Institutional challenges in the medical evaluation of CAM in the U.S.

Résumé En

Drawing on an inductive socio-anthropological approach, our ongoing research focuses on the very particularity of the American health system which, after having initiated a model of complementarity by integrating a legitimization of CAM, is recently instituting an integrative model, more particularly regarding oncology. Since the 1990s, this original institutionalization is implemented through the creation of two federal entities in charge of medical research on CAM: the NCCAM and the OCCAM at the NCI both part of the National Institutes of Health. These medical researches on the efficacy, safety and placebo effect of such CAM are mainly structured around cancer and chronic illnesses. Since 2014, a new turning point is emerging: "integrative oncology", part of the "integrative medicine" movement, as shown by different articles in systemic journals and the new name of the NCCAM, the National Center for Complementary and Integrative Health (NCCIH). This new wave of the institutionalization of CAM is co-constructed by a plurality of agents mobilizing a variety of discursive and practical elements such as the complementarity and the integration of such CAM, terms and practices that we consider as many social, historical, political and economical characteristics of the legitimizations we try to analyze.These two federal institutions dedicated to medical research on CAM question thedifferent, sometimes competing and conflicting, modalities of evaluating the efficacy ofCAM, research ethics, public health policies regarding this medical evaluation and thevarious challenges at stake in the legitimization of an integrative model towards cancerCAM.NCI : National Cancer InstituteNCCAM : National Center for Complementary and Alternative MedicineOCCAM : Office of Cancer Complementary and Alternative Medicine