Complementary and Alternative Medicine

Structures and Safeguards

Geraldine Lee-Treweek, Tom Heller, Hilary MacQueen, Julie Stone, Sue Spurr

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000082777
• Edition: 1
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Complementary and alternative medicine (CAM) is a fascinating and fast-changing area of medicine. This book explores the challenging issues associated with CAM in the context of the social, political and cultural influences that shape people's health. It:

• provides an overview of social change, consumption and debates arising from the increased public interest in CAM, arguing for and against different classifications
• discusses how CAM developed in a political and historical context, critically assessing the importance of ethics and values to CAM practice and how these inform what practitioners do
• analyzes the question of what people want, the changing contested nature of health, and the nature of personal and social factors associated with the use of CAM
• examines the diversity of settings in which CAM takes place
• explores the social, political and economic milieu in which CAM is provided and used.

The book is one of three core texts for the forthcoming Open University course K221 Perspectives on Complementary and Alternative Medicine (first presented in February 2005).

1
CAM Organisation: Safety and Standards

Edited by Tom Heller and Geraldine Lee-Treweek

Chapter 1 Knowledge, names, fraud and trust

Geraldine Lee-Treweek

Content

Aims

1.1 Introduction

1.2 Knowledge, value, monopoly and diversity

1.3 Naming, blaming and claiming

1.4 Trust, knowledge and expectations: CAM users and deception

1.5 Conclusion

Key points

References

AIMS

■ To understand how knowledge competes for authenticity and legitimacy in social life and, in particular, the way this operates in CAM.

■ To give an insight into the political nature of name-calling and blaming within CAM and between CAM and other forms of knowledge.

■ To examine the notion and label of fraud and deception in relation to CAM therapies.

1.1 Introduction

In today’s society there are increasing numbers of individuals or groups of people who claim to have knowledge that can help in health and wellbeing. On the one hand, this can be seen as a positive trend that allows people to make choices. On the other hand, it raises problems of informed choice and of the user being able to select safe and efficacious treatments. It is also certainly not the case that older forms of knowledge are ‘good’ whereas new knowledge is ‘bad’ or vice versa. This chapter will elaborate on the notion that knowledge is, in fact, ever-changing, subject to fads and fashions and, most of all, affected by power relationships. That is to say, knowledge is neither neutral nor fixed. Those who work with accepted knowledge today might be denounced as quacks or frauds by new knowledge tomorrow. At the same time, there are people whose outright deception and wish to deceive mean the label of ‘fraudster’ is justified.

This chapter begins by discussing the nature of knowledge and the relationship between the concepts of power and knowledge. Social scientists have been interested in the way forms of knowledge arise and can then maintain power in particular settings (Foucault, 1980; Mennell and Goudsblom, 1988; Delanty, 2000). Some high-status knowledge is culturally valued more than other forms. Here, the focus is on scientific knowledge and how its position as the premier form of knowledge is maintained in contemporary society. It is important to think about science as a form of knowledge because many critiques of CAM stem from the view that it is ‘unscientific’. And yet the history of much science can be considered ‘unscientific’ (Dobraszczyc, 1989). To understand this fully it is necessary to ask questions, such as how did science develop and progress? Also, are there other ‘sciences’ or approaches to explaining the world that, for one reason or another, cannot challenge orthodoxy? Established forms of knowledge can often be defended and used to attack other forms and it is interesting to identify how they are able to do this.

This chapter goes on to give some examples of disputes between different forms of knowledge and within forms of knowledge but between factions. Such disputes highlight the political nature of knowledge and often revolve around notions of authenticity — who may call themselves a practitioner, the correct forms of training and whether one approach to health and wellbeing is better than another (Gamarnikow, 1978). Also the name-calling and counterclaims of fraud-busting groups are outlined. In these cases, CAM knowledge can be seen as being attacked from outside, by those who claim to represent science and to protect the public. Such claims are sometimes said to be driven by concerns other than the lack of a scientific approach by CAM modalities.

Finally, this chapter looks at how knowledge and expertise about health and wellbeing are accepted by the lay public. In particular, it outlines the social expectations and social conditions that make people place their trust in an astonishing array of forms of health knowledge (both orthodox and CAM).

1.2 Knowledge, value, monopoly and diversity

Different forms of knowledge have varying levels of value in society. Some are more likely to be accepted and believed and have more influence over people’s lives. This ranking of information could be termed ‘a hierarchy of knowledge’, although always bear in mind that this hierarchy is fluid and changeable. Ranking will differ both among cultures and within different sectors of cultures. Individuals may have vastly different personal rankings of the importance of forms of information from each other.

ACTIVITY DESCRIBING THE WORD ‘KNOWLEDGE’

Allow 5 minutes

Look at the definition of knowledge below. It is taken from the Oxford Dictionary and is similar to definitions given in other dictionaries. Given the discussion above about knowledge, power and authority, do you notice anything about this definition and, in particular, how the word ‘knowledge’ is described?

knowledge familiarity gained by experience (of person, fact or thing); person’s range of information (it came to my -, became known to me; to my -, so far as I know, as I know for certain); theoretical or practical understanding (of language, subject); some of what is known (every branch of knowledge); -able well informed, intelligent.

Comment

You might have noticed that there is no mention of different forms of knowledge having more or less value than others within society. So, the knowledge gained by personal experience is cited as knowledge along with theoretical understanding. This type of description of knowledge has a neutral focus. However, several academic disciplines - such as philosophy, sociology, political theory and social policy - take a very different view of knowledge. These disciplines tend to emphasise the hierarchies of knowledge that define some people as more ‘knowledgeable’ and have also focused on the way in which knowledge develops, changes and is re-evaluated in different cultural and historical contexts. Furthermore, what might be termed ‘high-status knowledge’ is always bound up with interest groups and power. For instance, many powerful forms of knowledge in western society are linked to particular occupational or professional groups, leading some commentators to argue that knowledge and power are intimately related (Foucault, 1980).

One of the most interesting facts about knowledge is that it is not contained solely in books or in the minds of people who are considered intellectual or professional. Knowledge is essentially everywhere (see Box 1.1).

BOX 1.1 WHAT IS KNOWLEDGE?

It is easy to think of knowledge as being held or used by people in the professions. However, everyone uses what can be termed ‘lay knowledge’. Over time and with experience, individuals gather together ideas, skills, understandings and explanations that help them to go about their lives and deal with the issues at hand. Such knowledge is based on experience with a mixture of knowledge from a range of sources. Groups of ideas and understandings also come together to form sets or groups of knowledge and so it is possible to speak of medical knowledge, osteopathic knowledge, the lay person’s knowledge, etc. Such sets of knowledge may disagree with or contradict one another. It can also be said that some forms of knowledge, for whatever reason, are more valued in society than others.

While knowledge can be described as ranked in terms of its importance in society, there is increasing recognition that the knowledge of lay people can positively add to health care provision and practice. For instance, in the case of people with chronic illnesses, such as Parkinson’s disease, lay knowledge of how to cope with illness, which home remedies help alleviate symptoms, or practical tips on travelling are very important to the person with the illness. In many cases the medical knowledge of Parkinson’s disease cannot answer the day-to-day issues that arise, whereas lay experience and knowledge sometimes can (Pinder, 1988). The importance of harnessing lay information about illness is being recognised by the current government through the expert patient programme (Department of Health, 1999, 2000), in which people with chronic illnesses help others by passing on their lay knowledge.

Box 1.1 shows how health policy is changing towards integrating lay knowledge in some areas. However, such a view obscures the reality that some forms of knowledge are more readily accepted in formal or legal settings as ‘real’ than others. Thus the patient’s view of their illness in the orthodox medical system is usually not valued as much as their consultant’s view. The hierarchy of knowledge — or the value placed on one type of knowledge or another — is best seen on those occasions when lay knowledge challenges more formalised and institutionalised knowledge. It is interesting to note how higher-status knowledge can critique other forms of knowledge in these situations. The case study of Camelford illustrates this well.

THE CAMELFORD WATER POISONING: AN EXAMPLE OF LAY AND SCIENTIFIC KNOWLEDGE CLASHING

Water is always a problem in Cornwall: there is usually too little of it during hot summers and too much of it in winter. However, on 6 July 1988, a very different problem arose when a lorry driver accidentally tipped 20 tons of aluminium sulphate solution into the water treatment plant supplying Camelford and the immediate area of North Cornwall. Unfortunately, the accident went undiscovered for some time and local residents and tourists had already drunk the water and began to report side effects. These included vomiting, rashes, nausea, headaches and stomach upsets. Williams and Popay (1994) studied the Camelford poisoning and note that the people affected demanded information from local health professionals, the health authority and the council. The local people also organised to pull together both support and specific expertise within the community. One of the groups formed - Camelford Scientific Advisory Panel (CSAP) - comprised local people with expertise in health and allied areas who monitored people’s reports of illness and collated their accounts.

A government committee was given the task of investigating and responding to concerns about the incident (Williams and Popay, 1994). This committee reviewed all the evidence, including that given by the CSAP and the district health authority, and concluded that:

■ there had been immediate health effects, experienced by a number of people consuming the water

■ the chemicals involved were unlikely to cause problems after such a short term of exposure

■ the ‘very real health complaints’ still visible in the community were probably caused by ‘the sustained anxiety naturally felt by many people’.

The report did little to allay public fears about the long-term effects of ingesting the water and the symptoms that many people felt they continued to experience. There was a campaign demanding that the local people’s experiences be taken into account properly and, eventually, the governmental committee was reconvened. However, as Williams and Popay note, no local people, other than g...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Contributors
• Acknowledgements
• Introduction
• Part 1 CAM Organisation: Safety and Standards
• Part 2 Researching CAM
• Index