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52 Soc. Probs. 38 (2005)
From Quackery to Complementary Medicine: The American Medical Profession Confronts Alternative Therapies

handle is hein.journals/socprob52 and id is 44 raw text is: From Quackery to Complementary Medicine: The American Medical Profession Confronts Alternative Therapies TERRI A. WINNICK, Ohio State University-Mansfield This research examines trends in coverage of complementary and alternative medicine (CAM) in five pres- tigious medical journals during a period of intense reorganization within medicine (1965-1999). Content anal- ysis of a sample of documents (N = 102) shows the medical profession responded to the growth of CAM in three distinct phases. During each phase, changes in the medical marketplace-such as relaxed medical licensing, the development of managed care, rising consumerism, and the establishment of the Office of Alternative Medicine- influenced the type of response in the journals. From the late 1960s to the early 1970s, during the condemnation phase, authors ridiculed, exaggerated the risks, and petitioned the state to contain CAM. In the reassessment phase (mid-1970s through early 1990s), increased consumer utilization of CAM prompted concern, and authors pondered whether patient dissatisfaction and shortcomings in conventional care contributed to this trend. Throughout the 1990s, in the integration phase, struggles to outlaw CAM were abandoned, physicians began learning to work around or administer CAM, and the subjugation of CAM to scientific scrutiny became the pri- mary means of control. This analysis demonstrates the evolutionary process of professionalization, a process in which dominance is sustained through adaptation to structural change. Medical practices outside the orthodoxy can be referred to and defined in a number of ways. While some still call them quackery (Barrett and Jarvis 1993; Dawkins 2003) or, less derisively, unorthodox or unconventional therapies, the current custom among research- ers is to refer to treatments such as acupuncture, chiropractic, homeopathy, naturopathy, and herbal remedies collectively as complementary and alternative medicine or CAM. The term CAM acknowledges both their disjuncture or lack of conformity with the standards of the medical community (Eisenberg et al. 1993:246), and the simultaneous growth of public acceptance and their integration into conventional treatment regimens. Almost half of Americans have tried some type of CAM. Visits to CAM practitioners have eclipsed visits to primary care physicians, with expenditures for these treatments in 1997 esti- mated at approximately $27 billion (Eisenberg et al. 1998). Articles on CAM referenced in Medline in 1996 represented about 10 percent of scientific articles in the medical literature (Barnes et al. 1999). In November 1998, an entire issue of the Journal of the American Medical Association (JAMA) was dedicated to CAM, and included several articles presenting the results of randomized controlled trials. As Michael S. Goldstein (1999) cogently observes, CAM has taken on a significant and growing presence in America (p. 8). Explanations for CAM's popularity have not kept pace with its growth, but a body of knowledge is rapidly developing. Some scholars (Astin 1998; Eisenberg et al. 1993; Kelner and Wellman 1997) find that CAM use is most prevalent among the well-educated middle-class. Others (Eastwood 2000; Goldstein 1999; Siahpush 1998) view CAM as a cultural phenomenon The author wishes to thank Eliza K. Pavalko for her guidance throughout this research and several anonymous reviewers for their helpful comments and suggestions. Direct correspondence to: Terri Winnick, The Ohio State University- Mansfield, 1680 University Drive, Mansfield, OH 44906. E-mail: winnick.3@osu.edu. Social Problems, Vol. 52, Issue 1, pp. 38-61, ISSN 0037-7791, electronic ISSN 1533-8533. © 2005 by Society for the Study of Social Problems, Inc. All rights reserved. Please direct all requests for permission to photo- copy or reproduce article content through the University of California Press's Rights and Permissions website, at http://www. ucpress.edu/journals/rights.htm.

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