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This paper examines the differential incorporation of acupuncture and homeopathy into the medical establishment in Portugal. While the former has been incorporated into the medical establishment, the latter is still banned by the Medical Council, yet remains in practice by medical doctors in the country. Drawing on the insider viewpoints of medical doctors committed to these two therapies, the findings of this paper suggest that the rhetoric of insufficient scientific evidence of homeopathy still prevails within the medical establishment. However, two other factors were emphasised: the medical prejudice or 'resistance to innovation' of the Portuguese Medical Council and the idiosyncrasies of acupuncture and homeopathy, which have made them amendable to biomedicine (or not). This paper argues that the differential responses of the Portuguese medical establishment to acupuncture and homeopathy are due to reasons beyond that given of the medical rhetoric of insufficient scientific evidence for homeopathy, and which extend to issues of professional status and power. This paper suggests that the emerging commercial interest of the pharmaceutical industry in homeopathy's pharmacopeia worldwide could enhance homeopathy's status in the country and could therefore pressurise the medical orthodoxy to redress its position towards this therapy. [ABSTRACT FROM AUTHOR]

This paper explores the contemporary relevance of sociological theorisations centred on medical power, including the medical dominance and deprofessionalisation theses. To achieve this it examines two issues that have been tentatively linked to the relative decline of the power and autonomy of biomedicine - complementary and alternative medicine (CAM) and the Internet-informed patient. Drawing on these two different but interconnected social phenomena, this paper reflects on the potential limitations of power-based theorisations of the medical profession and its relationship to patients and other non-biomedically situated professional groups. It is argued that power-based conceptual schemas may not adequately reflect the non-linear and complex strategic adaptations that are occurring among professional groups. [ABSTRACT FROM AUTHOR]

The branding of ayurveda as a market strategy for the health consumer has become an important factor in the creation of 'New Age orientalist desire'. Using Vedic Village as a case, this paper shows how new age orientalism has been spread in modern India to middle class professionals, entrepreneurs and overseas health tourists. With this representation, ayurveda has become a wellness therapy instead of a means to restore health, and affluent people can now buy a package of 'ayurvedic healthy life' without changing their lifestyles. In addition to Euro-American health tourists, emerging middle class professionals and entrepreneurs in modern India have also become an integral part of the process of 'new age orientalization'. This paper concludes that the commodijied version of ayurveda, which has been developed in the West as part of 'wellness and spa culture', has become popular among the affluent middle class in India and abroad today, and through this the West has claimed and justifies authority over Eastern medicine. [ABSTRACT FROM AUTHOR]

Nurse practitioners were introduced into Australia in 1990 to improve access to health care in isolated communities where medical doctors are scarce. The slow uptake of nurse practitioners in these areas has largely been the result of legislation not affording them access to provider numbers through the Medicare Australia Act 1973. This has denied nurse practitioners the opportunity to become primary care providers because they cannot prescribe medications and order diagnostic tests at rebated costs. Recently this Act changed, making provision for nurse practitioners. Ironically the enactment of the new legislation still prevents nurse practitioners from practicing effectively. This paper describes the discursive practices in legislation, driven by traditional power brokers, which perpetuate the traditional role of nurses as care givers and fails to support the evolution of nurse practitioners as care providers. These continued practices effectively prevent nurse practitioners from working to their potential, despite government reassurance under recent health care reform in Australia. [ABSTRACT FROM AUTHOR]

Postgraduate physician assistant (PA) programs designed to train individuals for the workplace have existed since the advent of the profession itself. These residency programs continue to grow in number despite the lack of outcome data supporting improvements in PA learning, effects on career development, or improved patient care. Leadership bodies of the PA profession in the US have been at odds regarding the meaning and ramification of postgraduate programs on specialty credentialing, accreditation standards, insurance reimbursement, and employment. Using Bourdieu's cultural conflict theory as a framework, we analyze the issues confronting postgraduate PA training programs. Our paper discusses implications related to shifts in power amongst the different stakeholders concluding that, although formal postgraduate PA training can be beneficial to both the PA and the medicine, considerations related to underlying agendas need attention. [ABSTRACT FROM AUTHOR]

Much of the medical literature on patient compliance explores why patients fail to follow practitioners' instructions. This paper explores perspectives on 'compliance' expressed in online discussion groups for kidney patients. Discourse analysis was used to investigate how contributors conceptualise knowledge and the role of the renal patient. In the discussion groups, patients were sometimes seen to have better understanding of the details of their illness than some practitioners, a focus born of inhabiting their situation and therefore having more at stake. Some patients set themselves the task of supervising their own care, double checking the work of practitioners. This did not threaten biomedical knowledge, but these counter-discourses challenge professional boundaries by making it the prerogative of patients to obtain biomedical knowledge. I explore issues of surveillance and frustration, and the potential usefulness of patients' overseeing their own safety, while flagging the potential plight of less 'empowered' or motivated patients. [ABSTRACT FROM AUTHOR]

To date, sociology of health and medicine has engaged in only a limited way in debates about cognitive enhancement drugs and how they might affect or change the way we live our lives. In this review we explore the implications of the development of such drugs, both now and in the future, with particular reference to the changing drivers and dynamics of medicalisation or biomedicalisation over time. Whilst both concepts shed important light on these developments, pharmaceuticalisation provides a more precise sociological term of reference we suggest for tracing and tracking these trends in cognitive enhancing drugs over time. The paper ends with some further suggestions for a research agenda in this domain, drawing on concepts located at the nexus between science and technology studies (STS) and the sociology of health and biomedicine. [ABSTRACT FROM AUTHOR]

In this paper we explore the ways in which corporations have become powerful actors in the political and economic landscapes, and the role the state has played in this development. Focusing on the pharmaceutical industry, we find that revolving door practices have been a key instrument in furthering the growth of corporate power, leading us to a reconsideration of the concepts of class struggle and the role of the state in the maintenance of the dominant class' privileges. We conclude that our findings lend support to Harvey's theory of neoliberalism as a specific project to restore power to the dominant class, and also to Marx's conception of state power subordinated to capitalist economic power. [ABSTRACT FROM AUTHOR]

Understandings of culture and multiculture are broad and deeply embedded in every day talk and practices. In an increasingly globalised world, how we understand and work with these terms affects how parents and their families experience health care services and the support intended by health care professionals. This is particularly important for parents who are new to Australia. In this paper we report on findings from an ethnographic study undertaken across two community child and family health nursing sites in South Australia. Using examples, we explore how child and family health nurses appear to understand and use constructs of culture and multiculture during everyday, intercultural communication with parents who are new to Australia and Australian health services. By analysing these understandings through postcolonial and feminist theories we found pervading evidence that neo-colonial constructs of a white western monoculture shaped intercultural communication practice. We conclude by reflecting on how these constructs might be addressed to improve intercultural communication in child and family health settings. [ABSTRACT FROM AUTHOR]

Contemporary health policy increasingly positions responsibility for the management of health with the individual which reflects newer neo-liberal discourses of health. Such an approach can be seen as problematic in the context of men's health, with men tending to be seen as largely 'irresponsible' towards their own health. This paper addresses this question by drawing on qualitative data on how men conceptualise responsibility for health. Whilst the desire to be responsible for health was borne by most of the men in the study, this was not always reflected in practice. There was also evidence of strategies that men adopted for either divesting themselves of responsibility for health or for legitimising lack of responsibility. In some instances, acting 'irresponsibly' was what defined participants as 'real men'. The implications of these findings for men's health policy are discussed with specific reference to the recent publication of Ireland's National Men's Health Policy. [ABSTRACT FROM AUTHOR]

This essay critically examines the process of governmentality as revealed in the construction and resistance to the categorisation and classification of ‘Healthy Senior Citizenship’. This also includes an illustrative analysis of data from a national UK qualitative interview study of the input into the policy process of older adults in voluntary and community organisations. The paper demonstrates how governmentality finds its expression within the construction of healthy senior citizenship as synonymous with activity and participation within the technologies of collaboration and consultation. The conclusion reflects upon developing a critical sociology of old age in order to scrutinize conceptions of the ‘problems’ of governing an ageing population in post-welfarist or advanced liberal states. [ABSTRACT FROM AUTHOR]

This paper examines the governance of the medical profession in the UK. As in many other countries, external and internal pressures have brought a shift in relations between the state and medicine. From a relatively protected position within the British NHS, where clinical autonomy, social status and involvement in a corporatist politics, the context in which doctors practise has undergone radical change. In common with many countries, the UK has turned to competitive markets, and state-sponsored regulatory measures to boost performance. As a consequence, state domination of the health policy agenda has increased replacing a corporatist politics and doctors' individual clinical autonomy has been reduced. Moreover, the existing system of self-governance is in question. It is argued that, nevertheless, there is evidence of different forms of accommodation. The medical profession continues to control a valued knowledge base, retains its social standing and is able to reap economic rewards. A more plural form of medical leadership may emerge better suited to assuring quality in patient care. [ABSTRACT FROM AUTHOR]

Choice and control for birthing women have recently come under the global spotlight as a human rights issue, and are likely to remain so while midwives are being targetted for providing home birth care. While focussing on these issues appears to further widen the dichotomy between medicine and midwifery, understanding how this divide is maintained is necessary if we are to move beyond it. This article, utilising Foucault's theory of genealogy, recapitulates how midwifery knowledge came to be subjugated by a dominant medical discourse, particularly through the process of hospitalising birth. The submission of the Australian Medical Association to a government enquiry into maternity services is then examined to illustrate how discourse is perpetuated, and how medicine still configures itself as the dominant birth discourse in Australia. The importance of focussing on midwifery specific knowledge, using the notion of embodiment, is put forward. [ABSTRACT FROM AUTHOR]

Explaining the trajectory of Australian health policies over the last century requires an analysis of different political regimes and their dreams of order for managing risk. Crook reverses the Beckian axiom that risk is the unintended outcome of the failure of industrial societies, arguing for an understanding of risk within a Foucauldian and Actor Network Theory of governmentality. Risk becomes a mechanism for the realisation of different dreams of order. The welfare state was the risk management mechanism of organised capitalism. Individual aspirations of reflexive individuals form the risk management mechanism of neo-liberal regimes. As competing risk discourses destabilise the field of maternity care, key actors (including doctors, midwives, women and policymakers) form themselves into neo-traditional communities in ongoing struggles to have their risk claims institutionalised within policies and protocols that further legitimise their interests. These struggles around risk and power are evident in recent debates over maternity policy in the context of the 2009 Maternity Services Review and the policy aftermath. [ABSTRACT FROM AUTHOR]

Cognitive-behaviour therapy (CBT) has been a central plank in the mental health policies of many Anglophone countries in recent years. This emphasis reflects the triumph of modern rationalism in two senses. First, the appeal of CBT to policy makers rests largely on its claims of being evidenced-based and quickly effective. Second, it is committed to a view of eudemonia (the good life) in which rationality predominates over non-rationality to generate the greatest happiness for the greatest number. Both aspects, which appeal to policy makers, warrant sociological interrogation. This article provides a brief history of CBT to highlight the rhetoric of rationalism it has espoused successfully. Then, using the UK Depression Report as a point of departure, it compares this success of CBT with the criticisms it has encountered. Both positions of advocacy and critique are examined in relation to disciplinary knowledge and professional interest work. These orientations from poststructuralist accounts of the modern episteme, on the one hand, and neo-Weberian sociology of the professions, on the other, help us understand the current controversy surrounding CBT. [ABSTRACT FROM AUTHOR]

Indigenous cultural training for health workers is an increasingly popular intervention designed to improve the health services provided to Indigenous peoples in Australia. The provision of this training is based on the recognition that the measured discrepancy between Indigenous and non-Indigenous health outcomes is in part influenced by cultural difference and a history of racism in Australian society. Indigenous cultural training in Australia predominantly draws on a 'cultural awareness' framework which seeks to educate health workers about 'Indigenous culture'. To date, evaluations of Indigenous cultural training programs have found them to have questionable efficacy, although most of these evaluations have been methodologically inadequate. This article draws on postcolonial theory to explore the limitations of Indigenous cultural training as it is commonly conceptualised. Issues of essentialising 'Indigenous culture', 'otherness' and the absence of systemic responsibility for culturally appropriate health service provision are discussed. Finally, we consider future directions for Indigenous cultural training that are useful to both Indigenous service users and the health workers charged with 'closing the gap' between Indigenous and non-Indigenous health outcomes. [ABSTRACT FROM AUTHOR]