Commentaries
Contextualizing Integration: A Critical Social Science Approach to Integrative Health Care

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Abstract

This article argues for the importance of examining the phenomenon of integrative health care in broader social and historical contexts. The authors examine mainstream approaches to identify patterns of integrative medicine and criticize them for their neglect of clashes among different philosophical paradigms and the wider social contexts that govern health care in practice. The authors outline a framework and highlight the values of a critical social science perspective in deepening our understanding of recent transformations in health care practice and issues surrounding biomedicine and complementary/alternative medicine (including chiropractic, naturopathy, massage, acupuncture/oriental medicine, etc) and traditional medicine. A critical social science perspective pays special attention to complex power relations, inclusionary/exclusionary strategies, and interprofessional dynamics in medicine. Drawing upon recent research findings, the authors illustrate how such a perspective reveals the intricacies and tensions that surround the integration of different paradigms of health care practice. The authors summarize the importance of situating integrative health care in structural contexts and affirm their commitment to a critical social science approach.

Section snippets

Prevailing Approaches/Models on IHC and Their Limitations

Over the last decade, many health service researchers and theorists have constructed models often to identify core values that may allow integrative care to be accomplished.14, 15, 16, 17 Such commentators have suggested that the construction of conceptual models may help in identifying possible patterns or forms of collaboration of conventional medicine and CAM in different health settings. For instance, Boon et al16, 18 devised a conceptual framework based on a comprehensive review of the IHC

A Critical Social Science Perspective on Health Care

Strictly speaking, the critical social science perspective is not a unique school but an interpenetrating body of work informed by the tradition of critical theory of the Frankfurt School7, 8 and recent developments in the sociological study of science and professions.9, 10, 11 Critical theory recognizes that existing social arrangements may not exhaust all possibilities, and it advocates the need for a critical engagement with contemporary social structures and power relations. By

Examining IHC From a Critical Social Science Perspective

In thinking about IHC critically, it is important to consider what is actually occurring interprofessionally between biomedicine and CAM within grassroots as well as wider sociohistorical contexts. Simplistic notions and models of integration suggest a coming together of practices and/or practitioners and a sense that there is more linearity to health care delivery across the modalities available. Yet, using a critical social science perspective and situating the development of IHC in wider

Conclusion

This article argues for the importance of examining the phenomenon of IHC in broader social and historical contexts. Through critiquing the mainstream approach to defining IHC, we highlight the value of a critical social science perspective in deepening our understanding of recent transformations in health care practice.64 With its concern to investigate power and knowledge, the perspective highlights the intricacies and tensions that surround the integration of different paradigms of health

Funding Sources and Potential Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Practical Applications

  • •

    This article criticizes mainstream approaches to integrative medicine for neglecting the wider structural contexts that govern health care in practice.

  • •

    The authors call for a critical social science approach that situates integration within complex power relations and interprofessional dynamics.

References (65)

  • StumpfSH et al.

    Divining integrative medicine

    Evid Based Complement Alternat Med

    (2008)
  • BarrettB

    Alternative, complementary, and conventional medicine: is integration upon us?

    J Altern Complement Med

    (2003)
  • BaerHA

    Toward an integrative medicine: merging alternative therapies with biomedicine

    (2005)
  • HeldD

    Introduction to critical theory: Horkheimer to Habermas

    (1980)
  • CalhounC

    Critical social theory: culture, history, and the challenges of difference

    (1995)
  • YearleyS

    Making sense of science: understanding the social study of science

    (2005)
  • FreidsonE

    Professionalism: the third logic

    (2001)
  • StrausR

    Nature and status of medical sociology

    Am Sociol Rev

    (1957)
  • CoulterID

    Sociological studies of the role of the chiropractor: an exercise in ideological hegemony?

    J Manipulative Physiol Ther

    (1991)
  • SundbergT et al.

    Towards a model for integrative medicine in Swedish primary care

    BMC Health Serv Res

    (2007)
  • MyklebustM et al.

    An integrative medicine patient care model and evaluation of its outcomes: the University of Michigan experience

    J Altern Complement Med

    (2008)
  • BoonH et al.

    From parallel practice to integrative health care: a conceptual framework

    BMC Health Serv Res

    (2004)
  • TatarynDJ et al.

    Combining conventional, complementary, and alternative health care: a vision of integration

  • BoonH et al.

    Integrative healthcare: arriving at a working definition

    Altern Ther Health Med

    (2004)
  • MannD et al.

    Moving toward integrative care: rationales, models, and steps for conventional-care providers

    Complement Health Pract Rev

    (2004)
  • VohraS et al.

    Integrating complementary and alternative medicine into academic medical centers: experience and perception of nine leading centers in North America

    BMC Health Serv Res

    (2005)
  • BoonHS et al.

    Integrative medicine: a tale of two clinics. BMC Complement

    Altern Med

    (2008)
  • BellIR et al.

    Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary health care

    Arch Intern Med

    (2002)
  • DacherES

    A systems theory approach to an expanded medical model: a challenge for biomedicine

    J Altern Complement Med

    (1995)
  • RanjanR

    Magic or logic: can “alternative” medicine be scientifically integrated into modern medical practice?

    Adv Mind Body Med

    (1998)

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