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Between formal and enacted policy: changing the contours of boundaries

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  • Mizrachi, Nissim
  • Shuval, Judith T.

Abstract

This study examines the strategies of the biomedical discourse vis-à-vis the growing public demand for alternative medicine by comparing formal and informal claims for jurisdiction. The analysis is based on two main sources of data from Israel: (a) two formal position statements, and (b) a series of participant observations and interviews with practitioners in clinical settings where biomedical and alternative practitioners collaborate. At the formal level, the biomedical discourse seeks to secure its dominant position by drawing strict cognitive and moral lines differentiating "proper biomedicine" from "improper alternative medicine." At this level alternative medicine appears morally "contaminated" and its knowledge-base delegitimized by extreme forms of boundary-work. At the informal level, the contour of boundaries change. In the hospital field where alternative and biomedical practitioners are collaborating, mutual respect was expressed even as social and symbolic boundaries were being demarcated. Modifying the forms of boundary-work appears to be biomedicine's reactive strategy in the field to changing environmental and market demands. It is a strategy that allows biomedical discourse to absorb its competitor within its professional jurisdiction with no battle, while retaining absolute epistemological hegemony and Institutional Control.

Suggested Citation

  • Mizrachi, Nissim & Shuval, Judith T., 2005. "Between formal and enacted policy: changing the contours of boundaries," Social Science & Medicine, Elsevier, vol. 60(7), pages 1649-1660, April.
  • Handle: RePEc:eee:socmed:v:60:y:2005:i:7:p:1649-1660
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    1. repec:dau:papers:123456789/13557 is not listed on IDEAS
    2. Martin, Graham P. & Currie, Graeme & Finn, Rachael, 2009. "Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the 'modernization' of the medical workforce," Social Science & Medicine, Elsevier, vol. 68(7), pages 1191-1198, April.
    3. Wilson, Nicky & Pope, Catherine & Roberts, Lisa & Crouch, Robert, 2014. "Governing healthcare: Finding meaning in a clinical practice guideline for the management of non-specific low back pain," Social Science & Medicine, Elsevier, vol. 102(C), pages 138-145.
    4. Pedersen, Pia Vivian & Hjelmar, Ulf & Høybye, Mette Terp & Rod, Morten Hulvej, 2017. "Can inequality be tamed through boundary work? A qualitative study of health promotion aimed at reducing health inequalities," Social Science & Medicine, Elsevier, vol. 185(C), pages 1-8.
    5. Kroezen, M. & Mistiaen, P. & van Dijk, L. & Groenewegen, P.P. & Francke, A.L., 2014. "Negotiating jurisdiction in the workplace: A multiple-case study of nurse prescribing in hospital settings," Social Science & Medicine, Elsevier, vol. 117(C), pages 107-115.
    6. Brosnan, Caragh, 2017. "Alternative futures: Fields, boundaries, and divergent professionalisation strategies within the Chiropractic profession," Social Science & Medicine, Elsevier, vol. 190(C), pages 83-91.
    7. Yufan Xu, 2024. "Boundaries and classification: the cultural logic of treating foreign medicine," Palgrave Communications, Palgrave Macmillan, vol. 11(1), pages 1-8, December.
    8. Graeme Currie & Rachael Finn & Graham Martin, 2009. "Professional competition and modernizing the clinical workforce in the NHS," Work, Employment & Society, British Sociological Association, vol. 23(2), pages 267-284, June.
    9. Shachar, Leeor, 2022. "“You become a slightly better doctor”: Doctors adopting integrated medical expertise through interactions with E-patients," Social Science & Medicine, Elsevier, vol. 305(C).
    10. Suh, Siri, 2014. "Rewriting abortion: Deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal," Social Science & Medicine, Elsevier, vol. 108(C), pages 20-33.

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