- Pia Vuolanto (University of Tampere) email
- Jenny-Ann Danell (Umea University) email
- Caragh Brosnan (University of Newcastle) email
This traditional track with standard papers focuses on the processes associated with the knowledge production, professionalization, standardisation, integration and globalization of complementary and alternative medicine (CAM)
Complementary and alternative medicine (CAM) has emerged as a key topic in the sociology of health and illness over the past 15 years. Increased rates of CAM use in the West have led sociologists to seek explanations for this trend and to explore patient experiences of CAM, and the relationship between CAM and other health professions. However, what remains largely unexamined until now is how CAM itself is shaped by social processes.
The purpose of this track is to examine the way that CAM itself - as knowledge, philosophy and material practice - is constituted by and transformed through, broader social developments. Rather than viewing CAM as a stable entity that elicits perceptions and experiences, the track will focus on the processes associated with the knowledge production, professionalization, standardization, integration and globalization of CAM. The track seeks STS perspectives and examinations of the forms that CAM takes in different settings, how global social transformations elicit varieties of CAM, and how CAM philosophies and practices are co-produced in the context of social change.
In particular, the track will examine what happens to CAM knowledge, CAM practices and the philosophy of the various CAM modalities in an increasingly standardized world; whether, when and why CAM takes on local characteristics, and what new forms of health practices and knowledge may emerge as CAM is subject to these influences.
This track is closed to new paper proposals.
Negotiation and translation of complementary and alternative medicine in the political domain
This paper is focused on how CAM is translated and negotiated in Swedish politics. How are boundaries of CAM and conventional medicine drawn in the political debate? What is defined as problems or in need of political intervention? What goals are suggested? If and how is scientific knowledge used?
This paper is focused on how CAM is translated and negotiated in Swedish politics, and the role of scientific knowledge and evidence based medicine in these processes. A number of studies show that CAM is a growing research field, both concerning studies of use/prevalence, clinical effects, RCT:s, and preclinical studies. However, this development does not necessarily implicate that the research is accepted, acknowledged, or applied. In general, CAM-research is often questioned, on the grounds of poor research design and small numbers. There are also indications that CAM-research mainly is acknowledged within the delimited CAM research field, and close related areas such as pharmacology and plant science, and only to a limited extent in general medicine or public health. If and how CAM-research is acknowledged or applied in other contexts, outside medicine, is to large extent unexplored. This paper is restricted to the Swedish parliament, and how translation and negotiation of CAM is performed in written documents, by different kinds of actors. How are boundaries of CAM and conventional medicine drawn in the political debate? What is defined as problems or in need of political intervention? What goals or solutions are suggested? If and how is scientific knowledge, for example studies in or about CAM, used in these processes? The empirical material consists of about 300 documents, from the time period 1980 to 2015.
The 'S-word' in chiropractic education: exploring the paradoxical relationship between standardisation and professionalisation
This paper contributes to unpacking the complex and sometimes paradoxical relationship between standardisation and professionalisation, through a study of the role of educational standards in the evolving status of the chiropractic profession.
Contributing to the sociology of standards (Timmermans and Epstein 2010), this paper explores the relationship between educational standardisation and the professional status of chiropractic. Chiropractic is a manual therapy whose nineteenth century founders held vitalistic beliefs about the role of the spine in health. Following battles for recognition in the twentieth century, chiropractic has received statutory regulation in various countries and access to public higher education systems in order to deliver degrees. Despite these gains, chiropractic is a deeply divided profession, with some sectors adhering to vitalistic concepts such as the chiropractic 'subluxation', and others advocating a 'musculoskeletal' approach founded on scientific evidence. One way the latter agenda has been promoted is by developing standards which prescribe an evidence-based approach in chiropractic education. Drawing on interviews with chiropractic educators and members of professional and regulatory bodies in the UK and Australia, this paper explores the production, content and implementation of the education standards and, importantly, their potential impact on the profession. Although educational standardisation can enhance professional status, this study suggests that imposing standards of evidence in chiropractic education has the potential to reduce the profession's distinctiveness by merging its knowledge base with that of other professions. At the same time, the study identified a number of factors - including the porosity of educational institutions - that, in practice, limit the possibility of standardising the philosophical approach that underpins chiropractic education. The paper helps unpack the complex and sometimes paradoxical relationship between standardisation and professionalisation.
"Hiding in the corridors, fearing the Sceptic" - Inside the social world of integrative medicine
Integrative medicine attempts to merge different therapies, for example, traditional Chinese medicine and homeopathy with evidence-based medicine. I present results from a multi-sited ethnography which looks at knowledge production practices of Finnish researchers in integrative medicine.
Integrative medicine attempts to merge different therapies, for example, anthroposofic medications, traditional Chinese medicine and homeopathy with evidence-based medicine. In public debate, this integrative endeavour is often seen to challenge and to necessitate change in the research practices of evidence-based medicine. For example, such groups as the scepticism movement hurry to show that integrative medicine does not apply the guidelines of good research and good scientific conduct. These groups claim that the integrative approach is humbug and unscientific. This well-known and persisting debate holds onto the differences between the research practices of evidence-based medicine and those of integrative medicine. These differences are seen as self-evident and taken for granted. However, what kind of knowledge is produced in integrative medicine and its actual knowledge making practices are in fact hidden from the eyes of the sceptics and the society at large.
The focus of the presentation is the social world of integrative medicine. I use the tradition of the social worlds framework in STS (Clarke & Star 2008). I present results from a multi-sited ethnography study (Marcus 1995) which looks at integrative medicine from the inside - from the perspective of people who do research in integrative medicine in Finland. The research questions are:
- How do people (or groups of people) who conduct research in integrative medicine understand knowledge production as philosophy and practice?
- What negotiations of different knowledge traditions, cultural meanings and identities are involved in their processes of knowledge production?
Neo-colonial turf wars and traditional medicine regulation: a case study
Analysing a Canadian case of acupuncture regulation, we use postcolonial theory to examine the privileging of biomedical and non-immigrant practitioners using traditional medicine-rooted therapies. We propose a series of regulatory strategies aimed at prioritizing traditional knowledge protection.
Many complementary and alternative medicine (CAM) interventions are rooted in traditional medicine (TM) systems. United Nations agencies have recommended that nations take steps to regulate both TM and CAM practitioners to enhance 'safety, quality and effectiveness'; but also to take steps to protect TM knowledge, and prevent further misappropriation of TM practices. The statutory regulation of TM-rooted CAM practices raises complex, but under-examined, questions at the clinical/cultural intersect. With reference to the case of acupuncture regulation in Ontario, Canada, we explore several regulatory complexities arising from: a) TM practices' globalized movement outside of their regions of origin; b) their increased adoption by biomedically-trained health care professionals; and c) the growing body of biomedical evidence substantiating these practices' efficacy. Our work engages critical theories of professionalization and boundary work within a postcolonial framework to discuss an extensive document review and thirty key informant interviews. By examining state risk discourses and regulatory boundary construction for acupuncture; the question of English-language fluency requirements for immigrant practitioners; and the negotiation of standards across acupuncture-practising professions, our work points to a systemic privileging of biomedical and non-immigrant practitioners. In addition, we find that the jurisdictional struggles between biomedical and TM acupuncture practitioner groups are fundamentally epistemic; and carry the weight of historical colonial relationships. In this light, we propose a series of strategies that regulators may engage in negotiating equitable approaches to CAM and TM regulation that prioritize protection of traditional knowledge, while seeking to accommodate biomedical practitioners and ensure the protection of the public.
Modes and moves of Chinese Medicine in post/socialist Europe
Together with ongoing (geo)political, socio-material and economic changes, Chinese medicine (CM) has been enacted in multiple and sometimes conflicting versions in the Czech Republic. Inspired by Mol, we ethnographically follow four different modes and moves of CM and their relations to biomedicine.
Chinese medicine (CM) has been present in Czechoslovakia and later the Czech Republic since 1950s when it was brought to the country by physicians who had participated in the Korean war. Since then it has been enacted in multiple and sometimes conflicting versions in the changing (geo)political, social-material and economic conditions in the country. Inspired by Mol's praxiographical approach and Zhan's study of worldling of CM, we ethnographically follow articulations of four modes and moves of CM and their relations to biomedicine. 1) "Medical acupuncture" which was developed as a method within state-socialist biomedicine guided by "scientific materialism" and supported by e.g. industrial production of acupuncture needles and electro-acupuncture devices. 2) A dissident CM cultivated by practitioners during socialism who embraced an alternative (non-biomedical) theory of body, health and disease and was practiced in grey zones of biomedical facilities or on practitioners' family members and friends. 3) The "traditional Chinese medicine" gaining strength after 1989 when private clinics and other institutions (schools and the Chamber of TCM) were gradually established by bottom up efforts of local practitioners, with a mix of ignorance, denial and cautious interest from biomedical establishment. 4) Recent efforts to introduce CM to the public healthcare system with a strong political support from both Czech and Chinese governments and corporate businesses, which induced a heated controversy in the Czech medical circles and the public space on evidence-based medicine, limits of biomedicine and the economy and geopolitics of healthcare.
Self-Responsibilization and Self-Actualization: CAM as Neoliberal Governance and Embodied Wellness
This paper will draw upon documentary and ethnographic research data to support its main argument that contemporary developments of CAM in local (e.g. Canada) and global settings simultaneously embody self-responsibilization and self-actualization of individuals in their use of CAM.
Rather than viewing CAM as a monolithic "Other" versus a hegemonic biomedicine, recent social science scholars rightly argue that "hybridity" offers a more spatially-informed analysis of the ways in which CAM and biomedical knowledges are co-constituted in a complex nexus of negotiated power enabled by transnational cultural flows. Yet, given the current global economic downturn, which has yielded a globalized neoliberal climate, CAM is also discursively shaped by neoliberal strategies of governance to focus on enabling citizens to accept individual responsibility for their own health, thus diverting collective responsibility for health care.
In order to make sense of this tension between hybridity and neoliberal governance in which CAM is implicated, I will use a Foucauldian perspective to examine contemporary developments of CAM that simultaneously embody self-responsibilization and self-actualization of individuals in their use of CAM. In particular, I will highlight Foucault's concept of biopower to understand how individuals become self-regulating subjects through CAM as "technologies of the self" (Foucault 1988) whereby individuals take it upon themselves to ensure they function as healthy subjects for the state not through coercive but desirable means as this is perceived to be in their own best interests. Further, I will draw upon Foucault's theorizing of the "care of the self" (1987) to demonstrate CAM use as an increasingly popular form of self-care that enables self-actualization, an embodied wellness that is personally meaningful, simultaneously embracing holism, vitalism, spirituality and nature - all benevolent symbols of CAM.
Acupuncture, Science and Higher Education: negotiating competing paradigms and professional autonomy within British Universities
This project is designed to investigate the tensions that emerge as traditional acupuncture is taught within the University sector in Britain and is aligned with biomedical, scientific methods and knowledge.
From the 1960s, in an effort to distance themselves from 'mainstream' biomedicine, many CAM practitioners adopted a 'holistic'/'anti-reductionist' rhetorical strategy, mirroring the counter-culture critique of biomedicine. However, since the 1980s, several major CAMs moved in the opposite direction, pursuing external legitimacy via 'mainstreaming' strategies including as the development of formal training programmes and accreditation procedures. This, in light of the authoritative position of biomedicine in society and its domination of medical knowledge, involved increasing biomedical content as part of CAM training and education. These emerging tensions, the product of bringing competing paradigms together, have to be managed bureaucratically through formal validation processes and practically by practitioners, academics and students.
This research project is set to examine the way these tensions are negotiated by acupuncture educators and their students, while exploring the role of universities is shaping acupuncture knowledge and practice.
Data collection for this qualitative study includes a) 15 in-depth interviews with traditional acupuncture programme leads and lecturers from both professionally accredited /university validated and professionally accredited /non-university validated programmes; b) two focus group discussions with acupuncture students on such courses; and c) textual documentary analysis of courses' syllabi. Data collection is at advanced stages and it is expected to be completed prior to April 2016. Ethical approval for the study was obtained from the Science Faculty Ethics Committee at the University of Portsmouth (SFEC-07-2015-‐040).
Institutional challenges in the medical evaluation of CAM in the U.S.
Drawing on inductive socio-anthropological approach and focusing on "federal making of legitimizations towards cancer CAM" by a plurality of agents, this research analyzes challenges of an integrative model at stake in the different modalities of the medical evaluation of cancer CAM in the U.S.
Drawing on an inductive socio-anthropological approach, our ongoing research focuses on the very particularity of the American health system which, after having initiated a model of complementarity by integrating a legitimization of CAM, is recently instituting an integrative model, more particularly regarding oncology.
Since the 1990s, this original institutionalization is implemented through the creation of two federal entities in charge of medical research on CAM: the NCCAM and the OCCAM both part of the National Institutes of Health. These medical researches on the efficacy, safety and placebo effect of such CAM are mainly structured around cancer and chronic illnesses. Since 2014, a new turning point is emerging: "integrative oncology", part of the "integrative medicine" movement, as shown by different articles in systemic journals and the new name of the NCCAM, the National Center for Complementary and Integrative Health (NCCIH). This new wave of the institutionalization of CAM is co-constructed by a plurality of agents mobilizing a variety of discursive and practical elements such as the complementarity and the integration of such CAM, terms and practices that we consider as many social, historical, political and economical characteristics of the legitimizations we try to analyze.
These two federal institutions dedicated to medical research on CAM question the different, sometimes competing and conflicting, modalities of evaluating the efficacy of CAM, research ethics, public health policies regarding this medical evaluation and the various challenges at stake in the legitimization of an integrative model towards cancer CAM.
Alternative Methods in Anaesthesia: Mesmerism in 1840s Britain and Hungary
The paper uses a case study to illustrate how different factors create contingency in the history of science. As the analysis shows, the battle between professional groups to control anaesthetics by advocating either mesmeric or ether pain relief was intertwined with wider socio-cultural issues.
The history of science reveals the contingent nature of scientific development. At crucial moments, when rival approaches present themselves, this contingency is more salient. The triumph of one alternative over the other is never predetermined. The paper analyzes a moment of history when innovative methods, incidental discoveries, professional and cultural frontlines and business interests influenced the subsequent history of the emergent field of anaesthesia.
'Animal magnetism' or 'mesmerism' referred to a wide range of practices that arrived to Britain in the 1830s. As a result of public shows and famous medical cases, the technique became notorious. After November 1842, when a well-publicized amputation of a leg under mesmeric anaesthesia took place, the debate was focused on pain relief. Gaining control over pain relief would yield greater reputation and potential financial profit for the practitioner, and, for the 'mesmeric camp', a victory in the effort to turn a practice of dubious fame into a respectable medical technique. Hence, four years later, when the news about ether anaesthesia arrived to London, the novel method was immediately seized and promoted by the opposing camp. Ether was used not only as an alternative to but also as a weapon against mesmerism. However, it had undesired side-effects, including fatalities, and was therefore open to attacks. With no licensing schemes, ether could be used indiscriminately, which led to demands from the medical profession for a limitation and regulation in its application. As the paper shows, efforts to control anaesthetics were intertwined with wider socio-cultural issues.
This track is closed to new paper proposals.