Discussant/Commentateur/Commentatrice : Olivier Jacques (McGill University)
The Social Construction of Naturopathic Medicine: Evidence from the Provinces: Dave Snow (University of Guelph) Abstract: Since 2008, five of Canada’s six most populous provinces have legislated to bring naturopaths under the governance structure for self-regulated professions. While proponents claim this has legitimized the profession and should improve patient care, critics argue that it has done little to improve governance and may encourage unsafe practices. However, there has been little empirical research on the factors behind the provinces’ decisions to regulate and thus legitimize naturopathic medicine. Drawing from the Social Construction of Target Populations (SCTP) approach, this paper explores the way in which naturopathic medicine was conceptualized by policymakers in legislative discourse and in the actual language of public policy. To do so, it draws from two original datasets. The first is a collection of every Hansard debate and committee hearing concerning the regulation of naturopaths from the five provinces that have legislated (Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia). The second, using Canadian Newsstream, is a collection of all newspaper stories from 2013-2017 involving naturopathic medicine. Using the SCTP framework, I hypothesize that although public policy ought to have made naturopaths “advantaged,” the media analysis suggests that naturopaths remain “contenders” due to overwhelmingly negative social constructions in media outlets. These negative social constructions stem from the “boundary work” being done by medical and scientific professionals skeptical about naturopathic medicine. While naturopaths have been legitimized through public policy, they remain delegitimized in public discourse, leaving their social construction—and professional legitimacy—in flux.
(Re)defining Legitimacy? Expertise and Public and Patient Involvement in Canadian Drug Assessment: Katherine Boothe (McMaster University) Abstract: This paper investigates shifting ideas about legitimacy related to scientific evidence and public participation in health policy decision making, specifically recommendations about which drugs should be publically funded. Public drug plans in Canada rely on drug advisory committees to review clinical and economic evidence about new drugs, and make recommendations about reimbursement. Starting in 2006, committees that were previously entirely made up of technical experts began to include patients and members of the public. In 2010, committees began accepting submissions from patient groups. This paper asks how these changes affected understandings of legitimacy on the committees, focusing on the views of committee members.
My previous research suggests there are important tensions between democratic conceptions of legitimacy linked to the inclusiveness of the policy process and which drive public and patient involvement, and moral-scientific conceptions of legitimacy that are linked to objectivity and specific norms of scientific evidence. The paper uses interviews with three Canadian committees as well as evidence of participants’ early views in published reports to analyze stability and change in participants’ ideas, and to compare the views of lay and technical member of the committees. It addresses issues about the nature of evidence and the inclusion of different voices in policymaking. It responds to calls in the literature for more rigorous measurement of ideas and ideational change, and develops hypotheses about links between ideational and institutional change that may apply to other policy areas, particularly those that involve highly specialized knowledge and questions about legitimacy and public values.