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This paper presents a systematic mapping of the disparate literature on non-biomedical therapeutic modalities using co-word analysis. Non-biomedical modalities are defined in this paper as therapeutic modalities that exist in separation, but not isolation from, biomedicine. Bibliometric visualisation based on co-word analysis, a method sensitive to the configuration of socio-cognitive networks of knowledge, is employed to create a semantic topography of thirty years' literature from across different disciplines. The proliferation of terminologies to describe non-biomedical modalities from different disciplines raises important issues about the structure of scholarly knowledge about this area, particularly with regards to domains of meaning and conceptual spaces that lay dormant within this discourse. Drawing from a bibliographic dataset of 17,163 peer-reviewed publications written in English between 1987 and 2017 (retrieved on September 31, 2018), this paper presents a rigorous map with which to navigate the highly complex and interdisciplinary literature on non-biomedical knowledge and practices. Arguing that knowledge production about non-biomedical modalities in scholarly literature resembles that of problematic networks of interest, this paper substantiates the separation from biomedicine that contradistinguishes non-biomedical modalities. It does so by analysing the semantic trajectories of the most widely used terminologies in this domain, namely traditional medicine, alternative medicine, herbal medicine, and unclassified drug. Although all equally problematic, these contested terminologies are unlikely to replace one another in any form of paradigmatic shift in the foreseeable future. Their persisting conceptual usefulness is anchored in their own respective clusters of meaning, and researchers wishing to engage in the production of knowledge in this domain should be mindful of the pitfalls associated with their terminology use. Non-biomedical modalities as a term might be better equipped to capture the diversity as well as the historical continuities and discontinuities of therapeutic traditions and practices at the margin of mainstream scientific medicine. • A map of terminologies from 17,613 peer-reviewed publications over 30 years. • Problematic terminologies continue to be used across different knowledge domains. • Contested nature of common terminologies is analysed in relation to each other. • Definition of non-biomedical modalities is provided and substantiated with data. [ABSTRACT FROM AUTHOR]

This paper presents a case study of the traditional treatment of a Q'eqchi' Maya man in southern Belize in 2011 who is suffering from AIDS-related sickness. The purpose is to detail the empirical nature of Q'eqchi' Maya medicine, distinguishing between manifest and latent empiricism, as evidenced in the healers evolving attempts to treat the patient in the absence of knowledge of his biomedical diagnosis. The paper argues for a more complete understanding of the empirical nature of much Indigenous healing, which parallels aspects of scientific medicine, and for better collaboration among traditional healers and biomedical practitioners in strongly Indigenous areas. [ABSTRACT FROM AUTHOR]

This paper details how exposure to new clinics, diagnostic technologies, and pharmaceuticals during humanitarian relief operations in the Somali Region of Ethiopia shaped local pluralistic health systems and altered the ways in which residents subsequently conceived of and treated illness and disease. Despite rising demand for pharmaceuticals and diagnostic technologies among Somalis in Ethiopia, local ethnophysiologies continued to draw upon popular ideas about humoral flows, divine action, and spirit possession. Demands for therapeutic camel milk, Qur'anic spiritual healing, herbal remedies, and other historically popular therapies persisted, but were shaped by concurrent demands for and understandings of diagnostic biotechnologies and pharmaceutical medications. The reverse was also true: contemporary understandings and uses of non-biomedical healing modalities among Somalis shaped evaluations of clinical care, including healthcare during humanitarian responses. To illustrate these phenomena, based on ethnographic research in eastern Ethiopia between 2007 and 2009, this paper explores three topics vital to Somalis' pluralistic healthcare systems: camel milk and the management of digestive bile; women's experiences and clinical presentations with pain and disorder in their reproductive systems; and the rising popularity of high-tech diagnostic tests. I conclude that medical humanitarian aid never happens in a vacuum or among truly treatment-naïve populations. Instead, aid unfolds within ever-changing and pluralistic health cultures, and it permanently alters and is altered by the frames within which people evaluate and make future decisions about healthcare. [ABSTRACT FROM AUTHOR]

As genetic models are increasingly incorporated in medicine, health service users seem to accept these models to varying degrees. To appreciate these differences, this paper examines how health service users' genetic beliefs of health are associated with their use of traditional, complementary, and alternative medicine (TCAM) via responses from 31 countries in the 2011 ISSP survey. It finds an interesting contrast between East Asian countries and other countries in the world. The negative association between genetic beliefs and TCAM use is strong in the latter, whereas it is weak in the former. More intriguingly, the analysis demonstrates significant cross-national differences within East Asian countries. Chinese and Koreans reveal a negative relationship between genetic beliefs and TCAM use, while Japanese show a positive relationship. The paper provides an explanation to these cross-national differences by drawing on comparative studies of medical systems. When TCAM is institutionalized as valid and distinct medical resources, and when TCAM is practically available to everyday use, health service users who subscribe to genetic beliefs are likely to use TCAM as well. These findings contribute to revealing the pragmatic nature of health-seeking action and the institutional context in which geneticization and medical pluralism are conditioned to form. • This study examines the association of people's beliefs in genetic attribution and TCAM use. • The negative association of genetic beliefs and TCAM use is weak in China and Korea. • Genetic beliefs and TCAM use are positively associated in Japan. • Geneticization and medical pluralism are conditioned by institutionalization of TCAM. [ABSTRACT FROM AUTHOR]

In contexts where healthcare regulation is weak and levels of uncertainty high, how do patients decide whom and what to trust? In this paper, we explore the potential for using Signalling Theory (ST, a form of Behavioural Game Theory) to investigate health-related trust problems under conditions of uncertainty, using the empirical example of ‘herbal clinics’ in Ghana and Tanzania. Qualitative, ethnographic fieldwork was conducted over an eight-month period (2015–2016) in eight herbal clinics in Ghana and ten in Tanzania, including semi-structured interviews with herbalists (N = 18) and patients (N = 68), plus detailed ethnographic observations and twenty additional key informant interviews. The data were used to explore four ST-derived predictions, relating to herbalists' strategic communication (‘signalling’) of their trustworthiness to patients, and patients' interpretation of those signals. Signalling Theory is shown to provide a useful analytical framework, allowing us to go beyond the primary trust problem addressed by other researchers – cataloguing observable indicators of trustworthiness – and providing tools for tackling the trickier secondary trust problem , where the trustworthiness of those indicators must be ascertained. Signalling Theory also enables a basis for comparative work between different empirical contexts that share the underlying condition of uncertainty. [ABSTRACT FROM AUTHOR]

This paper examines first-generation Korean immigrants' barriers to healthcare in the US and their strategies for coping with these issues by analyzing survey data from 507 Korean immigrants and in-depth interviews with 120 Korean immigrants in the New York-New Jersey area. It reports that more than half of Korean immigrants have barriers to healthcare in the US, with the language barrier being the most frequent response, followed by having no health insurance. Korean immigrants are not passive, but rather active entities who display coping strategies for these barriers, such as seeing co-ethnic doctors in the US, seeking Hanbang (traditional Korean medicine) in the US, and taking medical tours to the home country. However, their coping strategies are far removed from formal US healthcare as their behaviors are still restricted to the informal healthcare within the ethnic community or home country. This study methodologically and theoretically contributes to the literature on immigrants’ healthcare behaviors by using a mixed-method approach and developing a specific framework for one particular immigrant group. [ABSTRACT FROM AUTHOR]

Abstract: Although socioeconomic status is acknowledged to be an important determinant of modern health care utilisation, most analyses to date have failed to include traditional systems as alternative, or joint, providers of care. In developing countries, where pluralistic care systems are common, individuals are likely to be using multiple sources of health care, and the order in which systems are chosen is likely to vary according to income. This paper uses self-collected data from households in Ghana and econometric techniques (biprobit modelling and ordered logit) to show that rising income is associated with modern care use whilst decreasing income is associated with traditional care use. When utilisation is analysed in order, results show rising income to have a positive effect on choice of modern care as a first provider, whilst choosing it second, third or never is associated with decreasing income. The effects of income on utilisation patterns of traditional care are stronger: as income rises, utilisation of traditional care as a first choice decreases. Policy should incorporate traditional care into the general utilisation framework and recognise that strategies which increase income may encourage wider utilisation of modern over traditional care, whilst high levels of poverty will see continued use of traditional care. [Copyright &y& Elsevier]

Abstract: Traditional medicine is believed to constitute a crucial healthcare option for poor or remote households in developing countries that have limited access to allopathic medicine and/or a strong cultural attachment to traditional medicine. However, little research has been performed on medicinal plant reliance in developing countries, and the determinants of medicinal plant consumption at the household level in these countries have not been empirically studied. Quantifying the use of traditional medicine at the household level is, therefore, essential to the development of sustainable healthcare policies in the developing world. This paper quantifies household-level use of traditional medicine and identifies determinants of the choice of traditional treatment in the south central region of Burkina Faso. Structured household interviews (n = 205) were conducted in nine villages of rural Burkina Faso from November 2007 to November 2008 and in November 2009 to collect data on household characteristics (e.g., income, education, demographics), illness frequencies, illness types, and treatment strategies employed. Comprehensive analysis of treatment choice was performed through bivariate analyses. Results indicate that traditional medicine was primarily relied on by middle-aged individuals from relatively uneducated households who were living in villages with limited allopathic medicine service provision. Moreover, a differential approach to medicinal plant consumption was used to distinguish between patients using traditional medicine as a self-care treatment and those visiting a traditional healer. Although poorer households were shown to use traditional medicine as a self-treatment, traditional healers’ services were relied on by wealthier households. [Copyright &y& Elsevier]

Abstract: Researchers examining the relationships between traditional medicine and biomedicine have observed two conflicting tendencies. Some suggest that the use of biomedicine and biomedical concepts displaces the use of traditional medicine and medical beliefs. Other scholars have found that traditional medicine and biomedicine can co-exist, complement, and blend with each other. In this paper we use an econometric model and quantitative data to test the association between individual knowledge of pharmaceuticals and individual knowledge of medicinal plants. We use data from a survey among 136 household heads living in a rural indigenous community in Oaxaca, Mexico. Data were collected as a part of long term fieldwork conducted between April 2005 and August 2006 and between December 2006 and April 2007. We found a significant positive association between an individual’s knowledge of medicinal plants and the same individual’s knowledge of pharmaceuticals, as well as between her use of medicinal plants and her use of pharmaceuticals. We also found a negative association between the use of medicinal plants and schooling. Our results suggest that, in the study site, individual knowledge of medicinal plants and individual knowledge of pharmaceuticals co-exist in a way which might be interpreted as complementary. We conclude that social organization involved in the use of medicines from both traditional medicine and biomedicine is of particular significance, as our findings suggest that the use of pharmaceuticals alone is not associated with a decline in knowledge/use of medicinal plants. [Copyright &y& Elsevier]

Abstract: For demographic reasons and as a result of a number of high profile health incidents in recent years, much of the health research and policy focus is on the younger cohorts of Aboriginal peoples in Canada. A critical examination of recent demographic trends reveals, however, that older cohorts of the Aboriginal population are increasing at a faster rate than younger cohorts, primarily due to improvements in life expectancy and declining fertility rates. Yet, there are surprisingly few health studies that have recognized the aging of the Aboriginal population. The overall goal of this paper is to examine differences in health status, use of conventional health care and traditional approaches to healing between older and younger cohorts of the Aboriginal population as well as to examine the importance of age as a determinant of health and health care use. Using data from the 2001 Statistics Canada Aboriginal Peoples Survey and contingency tables and logistic regression, the results demonstrate that older Aboriginal people face unique challenges – e.g. loss of traditional approaches to healing, geographic isolation, identity politics, constitutional and legal divisions within the Aboriginal community – with respect to their health and access to health services. These outcomes result from a colonial past and contemporary policies that affect all Aboriginal people. [Copyright &y& Elsevier]

Abstract: In many Western societies, alternative healing options, including Chinese medicine, have started to move from the marginal to mainstream. In China, Chinese medicine has been an established component in the official health care system, but its relevance and effectiveness have often been challenged in a society committed to modernization. Despite abundant speculation, little research has established empirical facts regarding the use of Chinese medicine in China. This paper uses a longitudinal dataset to examine the trends from 1991 to 2004, and explore the extent to which changing population demographic and socioeconomic characteristics contributed to the observed trends. It finds that in the formal medical sector, the use of Chinese medicine has contracted, particularly in cities. Changing population demographic and socioeconomic characteristics cannot entirely account for the contraction. Rather, shifts in cultural values and structural changes in the health care system may have led to the observed decline. [ABSTRACT FROM AUTHOR]

Abstract: In an attempt to promote patient agency and foster more egalitarian relationships between patients and doctors, discourse concerning health and wellbeing in the UK has increasingly centred around the notion of informed and ‘expert’ patients who are able to effectively input into the direction and management of their own health care and treatment. While the relationship between a patient and their doctor can play a vital role in influencing the treatment decisions and health-related outcomes of people living with long term illness, little is known about the ways in which people living with HIV actually perceive their relationship with their doctors, nor the implications this may have for the types of treatment they may seek to use and the related information that they share. Drawing on 11 focus group discussions and 20 repeat interviews undertaken in 2008–2009 with HIV-positive adult migrants from Zambia, Zimbabwe and South Africa living in the UK, this paper argues that patient-doctor relationships can be heavily influenced by the perceived legitimacy of different forms of medical knowledge and treatments and by culturally influenced ideas regarding health, wellbeing and agency. Despite a desire amongst some migrants to use ‘traditional’ medicines from southern Africa as well as other non-biomedical treatments and therapies, the research found that the perceived lack of legitimacy associated with these treatments in the UK rendered their use a largely clandestine activity. At the same time, many patients made clear distinctions concerning issues affecting their immediate health and factors influencing their more general wellbeing, which in turn, impacted upon the information that they chose to share with, or conceal from, their doctors. Such findings challenge assumptions underpinning policy promoting patient agency and have significant and, in cases, potentially adverse implications for the safety and effective administration and management of HIV treatments in African migrant populations and possibly more generally. [Copyright &y& Elsevier]

Abstract: India has an eclectic health system that incorporates biomedical as well as traditional, complementary and alternative medicine (TCAM). Our understanding of the co-existence of these therapeutic modalities in this diverse, postcolonial and developing nation is extremely limited, and in the context of cancer care, to our knowledge no sociological work has been carried out. Contemporary Indian oncology represents a fascinating site for examining the interplay and articulation of forms of tradition/modernity, economic progress/structural constraint and individual beliefs/cultural norms. In a context of an increase in the prevalence and impact of cancer in an ageing Indian population, this paper reports on a qualitative investigation of a group of oncology clinicians'' accounts of ‘pluralism’ in India. The results illustrate the embeddedness of patient disease and therapeutic trajectories in vast social inequalities and, indeed, the intermingling of therapeutic pluralism and the politics of social value. We conclude that notions of pluralism, so often espoused by global health organisations, may conceal important forms of social inequality and cultural divides, and that sociologists should play a critical role in highlighting these issues. [Copyright &y& Elsevier]

Abstract: The project of modernising Western herbal medicine in order to allow it to be accepted by the public and to contribute to contemporary healthcare is now over two decades old. One aspect of this project involves changes to the ways knowledge about medicinal plants is presented. This paper contrasts the models of Evidence-Based Medicine (EBM) and Traditional Knowledge (TK) to illuminate some of the complexities which have arisen consequent to these changes, particularly with regard to the concept of vitalism, the retention or rejection of which may have broad implications for the clinical practice of herbal medicine. Illustrations from two herbals (central texts on the medicinal use of plants) demonstrate the differences between these frameworks in regard to how herbs are understood. Further, a review of articles on herbal therapeutics published in the Australian Journal of Herbal Medicine indicates that practitioners are moving away from TK and towards the use of EBM in their clinical discussions. [Copyright &y& Elsevier]

Abstract: This paper examines the ways in which the acupuncture phenomenon is translated into scientific language through the mobilization of functional magnetic resonance imaging. In doing so, it explores how differences between science and traditional medicine are bridged and negotiated through an open-ended tuning process among heterogeneous elements. By showing the constructive interaction between traditional medicine and science, I aim to refute a conception of East Asian medicines as culturally bounded and to provide an interpretation of transculturalism that emphasizes its diverse and hybrid formations. Particularly, in order to explain the scientific translation of acupuncture, I refer to Andrew Pickering''s “mangle of practice” as an alternative to Thomas Kuhn''s paradigm. Adopting a performative perspective rather than a representational one with regard to science, I read the scientific interpretation of acupuncture as an interactive stabilization between the acupuncture phenomenon, neurological theory, and the material procedure of the MRI machine. [Copyright &y& Elsevier]

This paper focuses on the question of why the social and political acceptance of Chinese medicine has grown in the former British colony of Hong Kong since the late 1980s. To supplement the conventional explanations for the institutionalization of alternative medicines, we propose a political process perspective that highlights the effects of political changes amidst the decolonization process in Hong Kong. During the late 1980s and early 1990s, the weakening of the political position of the established elite, the opening up of political space for previously excluded groups, and the competition for support among the new political elite, all stimulated the indigenous Chinese medicine organizations to mobilize for the institutionalization of Chinese medicine. By the mid-1990s academics from leading tertiary institutions began to take over the leadership of the movement and in doing so carried it to a higher level. In the conclusion, we briefly consider the implications of this movement for the future development of alternative medicine in Hong Kong and other societies. [ABSTRACT FROM AUTHOR]

Hierarchies of power among healthcare professionals are well documented, nonetheless, power remains neglected, understudied and under-theorised in health systems analysis and policy discussions, especially in the domain of Traditional, Complementary and Alternative Medicine (TCAM). Sociological and public health scholarship has documented the persistence of medical dominance in the health system, theorised as the limitation, subordination, exclusion and incorporation of other professions. This paper explores how interprofessional power dynamics shape the integration of TCAM into Indian primary healthcare centres, as part of a nationwide policy of TCAM integration and medical pluralism implemented since 2005. We conducted interviews (n = 37) with health system administrators, nurses, pharmacists, TCAM and biomedicine doctors, and observed day-to-day activities of primary healthcare centres for six months in Odisha state, India. Thematic analysis enabled the identification of themes and exploration of sub-themes. The analysis revealed multilayered forms of medical dominance within the primary healthcare system and identified multiple sites where everyday power is mobilised. Biomedicine practitioners exercised authoritative power and restricted TCAM doctors' access to facility-level resources, i.e. financial and workforce support, which inhibited the integration policy implementation. Significantly, TCAM doctors were 'ordered' to practice biomedicine at primary healthcare centres, which was beyond the scope of the integration policy. However, TCAM doctors were also able to exercise countervailing power in their day-to-day activities in the primary healthcare centres and sought to assist patients' health behaviour change through their authoritative knowledge about 'how to live a healthy life'. The health system actors involved in policy implementation hold a range of forms of power specific to the circumstances, influencing the integration processes. We explain these dynamics in relation to existing theories of medical dominance and countervailing power, while introducing a previously unreported dimension of dominance: 'co-optation', which enrols TCAM practitioners in the practice of biomedicine. • Medical dominance in Indian primary health care centres (PHCs) is multi-layered. • AYUSH doctors working in PHCs experience subordination, exclusion and limitation. • A new form of medical dominance – co-optation – was also uncovered in this setting. • Co-optation here involved AYUSH doctors being ordered to undertake biomedical tasks. • Via countervailing power, AYUSH doctors retained autonomy in community-based work. [ABSTRACT FROM AUTHOR]