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It is now the beginning of the 21st century. Scientific medicine has made huge progress in decoding the workings of the body and found cures or effective preventions for many of the diseases that have plagued humans throughout history. In some ways medicine has come full circle. Like ancient healers, today’s physicians make recommendations about diet, exercise, and lifestyle as part of medical care.

Why do alternative forms of medicine survive? Why does our Ladakhi patient (remember her?) seek out first the shaman and/or traditional practitioner before going to see a doctor at the hospital? Why do so many Americans and Europeans seek remedies from traditional Chinese and Indian medicine?

First of all, today’s hi-tech medicine is incredibly expensive. It is so costly that the issue of how to pay for it dominates public policy discussions in the Western world. This is true both in countries in which the government pays for health care and in others, notably the United States, where the system is privately based and access is very uneven. In other parts of the world, patients usually pay more to see a doctor than one of the other practitioners.

And that doctor, particularly in more remote areas, does not have access to much of the expensive technology or drugs that have transformed health care in the West. Those amazing artificial legs are not a realistic option for people in poor countries or poor people in wealthy countries. Other solutions must be sought. One is a device called the Jaipur foot—a simple but effective, mostly rubber foot invented by two doctors in India. Likewise, a major effort is underway to get AIDS drugs cheaply to the millions of HIV-infected people in Africa.

Second, modern medicine is extraordinarily specialized. There are far more medical specialties than have been mentioned here. Other specialties include endocrinology (which deals with the glands and hormones), urology (the kidneys and urinary system), or gastroenterology (the digestive system), to name a few. A patient is often bounced from one to another specialist, with no one doctor overseeing the process. Earlier doctors may not have had the knowledge or the tools to cure you of your disease, but they sat by your bedside and provided a comfort that is mostly lacking in the practice of today’s highly technical medicine.

This fractured approach to treatment has sparked interest, even in the Western world, in the more holistic approach of traditional medical traditions. It is also true that there are some in the West who view sickness and recovery in supernatural terms. Healing through faith is part of the Christian tradition, although there are a limited number of believers. So it is not just in remote or less-developed parts of the world where the three healing traditions continue to coexist. Some Western-trained doctors are now learning traditional methods, which they practice in conjunction with modern medicine. Pharmaceutical companies are researching the active compounds in traditional herbal medicines.

Science still has major diseases to conquer. Despite advances in many areas, heart disease and cancer remain major killers. And newer diseases occur from time to time, for example avian flu. The threat from variations of long-known diseases remains as well. Epidemiologists continue to worry about the appearance of a particularly virulent influenza, like the one in 1918-19 that killed between 50 and 100 million people around the world.

The environment, of course, is another factor. Air pollution, water pollution, adulterated food, toxic waste, the dangers of pesticides, you name it—affect health in one way or another. Many of these have been implicated in the causation of cancer. The effect of global warming on people’s health is not known, but a warmer Earth will provide an even more hospitable environment for mosquitoes and all the diseases they carry. Medicine has its work cut out for it.