The untenable boundaries of biomedical knowledge: epistemologies and rhetoric strategies in the debate over evaluating complementary and alternative medicine

Abstract

The article addresses contemporary epistemologies in examining struggles between the proponents of diverse medical approaches — some accepted as scientific and others that have not gained this status. It is based on research that investigated one of the central questions raised as a result of the growing popularity of complementary and alternative medicine (CAM) in western countries during the past three decades, namely: How can we know if CAM treatments are effective and beneficial? Discourse analysis was conducted on publications written by medical knowledge producers — experts participating in different professional groups addressing controversies over questions such as the desirability of researching CAM treatment effects, the appropriate methodology to be employed and the appropriate criteria for evaluating these effects. Some central debates are presented in the article. Examination of these controversies indicates that diverse kinds of knowledge are held by different groups of medical professionals. The ways in which they justify their knowledge and the rhetoric strategies they use for legitimizing it are specified. The great variety found among the different kinds of medical knowledge and rhetoric strategies and their dispersal along a `scientific'—'nonscientific' continuum, highlight the untenable and ambiguous boundaries of orthodox institutionalized biomedical knowledge.