Integrative health care: a critical analysis of the integration of complementary

The development of 'integrative health care' (IHC) combining various aspects of conventional biomedicine and complementary/alternative medicine (CAM) is a relatively recent phenomenon among the biomedical and CAM professions. While IHC is recognized internationally and occurs in many different health contexts, patterns of interaction between biomedical and CAM practitioners, and the nature of IHC settings, are largely unknown. Further, the health system context in which IHC occurs, and its various effects on IHC settings, has not been systematically analyzed. Finally, there is virtually no critical literature on the IHC phenomenon. This research attempts to fill these gaps. This thesis examines three IHC settings in Canada, by examining how biomedical and CAM practitioners are integrating or not integrating with each other at the level of professional interaction in IHC settings. The thesis also examines one aspect of health systems---the unfunded nature of CAM health services located in the private health sector, and its various effects on the integration of biomedicine and CAM in Canada. A critical examination of IHC from an anti-colonial perspective, one that is largely overlooked in analysis of the CAM and biomedical professions, is offered here. The findings in this thesis suggest that when attempts are made to integrate biomedicine and CAM, dominant biomedical patterns of professional interaction continue to exist. Furthermore, the private nature of CAM services in Canada is one aspect of health systems, among others, that negatively affects attempts to integrate biomedicine and CAM. Fundamental challenges such as biomedical 'evidence', knowledge devaluation, and appropriation and assimilation of CAM modalities remain challenges to establishing 'more equitable' forms of IHC. It is likely that biomedically-controlled and other types of IHC will continue to co-exist in health care systems. Future analysis of IHC needs to take into account the complexity of a health system context that continues to shape IHC. Fifty in-depth interviews were conducted between 2002 and 2003, with biomedical and CAM practitioners, patients and stakeholders, drawing on a critical ethnographic methodology. Detailed field observations of the sites were also made. Comparative analysis of the sites revealed that biomedical practitioners enact patterns of exclusionary and demarcationary closure, in addition to using 'esoteric knowledge'. CAM practitioners, in turn, perform usurpationary closure strategies. Patients could not consistently afford certain biomedical and CAM treatments, resulting in the premature termination of an integrative care plan. CAM practitioners working in the private sector could not uniformly attend group rounds as they were not publicly funded. Certain biomedical institutions viewed CAM as a commodity from which to generate revenue and lower budgetary deficits. An anti-colonial analysis illustrates how interprofessional conflict between biomedicine and CAM 'glosses over' fundamental paradigm clashes and biomedical processes of appropriation, assimilation and knowledge devaluation, ultimately traced to colonial exploits of other subjugated knowledges and sciences.

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