'Fantastic hands' - But no evidence: The construction of expertise by users of CAM

Both in the Scandinavian welfare states and elsewhere the private CAM market acts as a health provider alongside the state. There is very limited established scientific evidence for the effects of treatments and often they are non-authorised. How, then, do users construct and attribute expertise to CAM practitioners? Drawing on 90 in-depth interviews with 30 Danish CAM users of reflexology or acupuncture, three aspects of expertise emerged from the empirical analysis of how the CAM users ascribe legitimacy to the therapies involved. Thus, expertise is: (i) embodied and produced by means other than those used in evidence-based knowledge or abstract expert systems; (ii) constructed by making a clear-cut division between the roles and responsibilities of the practitioner and the user; and (iii) constructed on the basis of specific training or education that practitioners have achieved. The expertise that the users seek and construct is not necessarily available, and users therefore consult many different kinds of experts. In doing so, they may themselves become the 'experts' in heterogeneous, context-specific dimensions of knowledge. In conclusion we propose further studies of what lay people can offer to a democratised and customer-sensitive system of health care as an area of inquiry that holds promise for providing a sociological approach to the domain of expertise.