Mainstreaming Complementary and Alternative Medicine

Studies in Social Context

Philip Tovey, Gary Easthope, Jon Adams

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9780415266994
• eBook ISBN: 9781135545079
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Stepping back from the immediate demands of policy-making, Mainstreaming Complementary and Alternative Medicine allows a complex and informative picture to emerge of the different social forces at play in the integration of CAM with orthodox medicine. Complementing books that focus solely on practice, it will be relevant reading for all students following health studies or healthcare courses, for medical students and medical and healthcare professionals.

Part I

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Consumption in cultural context

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Chapter 1

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Consumption as activism

An examination of CAM as part of the consumer movement in health

Melinda Goldner

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Is CAM a social movement?

CAM is more often defined as a set of diverse techniques or beliefs than as a social movement: techniques and beliefs that vary widely in their use and acceptability. However, Alster believes CAM does constitute a movement, because there are:

common beliefs about health and some common goals regarding healthcare. Furthermore, the existence of holistic journals and organisations indicates that the theme provides a common ground for diverse groups…. ‘Movement’ probably comes as close as any available term to describing the collective activity of the holists.

(Alster 1989: 47)

He goes on to argue that the CAM movement has coalesced around slogans, such as ‘you are responsible for your own health’, ‘health is more than the absence of disease’, and ‘a good practitioner must care for the whole person’ (Alster 1989: 54–5). Such beliefs and slogans provide a common sense of collective identity. Goldstein suggests that these values and beliefs allow people within such a diverse movement to ‘find a common sense of identity’ (Goldstein 1999: 136). This identity allows diverse people to identify with a seemingly cohesive movement, even when they may never interact or never agree entirely on such elements as goals. It is this collective identity, not social movement organisations, which provides cohesion for the movement.

The CAM movement, it is suggested, operates on two levels simultaneously (Schneirov and Geczik 1996). First, it acts as an interest group through lobby groups such as the Nutrition Health Alliance and professional associations such as the American Holistic Medical Association (Goldstein et al. 1987; Wolpe 1990). Interest groups try to mobilise support through advocating legislative reform, educating the general public, acquiring resources and developing coalitions. Second, the movement operates in submerged networks of social movement communities (Buechler 1990) where activists attempt to create and sustain an alternative way of life, especially through sharing information. This information is frequently mundane, such as what foods a healthy person should eat. However, ‘[it is] often placed within the broader context of a moral crusade for a deeper and more fundamental change in basic values and assumptions’ (Goldstein 1999: 136). The various submerged networks have played a larger role within the CAM movement than the interest groups just described above.

Though some activists still advocate CAM as an alternative to Western medicine (Goldner 2001), the CAM movement has been increasingly successful with the goal of integration into Western medicine so that ‘the question for healthcare systems has become not if, but when they will get involved’ (emphasis added) (Larson 2001: 6). In response to the increased numbers of consumers who are using CAM, the number of community hospitals in the USA offering CAM increased by 25 per cent from 1998 to 1999 (American Hospital Association’s Survey of Hospitals as cited in Larson 2001: 6). Medi-Cal, which is California’s version of Medicaid, now allows acupuncturists to serve as primary practitioners for enrollees (Baer et al. 1998a, 1998b). Any facility that receives accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) must educate patients about pain management with CAM. Referring to this policy, Weeks says ‘this is no longer just a consumer movement … the police power in the industry is now involved … [but] you need ongoing marketing pressure [to sustain these practices financially]’ (as quoted in Larson 2001: 9).

These various writings suggest that CAM consumers may be part of a social movement. To ascertain whether such consumers do or do not constitute a movement, I conducted an exploratory study of CAM consumers. The study is detailed below.

The study

The study was based on interviews with individuals in two locations. The first sample consisted of consumers from the San Francisco, California Bay area. This area was chosen as it has been argued that the CAM movement in the USA originated and flourished there (Baer et al. 1998a, 1998b). In order to show activism in other locations, the second sample consists of consumers from the Capital District around Albany, New York. I rely upon data from consumers; however, I also include some information on how practitioners are active as consumers.

The Bay area sample comes from a larger study of forty people: thirty practitioners and ten clients. Though I highlight the ways in which some of the thirty practitioners are active in the CAM movement as consumers, I mainly rely upon interviews with ten clients; two of whom were in the process of training to become alternative practitioners. Since I only wanted to interview people who used CAM, I located all forty respondents through posting fliers in alternative clinics and other public locations, asking clinics for recommendations from their client lists, and then using snowball sampling. Respondents were more likely to have used acupuncture, chiropractic and herbs. On average, consumers had used seven modalities; however, there was one individual who used over thirty techniques. Since I include some data on practitioners, the following are the demographic characteristics of all forty people interviewed. Respondents were overwhelmingly female (73 per cent) and Caucasian (97 per cent), and ranged in age from 35 to 63 (mean age = 47). All respondents had taken some college courses, and twenty-eight (70 per cent) finished some graduate work or earned graduate degrees. Religious or spiritual affiliation varied greatly, though ten (26 per cent) said they had no affiliation with any religion. Sixteen (40 per cent) of the respondents were currently married, though an additional thirteen (33 per cent) were previously married. Finally, respondents did not report their incomes accurately enough to ascertain a reliable range or mean.

The Capital District sample consisted of nine consumers. Three were also alternative practitioners; however, I highlight the ways in which they are active as consumers. These respondents were also located by posting fliers in clinics and utilising snowball sampling. There were four men and five women with an average age of 45 (range from 27 to 57). All were non-Hispanic white, except for one who identified as Hispanic. Four were married, three were never married and one was widowed. Three respondents had children. All respondents had some exposure to college courses, and all but one had a college degree. One also had a graduate degree. One was unemployed, while the rest were employed in a variety of jobs. Three did not identify with any religion, one identified as Pagan, another Jewish, and two as Wiccan. On average, respondents regularly used 3.2 forms of CAM with herbs, chiropractic, acupuncture and Reiki as the most popular.

Results

Most respondents identified themselves as activists within a larger CAM movement. Their activism started from their use of these techniques. They began to experience results and identify with the beliefs behind these techniques. Their activism then extended to educating others about CAM. No one in this study used CAM exclusively; rather, they desired integration with Western medicine. Consequently, they engaged in tactics that attempted to change institutions, not just individuals. For example, they requested insurance reimbursement and asked physicians, and their respective healthcare organisations, to be more accepting of CAM.

Shared actions and beliefs

In the Bay area sample, most believed there is a CAM movement, and two-thirds of the consumers identified as activists. All of the respondents in the Capital District sample believed there is a CAM movement and all identified as activists. Thus the majority of consumers in both samples believed there is a CAM movement, and most identified as activists within it. However, one Capital District respondent qualified her answer by saying, ‘I wouldn’t [consider myself an activist], because I think activists are more vocal … writing letters, lobbying … [however] within my own healthcare I would consider myself one, but I keep it to myself more’. Such a response is indicative of the different strategies and tactics that are used in this movement in comparison to most social movements. In particular, activism in the CAM movement often involves individual acts such as using these techniques, educating others and seeking insurance reimbursement. Many respondents noted how different these tactics are in comparison to other social movements that are more likely to utilise collective activities, such as public protests.

Most respondents believed that using CAM and improving their own health are forms of activism. One male said ‘[I] consider myself active [in the movement], since I use a lot of these services’. He believed that consumers can have ‘a big impact, because you’ve got more people using [CAM]’. Another respondent, who is a practitioner, stated:

it starts within each of us. It has to begin internally, I think, but then if we can help one another and influence the culture and the world we are in, then that’s fantastic. That’s what I hope for too.

A male consumer expanded on this idea:

I know for me I definitely want to use [CAM] as a tool for empowerment and politics … [In] health movements, you work on yourself first, and then work on other people … I feel really strongly about that – that you need to work on yourself whether it [is] mental, physical, or spiritual issues, and whether [you use] Qigong or another form of medicine. Whatever will help you strive to be the best you can be so you can be more effective in your daily life and help really make the change.

Consumers are often profoundly affected by CAM, not just because of the results, but because they agree with the beliefs behind these techniques. Core beliefs include defining health holistically as well-being rather than the absence of disease, stressing individual responsibility for health, and using ‘natural’ therapeutic techniques (Kopelman and Moskop 1981). These beliefs provide coherence for the movement, because they allow activists to recognise a shared ideology.

In terms of holism, some respondents simply stressed that CAM looks at the ‘whole’ person, not just one part of that person. In dealing with health and illness, this means that mental, emotional and spiritual concerns are just as important as physical symptoms and disease. Other respondents referred to specific aspects that CAM addresses, such as one woman who said that people’s feelings impact their health. The goal of health then is well-being, not simply the absence of disease. Many used the term ‘balance’ to describe what they meant by well-being. They strive for balance in their lives even when disease is not present. Others explained well-being by distinguishing between healing and curing. Even when people have a disease that cannot be cured, they can improve their lives spiritually, emotionally, mentally and socially. They experience healing. The focus on holism and well-being requires a different relationship between the practitioner and patient.

A patient’s relationship with the practitioner is different because of CAM’s expectation that consumers will take individual responsibility for their health, thus become empowered. (For a detailed elaboration of the concept of responsibility see Hughes, Chapter 2.) Individual responsibility means different things to different people. In the extreme it can mean that ‘if you accept responsibility for your health, you have to also accept responsibility for having allowed the disease, creating the disease, or gotten the disease, and that can be something people don’t want to do’. Others simply take this to mean that they need to take responsibility for finding the solution, rather than for having created the problem. Many consumers felt empowered by this. One informant even mentioned that he uses CAM as a ‘tool for empowerment’. Several respondents mentioned that being empowered to take responsibility could mean that, rather than simply taking a pill given to them by a physician, they might need to change their lifestyle.

Consumers in this study believed that CAM utilises more natural treatments, prevention and lifestyle changes. Comparing what they perceive as the more ‘natural’ treatments in CAM to Western medicine, one male said ‘you almost can’t trust regular doctors because you don’t want to be drugged up all your life’. Since many agreed that ‘a lot of times most of my ailments are ultimately lifestyle or stress-related’, possible treatments included changing jobs, seeking counselling or reducing stress. Given this belief, another woman stated ‘sometimes healing isn’t about taking a pill. Sometimes you just need to go get mad at someone, instead of holding it in. Illness will grow and grow if you don’t let that go’. Another said:

Instead of taking a Valium, come in and talk about your feelings. Come and get some support. People are beginning to realise that your emotions, instead of being dulled, need to be expressed if people are going to survive with any degree of health at the end of it.

As these quotes suggest, many consumers interviewed stressed that CAM can help to get at the ‘root of the problem’ or prevent disease entirely.

Educating others

As many respondents said, people see results, and then want to share these techniques and beliefs with others; their activism extends beyond personal consumption. Respondents emphasised that CAM is not a typical social movement, given its grassroots nature. One noted that there are pockets of users, especially in places like New York City, San Francisco and Boston, but she could not think of anyone who acts as a lead spokesperson for the national movement. Others could not think of any national organisations that are part of the movement. With no identifiable place to turn to, one activist noted that you have to talk to people to find information on CAM.

This is why one of the most critical tactics of the movement is what activists call ‘word of mouth’. Many mentioned that a family member or friend’s recommendation was the reason they first tried CAM. Now they encourage others to use these techniques. One woman said that ‘for the most part’ patients tell their family members and ‘bring them into consciousness of it…. Word of mouth is very important [because it leads to openness to try these techniques]’. Another respondent added that she considered herself an activist to the extent that she tries to ‘encourage others to look at alternatives’.

Respondents reported that many people have heard of CAM, but do not use it until someone personally recommends it. As one respondent explained, ‘most of the people that I’ve spoken to are a little bit leery about alternative medicine. Once I tell them that it’s very effective, then they catch on’. Another pointed out that someone can read an article about CAM, but they will not try it until a friend recommends it. She went on to say that her friend changed her mind. Since her consumption has ‘had a positive influence [since she says she is healthier now than she was twenty year...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of illustrations
• Notes on contributors
• Foreword: the end(s) of scientific medicine?
• Introduction
• Part I Consumption in cultural context
• Part II The structural context of the state and the market
• Part III Boundary contestation in the workplace
• Postscript
• Index