The purpose of this article is to discuss the attitude of Jewish law (halachah) towards the category of medicine sometimes referred to as complementary and alternative medicine (CAM). We will first give a brief background as to what we mean by those terms, and then discuss how and when this topic intersects with halachah.

What Is Complementary and Alternative Medicine?

There are many healthcare approaches that are not typically part of conventional medical care as it is practiced in Western society. According to a recent survey, over 30% of adults have used one of these approaches within the past twelve months.1 In 1992, the National Institute of Health (NIH) established a center devoted to studying these therapies, now known as the National Center for Complementary and Integrative Health (NCCIH). The NCCIH defines “complementary medicine” as those therapies used together with conventional medicine, and “alternative medicine” as those used instead of conventional medicine.2

There are many different types of these “unconventional” therapies; for example, iridology, acupuncture, homeopathy, hydrotherapy, naturopathy, phytotherapy and reflexology. Some of these therapies have been evaluated by multiple studies, although often there simply isn’t enough data to demonstrate efficacy (which of course is not the same thing as demonstrating inefficacy).3 The role of data and statistics in evaluating these therapies will be discussed at a later point in this article.

The Relevance of Halachah

There is a basic concept in Jewish thought that one is obligated to seek healing.4 Therefore, we must establish whether, according to Jewish law, one is allowed to seek one of these unconventional therapies in place of the more conventional therapies. In other words, do these therapies satisfy the requirement to seek healing? Are they legitimate therapies? And how does halachah determine what is considered a legitimate therapy and what isn’t?

Determining what constitutes a legitimate therapy plays a central role and has bearing on our discussion of complementary and alternative medicine. Because even if one were to use these therapies as a complement to conventional therapy, there are still some potential issues in two areas of halachah.

The first of these involves the basic rule that things that are prohibited in halachah can be overridden for a sick person, depending on the circumstances.5 The sicker the patient, the greater the ability to override certain prohibitions. If a patient is at death’s door, one may override nearly every restriction in halachah in order to save him or her.6 This often comes into play with the laws of Shabbat and kosher. If obtaining a specific medicine is needed to save a patient’s life, then one may override the laws of Shabbat and kosher if need be to obtain this medicine. Clearly, this override will only apply if we have a reasonable expectation that this medicine might work. Therefore, halachah finds it necessary to attempt to define what constitutes a legitimate therapy for this purpose.

The second area of halachah is lesser known, and is based on the verse “And in their statues you shall not walk.”7 G‑d is telling Moses to convey to the Jewish people that upon entering the Land of Israel they should not emulate the practices of their pagan Emorite neighbors. In classic halachic literature, this verse (in conjunction with other similar verses) is seen as a commandment not to emulate the nations around us, not only in dress and behavior, but also with respect to adopting their superstitious practices.8 Based on this, any activities that smack of quackery or superstition are forbidden under this commandment to not walk in the “ways of the Emorite” (darchei Emori, as this restriction is colloquially known). This prohibition does not apply if the behavior in question has some medical benefit,9 as will be discussed further in this article. It is therefore important for halachah to define what constitutes medical benefit.

To summarize then, it is important to know what constitutes a legitimate therapy for purposes of overriding certain halachic prohibitions such as Shabbat and kosher, for lifting the darchei Emori ban, and more broadly to satisfy one’s obligation to seek healing. We will begin by analyzing some of the more classic halachic texts, which will give us a broad framework in which to operate.

Classic Halachic Framework

There is a mishnah10 which discusses the law prohibiting one from carrying items outside on Shabbat. The mishnah cites an opinion permitting carrying certain items for medicinal purposes, such as the egg of a locust or the tooth of a fox;11 the Talmud comments that because they are medicinal, they are not banned under the darchei Emori ban.12 Maimonides13 references this mishnah in his work Guide for the Perplexed14 when discussing the general scope of darchei Emori. He states that generally, the ban is only lifted for therapies which have some rationale, some plausible mechanism of action. However, these items listed in the mishnah are not banned, despite having no plausible mechanism, because they nevertheless demonstrated a degree of efficacy.

This explanation of Maimonide contrasts with his comments on another mishnah,15 which states that one who is bitten by a rabid dog may not be fed from that dog’s liver, because a dog is not kosher, despite the fact that in those days that was an accepted treatment. Maimonides explains that the dog’s liver is forbidden because one can only override halachah with a therapy based “on reason or experience approaching truth,” as opposed to therapies that help in a superstitious manner, without clear mechanism, and with only scant efficacy.16

In reconciling these two passages in Maimonides, the explanation is advanced that there are three distinct categories of therapy:17

● A therapy that lacks efficacy and plausible mechanism remains forbidden under darchei Emori.

● A therapy that is based on “reason or experience approaching truth” is not only exempt from darchei Emori, but can even override certain halachic prohibitions such as kosher.

● A therapy that falls somewhere in the middle, lacking overwhelming empirical support but nonetheless showing some efficacy or having a plausible mechanism and therefore a reasonable expectation of efficacy, may not override halachah but is not included in the darchei Emori ban.

○ Along a similar vein, the first Rebbe of Chabad, Rabbi Shneur Zalman of Liadi (known as the “Alter Rebbe”), cites two opinions in his Code of Jewish Law as to when medicinal practices are not forbidden under darchei Emori.18 The first opinion is that as long as it is obvious that the intent is for healing, then as long as there is a reasonable expectation that it might work, it is not forbidden under the darchei Emori ban. The second opinion is that unless the therapy is known to be tried and true, it remains forbidden under the darchei Emori ban. The Alter Rebbe rules that the first opinion is the main halachah, although one should try to follow the more cautious second opinion (unless there is a strong need).

Halachic Concept of Efficacy

Although the above discussion referenced “efficacy” in qualitative terms, we have not yet provided a more quantitative definition in classic halachic literature. There are other contexts in halachah where the attempt is made to quantify efficacy. The Talmud states that a medicinal amulet (or healer) must heal three times before being considered effective.19 However, if the amulet or healer subsequently fails to heal three times, they are no longer considered effective.20 There is some discussion in the halachic literature as to the exact scope and limits of this “three times” rule for establishing efficacy.21

Translating these standards into our current statistical framework for the purposes of our discussion is difficult. Simply put, our more thorough statistical methods were not used then and therefore extrapolating a rigidly quantified efficacy is difficult. Applying the concept on a more qualitative level to our current discussion, it would be fair to say that in broad strokes, halachic assessment of efficacy would depend on supportive data to that effect. Many of the more conventional therapies have robust data supporting them and plausible mechanisms of action, whereas many of the unconventional therapies do not overall enjoy the same statistical support or scientific mechanisms of action.22 It seems reasonable to posit that the higher standard of legitimacy ascribed to Maimonides above, requiring a high degree of empirical evidence, is generally more present in conventional therapies than many of the unconventional therapies. His lower standard of legitimacy, where one does nonetheless demonstrate a degree of efficacy, may indeed be met by many of the unconventional therapies.

While this may suffice to lift the darchei Emori ban, it is hard to justify their overriding Shabbat and kosher if they do indeed lack strong empirical evidence. Similarly, in terms of satisfying the basic requirement of every person to seek healing, it would seem that halachah would require one to seek the most efficacious treatment known, as characterized by the higher standard of Maimonides above.23

Contemporary Halachic Positions

On a more contemporary level, there are several recent poskim (halachic experts and adjudicators) who discuss aspects of this issue. Rabbi Shmuel Wosner, one of the great halachic poskim of post-war Jewry, was asked about homeopathy. In his responsum he reasserts several points of our above discussion, including that there are two standards of efficacy and only the higher one may override elements of halachah.24 However, he maintains that ultimately the only deciding factor is the degree of empirical evidence supporting any given therapy,25 and that if a therapy such as homeopathy was able to demonstrate true empirical evidence of efficacy, then there would be no reason not to classify it as “conventional” as any other conventional therapy.

With respect to whether one may seek out unconventional therapies in the quest for healing, there are several other halachic experts who state that unconventional therapies may only be used if they complement conventional therapy, not as an alternative to conventional therapy, and even then, only if there are no negative side effects.26

There are several letters from the Lubavitcher Rebbe on this matter.27 The Rebbe seems to take the approach that one may be allowed to utilize unconventional therapies if one can demonstrate the exact nature and extent of the success of that therapy. In one letter,28 when asked about a healer who “healed without medicines,” the Rebbe writes, “It’s not understood why one would seek paths not well understood, considering that the Torah gave permission for the doctor to heal . . .”

In another case, the opinions of the conventional doctors and naturopathic healers were in direct opposition regarding the care of a critically ill patient. The Rebbe instructed the family to ask a halachic expert, and agreed that they should consult with Rabbi Shlomo Zalman Auerbach.29 Rabbi Auerbach ruled that they should follow the opinion of the regular doctors, since more people work in that field, and they are therefore able to invest much more in research and development.30

Conclusion

To summarize, the main contemporary halachic determinant in the discussion between conventional and unconventional therapies seems to rest primarily upon the degree of efficacy demonstrated by any given therapy, which contemporary halachah discusses in qualitative and relative terms.

Only therapies with strong empirical backing may override halachah in certain circumstances; in addition, when seeking healing, one must seek the therapies with more empirical data over those with less data (although, generally speaking, the latter are nonetheless exempt from the darchei Emori ban).

May we each be blessed with true health, health that precedes and preempts the sickness,31 and may we witness the ultimate healing of our nation with the coming of Moshiach, speedily in our days.