The misconstruction of critical medical anthropology: a response to a cultural constructivist critique.

Since its emergence over a decade ago as a distinct theoretical framework, critical medical anthropology (CMA) has engaged in debate and dialogue with various other perspectives within medical anthropology, particularly clinical anthropology, medical ecology, and, to a lesser degree, postmodernism. While at least two genres of CMA have emerged, both of which are involved in a dialogue with each other, proponents of other perspectives often misread or "misconstruct" the agenda of CMA as both a theoretical framework and a strategy for health activism. This essay in particular critiques this process among proponents of the interpretative or cultural constructivist perspective. On a positive note, however, I urge critical medical anthropologists and cultural constructivists within medical anthropology to enter into a dialogue with each other because their two perspectives, despite the presence of obvious epistemological differences, share commonalities.

The drive for professionalization in British osteopathy.

This article examines the drive by osteopaths for professionalization in Great Britain. Whereas osteopathy evolved into osteopathic medicine and became part of the medical mainstream in the United States, osteopathy diffused from America to Britain around the turn of the century where it continues to function as a marginal profession. In an effort to overcome their marginality osteopaths have established associations and schools, lobbied for state recognition, created an umbrella organization to transcend intraprofessional rivalries, formed voluntary registers and redefined the scope of their practice. In addition to presenting an overview of these strategies for professionalization, I argue that the ability of osteopaths to obtain legitimacy depends upon convincing political and economic elites that they are useful in compensating for contradictions of capital-intensive, high technology medicine.

The American dominative medical system as a reflection of social relations in the larger society.

Expanding upon Navarro's analysis of the American biomedical sector, I argue that the phenomenon of medical pluralism has historically and continues to reflect class, racial/ethnic, and gender relations in American society. The evolution of the American medical system is traced from a relatively pluralistic one in the nineteenth century to a dominative one in the twentieth century. While legitimation and even professionalization of various alternative medical systems supports the assertion that the dominance of biomedicine is delegated rather than absolute, these processes reflect the growing accommodation on the part of alternative practitioners to the reductionist disease theory which is compatible with capitalist ideology.

The holistic health movement in the San Francisco Bay area: some preliminary observations.

This essay presents a preliminary overview of the holistic health movement in the San Francisco Bay Area. In part drawing upon ethnographic data, it examines the juxtaposition of the drive for professionalization and resistance to professionalization on the part of various alternative healers. It also considers the growing interest of biomedical physicians, corporations and government policy makers in holistic health. Despite the frequent claim that the holistic health movement constitutes a counterhegemonic effort that challenges the basic premises of biomedicine, we argue that the holistic health movement exhibits strong hegemonic attributes in that it tends to offer individualistic solutions rather than social structural ones in addressing health problems.

The drive for professionalization in acupuncture: a preliminary view from the San Francisco Bay area.

Although various biomedical physicians and chiropractors now employ acupuncture, generally as an adjunct therapy to their practices, acupuncture is quickly evolving into a professionalized heterodox medical system in various areas of the United States. This process has overlapped considerably with the rise of the holistic health movement. Acupuncture particularly obtained public recognition and political legitimation in California, where about one half of all the licensed acupuncturists in the U.S. presently practice. In part drawing upon case studies that various students conducted in a course titled "Medical Pluralism in North America and Europe" that one of the authors taught at Berkeley in the spring of 1994, this paper examines several aspects of the drive for professionalization within acupuncture in the San Francisco Bay area, one of the major centers of acupuncture in the U.S. Other major centers of the holistic health movement include New York, Boston, Washington, DC, Houston, Seattle, and Santa Fe. It considers two dimensions involved in the professionalization of acupuncture: (1) the creation of schools of traditional Chinese medicine and acupressure and (2) accommodation to the biomedical model. The essay also explores the health policy implications of the emergence of acupuncture as a professionalized heterodox medical system that views itself as an alternative or complementary form of primary health care.

Pharmacy access to syringes among injecting drug users: follow-up findings from Hartford, Connecticut.

OBJECTIVE: To break the link between drug use and the human immunodeficiency virus (HIV), in 1992 the state of Connecticut rescinded a 14-year ban on pharmacy sales of syringes without a physician's prescription. In 1993, the Center for Disease Control and Prevention (CDC) evaluated the impact of the new legislation on access to syringes among injecting drug users (IDUs) and found an initial pattern of expanded access. However, it also found that some pharmacies, after negative experiences with IDU customers, reverted to requiring a prescription. This chapter reports findings from a four-year follow-up study of current IDU access to over-the-counter (OTC) pharmacy syringes in Hartford, Connecticut. METHODS: Through structured interviews, brief telephone interviews, and mailed surveys, data on nonprescription syringe sale practices were collected on 27 pharmacies, including 18 of the 21 pharmacies in Hartford and none from pharmacies in contiguous towns, during June and July 1997. Interview data on pharmacy syringe purchase from two sample of IDUs, a group of out-of-treatment injectors recruited through street outreach, and a sample of users of the Hartford Needle Exchange Program, also are reported. RESULTS: The study found that, while market trends as well as negative experiences have further limited pharmacy availability of nonprescription syringes, pharmacies remain an important source of sterile syringes for IDUs. However, the distribution of access in not even; in some areas of the city it is much easier to purchase nonprescription syringes than in other. All of the seven pharmacies located on the north end of Hartford reported that they had a policy of selling OTC syringes, whereas only six (54.5%) of the II pharmacies located on the south end have such a policy. Overt racial discrimination was not found to be a barrier to OTC access to syringes. CONCLUSIONS: To further decrease acquired immunodeficiency syndrome (AIDS) risk among IDUs, there is a need for public education to counter empirically unsupported stereotypes about IDUs that diminish their access to health care and AIDS prevention resources and services. In states or cities where pharmacy sale of nonprescription syringes is illegal, policy makers should examine the benefits of removing existing barriers to sterile syringe acquisition. In cases in which pharmacy sale of nonprescription syringes is legal, local health departments should implement educational programs to inform pharmacy staff and management about the critically important role low-cost (or cost-free), sterile syringe access can play in HIV prevention.

The potential rejuvenation of American naturopathy as a consequence of the holistic health movement.

Naturopathy is a heterodox professionalized medical system which, in contrast to osteopathy and chiropractic, has received little attention from social scientists, particularly in the United States. This article is an attempt to correct that situation. It focuses on the history of this healing tradition by discussing three stages in the development of American naturopathy: 1) its emergence around the turn of the century; 2) its decline beginning in the late 1930s; and 3) its recent potential rejuvenation, particularly in the Pacific Northwest. The essay concludes that as a consequence of its philosophical and therapeutic eclecticism, naturopathy found itself pre-adapted to the holistic health movement that emerged in American society during the 1970s.

Bringing political ecology into critical medical anthropology: a challenge to biocultural approaches.

This essay presents an effort to incorporate the "environment" into critical medical anthropology. Rather than relying upon the multifactorial approach characteristic of medical ecology or biocultural approaches in medical anthropology, it urges critical medical anthropologists to turn to the burgeoning literature on eco-Marxism, eco-socialism, or political ecology in their efforts to develop a political ecology of health. Given that political ecologists generally advocate democratic eco-socialism as a meaningful alternative to the capitalist world system, this essay also presents a critical examination of the environmental record of post-revolutionary societies.

How critical can clinical anthropology be?

In recent years a dialogue has occurred between critical medical anthropologists and clinical anthropologists about the possibility of developing a critical clinical anthropology. Although critical medical anthropology aims to merge theory and praxis, I argue that achieving this goal in a biomedical clinical setting will be extremely difficult if not impossible. In pursuing their commitment to social action, critical medical anthropologists need to establish connections with other groups including: labor unions, ethnic minorities, women's organizations, environmentalists, and self-help groups, in the struggle to create a healthy society.

Practice-building seminars in chiropractic: a Petit Bourgeois response to biomedical domination.

As biomedicine evolved into the preserve of upper-class and upper-middle-class physicians, working-class and lower-middle-class individuals turned to chiropractic as a vehicle of upward social mobility. Practice-building seminars constitute a largely overlooked strategy by which many chiropractors have sought to address their marginal status within the U.S. medical system. Using archival and research data, this article discusses the role of these seminars in assisting chiropractors to convince their patients of the efficacy of their treatment modalities, increase their incomes, and bolster their confidence as heterodox medical practitioners.

The sociopolitical status of U.S. naturopathy at the dawn of the 21st century.

Naturopathic medicine in the United States had its inception around the turn of the 20th century. Subsequently, it underwent a process of relatively rapid growth until around the 1930s, followed by a period of gradual decline almost to the point of extinction due to biomedical opposition and the advent of "miracle drugs." Because its therapeutic eclecticism had preadapted it to fit into the holistic health movement that emerged in the 1970s, it was able to undergo a process of organizational rejuvenation during the last two decades of the century. Nevertheless, U.S. naturopathy as a professionalized heterodox medical system faces several dilemmas as it enters the new millennium. These include (1) the fact that it has succeeded in obtaining licensure in only two sections of the country, namely, the Far West and New England; (2) increasing competition from partially professionalized and lay naturopaths, many of whom are graduates of correspondence schools; and (3) the danger of cooptation as many biomedical practitioners adopt natural therapies.