Narratividade na promoção da saúde: limites e possibilidades da racionalidade médica homeopática no cuidado centrado no sujeito / Narrativity in promoting health: limits and possibilities of homeopathic medical rationality in subject-centered care

Este artigo tem como objeto o papel da narração das histórias de vida dos pacientes durante a consulta homeopática na promoção da saúde e produção de autonomia dos sujeitos. Objetivos e Metodologia: A partir da abordagem sócio-histórica, foi realizada revisão de literatura narrativa, a fim de identificar os limites e as possibilidades do ato de narrar na racionalidade médica homeopática para a produção de subjetividades e autonomia na trajetória singular de cada indivíduo levar sua vida. Considerações Finais: Há atualidade e consonância de conceitos da racionalidade médica homeopática com o paradigma contemporâneo da promoção da saúde; as narrativas produzidas no ato da anamnese homeopática têm a potencialidade de ampliar a compreensão médica e do indivíduo para além da doença, analisando o fenômeno existencial do adoecimento. A anamnese homeopática, ao valorizar as experiências existenciais relatadas no âmbito de uma consulta, concorre para uma valorização dos sujeitos, o que contribuiria para a construção de sua subjetividade, autonomia e emponderamento.

This article focuses on the role of narrating patients' life stories during homeopathic consultations in promoting health and producing autonomy for subjects. Objectives and Methodology: Using a socio-historical approach, a narrative literature review was carried out in order to identify the limits and possibilities of the act of narrating in homeopathic medical rationality for the production of subjectivities and autonomy in the unique trajectory of each individual. your life. Final Considerations: The concepts of homeopathic medical rationality are current and consistent with the contemporary paradigm of health promotion; The narratives produced in the act of homeopathic anamnesis have the potential to expand medical and individual understanding beyond the disease, analyzing the existential phenomenon of illness. Homeopathic anamnesis, by valuing the existential experiences reported in the context of a consultation, contributes to an appreciation of the subjects, which would contribute to the construction of their subjectivity, autonomy and empowerment.

Demarcation and transformation within homoeopathic knowledge. A strategy of professionalization.

Both the medically and non-medically qualified homoeopaths in Britain have engaged in a number of changes to the way that their knowledge is constructed and communicated. In this paper we describe these changes and link them to claims for legitimacy, status and authority in the health care market. The public presentation of homoeopathic knowledge claims are thus linked to a 'professional project'.

Self-experimentation.

Except in certain cases of unusual risk, self-experimentation should not be encouraged. It is usually scientifically inadequate for lack of proper controls and sufficient subjects to generate meaningful results. It is also inadequate as an ethical test because even if lay persons are also enrolled, self-experimentation is neither necessary nor sufficient to establish that they may participate. It is not necessary to establish that lay persons may participate because institutional ethics review and informed consent are better ways to determine this. It is not sufficient because the investigator may be more risk accepting or not medically typical. Moreover, because scientific research is now done in teams, self-experimentation may involve undue influence when junior investigators participate as research subjects.

Educating the reflective practitioner: graduates in practice.

This paper draws on interview research exploring how recently graduated acupuncturists and homeopaths construct their professional identities, with a goal of assessing whether the processes and values developed in the program are carried forward into practice. The interviews were designed to engage the participants in telling stories about their work and were analyzed through discourse analysis. Although the two practitioners at the focus of this paper show considerable difference in the sophistication of their client management, both can be seen to use reflection to identify problems and find solutions in their work with clients.

No alternative? The regulation and professionalization of complementary and alternative medicine in the United Kingdom.

In conjunction with its growing popularity, complementary and alternative medicine (CAM) in the United Kingdom has witnessed increasing professionalization, partly prompted by the landmark Parliamentary Inquiry that reported in November 2000. Professionalization has become a significant strategy for practitioner associations and a key focus for the government, media, and patient groups. It is being driven by concern over the interests of patients and consumers, and in relation to the possible integration of certain forms of CAM into publicly funded healthcare. It is, moreover, being reconfigured in explicitly national terms. This paper draws on research into practitioner associations representing nine CAM modalities in the UK-aromatherapy, Chinese herbal medicine, chiropractic, crystal healing, feng shui, 'lay' homeopathy, medical homeopathy, osteopathy, and Radionics-, examining the recent wave of professionalization in relation to Foucault's concern with 'techniques of the self.' It highlights the contrasting experience of an association of Chinese herbalists seeking statutory self-regulation (SSR) and an association of chiropractors that was instrumental in securing SSR for chiropractic.

Legal ramifications of homeopathy.

The article addresses four regulatory challenges faced by practitioners of homeopathy: (1) medical practice acts, which prohibit the unlicensed practice of "medicine," (2) scope of practice limitations, which restrict nonmedical providers' ability to diagnose and treat disease; (3) prohibitions against "unprofessional conduct;" and (4) malpractice rules. The article concludes with suggestions for regulatory reform.

Midwives' support for Complementary and Alternative Medicine: a literature review.

OBJECTIVE: There is evidence that the use of Complementary and Alternative Medicine by childbearing women is becoming increasingly popular in industrialised countries. The aim of this is paper is to review the research literature investigating the midwives' support for the use of these therapies. METHOD: A search for relevant research published from 2000 to 2009 was undertaken using a range of databases and by examining relevant bibliographies. A total of thirteen studies were selected for inclusion in this review. RESULTS: The findings indicate that the use of Complementary and Alternative Medicine is widespread in midwifery practice. Common indications for use include; labour induction and augmentation, nausea and vomiting, relaxation, back pain, anaemia, mal-presentation, perineal discomfort, postnatal depression and lactation problems. The most popular therapies recommended by midwives are massage therapy, herbal medicines, relaxation techniques, nutritional supplements, aromatherapy, homeopathy and acupuncture. Midwives support the use Complementary and Alternative Medicine because they believe it is philosophically congruent; it provides safe alternatives to medical interventions; it supports the woman's autonomy, and; incorporating Complementary and Alternative Medicine can enhance their own professional autonomy. CONCLUSIONS: There is considerable support by midwives for the use of Complementary and Alternative Medicine by expectant women. Despite this enthusiasm, currently there are few educational opportunities and only limited research evidence regarding CAM use in midwifery practice. These shortfalls need to be addressed by the profession. Midwives are encouraged to have an open dialogue with childbearing women, to document use and to base any advice on the best available evidence.

[Not Available]. / Professionalisierung homöopathischer Arzte: Deutschland und Vereinigte Staaten von America im Vergleich.

The processes leading to doctors becomming professional were not until recently compared on an international scale. There is, however, still no such comparison for doctors practicing alternative medicine. The national homoeopathic doctors' association of Germany and that of the United states of America are taken here as examples to examine the similarities and differences on the road to recognition and influence. The respective institutional frameworks of these two medical markets have a considerable effect on the possibilities of homeopathy and for those practicing homeopathy to organize themselves as a recognized profession.

Autonomy and practice: the case of complementary practitioners in the UK.

OBJECTIVE: 1. To identify the level of acceptance of the principle of British Medical Association (BMA) participation in the formulation of practice guidelines for complementary medicine amongst currently active non-orthodox practitioners in the UK. 2. To identify the level of support for individual BMA proposals. 3. To identify similarities and differences of attitude to the proposals between practitioners of selected non-orthodox therapies. DESIGN: A postal survey of 1000 practitioners of complementary medicine. SETTING: The UK between late 1993 and early 1994. STUDY PARTICIPANTS: One thousand currently practising UK complementary therapists from 4 groups-chiropractic, "lay" homeopathy, medical herbalism and reflexology. Systematic sampling (every nth practitioner) was used to select 250 respondents from membership lists of relevant representative bodies. The reponse rate was 57%. RESULTS: The principle of BMA participation in policy formation was accepted by the vast majority of respondents, although 87.7% stipulated that this should not constitute a major role. Each of the individual BMA proposals received majority support. Acceptance rates varied from 59.7% to 92.9%. Statistically significant differentiation between therapies was recorded on certain proposals. DISCUSSION: The revised stance of the BMA is finding a potentially receptive audience amongst UK complementary practitioners. There is a large amount of common ground between the proposals and what is acceptable to practitioners. However, the situation is complicated by intra-sectoral differentiation. Particular therapy and issue-specific barriers exist to the universal utilization of the kind of measures proposed.

Moving forward? Complementary and alternative practitioners seeking self-regulation.

Complementary and alternative medicine (CAM) occupations continue to struggle towards achieving professional status, especially in the form of statutory regulation. Many consider professional status a worthwhile goal for CAM occupations, yet it is a process fraught with tensions. In this paper we present in-depth interview data from the leaders of three CAM groups (naturopaths, traditional Chinese medicine practitioners acupuncturists, and homeopaths) in Ontario, Canada that demonstrate four main strategies used by these groups to professionalize. The strategies discussed are related to how the knowledge base of each group is organised and transmitted. These strategies include: improving educational standards, improving practice standards, engaging in peer-reviewed research and increasing group cohesion. At the core of these strategies is the demarcation of who is qualified to practice, and a signalling to 'outsiders', such as medicine and the government, that practitioners are qualified and legitimate. Across the three groups, the leaders referred to the inclusion of medical science as a basis for distinguishing between 'science' and 'non-science' as well as who should practice and who should not. We highlight how internal battles over the infusion of medical science into the knowledge base are part of the process for establishing legitimacy for the three CAM groups in our study. We end with a brief discussion of the implications of these internal battles over medical science knowledge for the future of CAM groups.