Secret remedies: 100 years on

Paradigm-Specific Risk Conceptions, Patient Safety, and the Regulation of Traditional and Complementary Medicine Practitioners: The Case of Homeopathy in Ontario, Canada

While the principle of risk reduction increasingly underpins health professional regulatory models across the globe, concepts of risk are neither static nor epistemically neutral. Conventional biomedicine's risk conceptions are substantially rooted in principles of scientific materialism, while many traditional and complementary medicine systems have vitalistic epistemic underpinnings that give rise to distinctive safety considerations. The statutory regulation of traditional and complementary medicine providers has been identified by the World Health Organization as a strategy for enhancing public safety. However, complex risk-related questions arise at the intersection of medical epistemologies whose concepts are at best overlapping, and at worst incommensurable. Elaborating a theoretical concept of "paradigm-specific risk conceptions," this work employs Bacchi's poststructural mode of policy analysis ("What's the Problem Represented to Be?") to critically analyze risk discourse in government documents pertaining to the 2015 statutory regulation of homeopathic practitioners in Ontario, Canada. The Ontario government's pre-regulatory risk assessments of the homeopathic occupation discursively emphasized cultural safety principles alongside homeopathy-specific risk conceptions. These paradigm-specific concepts, rooted in homeopathy's epistemic vitalism, extend beyond materialist constructions of adverse events and clinical omission to address potential harms from homeopathic "proving symptoms", "aggravation," and "disruption," all considered implausible from a biomedical standpoint. Although the province's new homeopathy regulator subsequently articulated safety competencies addressing such vitalistic concepts, the tangible risk management strategies ultimately mandated for practitioners exclusively addressed risks consistent with the scientific materialist paradigm. This policy approach substantially echoes the implicit biomedical underpinnings evident in Ontario's broader legislative context, but leaves a significant policy gap regarding the primary safety considerations originally articulated as substantiation for homeopathy's statutory regulation. To optimally preserve patient safety and full informed consent, regulators of traditional and complementary medicine professionals should favor a pragmatic, epistemically-inclusive approach that actively negotiates paradigm-specific risk conceptions from both biomedicine and the occupation under governance.

Complementary and alternative medicine: Exploring the gap between evidence and usage

Debates over the efficacy of complementary and alternative medicine (CAM) are highly polarized and have received much publicity of late. While ‘believers’ in CAM campaign for its integration into the NHS, ‘sceptics’ call for the withdrawal of any public funding for such services. These debates take place in the context of a steady rise in CAM usage both in the UK and abroad. Critics of CAM often point to the lack of scientific evidence demonstrating its efficacy. The lack of evidence gathered by means of randomized controlled trials is often used to make the claim that CAM is no more effective than placebo. This article examines some of the debates surrounding the use of evidence-based medicine to assess the efficacy of CAM. It also explores a number of issues pertaining to CAM and the placebo response including the moral questions surrounding the knowing use of placebo as therapy. The rest of the article presents material from a qualitative study carried out in northern England on the understandings of CAM efficacy. The material shows that CAM therapists and patients do not reflect the polarities evident in the public debate in their own understanding and usage of CAM. Rather they are pragmatic pluralists with clear ideas about when CAM treatment is appropriate and often have sophisticated insights into the placebo response. The article concludes with a brief discussion of the implications of these findings for future work in the growing field of CAM research.