State Risk Discourse and the Regulatory Preservation of Traditional Medicine Knowledge: The Case of Acupuncture in Ontario, Canada

Alongside increasing Western scientific evidence of clinical efficacy, acupuncture – a practice with roots in traditional Chinese medicine (TCM) – has recently come into increased usage by biomedically-trained health care professionals. Concurrently, a regulatory trend in Canada, the United States and Australia increasingly permits biomedical professionals such as medical doctors, physiotherapists and chiropractors to perform acupuncture alongside registered TCM acupuncturists. While ‘public safety’ is an established parameter around which professional regulatory decisions – such as these – are commonly framed, risk is not a politically neutral concept.  The case of Ontario (Canada), where ten professional groups were authorized to perform acupuncture in 2006 based on ‘safety’ grounds, exemplifies this point.  In this paper we explore the implications of this for the regulatory preservation of traditional medicine practices and knowledge systems, as recommended by several United Nations bodies.  We report on a critical postcolonial discourse analysis of two contrasting Ontario government reports preceding that jurisdiction’s acupuncture regulations. The earlier (1996) report, produced when Ontario’s regulatory lobby was largely comprised of TCM practitioners, integrates risk-related perspectives from both TCM and Western biomedical science. The 1996 report uses this ‘inclusive’ risk discourse to support a regulatory definition for acupuncture that aims to protect TCM knowledge, without excluding diverse professions from needling practices. The later (2001) report –reflecting the interests of an increasingly biomedical practitioner lobby - exclusively privileges Western scientific perspectives on risk, while implicitly denigrating TCM-informed views. The 2001 risk discourse ultimately supports an ‘atheoretical’ regulatory definition for acupuncture that subordinates traditional knowledge perspectives. Our analysis demonstrates ways in which state-constructed risk discourses may reflect particular epistemic underpinnings, carrying implications for the regulatory preservation of traditional medical knowledge across jurisdictions.