In the shadow of the healing rainbow: belonging and identity in the regulation of traditional medicine in Mauritius

This article explores how traditional healing is regulated in the island of Mauritius. Drawing on postcolonial Science and Technology Studies and their encounter with socio-legal studies, it maps the emergence of the Ayurveda and Other Traditional Medicines Act of 1990, pointing out the selectivity of the notion of 'tradition' and its entanglement to broader nation-making processes, born in the process of its independence from Britain. While the social and political histories embedded in the text of the law favour the authorisation of some healing traditions and not others, outside its scope, other practices persist, and triggering competing visions about the island's healing futures. By bringing into the frame the plurality of Mauritius's healing landscape, where different traditions coexist despite their ambiguous legal status, this article accounts for the tensions in the regulation of traditional medicine, where the law produces its own inclusions and exclusions, and mundane legalities of everyday healing become sites of broader political questioning about the relationship between law, science, and nation-making.

Traditional Healing and Law in Contemporary Senegal: Legitimacies, Normativities and Practices

In this paper, we chart the context in which contemporary legal debates around traditional healing in Senegal unfold, pointing in particular to the type of power-knowledge relations that are at stake in both the current legal status-quo, and legal changes proposed in 2017. We interrogate the struggles over legitimacy and recognition that are at play in these processes, and the ways in which different actors relate to both formal legal rules, and more fluid forms of legalities, in which imaginaries of the law, and negotiations with the law, translate into everyday practices. We underline how legal and scientific discourses are mobilised to draw the opportunities and boundaries offered to different healing agents, and to organise their respective authority. Traditional healers overlap with modern health practices, while retaining their own ontologies and claims to legitimacy while representatives of the biomedical professions insist that they should have some oversight over the regulation of all healers. As negotiations continue over the possibility for the state to regulate traditional healing, everyday legal choreographies define the relative roles, possibilities and precarity of different healing agents.

Legalities of Healing: Handling Alterities at the Edge of Medicine in France, 1980s-2010s

The practice of healing by anyone other than qualified doctors or pharmacists has been allegedly illegal in France since the nineteenth century. In this judicial order, the state delegated the power to oversee the boundaries of medicine to doctors and pharmacists, allowing them, with support from criminal courts, to determine which therapeutic techniques should remain their exclusive right. In practice, this apparently neat legal system was never clear-cut; therapists without medical qualifications continued to infringe upon spaces that doctors and pharmacists saw as their preserve, often carving out zones of juridical tolerance. In the 1980s and 1990s, negotiations over the legality or illegality of different kinds of healing intensified. Alternative therapies, such as acupuncture and herbalism, had gained in popularity and their practitioners were keen to negotiate a legal position that would make their work licit. While some succeeded, others got entangled in a new governmental framework that characterized alternative medicines as gateways to "sects." This article examines these developments and explains how new juridical techniques to govern certaintherapies arose in the 1990s. These operated through decentralized surveillance systems that enrolled new actors. These included agencies dedicated to monitoring sects; associations of victims; and individuals such as users, their families, or health professionals. Together, they aimed to "prevent" deviant behavior, thereby fostering what is today one of the most peculiar features of the way the French state regulates alternative healing, which it considers potentially "cult-like."

The regulation of acupuncture in France and the UK: Shifts and fragmentation in contrasting healthcare systems

This article explores the regulation of acupuncture in the UK and France. It focuses on the dilemmas such regulation has raised, and the effects of two contrasting approaches to the regulatory organisation of acupuncture within healthcare systems on practices and care. Although the question of how acupuncture, like other complementary, alternative or traditional therapies, should be regulated has often been reduced to a question of scientific knowledge, it is also dependent on the intricacies of national health system governance, state rationales and professional identities. France and the UK provide exemplary instances of contrasting systems, in which each of these factors has come to shape the regulation of the highly heterodox practice that is acupuncture. Overall, exploring the challenges of regulating acupuncture provides useful perspectives on how the make-up of legitimate therapies is constituted in particular healthcare contexts.

Law and biomedicine and the making of 'genuine' traditional medicines in global health

This paper explores the joint roles of law and biomedicine in constituting the boundary between legitimate and illegitimate (and genuine and 'pseudo') traditional healing. It argues that, as law and biomedicine have grown to share common understandings of the nature of knowledge, they have come to act as converging colonizing forces that displace and alter 'other' forms of knowing and ordering. Even as regulatory systems set out to recognize some forms of traditional medicine, they continue to operate on assumptions that disqualify knowledge, products, and actors, that do not resemble their biomedical counterparts. This leaves traditional healing systems potentially having to either operate outside the law or adapt to it by transforming themselves, potentially beyond the point of recognition, to fit better into the systems provided by law and biomedicine. The paper explores the series of dilemma this creates for those seeking to 'regulate better' traditional medicine.

Regulating Alternative Healing in France, And the Problem of 'Non-Medicine'

This article explores the ambiguities of the legal system that, in France, regulates 'alternative healing', and determines the boundaries of legitimate medical care. While the law suggests that the delivery of therapeutic care should be the monopoly of biomedically-trained professionals, alternative healers operate very widely, and very openly, in France. They practice, however, on the verge of (il)legality, often organising their activities, individually and collectively, so as to limit the likelihood of state intervention. This creates a high degree of precarity for both practitioners and, crucially, for patients. Efforts to change the system are being deployed, but while healers themselves have increasingly organised to seek recognition by the state, alternative healing occupies an uncertain policy space: they are not fully constituted as a social and policy matter by the state, and occupy a liminal position between medicine and spirituality that "unsettles" republican ideals of scientific rationality, and of secularism. This article explores some of those tensions, at the crossroad between law, science, and medicine. It reflects on why tensions seem to persist around the regulatory questions at stake, and suggests that ways forward may depend on moving away from science as a sole arbiter in drawing boundaries of legitimate and illegitimate care in regulation.

'On the Perimeter of the Lawful': Enduring Illegality in the Irish Family Planning Movement, 1972-1985

Between 1935 and 1985, Irish law criminalized the sale and importation of condoms. Activists established illegal markets to challenge the law and alleviate its social consequences. They distributed condoms through postal services, shops, stalls, clinics, and machines. Though they largely operated in the open, their activities attracted little direct punishment from the state, and they were able to build a stable network of medical and commercial family planning services. We use 30 interviews conducted with former activists to explore this history. In doing so, we also examine the limits of 'illegality' in describing acts of everyday resistance to law, arguing that the boundaries between legal and illegal, in the discourses and practices of those who sought to challenge the state, were shifting and uncertain. In turn, we revisit 'illegality', characterizing it as an assemblage of varying selectively-performed political practices, shaped by complex choreographies of negotiation between state and non-state actors.

International law, public health, and the meanings of pharmaceuticalization

Recent social science scholarship has employed the term "pharmaceuticalization" in analyses of the production, circulation and use of drugs. In this paper, we seek to open up further discussion of the scope, limits and potential of this as an analytical device through consideration of the role of law and legal processes in directing pharmaceutical flows. To do so, we synthesize a range of empirical and conceptual work concerned with the relationships between access to medicines and intellectual property law. This paper suggests that alongside documenting the expansion or reduction in demand for particular drugs, analysts of pharmaceuticalization attend to the ways in which socio-legal developments change (or not) the identities of drugs, and the means through which they circulate and come to be used by states and citizens. Such scholarship has the potential to more precisely locate the biopolitical processes that shape international agendas and targets, form markets, and produce health.

The regulation of nicotine in the United Kingdom: how nicotine gum came to be a medicine, but not a drug

This article explores the utility of actor-network theory (ANT) as a tool for socio-legal research. ANT is deployed in a study of the evolution of divided regulatory responsibility for tobacco and medicinal nicotine (MN) products in the United Kingdom, with a particular focus on how the latter came to be regulated as a medicine. We examine the regulatory decisions taken in the United Kingdom in respect of the first MN product: a nicotine-containing gum developed in Sweden, which became available in the United Kingdom in 1980 as a prescription-only medicine under the Medicines Act 1968. We propose that utilizing ANT to explore the development of nicotine gum and the regulatory decisions taken about it places these decisions into the wider context of ideas about tobacco control and addiction, and helps us to understand better how different material actors acted in different networks, leading to very different systems of regulation.