Cancer, the making of proof and the evaluation of CAM in the USA

Résumé En

Drawing on an inductive socio-anthropological and socio-historical approach, my ongoingresearch focuses on the very particularity of the American health system which, after havinginitiated a model of complementarity by articulating a legitimization of CAM, is recently institutingan integrative model, more particularly regarding oncology. This research attempts to analyze the“federal making of legitimizations towards cancer CAM” understood as the whole of practical anddiscursive processes structuring and restructuring the treatment, prevention and experience ofthe disease. To do so, this research focuses on three main objectives: public health policies,medical research and the translationality of the latter.Since the 1990s, this original institutionalization is implemented through the creation oftwo federal entities in charge of medical research on CAM: the NCCAM and the OCCAM at theNCI both part of the National Institutes of Health (NIH).1 These medical researches on the efficacy,1 NCCAM : National Center for Complementary and Alternative Medicine. NCI : National Cancer Institute. OCCAM :Office of Cancer Complementary and Alternative Medicine.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 “integrativemedicine” movement, as shown by different articles in systemic journals and the new name ofthe 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 agentsmobilizing a variety of discursive and practical elements such as the complementarity and theintegration of such CAM, terms and practices that I consider as many social, historical, politicaland economical characteristics of the legitimizations I try to analyze.These two federal institutions dedicated to medical research on CAM question thedifferent, sometimes competing and conflicting, modalities of evaluating the efficacy of CAM,research ethics, public health policies and health practices regarding cancer and CAM and thevarious challenges at stake in the legitimizations of an integrative model towards cancer CAM. Itaddresses the issues faced by agents within processes of evidence building for such CAM,practices which are often hardly fitting in experimental frameworks.The focus on cancer answers not only to the historical context and shifts in CAM researchbut also to the missions of the institutions at stake. It reveals the manners how the medicalevaluation of CAM and its legitimizations are part of the co-construction of the medical work,namely the management of patients’ care, the prevention and treatment of the disease, and theadvice offered to the patients by healthcare teams, the constitution of “integrative” wards and inparticular the task allocation between biomedical and CAM practices. It investigates how medicalresearch on cancer and CAM impacts the meanings and directions of this medical work as well asthe experience of the disease. This “negotiated order” is the product of interactions between avariety of both institutional and individual agents. It questions the significance of this making on“cancer stages”, on the agents and spaces upon which they depend, and the influence of suchlegitimizations on “therapeutic itineraries or trajectories”.This research also examines the management of the heterogeneity of health practices, itsshaping and reshaping, by sets of multiple agents and institutions belonging to different networksof interrelations. The question of the plurality of medical practices, conceptualized under theterm of “medical/therapeutic pluralism”, is at the core of different historical, legal, philosophical,economical and sociological studies, both in Europe and in the U.S., more particularly interactionsbetween medicine and CAM. Nonetheless, only very few sociological and anthropologicalinvestigations focus on the scientific evaluation of CAM in this regard. This question of theplurality of medical practices usually involves about five broad categories of agents: the State andits apparatuses, the medical profession and its institutions, other medical practices, and patientsand their respective institutions. This on-going research also departs from these broaderquestions and participates in studies aiming at understanding more closely the mechanisms atstake within the complex construction of plural medical practices.This presentation will be articulated around five main points:1. Research aims and methodological perspectives2. CAM and medical research: An institutional setting3. Different regimes of proof in the evaluation of CAM4. The plurality of CAM categories and models of integration5. Mapping the variety of networks, agents and interactions