CAM within a field force of countervailing powers: the case of Portugal

Abstract

This paper examines the extent to which the position of the medical profession and the state towards complementary and alternative medicine (CAM) practitioners has changed since the late 1990s, taking Portugal as a case study. Using Light’s concept of countervailing powers we consider the alliances, interests, rhetorics and degrees of control between these three actors over time, focusing particularly on the extent to which CAM practitioners have acted as a countervailing force in their relationship with the medical profession and the state. It also brings to the fore the position of supra-state agencies concerning CAM regulation. A critical discourse analysis was conducted on data derived from a systematic search of information from the late 1990s until 2015. Our analysis suggests that CAM has emerged as an active player and a countervailing power in that it has been a significant influence in shaping state policy-making. The medical profession, in turn, has changed from rejecting to ‘incorporating’ CAM while the state has acted has a ‘broker’, trying to accommodate the demands and preferences of both actors while simultaneously demonstrating its power and autonomy in shaping health policy. In sum, the history of countermoves of CAM, the medical profession and the state in recasting power relations regarding CAM regulation in Portugal has highlighted the explanatory value of Light’s countervailing power theory and the need to move away from a professional dominance and corporatist approach where CAM has simply been seen as subjugated to the power of the medical profession and the state.