Debate on the paper by Nelson Filice de Barros & Everardo Duarte Nunes


Debate sobre o artigo de Nelson Filice de Barros & Everardo Duarte Nunes



Maria Cecília de Souza Minayo

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.



The incompleteness of models, imprecision of concepts, and scientificity 

This instigating and important paper by Nelson Barros & Everardo Nunes on the different meanings of Complementary and Alternative Medicine highlights various themes in the field of knowledge and interests shaping contemporary society. One relates to the position of uncontestable power wielded by official medicine or so-called "biomedicine", with its emissaries treating other forms of therapeutic knowledge and practice as alternative or complementary and generally inter-communicating by disqualifying or assigning them an inferior scientific rank. The second theme is that of alternative theories and practices which consolidate and display their potentialities by dealing with biomedicine through denial. The authors discuss this polarity and the possibilities that complementariness denotes not only accessories to the official system, but advances that have been emphasized by epistemological analyses, sociology, and anthropology.

In the field of sociology of knowledge, this discussion relates to various points: (a) the power constructed by the establishment (in this case, biomedicine) through institutions, actors, devices, and beliefs that tend to self-reproduce and crystallize; (b) the incompleteness of fields of knowledge and disciplines, since every scientific construction originating in modernity tends to cut and slice its niches in pursuit of a more in-depth and super-specialized focus on its objects; (c) the various failures of official medicine, since this reductionist and fragmented (albeit super-specialized) model is incapable of fully dealing with all the manifestations of the majority of contemporary diseases, with AIDS as the most paradigmatic case; and finally (d) the difficulties of other rationalities in establishing themselves other than by denial of the hegemonic project.

The aim of Barros & Nunes may have been merely to discuss the difficulties in conceptualizing what "medicine" is at this point in history, when the plurality of options (in a society marked by various senses of pluralism) is an issue not only for medical institutions but above all for users and consumers. Actually, I am incapable of discussing in depth all the aspects of rationality involved in the various alternatives presented by the authors, since this is not the object of my own research. I merely recall, as Lévy-Strauss, that every model of cure has its own rationality. In The Savage Mind 1, Lévy-Strauss contends that there is a similarity between mythical thought and scientific thought and thus that the human mind has only one common form of operation. He therefore highlights that the knowledge resulting from different forms of thought is rigorous and precise, since it all results from the relations established by human beings among themselves and with nature and from the elaboration of classificatory mechanisms and action technologies, oriented by characteristics and properties observed in the phenomena. Lévy-Strauss also shows that all medical rationalities, from the oldest to the most contemporary, are ruled by the same scheme of legitimization, or what he refers to as "symbolic efficacy", involving the belief devoted to it by the community. He says the following about systems of cure: "...we see that the efficacy of magic implies a belief in magic. The latter has three complementary aspects: first, the sorcerer's belief in the effectiveness of his techniques; second, the patient's or victim's belief in the sorcerer's power; and, finally, the faith and expectations of the group, which constantly act as a sort of gravitational field within which the relationship between sorcerer and bewitched is located and defined" 2 (p. 168).

I conclude by further complicating the Barros & Nunes' theme, adding a new "rationality" (can one really call it that?) that has been constructed since the late 1970s, based on the environmental movement, with its origins in North America, especially Canada 3,4,5,6. The strategy is called the "ecosystem approach to health" and seeks to link the social, environmental, and biomedical issues in the definition of health-disease processes. With an integrative and inter- and trans-disciplinary proposal, this model or strategy based on the complex approaches of system theories has gained ground worldwide, producing at least two thematic journals, an international congress, and countless publications 7,8,9,10 on real experiences that combine and integrate clinical approaches, epidemiology, collective health, toxicology, sanitary engineering, environmental sciences, and other disciplines when necessary. In such cases the focus is not the discipline but the theme or problem in actual reality.

The article by Barros & Nunes allows several derivations, but as the anthropologists say, it is mainly "food for thought", since it allows transcending and unveiling the weaknesses and shortcomings of our systems of thought and action.



1. Lévy-Strauss C. O pensamento selvagem. Campinas: Papirus; 1989.

2. Lévy-Strauss C. Structural anthropology. New York: Basic Books; 1963.

3. Kay J, Régier HA, Francis G. An ecosystem approach for sustainability: addressing the challenge of complexity. Futures 1999; 1:721-42.

4. Association Canadienne de Santé Publique. Santé humaine et de l'écosystème: perspectives canadiennes, action canadienne. Ottawa: Association Canadienne de Santé Publique; 1992.

5. Lebel J. Health: an ecosystem approach. Ottawa: International Development Research Center; 2003.

6. Forget G, Lebel J. An ecosystem approach to human health. Int J Occup Environ Health 2001; 7 (2 Suppl):S3-38.

7. Guimarães JR. Origins and effects of mercury on riparian populations of the Brazilian Amazon. Int J Occup Environ Health 2001; 7:23-5.

8. Houénou PV, Houénou-Agbo YMT. Ecosystem and human health in Africa: experience and perspectives from a research project in the Buyo Region of Southwestern Ivory Coast. Int J Occup Environ Health 2001; 7:26-9.

9. Likens GE. The ecosystem approach: its use and abuse. Hamburg: Ecology Institute; 1992.

10. Mergler D. Combining quantitative and qualitative approaches in occupational health for a better understanding of the impact of work-related disorders. Scand J Work Environ Health 1999; 25 Suppl 4:54-60.

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rio de Janeiro - RJ - Brazil