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Bounding BiomedicineEvidence and Rhetoric in the New Science of Alternative Medicine$
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Colleen Derkatch

Print publication date: 2016

Print ISBN-13: 9780226345840

Published to Chicago Scholarship Online: September 2016

DOI: 10.7208/chicago/9780226345987.001.0001

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Precincts of Care in CAM Research

Precincts of Care in CAM Research

(p.106) 4 Precincts of Care in CAM Research
Bounding Biomedicine

Colleen Derkatch

University of Chicago Press

Central to the question of methodology in research on complementary and alternative medicine (CAM) is the practitioner-patient relationship, the most unambiguously rhetorical element of clinical medicine. Increased interaction between practitioners and patients in any medical model may have unintended—and unquantifiable—therapeutic effects. Chapter Four examines how research on CAM configures practitioner-patient interaction, particularly in relation to prevalent models of medical practice, including patient-centered care and evidence-based medicine. It argues that studies of CAM posit practitioner-patient interaction as a potential contaminant in trials of acupuncture and chiropractic, wherein attempts to control for placebo effects are, in many cases, attempts to control for interaction effects. Probing these interaction effects can further contribute to new understandings of how practitioner-patient encounters can influence health outcomes. Finally, the chapter examines patient autonomy, closely linked to interaction and central to discourses about CAM both in the texts under study and I medical discourse more generally. The actual extent of autonomy afforded to patients in medical settings, alternative or not, is often illusory, framed within generic and rhetorical processes that necessarily tilt the course of decision-making in particular, and predictably biomedical, directions.

Keywords:   Methodology, interaction, clinical medicine, patient-centered care, evidence-based medicine, acupuncture, chiropractic, placebo effects, patient choice, medical discourse

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