RHETORICAL BOUNDARIES IN THE “NEW SCIENCE” OF ALTERNATIVE MEDICINE by COLLEEN JOAN DERKATCH BA (Hons.), The University of British Columbia, 2001 MA, Queen’s University, 2002 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES (English) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) October 2009 © Colleen Joan Derkatch, 2009 ii ABSTRACT This dissertation investigates scientific studies of complementary and alternative medicine (CAM) as episodes of scientific boundary work: these studies shift, and then seek to fix, the boundaries between what counts as proper medical science and what does not. Rhetoric scholars have mapped sites of boundary work both in science and in various CAM practices, but there is still some question of how biomedicine itself responds to challenges to its borders—and, by extension, challenges to its social and epistemic authority. This dissertation examines the rhetorical constituents of biomedical boundary work by analyzing a corpus of CAM-themed special issues of the journals of the American Medical Association from 1998, in which members of the medical profession consider the implications of including under biomedicine’s purview health practices formerly considered outside it. The project examines this corpus, and responses published in both medical and popular outlets, to illuminate some of the ways in which members of a culturally dominant profession evaluate medical therapies in the face of disciplinary unrest, both within and beyond the borders of their profession. The chapters move from contexts internal to medicine to those external, mapping, sequentially, the historical-professional, epistemological, clinical, and popular dimensions of biomedical boundary work. The project aims to provide a more nuanced, stratified account of the rhetorical negotiation of medical and scientific boundaries. Its main claim is that, despite the willingness of many medical researchers and practitioners to elide distinctions between mainstream and alternative medicine, this research on CAM, and its related activities (i.e., publication, clinical practice), ultimately strengthen those distinctions and expand science’s authority in medicine. iii TABLE OF CONTENTS ABSTRACT.................................................................................................................................... ii TABLE OF CONTENTS...............................................................................................................iii LIST OF ACRONYMS ................................................................................................................. iv ACKNOWLEDGEMENTS............................................................................................................ v INTRODUCTION Traversing Professional Boundaries in Rhetoric and Medicine ..................................................... 1 CHAPTER ONE Patrolling Professional Borders .................................................................................................... 23 CHAPTER TWO Scientific Method as a Rhetorical Topos...................................................................................... 67 CHAPTER THREE CAM Research and the Rhetorical Conditions Governing Clinical Practice ............................. 120 CHAPTER FOUR Defining Professional Borders in Popular Media ....................................................................... 171 CONCLUSION Boundaries as Points-of-Entry .................................................................................................... 217 WORKS CITED ......................................................................................................................... 227 APPENDIX................................................................................................................................. 244 iv LIST OF ACRONYMS AMA American Medical Association CAM Complementary and alternative medicine DSHEA Dietary Supplement Health and Education Act EBM Evidence-based medicine FDA Food and Drug Administration JAMA Journal of the American Medical Association NCCAM National Center for Complementary and Alternative Medicine NIH National Institutes of Health OAM Office of Alternative Medicine PCC Patient-centred care RCT Randomized, controlled trial SCI Socially complex intervention TCM Traditional Chinese Medicine v ACKNOWLEDGEMENTS I have had the good fortune over the course of writing this dissertation to have received care and attention and support from numerous colleagues, mentors, and friends, without whom I could not have completed it. This thesis was completed with financial support from the Social Sciences and Humanities Research Council of Canada, as well as several scholarships from my home department, funding for which I would like to express my gratitude. I am grateful to members of the UBC English Department for giving me a generative environment in which to work, and to the participants at the conferences and workshops at which I have presented portions of this thesis for their feedback. Deborah Dysart-Gale, Lisa Keränen, Joan Leach, and Philippa Spoel, especially, have gone out of their way to help me find my feet, and I am delighted and lucky to know them. My committee members have challenged and energized me throughout this project, and each has made a strong imprint on my scholarly development. I thank Leah Ceccarelli and Janet Giltrow for their careful reading of and commentary on my work. And Judy Segal, my supervisor, I really do not know how to thank for her careful attention, incisive critiques, mentoring, collaboration, and good company over these years. When I first met her, as an undergraduate in her History and Theory of Rhetoric class, I really thought I was going be a Shakespearean. She taught me what rhetoric is, and what it can do. Closer to home, my friends have been indispensible in the completion of this project, especially Kim Duff and Heather Latimer, and my parents, Dorothy and Jim Derkatch, have encouraged and supported me all along. Finally, I thank Isla Whitford, such a bright light and a lot of fun, and Nathan Whitford, who carried so much of the load, for so long, to give me space and time to work. All I can say to him, inadequately, is thanks—“just for.” 1 INTRODUCTION Traversing Professional Boundaries in Rhetoric and Medicine The study of rhetoric at the fringes of medicine is illuminating for both medicine and rhetoric. Rhetoric helps us to investigate fringe patients, fringe illnesses, fringe practitioners, and fringe health models—to study the means through which they fail, somehow, to fit within the accepted boundaries of mainstream scientific (or bio-) medicine. Such medical fringes, in turn, offer to rhetorical theory productive ways of tracing what sociologist Thomas Gieryn calls the “boundary work” of science: they focus attention on the shifting border between what is deemed legitimate within science, and what, not. This dissertation investigates the rhetorical constituents of boundary work within biomedicine by examining a specific moment, in the late 1990s, when certain of the fringe health practices known collectively as Complementary and Alternative Medicine (CAM) were subjected for the first time to concerted, large-scale scientific scrutiny. I view this moment as a period of disciplinary anxiety, with practitioners both within biomedicine and beyond struggling to identify their positions vis-à-vis this awkward union of different health models, loosely categorized here as “mainstream” and “alternative.”1 This study contributes to scholarship on medical and professional discourses and to humanities-based research on health, and adds greater nuance to our understanding of rhetoric as communication among individuals and groups with disparate backgrounds, motives, ideologies, and expertise. The present chapter introduces and contextualizes the project, describes my rhetorical methodology, and outlines the chapters that follow. 1 I return to definitions of mainstream and alternative health below but will note here that the category of CAM unites a disparate group of practices (e.g., chiropractic, energy healing, herbal medicine, homeopathy, meditation, naturopathy, Traditional Chinese Medicine) under a single rubric—a rubric that depends essentially on a negative relationship to conventional medicine. While the category itself is problematic, its negative definition reveals how such practices are conceived, generally, in biomedicine: as not-biomedicine. INTRODUCTION 2 CAM in Biomedicine: Developing a Rhetorical Account Contemporary Western medicine is shaped predominantly by the biomedical model, which medical anthropologist Howard Stein identifies as having its roots in the “basic sciences”: anatomy, biochemistry, microbiology, pathology, and physiology (xiv). As a descriptive term, biomedicine does not refer to a fully fixed set of medical values or practices, but certain overarching tenets characterize the ways in which medicine is conceptualized and taught in North America (and elsewhere). In addition to having its foundation in sciences such as anatomy and pathology, notes Stein, the biomedical model assumes the following: that medicine is, and ought to be, predicated on “rational, scientific, dispassionate, objective, professional judgment”; that the causes of disease are rooted in organic pathology, typically at the cellular level; and that disease is “optimally” treated by interventions resulting in a cure (xiv).