Bounding Biomedicine

Book excerpt: During the 1990s, unprecedented numbers of Americans turned to complementary and alternative medicine (CAM), an umbrella term encompassing health practices such as chiropractic, energy healing, herbal medicine, homeopathy, meditation, naturopathy, and traditional Chinese medicine. By 1997, nearly half the US population was seeking CAM in one form or another, spending at least $27 billion out-of-pocket annually on related products and services. As CAM rose in popularity over the decade, so did mainstream medicine's interest in understanding whether those practices actually worked, and how. Medical researchers devoted considerable effort to testing CAM interventions in clinical trials, and medical educators scrambled to assist physicians in advising patients about CAM. In Bounding Biomedicine, Colleen Derkatch examines how the rhetorical discourse around the published research on this issue allowed the medical profession to maintain its position of privilege and prestige throughout this process, even as its place at the top of the healthcare hierarchy appeared to be weakening. Her research focuses on the ground-breaking and somewhat controversial CAM-themed issues of The Journal of the American Medical Association and its nine specialized Archives journals from 1998, demonstrating how these texts performed rhetorical boundary work for the medical profession. As Derkatch reveals, the question of how to test healthcare practices that don't fit easily (or at all) within mainstream Western medical frameworks sweeps us into the realm of medical knowledge-making--the research teams, clinical trials, and medical journals that determine which treatments are safe and effective--and also out into the world where doctors meet patients, illnesses find treatment, and values, practices, policies, and priorities intersect. Through Bounding Biomedicine, Derkatch shows exactly how narratives of medicine's entanglements with competing models of healthcare shape not only the historical episodes they narrate but also the very fabric of medical knowledge itself and how the medical profession is made and remade through its own discursive activity.