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      Paradigm-Specific Risk Conceptions, Patient Safety, and the Regulation of Traditional and Complementary Medicine Practitioners: The Case of Homeopathy in Ontario, Canada

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          Abstract

          While the principle of risk reduction increasingly underpins health professional regulatory models across the globe, concepts of risk are neither static nor epistemically neutral. Conventional biomedicine's risk conceptions are substantially rooted in principles of scientific materialism, while many traditional and complementary medicine systems have vitalistic epistemic underpinnings that give rise to distinctive safety considerations. The statutory regulation of traditional and complementary medicine providers has been identified by the World Health Organization as a strategy for enhancing public safety. However, complex risk-related questions arise at the intersection of medical epistemologies whose concepts are at best overlapping, and at worst incommensurable. Elaborating a theoretical concept of “paradigm-specific risk conceptions,” this work employs Bacchi's poststructural mode of policy analysis (“What's the Problem Represented to Be?”) to critically analyze risk discourse in government documents pertaining to the 2015 statutory regulation of homeopathic practitioners in Ontario, Canada. The Ontario government's pre-regulatory risk assessments of the homeopathic occupation discursively emphasized cultural safety principles alongside homeopathy-specific risk conceptions. These paradigm-specific concepts, rooted in homeopathy's epistemic vitalism, extend beyond materialist constructions of adverse events and clinical omission to address potential harms from homeopathic “proving symptoms”, “aggravation,” and “disruption,” all considered implausible from a biomedical standpoint. Although the province's new homeopathy regulator subsequently articulated safety competencies addressing such vitalistic concepts, the tangible risk management strategies ultimately mandated for practitioners exclusively addressed risks consistent with the scientific materialist paradigm. This policy approach substantially echoes the implicit biomedical underpinnings evident in Ontario's broader legislative context, but leaves a significant policy gap regarding the primary safety considerations originally articulated as substantiation for homeopathy's statutory regulation. To optimally preserve patient safety and full informed consent, regulators of traditional and complementary medicine professionals should favor a pragmatic, epistemically-inclusive approach that actively negotiates paradigm-specific risk conceptions from both biomedicine and the occupation under governance.

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          Towards an International Classification for Patient Safety: key concepts and terms

          Background Understanding the patient safety literature has been compromised by the inconsistent use of language. Objectives To identify key concepts of relevance to the International Patient Safety Classification (ICPS) proposed by the World Alliance For Patient Safety of the World Health Organization (WHO), and agree on definitions and preferred terms. Methods Six principles were agreed upon—that the concepts and terms should: be applicable across the full spectrum of healthcare; be consistent with concepts from other WHO Classifications; have meanings as close as possible to those in colloquial use; convey the appropriate meanings with respect to patient safety; be brief and clear, without unnecessary or redundant qualifiers; be fit-for-purpose for the ICPS. Results Definitions and preferred terms were agreed for 48 concepts of relevance to the ICPS; these were described and the relationships between them and the ICPS were outlined. Conclusions The consistent use of key concepts, definitions and preferred terms should pave the way for better understanding, for comparisons between facilities and jurisdictions, and for trends to be tracked over time. Changes and improvements, translation into other languages and alignment with other sets of patient safety definitions will be necessary. This work represents the start of an ongoing process of progressively improving a common international understanding of terms and concepts relevant to patient safety.
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            Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials

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              Open label placebo: can honestly prescribed placebos evoke meaningful therapeutic benefits?

              Results from small clinical trials suggesting that placebos can be ethically and effectively used in clinical practice warrant further study, argue Ted Kaptchuk and Franklin Miller
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                Author and article information

                Contributors
                Journal
                Front Sociol
                Front Sociol
                Front. Sociol.
                Frontiers in Sociology
                Frontiers Media S.A.
                2297-7775
                21 January 2020
                2019
                : 4
                : 89
                Affiliations
                Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, ON, Canada
                Author notes

                Edited by: Nicola Kay Gale, University of Birmingham, United Kingdom

                Reviewed by: Joana Almeida, University of Bedfordshire, United Kingdom; Guido Giarelli, University of Catanzaro, Italy

                *Correspondence: Nadine Ijaz nadine.ijaz@ 123456utoronto.ca

                This article was submitted to Medical Sociology, a section of the journal Frontiers in Sociology

                Article
                10.3389/fsoc.2019.00089
                8022581
                33869409
                711f1886-0688-457a-b9d1-8de0c396a3c9
                Copyright © 2020 Ijaz.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 07 October 2019
                : 26 December 2019
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 66, Pages: 16, Words: 13137
                Categories
                Sociology
                Original Research

                traditional and complementary medicine,epistemology,homeopathy,professional regulation,risk,risk discourse,vitalism,scientific materialism

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