/ Des membres de Triangle participent

Jérémy Rollin participe à la conférence internationale « Complementary medicine in healthcare. International perspectives on concepts and normative challenges »

13 février 2023, à la Martin Luther Universität de Halle-Wittengerg

Présentation

• Jérémy Rollin, docteur en science politique, présentera une communication intitulée :
  « Downgrading a conventional treatment : the case of chest drainage for babies with bronchiolitis ».

Résumé de la communication :

Since the 1970s in France, physiotherapists have been involved in secretive bronchial diseases to practice manual clearance. These interventions were justified by medical studies explaining the physiological phenomena and by the repetition of favourable clinical observations in hospitals. Thus, physiotherapists used these techniques in cases of brocnhiolitis and exported them to their private practice, more autonomous from physicians. [1] This autonomisation occurred at the same time as a change in the evidence delivery method : repeated clinical observations are considered dependent on experimenters and are replaced by randomised controlled trials. [2]

In this context, expertise situations are set up to evaluate the treatments and the sci- entific evidence supporting them. [3] In 2000, a first recommendation is published, legitimising the practice of chest physiotherapy in case of bronchiolitis while calling for randomised studies. [4] In 2019, a new recommendation was published, which abandoned this technique at all. [5] What is the reason for this change which has taken place in less than 20 years ?

On the one hand, the change in the evidence standard has removed the historical evidence underpinning the practice (improvements measured by lung X-rays or scores). Thus, some unfavourable studies based on RCT have disqualified the pre- vious findings, without falsifying them : the categorisations and evaluation criteria used are different in nature. [6]

On the other hand, the autonomisation of physiotherapists in private practice has been coupled with a weak scientific development, they have not embraced the ran- domisation turn. At the same time, they distanced themselves from paediatricians, particularly in hospitals, who contributed to the import of this new system of evidence. A tension was then generated with university paediatricians who saw a child’s pathology slipping away from them to the benefit of independent auxiliaries in private practice. The latter then mobilised their symbolic (position of domination) and scientific (knowledge of the scientific standard all the more acute as they participate in its definition) capital to produce and put forward the evidence of the inefficiency of respiratory physiotherapy. These tensions, both in relation to the credibility of the data and the actors, then crystallised in the 2019 guideline. Although the papers used for discussion were nuanced (1/3 judging the technique useful, 1/3 useless and 1/3 not expressing an opinion), the legitimate academic paediatricians imposed their vision : the 10 paediatricians (including 4 academics) and the hospital emergency doctor were in favour of removing the technique from the recommended care while 3 physiotherapists out of 4 and 1 general practitioner were opposed. The tension was not only between professional groups but also includes a dimension of belief in the evidence regime : one GP agreed with the clinical opinions of the physiotherapists while one hospital physiotherapist with a university PhD followed the interpretation of the academic physicians. This empirical case thus informs us of the importance of positions of domination in the validation procedures of care considered “conventional”.