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Chapitre D'ouvrage Année : 2024

Downgrading a conventional treatment: the case of chest drainage for babies with bronchiolitis

Résumé

I will consider in this contribution whether the paradigm of the randomized controlled trial is becoming a way to arbitrate between conventional care and complementary and alternative medicine. I will use the case study of physiotherapy in respiratory ailments. Physiotherapists have practiced manual clearance in the case of secretive bronchial diseases in France since the 1970s. These interventions were justified by medical studies explaining the physiological phenomena and the repetition of favourable clinical observations in hospitals. Physiotherapists used these techniques in cases of bronchiolitis and exported them to their private practice, which enabled them to be more autonomous than physicians. This autonomization occurred at the same time as a change in the preferred study for demonstrating effects, as repeated clinical observations were replaced by randomized controlled trials. In this context, expertise situations were set up to evaluate the treatments and scientific evidence supporting them. There was not only a change in scientific practice but also in the ranking of evidence for public policy purposes. A recommendation was published in 2019 which abandoned the technique. I will initially point out the cognitive reasons for this change in evidence standards (section 1). There is a change from a reasoned explanation based on the clinic and physiology to a neutral and mechanical explanation, based on large numbers and randomness. I will demonstrate that this change is coupled with a willingness to provide expertise (and, consequently, conventional treatments) without regarding personal opinions. I will then show that a divide is created between conventional therapies, validated and recommended by the most legitimate actors in the medical field, and practitioners, who continue to practice them (section 2). In this way, the case of downgrading a conventional treatment shows that the frontier between complementary and alternative medicine and conventional care is blurred and constantly changing.
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Dates et versions

hal-04642280 , version 1 (09-07-2024)

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  • HAL Id : hal-04642280 , version 1

Citer

Jérémy Rollin. Downgrading a conventional treatment: the case of chest drainage for babies with bronchiolitis. Kremling, Alexander ; Buch, Charlotte; Schildmann, Jan. Complementary Medicine in Healthcare. International Perspectives on Concepts and Normative Challenges, W. Kohlhammer GmbH, pp.39-50, 2024, 978-3-17-044506-2. ⟨hal-04642280⟩
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