Use of and attitudes toward complementary and alternative medicine among obstetricians in Israel.

OBJECTIVE: To examine attitudes toward and use of complementary and alternative medicine (CAM) by obstetricians during pregnancy and childbirth. METHODS: Between 2010 and 2011, obstetricians from 7 medical centers (n=170) in Israel completed questionnaires examining the use and recommendation of CAM treatments during pregnancy and childbirth. Attitudes were examined via the CAM Health Belief Questionnaire (CHBQ). RESULTS: Over half of the participants (58.8%) reported using at least 1 CAM treatment, and nearly two-thirds had recommended or would recommend CAM to pregnant patients. By contrast, use of CAM during childbirth was recommended by only 26% of respondents. The total CHBQ score was moderately high (mean ± SD, 40.4 ± 7.30; possible range, 7.0-70.0), indicating an overall positive attitude toward CAM. Female board-certified specialists answered more favorably regarding attitudes toward CAM (P=0.004). The structural validity of the CHBQ was examined using varimax rotation factor analysis, which produced a 3-factor solution explaining 63.1% of the variance. CONCLUSIONS: Most obstetricians exhibited positive attitudes toward CAM and recommended its use during pregnancy, but did not support CAM use during childbirth. This discrepancy might be partly due to the involvement of Israeli obstetricians in predominantly high-risk cases of childbirth requiring intervention.

Complementary and alternative health care in Israel.

The paper explores the patterns of coexistence of alternative/complementary health care (CAM) and conventional medicine in Israel in the cultural, political, and social contexts of the society. The data are drawn from over ten years of sociological research on CAM in Israel, which included observation, survey research, and over one hundred in-depth interviews with a variety of CAM practitioners - many with bio-medical credentials - and with policy makers in the major medical institutions. The analysis considers the reasons for CAM use, number of practitioners, the frequency of CAM use and some of its correlates, and how CAM is regulated. The structure of the relationship between the conventional health care system and CAM is discussed in the public sector, which provides two-thirds of CAM services, and in the private sector, which provides about one-third. The history of the development of these structures and some of the dilemmas of their operation are discussed. A number of policy issues are considered against this background: regulation and licensing, CAM in primary care, reimbursement for CAM treatment, and the inclusion of CAM in education and training for the health professions.

Integrating CAM and biomedicine in primary care settings: physicians' perspectives on boundaries and boundary work.

In this article, we present the results of a study that was conducted among 15 family physicians who had incorporated complementary and alternative medicine (CAM) into their clinical work in Israel. We aimed to explore the types of boundaries those physicians encountered, how these boundaries were contoured, and under what circumstances they were crossed. We conducted in-depth interviews with the physicians in 2008, and found that epistemological and cognitive boundaries did not pose a problem for them. However, with regard to the organizational boundary, the participants indicated that it was necessary to use a variety of strategies before they could utilize their CAM skills. Many of the participants indicated that the epistemological differences between the biomedical and CAM paradigms, such as the absence of evidence-based medicine in CAM practices, are not important. The ease with which boundaries were crossed in the complex social context described here is characteristic of postmodern societies. On the whole, the integrative physicians interviewed can be viewed as "postmodern" professionals who reject the impermeability of many long-established boundaries and hierarchies.

Use of and attitudes toward complementary and alternative medicine among nurse-midwives in Israel.

OBJECTIVE: The objective of the study was to evaluate the use and attitudes of nurse-midwives in Israel toward complementary and alternative medicine (CAM). STUDY DESIGN: In a cross-sectional study, nurse-midwives from 5 Israeli medical centers completed the CAM Health Belief Questionnaire, a validated tool examining data regarding personal health behavior, use of CAM therapies, and attitudes toward CAM. RESULTS: One hundred seventy-three of 238 potential respondents completed the questionnaires (72.7%). Most (87.3%) reported using CAM (67.1% massage, 48.6% herbal medicine, 42.2% meditation, 40.5% touch therapies, and 39.9% prayer) and agree with many fundamental tenets of CAM such as the existence of energy forces, self-healing, and integrating patients' health beliefs and values into their care. CONCLUSION: The majority of nurse-midwives studied reported using and recommending CAM to their patients and believe that CAM can complement conventional medical therapies. Health care providers could benefit from education with regard to the efficacy and safety of CAM modalities during pregnancy and childbirth.

Boundary at work: alternative medicine in biomedical settings.

The study explores the process of boundary demarcation within hospital settings by examining a new phenomenon in modern medicine: collaboration between alternative and biomedical practitioners (primarily physicians) working together in biomedical settings. The study uses qualitative methods to examine the nature of this collaboration by calling attention to the ways in which the biomedical profession manages to secure its boundaries and to protect its hard-core professional knowledge. It identifies the processes of exclusion and marginalization as the main mechanisms by which symbolic boundaries are marked daily in the professional field. These processes enable the biomedical profession to contain its competitors and at the same time to avoid overt confrontations and mitigate potential tensions between the two medical systems.

Between formal and enacted policy: changing the contours of boundaries.

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.

Changing boundaries: modes of coexistence of alternative and biomedicine.

In this article, the authors address the boundaries of institutional structures, the dynamics of their configuration, and the nature of their permeability. The authors explored these issues in Israel, where the changing relationship of bio- and alternative medicine elucidates recent processes of professional boundary redefinition. They used qualitative methods to analyze in-depth interviews in clinics and hospitals where alternative and biomedical practitioners work under the formal auspices of publicly sponsored biomedical organizations. The findings show an incursion by alternative practitioners into territories viewed until fairly recently as the exclusive domain of biomedicine. However, the "alternatives" are not defined as regular staff members, and their marginality is elucidated by a variety of visible structural, symbolic, and geographical cues. The authors used decoupling theory in interpreting the findings. Changed boundary contours signal underlying processes of social change that could have meaningful implications in defining membership criteria in the biomedical community.

Entering the well-guarded fortress: alternative practitioners in hospital settings.

There is a growing evidence that alternative health care practitioners and physicians are working together in collaborative patterns. The paper examines these collaborative patterns in hospital settings in Israel. On the theoretical level, the specific issues relate to theories concerning relationships between dominant institutional structures which enjoy the benefits of epistemological legitimacy as well as extensive, supportive social structures and groups of non-conformists who seek to attain many of the same goals by utilizing different methods based on other epistemologies. In the most general sense, the issues involved concern processes of accommodation and social change. Data were collected by means of semi-structured, qualitative interviews in four general hospitals in Jerusalem during 2000. Nineteen persons were interviewed including 10 alternative practitioners working in a variety of fields and nine biomedical practitioners who worked with them (six physicians and three nurses). Interviews focused on background and training, reasons for entry into the hospital, length of practice, status in the hospital system, mode of remuneration, content of work, modes of interaction with others in the hospital and problems encountered. The findings suggest a dual process of simultaneous acceptance and marginalization of alternative practitioners. While small numbers of alternative practitioners were found to be practicing in a wide variety of hospital departments and in a broad spectrum of specialties, they were in no way accepted as regular staff members and their marginality was made clear by a variety of visible structural, symbolic and geographical cues. There is a division of labour expressed by focusing on the biomedical practitioners on the diagnosis and treatment of specific disease entities, while the alternative practitioners work in the illness context, concentrating of feelings and affective states involving the alleviation of pain, suffering and efforts to improve the quality of life.