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Bounding Biomedicine

Evidence and Rhetoric in the New Science of Alternative Medicine

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.

264 pages | 7 halftones, 2 tables | 6 x 9 | © 2016


Rhetoric and Communication


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.”

Lisa Keränen, author of Scientific Characters: Rhetoric, Politics, and Trust in Breast Cancer Research

“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. This is rhetorical analysis at its finest, and this manuscript suggests a promising future trajectory for the burgeoning subfield of health and medical rhetoric.”

Amy Koerber, author of Breast or Bottle: Contemporary Controversies in Infant-Feeding Policy and Practice

“Derkatch’s Bounding Biomedicine is a valuable rhetorical analysis of how the boundary between conventional and alternative medicine has been drawn, patrolled, and renegotiated. Focusing on the moment in 1998 when the Journal of the American Medical Association and its eleven associated journals published special issues on complementary and alternative medicine, 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.”

Susan Wells, author of Our Bodies, Ourselves and the Work of Writing

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 fıne-grained.”

J. Blake Scott | Rhetoric & Public Affairs

“This book is a critical contribution to the body of scholarship on rhetorics of science, and it is an especially significant addition to the growing subfield of health and medical rhetorics.”

Rhetoric Review

“Derkatch is asking questions that anyone assessing medicine, research, and rhetoric should be asking. She encourages the reader’s critical thinking with her tone; she prods her readers to define ‘medicine’ and thus expand their own perspective on care, wellness, illness, disease, evidence and medical rhetoric. Perhaps by transparently addressing the pre-existing boundaries of biomedicine, practitioners can bridge the differences and build respect and resolution between the overlapping fields of biomedicine and CAM.”

Medical History

Table of Contents


CAM Enters Biomedicine
Rhetoric at the Fringes of Medicine
Mapping Biomedical Boundaries
Analyzing a Rhetorical Moment
Preview of Chapters

1 Evidence, Rhetoric, and Disciplinary Boundaries
Biomedicine’s Shifting Terrain: From Intuition and Experience to “Evidence”
Quantitative Evidence and Jurisdictional Control
Medical-Professional Strategies of Exclusion

2 Patrolling Professional Borders
Constituting the Medical Profession
Peer Review as Professional Self-Regulation
Categorizing Complementary and Alternative Medicine
CAM à la Carte

3 Scientific Methods at the Edge of Biomedicine
Idealizing Evidence: Scientific Methods and CAM Research
Idealizing Research: The Genre of the Randomized Controlled Trial Report
Method as a Boundary Argument
Efficacy as a Boundary Object

4 Precincts of Care in CAM Research
Models of Clinical Practice
Regulating Rhetorical Interaction
Purifying Placebo Effects
Patient Choice across Medical Models
Dietary Supplements and Patient Agency

5 Professional Borders in Popular Media
The Newsweek Special Report as a Biomedical “Discourse Moment”
Reporting the New Science
“Does it Really Work?” Constructing Biomedicine in the Media
Mapping Boundaries of Expertise in Newsweek
Displaced Stories about CAM and CAM Research

Conclusion: Boundaries as Entry Points
Works Cited

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