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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]

Abstract: While accepting medical “pluralism” as a historical reality, as an intrinsic value inherent in any medical system, and as an ideal or desired goal that any multicultural society ought to achieve, this paper argues the need to go beyond the liberal pluralist tendencies that have dominated the debate so far. It holds that while documenting or dealing with the “co-existence” of varied medical traditions and practices, we must not ignore or underplay issues of power, domination and hegemony and must locate our work in a larger historical, social and political context. With this perspective, and based essentially on Assembly proceedings, private papers, official documents and archival materials from the first half of the 20th-century, this paper identifies three major streams in the nationalist discourse in India: conformity, defiance and the quest for an alternative. It shows that while the elements of conformity to biomedicine and its dominance remained more pronounced and emphatic, those of defiance were conversely weak and at times even apologetic. The quest for alternatives, on the other hand, although powerful and able to build trenchant civilizational and institutional critique of modern science and medicine, could never find adequate space in the national agenda for social change. The paper further holds that although the “cultural authority” and hegemony of biomedicine over indigenous science and knowledge were initiated by the colonial state, they were extended by the mainstream national leaderships and national governments with far more extensive and profound implications and less resistance. In light of the growing global networking of “traditional”, “complementary” and “alternative” health systems on the one hand and the hegemonic and homogenizing role and presence of multilateral organizations (such as the World Bank and IMF) in shaping national health policies on the other, such insights from history become extraordinarily important. [Copyright &y& Elsevier]

In recent years what can loosely be described as a sociology of complementary and alternative medicine (CAM) has begun to emerge. Although work has been conducted with lay therapists, orthodox practitioners, and consumers, overall, research in this area remains patchy and underdeveloped. Despite its role at the forefront of integration, the sociological study of the apparent affinity between nursing and CAM is virtually non-existent. This paper provides an exploratory analysis of how writers within the CAM nursing sub-world adopt a recourse to history (nostalgic and nostophobic referencing) as a strategy to authenticate the relationship between nursing and CAM and so facilitate continuing integration. A text analysis, of articles written on CAM in four nursing journals, was conducted. Eighty papers satisfied the inclusion criteria. Evidence is presented of the way in which writers attempt to authenticate integration of CAM through reference to its apparent interconnectedness with the historically grounded core of nursing values, and more specifically, with the key historical figure of the nurse Florence Nightingale (1820–1910). It is argued that these rhetorical strategies can be understood in the context of the need to engage in (primarily) intra-professional persuasion: to protect and develop the values of their nursing sub-world over alternatives. The findings are preliminary. Themes identified are illustrative of the potential offered by an analysis of nostalgic and nostophobic referencing in this context, and not a definitive account of it. Further research should examine individually produced texts from other sources, and documents produced by relevant professional bodies. [Copyright &y& Elsevier]

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]

Injury is a conspicuous feature of the practice and public spectacle of contemporary elite sports. The paper argues that the ‘biomedicalisation’ thesis (medico-industrial nexus, techno-scientific drivers, medical optimisation, biologisation, the rise of evidence and health surveillance) goes some way to capturing the use in elite sports injury of some highly specialised mainstream therapies and some highly maverick biological therapies, which are described. Nevertheless, these main strands of biomedicalisation do not capture the full range of these phenomena in the contexts of sports medicine and athletes' practices in accessing innovative, controversial therapies. Drawing on multi-method qualitative research on top-level professional football and cycling in the UK, 2014–2016, we argue that concepts of ‘magic’ and faith-based healing, mediated by notions of networking behaviour and referral systems, furnish a fuller explanation. We touch on the concept of ‘medical pluralism’, concluding that this should be revised in order to take account of belief-based access to innovative bio-therapies amongst elite sportspeople and organisations. [ABSTRACT FROM AUTHOR]

This paper examines the extent to which the position of the medical profession and the state towards complementary and alternative medicine (CAM) practitioners has changed since the late 1990s, taking Portugal as a case study. Using Light's concept of countervailing powers, we consider the alliances, interests, rhetoric and degrees of control between these three actors over time, focussing particularly on the extent to which CAM practitioners have acted as a countervailing force in their relationship with the medical profession and the state. It also brings to the fore the position of supra-state agencies concerning CAM regulation. A critical discourse analysis was conducted on data derived from a systematic search of information dating from the late 1990s up to 2015. Our analysis suggests that CAM has emerged as an active player and a countervailing power in that it has had significant influence on the process of state policy-making. The medical profession, in turn, has moved from rejecting to ‘incorporating’ CAM, while the state has acted as a ‘broker’, trying to accommodate the demands and preferences of both actors while simultaneously demonstrating its power and autonomy in shaping health policy. In sum, the history of countermoves of CAM, the medical profession and the state in recasting power relations regarding CAM regulation in Portugal has highlighted the explanatory value of Light's countervailing power theory and the need to move away from a professional dominance and corporatist approach, in which CAM has simply been seen as subjugated to the power of the medical profession and the state. [ABSTRACT FROM AUTHOR]

The use of complementary/alternative medicine (CAM) is typically modeled as a function of individual health beliefs, including changes in perceptions of conventional medicine, an orientation toward more holistic care, and increasing patient involvement in health care decision-making. Expanding on research that shows that health-related behavior is shaped by social networks, this paper examines the possibility that CAM usage is partly a function of individuals' social network structure. We argue that people are more likely to adopt CAM when they function as bridges between network members who are otherwise not (or poorly) connected to each other. This circumstance not only provides individuals with access to a wider range of information about treatment options, it also reduces the risk of sanctioning by network members if one deviates from conventional forms of treatment. We test this idea using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of older Americans. Analyses of egocentric social network data show that older adults with bridging potential in their networks are significantly more likely to engage in a greater number of types of CAM. We close by discussing alternative explanations of these findings and their potential implications for research on CAM usage. [ABSTRACT FROM AUTHOR]

Nearly four in ten American use complementary or alternative medicine (CAM) each year. Even with a large number of patients, CAM practitioners face scrutiny from physicians and biomedical researchers who, in an era of evidence-based medicine, argue there is little evidence to support CAM treatments. Examining how CAM has or has not been integrated into American health care is crucial in understanding the contemporary boundaries of healthcare systems. An analytical tool from science and technology studies, boundary objects, can help scholars of medicine understand which practices become integrated into these systems. Using a comparative analysis based on archival and interview data, this paper examines the use of boundary objects in two alternative medical practices – acupuncture and Christian Science. While boundary objects alone cannot explain what health practices succeed or fail, juxtaposing the use of boundary objects by different CAM groups identifies the work boundary objects do to facilitate integration and the conditions under which they “work.” I find that acupuncturists' use of sterile needles as a boundary objects assists in their effective integration into U.S. healthcare because needles are both a symbol of biomedical prowess and a potentially unsafe device requiring regulation. Christian Scientists' use of the placebo effect as a boundary object has not succeeded because they fail to acknowledge the different contextual definitions of the placebo effect in biomedical communities. This comparative analysis highlights how context affects which boundary objects “work” for CAM practices and theorizes why alternative health practices succeed or fail to become integrated into healthcare systems. [ABSTRACT FROM AUTHOR]

It has been suggested that complementary medicines are currently ‘under-regulated’ in some countries due to their potential for harm as a direct result from side-effects or interactions; from delaying more effective care; or from the economic cost of purchasing an ineffective or inappropriate treatment. The requirement of additional labelling on complementary medicine products has been suggested in Australia and may provide additional information to consumers at the point of purchase. This paper details a unique way of testing the potential effects on consumer behaviour of including either a traffic light logo or regulatory statement on labels. Using a discrete choice experiment, data were collected in 2012 in a sample of 521 Australians with either type 2 diabetes or cardiovascular disease. We find that additional labelling can affect consumer behaviour, but in unpredictable ways. The results of this experiment are informative to further the dialogue concerning possible regulatory mechanisms. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.11.043 Byline: Harish Naraindas Keywords: India; Evidence; Efficacy; Science; Medicine; Alternate; Ayurveda Abstract: The basic premise of the paper is that Western medicine's co-opting of specific technologies and materials from other (indigenous) medical traditions, stripped of the original theories underlying their use, has problematic consequences for the practitioners and patients of both source and recipient traditions. The paper begins by illustrating the historical continuity of this process by way of an example from India's colonial era. The fact that specific practices or materials are regarded as biomedically useful because they 'work' (are efficacious) does not mean that the 'traditional' theories underlying them are seen as correct. The knowledge contained in these traditions is not counted as legitimate, as the emphasis in biomedicine (the legitimate canon) on an identifiable concrete location in the body for the source of health problems creates difficulties -- both for patients when their problems are not provided with a cause that matches their subjective awareness, and for the practitioners of other traditions whose patients have been exposed to biomedicine. The paper goes on to demonstrate, using case examples from extended ethnographic fieldwork in southern India, how this is played out in a setting in which an educated Indian patient population accepts this form of knowledge as legitimate but espouses ayurvedic therapy. Notions of 'evidence' are shown to be central to the interplay between biomedical and other medical traditions, since objective tests and measures in biomedicine are accepted as the only legitimate 'evidence' of cure, but these do not necessarily accord either with the premises of these other traditions or with patients' subjective perceptions of well-being. Returning to an acceptance and practice of other traditions, consequently, requires nothing less than a fundamental cognitive shift in the grounds for what constitutes 'evidence.' Author Affiliation: CSSS/School of Social Sciences, Jawaharlal Nehru University, New Meharauli Road, New Delhi, Delhi 110067, India

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.11.025 Byline: Christine Ann Barry Keywords: UK; Evidence-based medicine; Anthropology; Alternative and complementary medicine Abstract: The growth of alternative medicine and its insurgence into the realms of the biomedical system raises a number of questions about the nature of evidence. Calls for 'gold standard' randomised controlled trial evidence, by both biomedical and political establishments, to legitimise the integration of alternative medicine into healthcare systems, can be interpreted as deeply political. In this paper, the supposed objectivity of scientific, biomedical forms of evidence is questioned through an illumination of the multiple rhetorics embedded in the evidence-based medicine phenomenon, both within biomedicine itself and in calls for its use to evaluate alternative therapeutic systems. Anthropological notions of evidence are constructed very differently from those of biomedical science, and offer a closer resonance with the philosophy of alternative medicine. Examples are given of the kinds of evidence produced by anthropologists researching alternative medicine. Ethnographic evidence of 'what works' in alternative medicine includes concepts such as transcendent, transformational experiences; changing lived-body experience; and the gaining of meaning. It is proposed that the promotion of differently constructed modes of evidence can be used to legitimise alternative medicine by widening the definition of what works in therapy, and offering a critique of what people feel is lacking from much of orthodox medical care. Author Affiliation: School of Social Sciences and Law, Brunel University, Gaskell Room 163, Uxbridge, Middlesex UB8 3PH, UK Article Note: (footnote) [star] The Department of Health National Co-ordinating Centre for Research Capacity Development supported me during the writing of this paper.

Abstract: In recent decades, Indigenous peoples across the globe have become increasingly urbanized. Growing urbanization has been associated with high rates of geographic mobility between rural areas and cities, as well as within cities. In Canada, over 54 percent of Aboriginal peoples are urban and change their place of residence at a higher rate than the non-Aboriginal population. High rates of mobility may affect the delivery and use of health services. The purpose of this paper is to examine the association between urban Aboriginal peoples'' mobility and conventional (physician/nurse) as well as traditional (traditional healer) health service use in two distinct Canadian cities: Toronto and Winnipeg. Using data from Statistics Canada''s 2006 Aboriginal Peoples Survey, this analysis demonstrates that mobility is a significant predisposing correlate of health service use and that the impact of mobility on health care use varies by urban setting. In Toronto, urban newcomers were more likely to use a physician or nurse compared to long-term residents. This was in direct contrast to the effect of residency on physician and nurse use in Winnipeg. In Toronto, urban newcomers were less likely to use a traditional healer than long-term residents, indicating that traditional healing may represent an unmet health care need. The results demonstrate that distinct urban settings differentially influence patterns of health service utilization for mobile Aboriginal peoples. This has important implications for how health services are planned and delivered to urban Aboriginal movers on a local, and potentially global, scale. [Copyright &y& Elsevier]

Abstract: Premenstrual syndrome (PMS) and its derivative Premenstrual Dysphoric Disorder (PMDD) are controversial medical diagnoses. On one hand they are ubiquitous in English-language cultures; on the other they are for many emblematic of unnecessary medicalization of natural physiological processes. In this paper, we use data produced by IMS, a health care information and research firm, to analyze office-based medical practice related to PMS/PMDD in five countries. We come to several conclusions: 1. Relatively few doctors in any country diagnose women as suffering from PMS/PMDD, despite significant national variations in frequency of diagnosis; 2. Women diagnosed with this condition are usually prescribed a medication no matter what kind of specialist they see; and 3. In North America and the UK, practitioners generally follow USA practice guidelines which favour use of anti-depressive drugs like SSRIs but this is not the case in France and Germany which exhibit unique prescription patterns. In France hormonal treatment and analgesics dominate; in Germany the plant extract Vitex agnus-castus, considered an alternative therapy in much of the English-speaking world, is most common. We go on to discuss the relevance of these conclusions to discussions of variations in medical practices, to the existing PMS literature that claims high rates of prevalence for this condition, and to recent studies of “demedicalization” in certain domains. [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: Rather than using different therapies in isolation, many cancer patients use different therapies in a complementary fashion. Little research to date has given attention to individuals’ experiences of the combined use of biomedically oriented health care (BHC) and complementary and alternative therapies (CATs). Therefore, this paper examines one individual''s negotiation between complementary self-care methods and BHC in the treatment of cancer in Stockholm, Sweden. Using narrative analysis, we explore how a personal narrative is told, in addition to what is told, in order to see how the meaning of the negotiation between different therapies is created. Our analysis suggests that the BHC retains a vital role as a frame of reference for the use of certain CATs. It is also apparent how one CAT can be used for different purposes simultaneously by one individual. A positive example is given of how a spouse interpreted his experience of successful communication about CATs with a BHC provider as indicative of a shift from a hierarchical to a more collaborative relationship. Such increased collaboration between stakeholders is an important aspect of models of ‘integrative health care’. Our findings highlight the need for an open and respectful dialogue about CATs between patients, their significant others and BHC providers. [Copyright &y& Elsevier]

Abstract: High levels of use of complementary and alternative medicine (CAM) have been consistently reported amongst cancer patients over recent years. This is occurring in the context of an apparent increase in sources of information on therapeutic alternatives and a growth in the range of those claiming professional expertise in the field. To date there has been little research on patient experience of discussions about CAM with biomedical cancer specialists in this increasingly complex social environment. This paper addresses three issues: patient experience with cancer specialists; the significance of that experience for patient engagement with CAM; and the nature and significance of inter-professional dynamics. It draws on the results of a qualitative study with cancer patients in the UK. In-depth interviews with 80 purposively sampled patients, incorporating a range of disease types and stages, were conducted. Patients reported three main types of approach by oncologists: explicit or implicit negativity; supportive ambivalence; and, pragmatic acceptance. Crucially, patients’ accounts suggest that the type of approach adopted influences (though does not determine) patient action. Specialist cancer nurses emerged as potentially powerful mediators between oncologists and patients. Despite the apparent potential for influence from multiple information sources and ‘experts’, on the basis of this study we would argue that oncologists remain crucial to patient engagement with CAM. However, this is not to argue that the influence is a simplistic one. Where patient and medical perspectives diverge, strategic alignment with specialist nurses may help patients make choices which conflict with perceived advice. [Copyright &y& Elsevier]

Abstract: The development of “integrative health care” (IHC) settings combining various aspects of Western biomedicine and complementary/alternative medicine (CAM) is a relatively recent phenomenon among biomedical and CAM professions. While IHC is recognised internationally and occurs in many different contexts (e.g. clinic or hospital), patterns of interaction between biomedical and CAM practitioners, and the nature of IHC settings, are largely unknown. This paper presents findings from a research study of two newly established IHC settings in Canada. The main research question was: how are biomedical and CAM practitioners integrating or not integrating with each other at the level of professional interaction in IHC settings? Using a case study design, in-depth interviews were conducted with 13 biomedical and eight CAM practitioners during 2002–2003, and ethnographic observation and document analysis was conducted at each site. Drawing from closure theory of the professions, comparative analysis of the sites revealed that biomedical practitioners enact patterns of exclusionary and demarcationary closure, in addition to the use of “esoteric knowledge”, by: (a) dominating patient charting, referrals and diagnostic tests; (b) regulating CAM practitioners to a specific “sphere of competence”; (c) appropriating certain CAM techniques from less powerful CAM professions; and (d) using biomedical language as the primary mode of communication. CAM practitioners, in turn, perform usurpationary closure strategies, by: (a) employing their own “esoteric knowledge” in relation to biomedicine and other CAM professions; (b) appropriating biomedical language and terminology; (c) increasing their professional status by working with biomedicine; and (d) referring among CAM practitioners to increase patient flow. The findings suggest that when attempts are made to integrate biomedicine and CAM, dominant biomedical patterns of professional interaction continue to exist. Despite continued patterns of social closure, biomedical and CAM practitioners continue to provide a certain form of integrative care that may be of benefit to patients, albeit not as integrative as current models of integration would prefer. [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]

There has been a continuing debate about the extent to which the public finds health-care technological innovation acceptable. The public's ambivalence about scientific medicine may have been exacerbated, more recently, by developments such as the introduction of the 'new genetics' with their associated ethical and social implications and the claims that public trust in health care and practitioners and, more widely, in society has been eroded. The aim of this paper is to examine public attitudes to a range of innovative health-care technologies to see whether (i) certain technologies are perceived as particularly problematic, and (ii) attitudes to new health-care technologies are associated more broadly with beliefs about science, trust in health care and social trust, and perceptions of the benefits and risks of complementary and alternative medicine versus orthodox (technological) medicine. These questions are examined through a statistical analysis of data collected in a national, postal survey of the adult population (n = 1187) in England and Wales. The results showed public ambivalence about new health-care technologies, although genetic technologies, as a whole, were not seen to be problematic and their acceptability depended on their ability to control serious diseases. However, there was a level of consistency in attitude across the different technologies. Those consistently against new health-care technologies were also more likely to be suspicious of science, and doubtful about the benefits of other established, orthodox technologies (screening; medications) and to have less trust in health and health-care practitioners. [ABSTRACT FROM AUTHOR]

This paper presents a narrative analysis of complementary/alternative medicine (CAM) use by parents for children with Down syndrome (DS), based on interviews conducted with thirty families. Critics often presume that CAM use for children with developmental disabilities reflects parental desperation in the face of limited biomedical options. Integrating insights from anthropological studies of CAM with narrative analyses in disability studies, we constructively complicate this interpretation in two ways. First, we suggest that the appeal of CAM may lie in its discursive consonance with the broader narrative strategies through which parents construct alternatives to conventional definitions of DS as a condition with a fixed, universal, and essentially pathological course. Second, we submit that the process of seeking and evaluating information about CAM is consonant with how parents construct their identities as ‘good’ parents through describing their roles as committed advocates and service coordinators for their children. In these ways, CAM can be conceptualized as a new discursive resource that parents engage in their culturally and historically specific efforts to articulate the essential human rights of their children, and to assert the moral soundness of their own parenthood. These findings provide a new conceptualization of parents’ motives for choosing CAM, thereby posing new questions for further research about CAM use for developmental disabilities. [Copyright &y& Elsevier]

In recent years, non-conventional medicine (NCM) has grown tremendously in popularity and economic importance. This paper explores a relatively unresearched phenomenon: patients’ dissatisfaction with non-conventional medical treatment they have received. 16 out of 20 patients who had severed their contact with a large, hospital-adjacent multi-modality NCM clinic in Israel were interviewed. Two of these patients had severed their relationship with the clinic right after being referred to a certain practitioner and 18 did not keep their next appointment while in the process of treatment. The narratives through which participants understand and communicate their experience regarding dissatisfaction with NCM are organized around three main topics: independence versus paternalism, foreign versus familiar, and care versus cure. Findings illustrate the patients’ views concerning the desirable doctor–patient relationship and their expectations of non-familiar treatments. Patients are characterized as “smart consumers” who place utmost importance on outcome and do not hesitate to discontinue treatment. Findings are further discussed in the context of domestication and the minimizing of cultural difference through the integration of NCM into a biomedical setting. [Copyright &y& Elsevier]

There is a growing evidence that alternative health care practitioners and physicians are working together in collaborative patterns. The paper examines these collaborative patterns in hospital settings in Israel. On the theoretical level, the specific issues relate to theories concerning relationships between dominant institutional structures which enjoy the benefits of epistemological legitimacy as well as extensive, supportive social structures and groups of nonconformists who seek to attain many of the same goals by utilizing different methods based on other epistemologies. In the most general sense, the issues involved concern processes of accommodation and social change. Data were collected by means of semi-structured, qualitative interviews in four general hospitals in Jerusalem during 2000. Nineteen persons were interviewed including 10 alternative practitioners working in a variety of fields and nine biomedical practitioners who worked with them (six physicians and three nurses). Interviews focused on background and training, reasons for entry into the hospital, length of practice, status in the hospital system, mode of remuneration, content of work, modes of interaction with others in the hospital and problems encountered. The findings suggest a dual process of simultaneous acceptance and marginalization of alternative practitioners. While small numbers of alternative practitioners were found to be practicing in a wide variety of hospital departments and in a broad spectrum of specialties, they were in no way accepted as regular staff members and their marginality was made clear by a variety of visible structural, symbolic and geographical cues. There is a division of labour expressed by focusing on the biomedical practitioners on the diagnosis and treatment of specific disease entities, while the alternative practitioners work in the illness context, concentrating of feelings and affective states involving the alleviation of pain, suffering and... [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]

This paper is based on long-term ethnographic fieldwork among the Lelet of New Ireland Province, Papua New Guinea. It draws on qualitative interviews with Pentecostal Christians intended to examine their understanding of Christianity and how this relates to their cultural practices – in this case, how their Pentecostalism affects their therapeutic beliefs and practices. The frequent observation that therapeutic repertoires are becoming less discrete is substantiated by the Lelet case, for in their search for therapy, the Lelet often cross the borders of different repertoires, seeing no contradiction, for example, between combining a vernacular therapy with biomedicine. With the advent of Pentecostalism, the issue has become far more complex. The Lelet therapeutic culture remains pluralist, but the research shows that Lelet Pentecostals are increasingly viewing their own Christian-based forms of healing as in competition with other therapies, especially vernacular therapies. This competitive outlook has brought a demonization of vernacular therapies, which are labelled 'satanic' and their use discouraged. In fact, Pentecostalism is refashioning the realm of therapy: rather than border crossing and mixing of therapeutic repertoires, the situation is increasingly dominated by notions of mutual exclusivity. In order to comprehend the full complexity of medical pluralism, it is now necessary not only to examine how the borders of the different therapeutic repertoires are blurred, destabilized or reconfigured but also how they may be demarcated and policed. In other words, we argue that medical pluralism is being eroded by its interaction with Pentecostalism. • Healing is an important aspect of Pentecostal Christian practice in Papua New Guinea. • Pentecostals see their forms of healing as in competition with other therapies. • Pentecostals seek to regulate the borders of their therapeutic repertoire. • The rejection of vernacular therapies is a marker of born-again Christian identity. • Biomedicine is increasingly seen in mutually exclusive terms by Pentecostals. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2004.11.048 Byline: K.A. Hirschkorn (a), I.L. Bourgeault (b) Abstract: There has been an explosion of literature on the attitudes of a variety of health care providers, particularly physicians, to the growing utilization of complementary and alternative medicines and modalities (CAM). What is most seriously lacking is a conceptual framework that helps to distill this mountain of literature into a manageable and more understandable amount. In this paper, we address these important issues by examining the literature that surveys the attitudes and behaviour of providers regarding CAM comparatively across the professions of medicine and nursing and across settings. We do so by drawing upon existing, more general theoretical contributions to the area of CAM in order to propose a comparative conceptual framework with which to interpret the diverse and at times discrepant results of this body of research. Author Affiliation: (a) Department of Sociology, McMaster University, Hamilton, Ont., Canada L8S 4M4 (b) Health Studies Program & Department of Sociology, McMaster University, Hamilton, Ont., Canada L8S 4M4