improves. Two of the greatest problems brought
on by technology are its cost and the ethicacy of its use. For
example: "early studies assumed that more services were synonymous
with better quality care; however, recognition has grown that many
technologies are used extensively in situations where they may not
be appropriate" (1995 Kovner 403-404).
We have a duty to the future
to study other cultures as well as our own. From this examination,
we have and will discover many valuable practices and lifestyles,
including the uses of various flora and fauna. Some of the less
technologically advanced peoples of the world have provided us with
some very valuable health information in the past. Many of our
most important medicines have come from the pharmacopeia of primitive
peoples and the search continues among them today as evidenced by
The University of Mississippi's Natural Products Center.
Applied social sciences, such as medical anthropology, can do much
to examine the current health care systems of the world and lead us
on to a healthier future.
Qigong with its emphasis as
a prevention and health maintenance method first and a treatment method
second has the potential to be an extremely effective and simple approach
to improve health and quality of life. TCM is based on thousands
of years of observation while modern scientific medicine is less than
one-hundred years old. Qigong is the final component of this
ancient health care system to receive attention and research in the
West. The other components of TCM, its plant and animal pharmacopeia
and acupuncture have been and continue to be researched and have provided
us with many treatments and drugs that have shown effectiveness.
This should demonstrate that TCM, as a practical approach to observed
phenomena, has validity; and qigong, as a part of that approach, deserves
our research attention. We can ill afford our past ethnocentric
perspective about the perfection of Western medicine, which has largely
come to mean scientific medicine as practiced in the United States,
and must utilize the scientific method in an unbiased way while keeping
an open mind with respect for the vast experience and possibilities
offered by much older systems of health care.
Much of the research in this
study has indicated mechanisms at work which are not understood or
completely validated at this time by science. However, many
of the mechanisms are probably as old as humanity itself and could
be termed a human universal. From the first shaman until today
the mind and body have worked largely the same; and ways to influence
the healing of it, as well, remain the same.
The conclusions from this study
leaves more questions than answers. Much of the ethnographic
experience in this study is difficult to explain in scientific terms
other than placebo effect or power of suggestion, which are powerful
healing methods with documented effectiveness, yet they do not seem
to convey or explain exactly all of what I observed. The survey
demonstrated significant positive results in the areas of Perceived
Health and Pain which are both very important for quality of life.
As well, the Pain score is interesting when considered in the context
of a possible relation to the external qi healer's reported ability
to reduce pain.
The overall conclusion that
I am able to draw from this study is that qigong has great potential
as a health care modality that could easily and economically be implemented.
Qigong has many applications "some of the most promising for Western
healthcare are for chronic problems such as hypertension, cardiovascular
disease, aging, asthma, allergies, neuromuscular problems, and cancer.
These areas of public health deserve consideration by Western medical
establishments." (1996 Sancier 45) As well, there is some basis for
the possibility that the TCM view of qi (or bioenergy) could be a
part of the mechanism at work in qigong. As would be expected,
from the few thousand year head start, the TCM view generally explains
the functioning and outcomes of its applications, such as acupuncture,
with far greater accuracy than scientific western medicine is yet
able to accomplish. From the interest generated by the study
survey and from the ethnographic subjects there appears to be an increasing
public perception and belief that qigong "works" as an acceptable,
accessible, and increasingly available health care system.
This study was intended to
be an initial examination of the health outcomes of qigong practice
and to assist in directing future and more refined studies.
The utilization of the World Wide Web as a source for research subjects
has its benefits and drawbacks from a sampling perspective.
The WWW was an invaluable tool for locating practitioners of such
a relatively recent health care import into the United States.
As well, survey data collected via this medium are already inputed
and ready to be utilized by computer analysis programs and virtually
eliminates the phenomena of missing data. The small sample size
of the survey, the sample method utilized, and the great similarity
between the groups could be reasons for there not being many differences
between the experiment and control groups. The Duke Health Profile
might not adequately measure the health outcomes of qigong practice.
Qigong practice for personal health can be done in around thirty minutes
a day, however, at advanced stages (for those wishing to be healers
etc.) it is a very time consuming and lengthy, to the point of years,
practice that might be better served by a measure longer than the
single week used by the Duke. Research into the effectiveness
of qigong healers could be completed in a relatively short time.
Both short term and long term studies of qigong practitioners should
be undertaken to examine the various health benefits attributed to
Specialized qigong surveys
for each of the different "groups" of qigong practitioners and methodologies
might demonstrate interesting differences among them. With the
growing popularity of this practice in the U.S. we should in time
have a larger sample size of practitioners to work with. Measures
of qigong practitioners in their first and subsequent years of practice
until they reach the "mastery" level could as well provide some interesting
results. A prospective study could be conducted to measure patients
or new practitioners and then after exposure to the healing techniques
of qigong another measure could be conducted to assess the actual
health outcomes. Qigong practice has great potential as a community
based health approach which could be implemented at very low cost.
Individual ethnographic research with those who are considered qigong
masters should as well be conducted to examine the often extraordinary
claims surrounding them.