Epistemic cultures in complementary medicine: knowledge-making in university departments of osteopathy and Chinese medicine

Abstract

There is increasing pressure on complementary and alternative medicine (CAM) to follow the evidence-based approach promoted in allied health and medicine, in which the randomised control trial represents the evidence gold standard. However, many CAM advocates see these methods as undermining the holism of CAM practice. This paper explores how such tensions are managed in CAM university departments – settings in which particular forms of knowledge and evidence are given ‘official’ imprimatur by CAM educators and researchers. By comparing two types of CAM, the paper also unpacks differences within this broad category, asking whether CAM academic disciplines comprise different ‘epistemic cultures’ (Knorr-Cetina, K. (1999). Epistemic cultures: How the sciences make knowledge. Cambridge, MA: Harvard University Press). Interviews were conducted with 20 lecturers in Chinese medicine and osteopathy, across five Australian universities, and augmented with observation in two degree programs. Findings reveal contrasting ontological and epistemological perspectives between the two academic fields. Chinese medicine lecturers had largely adopted bioscientific models of research, typically conducting laboratory work and trials, although teaching included traditional theories. Osteopathy academics were more critical of dominant approaches and were focused on reframing notions of evidence to account for experiences, with some advocating qualitative research. The study illustrates CAM’s ‘epistemic disunity’ while also highlighting the particular challenges facing academic CAM.

De‐legitimising complementary medicine: framings of the Friends of Science in Medicine‐CAM debate in Australian media reports

“…‘Pseudoscience’ and ‘nonsense’ were other common terms used in reports discussing specific modalities of CAM, as well as referring to CAM as the umbrella term for a whole swathe of undesirable practices and products. Because CAM therapies and products are so diverse, it is problematic to use this umbrella term to make generalisations about the legitimacy or efficacy of such a vast range of often paradigmatically different therapies (Broom and Tovey , Brosnan , Coulter and Willis , Derkatch , Doel and Segrott ,b, Fries 2008b, , Gale , Lewis 2011a, Wardle , Willis and White ). This ambiguity in what Fries (2008b) has referred to as the homogenisation of CAM enables the story to carry wider appeal to news audiences (Johnson‐Cartee ) and, as Wardle () argues, constructs CAM as ‘a dumping ground for therapies and practices that have little in common, meaning that well‐established therapies with good evidence of efficacy and safety are lumped in with whatever newly developed alternative health fad is being promoted on the internet’.…”

Alternative futures: Fields, boundaries, and divergent professionalisation strategies within the Chiropractic profession

“…Australia was the primary focus of the study with the UK included as a comparator case to gauge the effects of sceptic campaigns that had begun several years earlier there. While epistemic cultures in osteopathy and Chinese medicine are discussed elsewhere (Brosnan, 2016), this paper focuses on chiropractic as an example of a profession characterised by deep internal epistemological struggles. The paper draws primarily on 23 in-depth interviews with key stakeholders in chiropractic education and the profession.…”

“Do-it-yourself”: Vaccine rejection and complementary and alternative medicine (CAM)

“…We suggest that when it comes to vaccine hesitant and rejecting parents' engagement with CAM, there are competing epistemologies at work. Recent scholarship suggests that there are distinct epistemic communities within scientific disciplines and between CAM modalities, complicating the notion of such a divide (Brosnan, 2016). However, Navin's (2016) work on epistemic communities explains how those practicing the scientific method engage in adversarial methods of reasoning to ensure that 'truth will out', while communities resistant to biomedicine reason differently.…”