In the language of medicine, how does evidence persuade?
Debates in biomedicine about complementary and alternative medicine (CAM) generally hinge on whether or not there is sufficient evidence of their safety and efficacy. But evidence in medicine does not emerge, free of conflict or context, directly out of research settings. Instead, research data are transformed as they move from labs and clinics out into the wider world, qualifying as “evidence” only once validated in peer-reviewed journals published by established medical organizations.
Bounding Biomedicine: Evidence and Rhetoric in the New Science of Alternative Medicine (University of Chicago Press, 2016) tracks how the concept of evidence is invoked in arguments about CAM to show that what counts as a safe, effective health treatment—whether alternative or not—is shaped by the terms of the debate itself. It focuses on medical research on practices such as chiropractic, energy healing, herbal medicine, homeopathy, meditation, naturopathy, and traditional Chinese medicine. During the 1990s, an unprecedented number of Americans turned to these practices; by 1997, nearly half the US population was seeking CAM, spending at least $27 billion out of pocket. Bounding Biomedicine centers on this boundary-changing era, looking at how consumer demand shook the health care hierarchy.
Drawing on scholarship in rhetoric and science and technology studies, the book examines how the medical profession scrambled to maintain its position of privilege and prestige, even as its foothold appeared to be crumbling. I analyze CAM-themed medical journals and related discourse to illustrate how members of the medical establishment applied Western standards of evaluation and peer review to test health practices that did not fit easily (or at all) within standard frameworks of medical research. And I show that, despite many practitioners’ efforts to eliminate the boundaries between “regular” and “alternative,” this research on CAM and the forms of communication that surrounded it ultimately ended up creating an even greater division between what counts as safe, effective health care and what does not.
Praise for Bounding Biomedicine
Susan Wells, author of Our Bodies, Ourselves and the Work of Writing: “Bounding Biomedicine offers a deeply textured account of how two incommensurable frames of medical practice met. Derkatch’s book sets a new standard for research in medical rhetoric.”
Amy Koerber, author of From Hysteria to Hormones: A Rhetorical History and Breast or Bottle: Contemporary Controversies in Infant-Feeding Policy and Practice: “This innovative book is sure to attract readers from the humanities and social sciences as well as health and medicine. Derkatch weaves together an impressive amount of evidence to support her arguments. Yet she does so in a way that does not overwhelm the reader. Rather, her argument unfolds in such a way that to read this book is more like reading a compelling story that subtly, almost imperceptibly, changes the reader’s worldview along the way.”
J. Blake Scott, author of Risky Rhetoric: AIDS and the Cultural Practices of HIV Testing: “Bounding Biomedicine makes a groundbreaking methodological contribution to the rhetoric of health and medicine through its innovative variation of a rhetorical–cultural approach. In the process of examining a contextualized historical moment of boundary negotiation from multiple perspectives, Derkatch shows how rhetorical analysis can be culturally informed and multiangled, but also focused and fine-grained….[T]his book can also more broadly shape our understanding of other attempts to renegotiate biomedical boundaries, such as attempts to medicalize under-recognized illnesses, elevate the standing of marginalized practitioners, and better account for patients’ experiential knowledge of medical research and regulatory processes.”
Lisa Keränen, author of Scientific Characters: Rhetoric, Politics, and Trust in Breast Cancer Research: “Bounding Biomedicine deepens our understanding of how the borders between mainstream and complementary and alternative medicine are drawn and redrawn and illuminates the complex roles that competing forms of evidence play in that process. This book will be of interest to medical professionals, scholars, and practitioners alike.”
Erin A. Frost, Rhetoric Review: “Part of the beauty of Derkatch’s approach is that she takes a single set of artifacts and, over the course of the book, looks at it through a variety of rhetorical-cultural terministic screens. This multiple-methods approach offers a triangulated, descriptive account of boundary work, rather than a prescriptive argument for where biomedical boundaries should lie. In short, Derkatch’s Bounding Biomedicine is a cogent and valuable read for scholars of rhetoric, science, medicine, and technical communication. It is sure to provide material for vital conversations in studies of rhetorics of health and medicine for years to come.”
Carie S. Tucker King, Medical History: “The text should be introduced to graduate students as well as researchers and practitioners in science and the humanities. Like Segal’s Health and the Rhetoric of Medicine and Mol’s The Body Multiple, Derkatch’s Bounding Biomedicine is destined to become a muse for medical and scientific rhetoricians.”
Kristin Bivens, Technical Communication Quarterly: “Although scholars of the rhetorics of science, health, and medicine are the primary audience of this work, secondary audiences might include researchers from the social sciences and biomedical researchers. From Derkatch’s work, these scholars will benefit from her deeply contextualized rhetorical moment and the texts rooted in that rhetorical moment’s discourse. In particular, scholars interested in the reception and circulation of biomedicine’s discursivity from expert to non-expert publics will find Derkatch’s work helpful. Any scholar keen on understanding a corpus of evidence linked to a moment in history will benefit from Derkatch’s deeply contextualized, thoroughly considered, and methodically interrogated Bounding Biomedicine.”
Publisher’s Description
During the 1990s, an unprecedented number of Americans turned to complementary and alternative medicine (CAM), an umbrella term encompassing chiropractic, energy healing, herbal medicine, homeopathy, meditation, naturopathy, and traditional Chinese medicine. By 1997, nearly half the US population was seeking CAM, spending at least $27 billion out of pocket.
Bounding Biomedicine centers on this boundary-changing era, looking at how consumer demand shook the health care hierarchy. Drawing on scholarship in rhetoric and science and technology studies, the book examines how the medical profession scrambled to maintain its position of privilege and prestige, even as its foothold appeared to be crumbling. Colleen Derkatch analyzes CAM-themed medical journals and related discourse to illustrate how members of the medical establishment applied Western standards of evaluation and peer review to test health practices that did not fit easily (or at all) within standard frameworks of medical research. And she shows that, despite many practitioners’ efforts to eliminate the boundaries between “regular” and “alternative,” this research on CAM and the forms of communication that surrounded it ultimately ended up creating an even greater division between what counts as safe, effective health care and what does not.
At a time when debates over treatment choices have flared up again, Bounding Biomedicine gives us a possible blueprint for understanding how the medical establishment will react to this new era of therapeutic change.
Media
Interview on the New Books Network
Interview on the inaugural episode of Interdisciplinary Radio, in an episode entitled Science and Medicine, Pt. 1. A clip of this interview also kicks off episode 5, Science and Medicine, Pt. 2.
Where to Find Bounding Biomedicine
The University of Chicago Press Note: enter “PRBOUND15” at checkout for 15% off