Borderland Practices: Validating and Regulating Alternative Therapies in New Zealand

Abstract

This thesis focuses on the ways in which alternative approaches to health and healing are accommodated within the system of health care, controlled or rejected. A number of case studies are offered that detail the varieties of mechanisms which may limit the scope of alternative therapeutic practices. The first case study looks at the debates that occurred during the Royal Commission of Inquiry into Chiropractic in New Zealand. These debates demonstrate the rhetorical strategies used when the protagonists, the medical profession and the chiropractors, were openly confronting and attacking each other. The second case study, of medical acupuncture, is used to illustrate another dimension of regulation and control of therapeutic practice. In this case, medical practitioners using acupuncture negotiated an accommodation with their own colleagues. This case study explores debates amongst members of the New Zealand Medical Association and contrasts this with the debates amongst the medical acupuncturists themselves in terms of what forms of "knowledge" could justifiably be used by medical practitioners. It is suggested that in order for alternative therapeutic practices to gain favour, an important element required is the dilution and de-radicalisation of their philosophy. The concept of medical heresy is used to examine the way in which the orthodox medical profession deals with heretical challenges within its own ranks. The ways in which medical disciplinary bodies maintain boundaries between acceptable and unacceptable practice are investigated through a case study comparing "incompetent" doctors with a doctor who practised alternative medicine. Whereas the former were “forgiven”, the latter was ejected from the medical profession as he was deemed to have gone beyond the boundaries of sound medical practice. This occurred despite the existence of New Zealand legislation protecting doctors who adhere to unorthodox views. More subtle forms of regulation and control of therapeutic practice are explored by looking at issues that have arisen out of recent changes in medical legislation and the more broader changes in health reforms. From debates around these issues, and from interviews with general practitioners who utilise alternative therapies, ideal-type models relating therapeutic world-views, the role of the doctor, the role of the profession and the regulation of medical practices are generated. It is concluded that therapeutic practices are not validated and regulated as an outcome of findings on the efficacy of therapeutic regimes. Science and efficacy are rhetorically used, but other issues relating to political, economic and social arrangements are the overriding factors in determining the validation and regulation of clinical practice. The thesis concludes that although alternative therapeutic practices appear to be gaining in popularity, there are other developments limiting and controlling them.