Complementary and alternative medicine and conventional medicine: managing pluralism in therapeutic trajectories

Abstract

Introduction: Social studies on the use of Complementary and Alternative Medicine (CAM) have concluded that, in most cases, it occurs in combination with the continuity of the use of conventional medicine (CM), a phenomenon that has been called medical pluralism [1] or mixed therapy regimens [2]. The conjugation of elements of different therapeutic systems assumes different configurations in the individual therapeutic trajectories, in terms of practices and attitudes [3]. In this paper, we discuss the ways in which individuals manage this pluralism.

Materials and methods: This analysis is empirically based on data from a qualitative research in Portugal, where 29 in-depth interviews involving individuals that used CAM were conducted, both in urban and in rural contexts. The research was approved by the Ethics Commission of Egas Moniz-Higher Institute of Health Sciences, and an informed consent form was presented to and signed by all participants in the study.

Results: The results reveal the different ways in which individuals who use CAM engage both with this medicine and with CM. They were systematized in a typology with four modes of relation to CAM, where its use as well as the use of CM intersect. Eclecticism (n = 9) corresponds to situations of regular and continuous use of CAM and CM, either simultaneously or sequentially. There may be a combination of both medicines for the same health purpose or segmentation according to the diversity of purposes. Conviction (n = 4) includes trajectories of regular and continued appeal to CAM, with ideological adherence. Its use prevails against the use of MC, in a logic which tends to replace the latter by the former. However, there is no complete abandonment of CM. Experimentalism (n = 12) is characterized by the occasional use of CAM in a logic of experimentation, with CM being the predominant therapeutic resource. The use of CAM has occurred sporadically in the past or occurs occasionally along the therapeutic trajectories. Complacency (n = 4) corresponds to circumstantial use of CAM to avoid MC, whose use is also occasional, based on a “lesser evil” logic. There is a tendency to resist orthodox or heterodox expertise and the valuation of hygienist health investments and autonomous ways of managing disease.

Discussion and conclusions: The results point to two main conclusions. First, the diversity of social practices and logics that feature the involvement with CAM are put in evidence, opposing the analysis which tend to qualify CAM users as a socially and culturally homogeneous group. Secondly, it has been shown that a relevant and fruitful analysis about the use of CAM must include the relation with CM, given the fact that this use takes place in a context of biomedical control, opposing the approaches exclusively focused on CAM.

Acknowledgements

The author acknowledges all participants in this study, the institution that hosted the research – Centro de Investigação e Estudos de Sociologia (CIES-IUL) - and the institutions that funded the research – Foundation for Science and Technology and Infarmed, Portugal.