Introduction
Medicine in Iran has long adhered to a traditional model, deeply influenced by Greek teachings over centuries. Despite the introduction of modern medicine, pharmaceuticals, and advanced treatment methods, many aspects of Iran’s healthcare system continue to reflect these enduring traditional patterns. The doctor-patient relationships are also influenced by this blend of tradition and modernity. To better understand the formation of Iran’s medical model during the 1990s, Agnes G. Loeffler conducted an in-depth study employing oral history methods, interviews with influential researchers, and her field observations. Her work sheds light on the key factors that have shaped Iran’s medical system. However, despite its significance, Loeffler’s book has not yet been translated into Persian, nor has it been the subject of substantial scholarly analysis in Persian or English. By introducing and examining the content of Loeffler’s work, this article aims to encourage further research—including translation and critical engagement—so that her findings can serve as a valuable reference for contemporary Iranian medical modeling and its broader societal implications (Figure 1)..
Figure 1. The book “Health and Medical Practice in Iran (Traditional Culture and Modern Medicine)” by Agnes G. Loeffler
About the author and the book
Agnes G. Loeffler is an Associate Professor at the University of Wisconsin School of Medicine and Public Health’s Department of Pathology and Laboratory Medicine. Holding both an MD and a PhD in Cultural Anthropology from the University of Illinois at Urbana-Champaign, Loeffler bridges the medical and anthropological disciplines in her scholarly work. Her academic contributions span both cultural anthropology and allopathic medicine, exemplified by her co-editorship of the authoritative volume “Introduction to Human Disease: Pathophysiology for Health Professionals” (Loeffler, 2017, p. 2). Agnes Loeffler’s insightful and original book investigates how allopathic knowledge, theories, and practice guidelines come to be understood and applied by practitioners in a non-Western context. Drawing upon research conducted among Iranian physicians, Loeffler illustrates how allopathic medicine has evolved to incorporate regional explanations of health and disease and the economic, social, and religio-political factors that shape contemporary Iranian life and culture. This approach simultaneously problematizes the view of allopathic medicine as a ‘Western’ entity exerting a hegemonic influence over non-Western cultures. It provides a rare and nuanced glimpse into the intricacies of modern Iranian society by examining the intersections of culture, health, and the lived experience of illness (Loeffler, 2017, p. 226).
Table of Contents
The present book consists of two parts and ten chapters.
Part One: Iranian Conceptualizations of Health and Disease
In the first part, the author has addressed the following topics:
- Iranian Explanations for Ill Health; p. 45.
- Key Concepts: Nature, Purity and Balance in Relation to Health; p. 71.
- How Allopathic Knowledge and Practice are Interpreted in Distinctly Iranian Terms; p. 87.
Part Two: The Contexts of Medical Practice
In this section, the author has also analyzed and discussed the following topics:
- The Economic Context of Allopathic Practice; p. 103.
- Roots of Authority: Knowledge; p. 122.
- The Relationship of `Elm to Medical Practice; p. 142.
- Medical Knowledge and Islamic Ideals; p. 159.
Based on what has been mentioned and considering the importance of the content of this research, each chapter of this book has been separately examined in the following sections.
Chapter 1: Introduction
Chapter One examines the foundational framework for the study. The researcher, acting as a cultural proxy, delves into the study of how allopathic medicine was practiced in the Islamic Republic of Iran during the 1990s. She seeks to explore how culturally-embedded worldviews mediate physician-patient interactions. In this process, she focuses on understanding physicians’ perceptions of their profession through fieldwork, aiming to demonstrate how allopathic physicians attempt to reconcile local and Western medical systems while justifying their treatments with local cultural concepts and values. The chapter progresses systematically: first articulating the study’s theoretical underpinnings, then presenting its research objectives and working hypotheses. Finally, it provides a preliminary synthesis of key findings, serving as an orienting roadmap for subsequent chapters.
Chapter 2: The Contexts of Fieldwork
Chapter Two of this book recounts the empirical experiences of a foreign researcher in Iran, describing some of the challenges and obstacles encountered. The researcher discusses his expectations for conducting his intended research in Iran and declares that he has faced numerous difficulties. A significant portion of the chapter examines the complex bureaucratic hurdles in securing official research permissions, offering critical insights into the practical constraints facing ethnographic work in Iran.
Chapter 3: Iranian Explanations for Ill Health
In Chapter Three, the author examines Iranian perspectives on illness. He states that Iranians use various terms such as “maraz”, “mariz”, “bimar”, and “nakhoosh” to express sickness and the sick. They attribute reasons for feeling unwell or becoming ill to five main categories: natural forces, impurity, stress, supernatural forces, and Western medicine. In this chapter, the author examines the enduring influence of Greco-Galenic medical traditions on contemporary Iranian conceptions of health and illness. While the formal Galenic system has diminished in practice, core humoral concepts—particularly the classification of foods as “warm” (garm) or “cold” (sard)—remain culturally salient in dietary practices aimed at maintaining bodily equilibrium. Additionally, impurity is considered a strong factor in causing illness, and emphasis is placed on meticulous cleanliness for health maintenance. Iranians believe that microscopic entities such as “germs” threaten health, and strict cleanliness is essential. Overall, Chapter Three explores how Iranians conceptualize and respond to illness, highlighting the importance of diet and cleanliness in maintaining well-being.
Chapter 4: Key Concepts: Nature, Purity, and Balance in Relation to Health
Chapter Four of the book delves into the key concepts of nature, purity, and balance in relation to health among Iranians. It discusses how Iranians perceive nature as a remedy for illnesses and find tranquility and rejuvenation in natural environments. Additionally, the text explores how Iranians trust the inherent goodness and purity of natural elements such as herbal remedies and prefer natural remedies over chemical drugs. It is also noted that individuals’ physical and mental health depends on their balance and humility. This section elucidates that in the Iranian perspective, the concept of moderation generally influences decisions related to health and illnesses and is also used to justify medical treatments.
Chapter 5: How Allopathic Knowledge and Practice are Interpreted in Distinctly Iranian Terms
In Chapter Five, the author examines the interpretation of knowledge and practice of allopathic medicine in Iranian languages and concepts. He aims to demonstrate the commonality of Iranian people’s views and concepts with those of allopathic physicians to show that these two main perspectives do not necessarily conflict. Allopathic and traditional medicine are considered separate and distinct in Iran. Allopathic medicine is associated with advanced technologies, university education, and practical applications, while traditional medicine is perceived as a collection of informal personal knowledge and practices. However, people generally acknowledge that traditional medicine is not effective for many allopathic illnesses and cannot even diagnose them. Moreover, allopathic medicine also resorts to logic and traditional therapies in different settings. Traditional and allopathic interpretations of health and illness are never entirely contradictory; instead, they complement each other (>Islami, 2009, pp. 24-25). The claim that allopathic knowledge is the best justification for the effectiveness of traditional drugs is widely accepted among Iranians. Therefore, the interpretation of allopathic knowledge with the help of traditional concepts confirms the effectiveness of traditional medicines and methods. Iranians, even in allopathic environments, are inclined to understand and use traditional methods. Some physicians even provide scientific justifications for these methods and believe they will find more scientific validation in the future. (Ansaripour, et al., 2017, p. 30)
Chapter 6: The Economic Context of Allopathic Practice
Chapter Six examines cosmetic surgery’s economic background and role from the perspectives of patients and physicians. Above all, Iranians believe that access to medical resources in Iran depends on economic factors. As stated, various expenses such as plastic surgery, elective cesarean section, and the use of beauty products, all known for their cosmetic effects, are not feasible for everyone. Only the affluent could afford such expenses.
Chapter 7: Roots of Authority: Knowledge
Chapter Seven focuses on how patients evaluate the competence of physicians in Iran. The patient’s perception, the physician’s personal characteristics, and what the physician says or does not say significantly impact the patient’s assessment of a physician’s credibility. Additionally, patients consider criteria such as educational background, family history, international work experience, and physician’s gender when assessing their competence. This chapter delves into the ways in which these elements contribute to shaping a patient’s perception of a physician’s credibility and trustworthiness.
Chapter 8: The Relationship of ‘Elm to Medical Practice
Chapter Eight discusses an important feature of medical practice in Iran: the use of English for professional communication. The use of English for professional communications in the Shiraz University Medical School is common, and individuals, including professors, students, and paramedics, proudly employ English in their interactions. The reasons presented to justify this practice include preserving the monopoly on medical science, preventing patient anxiety, and adhering to the medical school tradition. However, some of these reasons may not seem acceptable, and others may lead to problems. For example, even if the names of prescribed medications are not disclosed to patients, which alleviates their anxiety, these names are still written prominently on packaging materials in both Persian and English. Additionally, media coverage of diseases and treatments through television and radio interviews is widespread, implying that patients may possess a basic understanding of common conditions and medications. However, since Iranian physicians spend the least possible time with their patients and often have quick and brief meetings with them, these conditions limit the time spent with patients, and details of diagnosis and treatment may not be communicated to them.
Chapter 9: Medical Knowledge and Islamic Ideals
The ninth chapter elucidates the distinction between “conventional ethics,” which shapes everyday behaviors, and “state ethics” (or ideology-based ethics), which serve as the foundation for public political actions in Iran. Conventional ethics, deeply rooted in Islamic teachings in Iran, encompass acts of charity toward the less fortunate and the prevention of harm to others. Given that Iranian physicians and students strongly identify as Muslim, they adhere closely to these Islamic ethical principles. Conventional ethics include fundamental principles that are not formally taught under the label of conscience. Principles derived from Islamic law are not always compatible with conventional ethics.
Conclusion
The author contributes to this book by exploring how various factors have influenced medical performance in Iran, shaping distinct behaviors within the healthcare environment. Framing the discussion within the conceptual framework of cognitive anthropology, the author argues that the environment plays a pivotal role in determining behavior—and that such environmentally shaped behaviors are both rational and purposeful. Since purpose is inherently linked to specific goals, contextual understanding is essential for accurately interpreting actions. In Iran, key concepts such as “discomfort,” “cleanliness,” and “impurity” require further cultural interpretation, as these notions influence physician-patient interactions in a purposeful manner. Finally, through her research on Iranian physicians, Agnes Loeffler demonstrates how Western medicine has adapted to local conditions in Iran, highlighting the interplay between global and indigenous perspectives in shaping contemporary healthcare practices.
Authors’ Contribution
Both authors of the article reviewed and provided their approval for the final version of the manuscript. All authors read and approved the final version of the work.
Funding
None.
Conflict of Interest
None.
References
- Ansaripour, M., Naseri, M., Esfehani, M.M., Nabipour, I., and Rakhshani, F., 2017. Modernity and tradition in medicine. Tārīkh-i Pizishkī, 9(30), pp. 139-167.DOI [in Persian]
- Islami, Sh., 2009. Homeopathy: Alternative Medicine. Gozaresh J, 19(214), pp. 24-25. [in Persian].
- Loeffler, A.G., 2017. Health and Medical Practice in Iran: Traditional Culture and Modern Medicine. London and New York: I. B. Tauris and Co. Ltd.
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