Constructing the East–West Boundary

Introduction

In contemporary South Korea, ¹ a pluralistic medical system exists in which traditional Korean medical practices are institutionalized and regulated in parallel with Western medical hospitals, pharmacies, medical schools, and medical associations. The latter were first introduced by Christian missionaries in the late nineteenth century and then greatly expanded and institutionalized by Japanese colonialists in the early twentieth century. Despite the South Korean government’s continual support for the Western hospital system in the postcolonial era, various forms of traditional healing and herbal treatment have survived and a substantial portion of the population continues to rely upon them. During and after World War II and the Korean War, a “reserve medical force” of traditional healers, including herbalists and acupuncture-moxibustionists, gained greater prominence as successive governments contended with the devastation and famine. ² Proponents of traditional Korean Medicine (KM) used this mobilization as leverage to consolidate their practices and gain government support for a more permanent (and in many respects modern) medical institution separate from the Western medical system (Cho 1988; Lee 2001). ³ So-called “Korean” medicine became professionalized, and its institutionalization marginalized many of the herbalists and acupuncturists who did not possess the institutional credentials represented by medical school degrees. At the same time, the new “Korean” system retained its symbolic connections with Eastern (Chinese, indigenous Korean, traditional) healing traditions, which remained crucial for maintaining a distinct identity.

We recognize that references to medical systems as “Western” and “Korean” are controversial and politically charged in the Korean context. ⁴ The term “Korean medicine” (recently adopted as the preferred translation of Hanuihak/Hanbang by a leading professional association in Korea) places a nationalistic frame on forms of traditional medicine in Korea that have sometimes been dubbed “Chinese” or “Oriental” medicine. The term “Western Medicine” (WM) also is problematic, as many Korean proponents of that medical system strongly resist acknowledging that it is Western in origin, and its literal translation is, simply, “medicine,” without an adjective. Despite such complications and contentions, we use the WM/KM distinction because both terms remain in common use within the ongoing disputes we describe in this article. ⁵

In this article, we describe a public controversy between proponents of WM and KM over the adoption of imaging technology by a KM clinic. The controversy is of interest because it provides a vivid case of a national situation in which the conceptual boundary between modern and premodern forms of medicine was rhetorically and institutionally maintained, while at the same time it was subjected to sporadic shifting and renegotiation due to continued traffic in people, technologies, and substances that crisscrossed that boundary. By examining the discursive conduct of this dispute, we show how conceptual and institutional boundaries between medical systems were historically, socially, and legally renegotiated.

Methodology and Analytical Perspective

The present article relies upon extended face-to-face and phone interviews with KM doctors, radiologists, and radiological technologists to elicit their perspectives on the controversy. It also draws upon written sources, including legal records of District Court and High Court verdicts, professional newspaper articles, and unpublished manuscripts submitted by proponents of both medical systems to support their arguments. In addition to casual conversations with more than fifty KMDs, in-depth interviews were done with one radiological technologist at the Kirin Clinic, eleven KM doctors (KMDs) at Gangnam KM Hospital and with ten KMDs at other KM clinics and hospitals. In addition, the lead author performed participant observation in a KM teaching hospital and made repeated visits over two weeks to a radiology ward of a WM hospital (the Asan Medical Center in Seoul, one of the largest general hospitals in Korea), in order to gain better insight into how CT scanners are applied and how WM doctors viewed KM doctors’ use of medical instruments. Extended interviews with sixteen radiologists and five radiological technologists were done at the Medical Center. ⁶

The controversy occurred as part of a series of struggles between competing medical professions to secure institutional and cultural authority and to access markets in a modernizing society. While legal arguments and economic interests were undoubtedly salient, the arguments presented in court cases also deployed themes and dichotomies reminiscent of those that often feature in more erudite discussions of science, medicine, and modernity. Claims and counterclaims during the dispute sometimes insisted upon “essential” and untranslatable differences between Eastern and Western medical philosophies. When stressing conceptual discontinuity, partisans sometimes made arguments that resembled Kuhn’s (1970) conception of incommensurability, though their arguments were made in contextually specific and strategic ways that were not necessarily in accord with Kuhn’s (notoriously ambiguous) conception of paradigms. At other times, parties to these disputes emphasized shared concepts and common rules and procedures. Litigants and judges during lawsuits explicitly deliberated over whether the knowledge, perception, and skills associated with the one medical system were translatable into those of the other. In other words, the question of whether the two systems were commensurable was itself featured in the controversy. Particular arguments changed with the context of dispute and did not necessarily reflect stable ideological differences between the two medical systems. Consequently, for analytical purposes, we are treating discourse about translatability and commensurability between “Western” and “Korean” medical systems as a substantive topic rather than a conceptual resource for our analysis (Garfinkel and Sacks 1970; Gilbert and Mulkay 1984). Instead of assuming that WM and indigenous healing traditions in Korea actually are or are not commensurable, intertranslatable, or otherwise compatible, we examine how the parties themselves rhetorically deployed claims about commensurability, translatability, and compatibility (or their lack).

We can draw an analogy here to the way historian of medicine Christopher Lawrence (1985) treats arguments about incommunicable knowledge. Such knowledge is a variant of tacit knowledge that emphasizes craft skills, such as “golden hands” and “bedside manner” in medicine; skills that are cultivated through personal experience and immersion in clinical practice. Lawrence observes that Victorian doctors deployed the concept of incommunicable knowledge to defend their professional privileges at a time when novel instruments such as the stethoscope and sphygmomanometer threatened to rationalize medical diagnosis. Fearful of losing their monopoly over diagnosis, these gentleman doctors asserted that experiential cultivation and gentlemanly sensibilities were essential aspects of diagnostic practice. Similarly, in a study of a more recent conflict between a so-called “scientific” program for reforming clinical practice that many doctors in an Australian hospital resisted by pointing to the “artisanal” and “craft” skills mastered through bedside practice, Warwick Anderson proposes to treat the distinction between “scientific” and “craft” medicine “symmetrically” (Anderson 1992, 655; also see Lynch 2013, 69). ⁷ Unlike Michael Polanyi (1967) or Harry Collins (2010), Lawrence and Anderson do not treat this variant of tacit knowledge as an intrinsically valuable and substantive possession of the practitioners in question; instead, they treat it as a discursive move in the contentious labor conflict they analyze. Similarly, in the present case, we treat the question of whether or not KM and WM are essentially separate medical paradigms—whether or not knowledge internal to one system is incommensurable with knowledge internal to the other—as a question in the dispute we analyze, rather than a question we would propose to answer (or, worse, presuppose) in this study. ⁸

Our analytical treatment of this dispute also draws upon sociological studies of specific legal controversies in which questions about science, technology, and expertise are explicitly addressed (Jasanoff 1995). Legal disputes occasionally involve particularistic arguments that resemble general positions advanced in sciences and technology studies (STS). For example, courts are sometimes called upon to rule about which fields are or are not “scientific,” and about the “expert” status of particular fields. Rather than try to evaluate such particular arguments by reference to, for example, demarcation criteria offered by philosophers, an established line of work in science and technology studies examines the contextual and interactional use of distinctions between science and nonscience, and between contestable and incontestable “facts” (Gieryn, Bevins, and Zehr 1985; Edmond and Mercer 2002; Lynch 1998). As Gieryn (1983, 781) observes, demarcation is a substantive, socially, and historically situated activity: “Even as sociologists and philosophers argue over the uniqueness of science among intellectual activities, demarcation is routinely accomplished in practical, everyday settings.” In the present case, a court took up the question of whether the understanding and use of a particular technology was essentially bound to the system of “Western” medicine, and not to that of “Korean” medicine.

A Dual Medical System

The institutionalization of South Korea’s dual medical system in the postwar period involved a series of boundary conflicts. Some of them became highly public affairs aired in the popular media and occasionally resulting in lawsuits. The disputes involved claims over professional jurisdiction, but these often were couched in much broader terms involving national identity, traditional culture, and the relations between (and stereotypes about) Eastern and Western medical systems. Like many disputes involving science, technology, and medicine, parties engaged in boundary work (Gieryn 1983, 1999) in which they made claims about “essential” differences between science and nonscience to support or contest particular claims of professional jurisdiction. In this case, not only were boundaries between “Eastern” and “Western” medicine negotiated, but rival claims and third-party judgments about where to draw the boundaries also were aired publicly in the media and courts.

Most of the boundary conflicts in recent decades involved accusations made by KM proponents that WM doctors and pharmacists were appropriating traditional herbal remedies and healing practices. KM proponents did not simply assert prior ownership of the contested objects and practices; they also deployed broader claims about the essential connection of the substances and practices in question with KM conceptions of the body and its forces. WM proponents countered that they were not appropriating KM knowledge and practice, but were interested only in select substances and technologies that could be extracted, tested, and validated through (Western) scientific research. KM proponents stressed that their remedies could not be translated into WM theory and practice without losing what was essential to their effectiveness, while WM proponents argued that some traditional technologies and substances were, in fact, intelligible and testable within their system. A series of such conflicts are described and analyzed in other work by Ma (2008, 2010).

What concerns us in this article is a more recent controversy in which the arguments and lines of demarcation worked in the reverse direction, as WM proponents objected to appropriation of “their” proper technology by KM hospitals. By the mid-1970s, Korean medical hospitals were well established, ⁹ and KM physicians were increasingly interested in using modern instruments for diagnostic purposes. ¹⁰ KM hospitals routinely used tools such as sphygmomanometers, digital thermometers, urinalysis instruments, and ophthalmoscopes, but by the end of the twentieth century they had begun to employ more complex imaging technology such as X-ray, ultrasound, and CT. They justified their use of such technology by reference to specific applications that, they held, were consistent with basic KM principles (Choi 2004; Park 2001; Son 1999; Yang 2005).

As KM hospitals began to use more of these medical technologies, they became the focus of direct conflicts between two professional organizations: the Korean Medical Association (KMA), an organization of licensed WM doctors, and the Association of Korean Oriental Medicine (AKOM), ¹¹ a similar organization of KM practitioners. The KMA tried to protect its jurisdiction from encroachment by KM doctors. They claimed ownership of particular diagnostic technologies, arguing that they were exclusive products of modern medical science, and charged that KM doctors lacked the necessary training, skill, and understanding to use them competently. The KMA (2001) lobbied the Ministry of Health and Welfare for legislation that would prohibit KM doctors from “misappropriating” biomedical technologies.

Professional turf wars over the control of imaging technologies and the associated interpretative skills were not unique to Korea, as similar conflicts have taken place in many countries and have been subject to distinct regulations. ¹² For instance, Howell (1995) discusses a conflict between physicians and photographers over X-ray images, and Simon (1999) discusses the micropolitics of visual interpretation of images generated by the Gamma Knife among biomedical specialists in North America. ¹³ Such cases are instances of broader historical struggles over the medicalization and monopoly control over the treatment of life events, personal, and interpersonal problems, and reproductive practices; struggles that continue to occur worldwide (Conrad and Schneider 2009; Wertz and Wertz 2009). Often, the jurisdictional gains of one profession are won at the expense of others, though they may have unintended consequences for the victors as well (Whooley 2010). The conflicts in recent decades in Korea are particularly interesting, if not unique, because they involve two established medical systems, rather than a single system claiming jurisdiction over “scientific” medicine in an effort to marginalize alternative healing practices. Both WM and KM systems in Korea are established modern institutions, though the former claims to be scientific while the latter claims jurisdiction over traditional healing practices. Although the relationship between the two systems is not necessarily symmetrical, the history of conflict (as illustrated by the dispute over CT scanning) has been subject to surprising shifts in rhetorical claims about technical jurisdiction.

The Dispute

As noted previously, proponents of KM had earlier objected to the misappropriation by Western pharmacies and clinics of selected herbal substances and practices (e.g., acupuncture). They argued that these could only be understood and properly used in the context of the entire KM system. In the dispute about CT scanners, jurisdictional rights also were contested; but in this instance, WM practitioners and their supporters were the ones who lodged the objection that the object in question was inseparable from their own comprehensive system of knowledge and training.

The dispute was brought to court in the early 2000s. A local KM clinic in Seoul began using CT for the purpose of obesity treatment. The clinic mainly used CT to gain an edge in the increasingly competitive market for dietary supplements, advertising that its advanced imaging technology could accurately visualize and monitor changes in a client’s fat layers. However limited, the clinic’s use of CT became a subject of protest by proponents of WM, who argued that it was an illegitimate appropriation of Western medical technology. This protest eventually led to a lawsuit to prohibit the practice. The point in contention was whether these diagnostic instruments incorporated epistemic values intrinsic to the Western system of medicine. Rather than attempting to resolve that point of contention, this article focuses on the claims and counterclaims about the place of these instruments in the two coexistent medical institutions in Korea.

In October 2002, the Kirin Oriental Clinic applied to a local health bureau in Seoul for permission to install a CT scanner. One month later, the bureau approved the application, and the hospital director hired a radiological technologist to take several CT scans per day (Seoul Administrative Court 2004). ¹⁴ The Kirin clinic was located in an affluent residential area, and like many other KM facilities it treated obesity. The hospital used a CT scanner to take two axial images of abdominal cavities (abdominal subcutaneous and abdominal visceral), and two images of both thighs, which were used to calculate the fat distribution and compare the density of bones and fat in the abdomen, internal organs, and subcutaneous areas, before and after obesity treatment (see Figure 1). ¹⁵ The visual CT data were converted into numerical measures, and adjusted for patients’ age, gender, and medical history, to determine statistically significant relationships with the treatment. The resolution was manipulated to enhance the contrast between fatty and non-fatty areas, to “make it more visible to the patient” (according to a radiological technologist at the Kirin KM clinic). ¹⁶

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Figure 1.

CT images of abdomen.

In 2004, the courts drew legal boundaries between WM and KM, when a local branch of the public health bureau in Seoul received an anonymous complaint that the Kirin Oriental Diet Clinic was performing illegal medical procedures. It was contended that Gil Soo Kim, a KM doctor and the director of the clinic, breached medical laws by practicing medicine beyond the “legal boundaries of licensed medical doctors.” The charges concerned two interconnected issues: first, the boundaries of medical jurisdiction for a KM doctor; and, second, the right to install advanced medical machines in a KM clinic or hospital (Articles of Korean Medical Law 2, 5, 25-1, 32-2, 51-1&2, 53-3). Dr. Kim was accused of using a CT scanner for diagnostic purposes when he installed a CT scanner at his clinic. The public health bureau investigated the case and concluded that the clinic had indeed breached articles of the medical law when it deployed a CT machine and hired a radiological technologist to take images with it. After concluding that reading such images was practicing radiology diagnosis (a specialty that did not exist in KM), the bureau ordered the hospital to shut down for three months.

Immediately after this order was given, Gil Soo Kim filed suit in Seoul administrative court against the public health bureau, claiming that KM physicians were entitled to use imaging technology and that he had followed correct procedures for installing and operating the CT scanner. In October, the Korean Society of Radiology (KRS), ¹⁷ the nationwide professional organization of radiologists, filed as a codefendant in support of the public health bureau’s ruling against the KM clinic. Radiology as a specialized medical field had been less competitive than other fields of WM and, accordingly, the professional status of radiologists had been less privileged. Thus, the Society viewed the use of CT by KM doctors as a sign of further degradation in their professional pride. ¹⁸

The administrative court ruled that Korean medical law respects the autonomy of medical practice and does not specify whether WM or KM doctors have an exclusive right to use medical instruments. Accordingly, medical practitioners are obliged to use all appropriate methods and tools for diagnosis and treatment. The court then deliberated over whether CT could be considered an appropriate KM diagnostic instrument. This involved a legal ruling about which tools, materials, and techniques were appropriate for either, or both, Western and Korean diagnostic practices, an epistemological bone of contention that had been gnawed at for decades. ¹⁹ The court found that the medical law loosely defined what constituted Western versus Korean medical practices, and so it did not prohibit KM physicians from using particular medical instruments, including imaging technology. According to the court, the relevant legal clauses define medical practices as including diagnostic and therapeutic actions taken by skilled physicians. Therapeutic actions include prescribing, compounding, and administering drugs, and performing surgical operations, and diagnosis includes consultation and examination. To identify a disease, the state of its progress, and the affected site, various scientific tools and methods are used such as percussion, auscultation, palpation, and traditional diagnostic methods such as “seeing” and “questioning.” The court then turned to a further legal and epistemological ambiguity—what, for example, “seeing” can mean in diagnostic practice—and asserted that in Western diagnostic practice “seeing” is interchangeable with the term’s use in Eastern medicine. Contrary to the idea that ways of seeing, including ocular instruments that enhance and extend diagnostic vision, are inseparably linked to practices and traditions, the court ruled that KM practitioners could use imaging devices as long as they are categorized as medical tools rather than Western biomedical instruments.

The court distinguished between WM and KM in terms of their distinct genealogies and theoretical foundations. Accordingly, Korean (WM) medical practice ²⁰ is based on medical ideas imported from the West, whereas Eastern medical practice is developed from inherited traditional medicine, Hanuihak (Eastern medicine). The court explained that, despite their different origins, there are no essential differences between their diagnostic tools and methods: the four traditional diagnostic methods (seeing, questioning, listening, and touching) are no less essential for WM imaging, verbal examination, and auscultation than they are for KM practice:

A CT scanner is a diagnostic instrument that uses a combination of X-rays and computer technology to produce cross-sectional images of the body. It helps to see the inside of the body that cannot be seen with the naked eye. Considering the functions and objectives of CT scanners (to help to see better and to examine more precisely the state of the patient) the use of CT scanners can be viewed as part of the diagnostic equipment and tools used for seeing in KM. (Guhap 10715 Upmu Jeongji Cheobun Chwiso [Seoul Administrative Court 2004])

The KM camp’s professional newsletter heralded the ruling as a legal precedent guaranteeing KM doctors the right to use medical instruments, but two WM professional associations, the KMA and the KRS (2004) protested the ruling in newsletters and public statements, contending that the “astonishingly shocking judicial decision” would hinder the progress of Korean medical culture. They blamed the government for being swayed by the KM lobby, which was trying to break into the lucrative market for diagnosis with expensive medical instruments. They also insisted that KM physicians lacked the relevant diagnostic skills and that traditional “seeing” with naked eyes was not equivalent to technical diagnosis:

KM physicians are expected to make diagnostic decisions without the aid of diagnostic instruments; they are skilled in gathering diagnostic information by examining a patient’s color and facial complexion, emotional stability, and the harmonious balance of the whole body with respect to the individual parts of the body. (KMA 2005)

In January 2005, the public health bureau of Seocho-gu in collaboration with the KRS (2005) appealed to the high court in Seoul, contending that WM physicians possessed an exclusive right to use complex medical instruments that should not be extended to KM physicians. The KMA, which was involved as a supplementary appellant, argued that its membership was responsible for preventing medical catastrophe by excluding nonexperts from using biomedical imaging instruments. The high court considered two general issues in the appeal: one had to do with administrative procedures and liabilities of the public health bureau and the other with the question of whether using CT scanners was within the remit of licensed KM doctors.

On the first question, the high court judges agreed that the Kirin clinic had taken appropriate steps to acquire authorization and that the public health bureau had overreacted when it ordered the hospital to close down for three months. The judges agreed that the relevant laws were unclear and that the public health bureau should have kept the clinic informed of any changes in regulations and supervised their use of CT scanners instead of shutting them down. The judges then turned to the second issue and agreed with the lower court that the law did not expressly forbid KM physicians from using biomedical diagnostic technologies. They ruled that the law did not draw clear boundaries around medical practice, whether based on WM or Hanbang (Eastern medicine). The high court thus affirmed that the cultural traditions in both systems could accommodate scientific and technological advances. However, at this point, the high court stepped in to inscribe the epistemic boundaries that had been left ambiguous in law.

The court began its demarcation exercise by contrasting the quintessential attributes of WM (“realistic, positivistic, objective, and experimental”) to those of KM (“subjective, intuitive, holistic, empirical, and philosophical”)—see Table 1.

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Table 1.

The Court’s Demarcations between WM and KM.

WM	Analytical	Material basis of investigation	Anatomical body	Organ-centered approach
KM	Holistic	Phenomenological basis of observation	Organic body	Mind-body unity

Note: WM = Western Medicine; KM = Korean Medicine.

Source: Ruling of Nu 1758, Seoul High Court (2006).

The court elaborated a conceptual gap in perceptions of the body: WM perceives an anatomical body whose fundamental processes can be reduced to physicochemical principles, whereas KM perceives the body as a microcosm based on gi (qi), which is a “spirit” or “energy” that circulates through bodily channels. In contrast to the administrative court’s earlier ruling, the high court then extended this dichotomy to diagnostic methods: WM diagnosis incorporates medical advances such as positron-emission tomography (PET), magnetic resonance imaging (MRI), and various lab tests and forms of examination such as medical interviews, physical examination, auscultation, percussion, and palpation, whereas KM uses the “four diagnostic methods” of seeing, listening, questioning, and touching. The high court thus contradicted the lower court’s assertion that modern diagnostic methods and tools were compatible with both medical traditions, arguing that diagnostic technologies cannot be treated independently of the associated theoretical principles:

The Korean medical system is divided into two professionally licensed groups: WM and KM. The law also stipulates that [Western] physicians practice [Western] medicine and KM physicians practice Hanbang [Eastern medicine]. With respect to CT, the law neither specifically prescribes that KM physicians can use CT for any purpose nor stipulates that KM hospitals can install CT. Moreover, the theoretical principles and foundations between WM and KM are not mutually compatible. For example, the WM body is analyzed and understood according to anatomy, whereas the KM body is holistic and perceived as a microcosm. Therefore, because of the differences in the perception of the body and disease, KM diagnostic methods and tools differ from those in WM. Given the situation, it can be ruled that Kim Gilsoo [KMD] trespassed across the professional boundaries of licensed jurisdiction into the realm of WM, since it is hard to perceive CT scans and interpret the results as KM diagnostic practice. (Ruling of 2005nu 1758 Upmu Jeongji Cheobun Chwiso, Seoul High Court. June 30, 2006.)

CT, Diagnostic Skills, and KM Diagnosis

As noted earlier, a series of conflicts had taken place when WM hospitals and pharmacies attempted to appropriate selected substances and equipment that KM practitioners claimed as their own. Generally, during those conflicts, representatives of KM stressed the essential place of those entities within the entire set of assumptions and practices in their tradition. However, when interviewed in 2005 and 2006, in the context of the dispute about CT scanning, KM doctors said they were keen to use biomedical instruments in addition to traditional KM instruments. They downplayed any essential link between those instruments and the entire medical system in which they were used. For example, a representative of the Kirin Diet Clinic asserted that CT images provide “supporting evidence” to reconfirm KM physicians’ judgments based on their four diagnostic methods, and he also said that “CT is a merely an instrument for taking pictures of the abdomen and thighs” to confirm the effects of the treatment. He acknowledged WM doctors’ arguments against the use of biomedical instruments, but he separated the particular use of the technology from the diagnostic system in question: he reiterated that he did not “read” films to acquire diagnostic information. He and other clinic administrators insisted that CT was used as a mundane tool in their hospital: it was not used for diagnostic purposes, but was like a camera for taking precise and detailed images of the targeted object, and anyone who had learned how to operate CT could use it in that way.

The Kirin Diet Clinic follows a contemporary trend in KM to accommodate biomedical concepts and technologies, which has been called “WM diagnosis and KM treatments.” ²¹ Unlike the High Court judges, and unlike KM proponents during earlier disputes, in this case, KM physicians treated modern biomedical innovations as being independent of either system of medicine. As one KM physician stated:

As far as diagnosis is concerned, there is no distinction between Eastern and Western medicine. That is, the act of doing diagnosis does not belong to either terrain of medical practice. However, it is possible to draw boundaries around treatment between Western and Eastern medicine. The reason is that medical innovations are made as science and technology advance. X-ray is a great example. And those medical innovations should be regarded as ‘common properties’ and not associated with a specific professional group. That taking pulses goes back thousands of years does not necessarily mean that modern KM practitioners should stick to that old practice without accommodating modern technological advances. Similarly, WM physicians started to use the X-ray for diagnostic purposes only after it was discovered. More importantly, physicians did not invent the X-ray. Does this mean that physicians should not be allowed to use the X-ray? CT was introduced into Korea in the mid-1980s, and apparently those physicians who had graduated from medical schools before then did not have a chance to learn about CT. If so, logically, they also should be banned from using CT for diagnostic purposes along with KM physicians … Now that diagnostic instruments are available, we should have access to them so that we can check against the diagnostic and therapeutic information gathered through the traditional four diagnostic methods. That is, we use diagnostic instruments to confirm our diagnosis rather than use them to make a diagnostic decision. (Interview with Choi, a KM doctor and then vice-president of Korean Han Medical Practitioners Association, March 3, 2005) ²²

In this case, proponents of WM expressed a different view of the matter. For example, during an interview in August 2006, Dr. Huh Gam, radiologist at Inje University Ilsan Paik Hospital and the president of the KRS, accused KM doctors of having misused one of the most expensive and advanced pieces of medical equipment. He was infuriated that KM physicians claimed to use CT scanners for a single purpose (measuring abdominal fat distribution). Huh had publicly expressed his anger against KM doctors and used the media to promote the professional image of radiologists. Alleging that the professional pride of radiologists had plummeted when the administrative court sided with the KM doctors, he forcefully asserted that epistemic differences between WM and KM militate against the KM profession’s trespass into WM territory.

He blamed the government for having erroneously endorsed the two-tier medical system.

The government has committed too many crimes against the profession of medicine, and it’s now time for the government to admit its past sins and correct them … Furthermore, the government was complicit with the KM profession in that the KM practitioners made use of nationalistic sentiments to promote KM as a national (minjok) medicine. This is as good as an inferiority complex. Nationalism is unhealthy patriotism, which, in fact, is festooned to grow scientifically unverified, mythical drugs in the name of treating so-called incurable diseases [with WM drugs]. (Interview with Huh Gam, August 12, 2006)

Second, he contended that radiology is an organic part of WM diagnostics and therapeutics, which cannot be separated from other specialties such as internal medicine, surgery, anatomy, and pathology. He gave two major reasons for why KM physicians are not qualified to use modern medical instruments. First, they espouse essentially different views about disease, and their therapeutic and diagnostic methods are not based on science and statistics. Second, they are not systematically trained through education and residency in modern medical hospitals. As mentioned earlier, KM physicians contended that they are entitled to use CT scanners because their curriculum included radiology. To nullify that claim, the KRS characterized radiology as a subdiscipline deeply interrelated with other clinical specialties, so that expertise in it could only be gained through years of clinical training and research. Spokespersons for WM, such as Dr. Huh, enumerated the scientific and medical subjects that must be mastered before radiology can be applied in clinical settings: physiology, pathology, anatomy, physics, chemistry, pharmaceutics, and genetics, among others. By arguing that radiology is part of a complex web of biomedical knowledge and practice, KRS spokespersons emphasized that WM education and clinical practice are essential for the scientific integrity of CT scanning. ²³ They emphasized that radiologists are medical professionals who learned scientific principles by heart and mastered research procedures to become “superspecialists.” They contrasted this to KM diagnostics, which they characterized as reliant on anecdotal evidence, trial-and-error practice, and outdated medical texts, all of which were quintessentially incompatible with WM diagnostics.

As Gawande (2007, 90) suggests, medical professionals have become more specialized, as seen in the Intensive Care Unit (ICU) with its staff of superspecialists. They have two advantages over ordinary specialists in that they have “greater knowledge of the details that matter and the ability to handle the complexity of the job.” Along the lines of what happened in the ICU, radiology has come to be divided into subspecialties organized around key scanning technologies: PET, functional MRI, and CT. Even CT expertise is further subdivided into angio-CT, therapeutic CT, chest CT, brain CT, and so on. As some radiologists stated, physicians need an extra four years of residency training to become sufficiently specialized to survive in the competitive WM market. Accordingly, radiologists challenged the credentials of KM doctors after the latter began using imaging technology, contrasting their shallow understanding of radiology with WM doctors’ extensive training in radiology.

Furthermore, Dr. Huh drew a line between the progress of Western biomedicine and the modernization of KM, contending that they are not comparable and that KM physicians’ use of scientific instruments should be restricted to modern Eastern medical instruments such as electroacupuncture machines and modern moxibustion tools. The KRS denied that seeing in Eastern medicine is compatible with the instrumentally mediated vision in WM. According to the KRS, diagnosis is a process of making precise decisions about disease. While acknowledging that WM includes sensory examination, the KRS argued that seeing in KM relies solely on unaided sensory organs, and thus is an intuitive, subjective, and rudimentary ritual that cannot be equated with highly sophisticated methods of visualization:

Human organs such as the liver, lungs, and heart in WM do not retain the same meanings as they do in Eastern medicine. They are fundamentally different. Organs in WM refer to concrete concepts that are understood based on natural sciences, while organs in Eastern medicine are perceived to be symbolic concepts that are based on natural philosophical principles such as Eum and Yang. That is, a KM physician and a WM physician are not seeing the same patient even when they see the same patient, since their views are essentially different. When CT is used to see the patient, a KM physician cannot acquire information about Eum, Yang, Huh, and Sil that are crucial to KM diagnosis and therapy … To make the radiation diagnostic process scientific—understanding the medical significance of the CT film image and making therapeutic decisions accordingly—one needs to have years of training in radiation films, cross-sectionals, anatomical structure of the body, and various kinds of internal and external diseases. (Interview with Huh Gam, radiologist, August 12, 2006)

Discussion and Conclusion

It is not uncommon for practitioners of traditional medicine to use biomedical technologies to corroborate diagnosis and treatment. For example, Adams (2001) describes a contemporary Tibetan text on women’s health that recommends that peer doctors should use medical instruments to validate the scientific truth of Tibetan medicine. Tibetan medicine practitioners use ultrasound machines to diagnose womb disorders caused by blocked “channels” and use microscopes to see the “bug” that causes a “feverish womb.” KM practitioners are no exception, as they have expanded their terrain by selectively incorporating biomedical science and technology (Kim 2007), while trying to protect their traditional practices from the WM profession’s encroachment. Threatened by the expansion of KM into the markets for medical knowledge and health care products, as well as by its increased demand for inclusion in Korea’s national health system, the WM profession has attempted to demarcate and reinforce its boundaries by insisting that medical instruments embody WM’s theoretical foundations and organizational characteristics. WM proponents claim that advanced medical technologies such as CT scanners reflect corresponding advances in Western science and should be applied exclusively by physicians trained in the scientific method. In contrast, KM proponents claim that medical technologies are neutral tools that can be transferred across professional jurisdictional boundaries.

This dispute is interesting for the way it represents a reversal of earlier conflicts in which KM practitioners defended their herbal remedies and practices against WM encroachment by claiming that they were essential parts of an entire system of knowledge and that their meaning could not be translated into modern biomedical terms, while the WM proponents lobbied for partial connections independent of tradition and belief. In the late 1970s and early 1980s, Western-style pharmacies attempted to expand their markets by retailing some of the more popular herbal remedies, and proponents of KM resisted what they viewed as the selective appropriation of their medical remedies. These conflicts were brought to a head in the 1980s and 1990s, when the government proposed or enacted a series of legislative initiatives that appeared to sanction the transfer of medicinal substances, and of the traditional cabinet that housed and symbolized those substances, to Western hospitals and pharmacies (Ma 2008). During those disputes, proponents of WM emphasized the translatability of some KM remedies and herbal substances into biomedical terminology and pharmaceutical products. KM proponents (often represented by the AKOM) insisted that these substances, along with the skills and technologies for administering them, could only be understood holistically, in terms of traditional conceptions of the body, and of health, disorder, and treatment, which were not reducible to biomedical idioms (Ma 2010).

In the present case, however, it was the WM profession that attempted to demarcate the epistemic and cultural boundaries between the two systems and to deny the possibility of selective borrowing from one system to the other. As KM proponents had done when complaining of encroachment during the earlier conflicts, in this case WM spokespersons emphasized the inseparability of instruments and materials from the entire medical system. Like the KM practitioners who, during the earlier disputes, had insisted upon holistic conceptions of herbal remedies that could not be fragmented into active ingredients, in this case WM spokespersons objected to the alienation of scanners from the cultivated skills for using them. Like KM proponents in the earlier disputes, they also stressed the essential differences between the contending theoretical conceptions of the body and its forces, and insisted upon the necessity to ground diagnostic vision in deep personal experience within a distinctive system of knowledge and practice. This historical reversal helped demonstrate that neither party was permanently committed to the idea that the two systems were conceptually incompatible, or incommensurable in the philosophical sense developed by Kuhn (1970) to emphasize the impossibility of translating between conceptually incompatible systems. ²⁴ In this case, the question in dispute was whether or not practices and artifacts (in this case, CT scanners) would be misunderstood and misused when appropriated from “Western” medicine into the distinct matrix of concepts and practices that make up the “Eastern” or “Korean” medical system. As with earlier disputes about the selective appropriation by WM hospitals and pharmacies of KM materials, claims about untranslatability and incompatibility did not entirely close off the possibility that the professional boundaries between the two systems permitted specific modes of exchange and practical alignment.

Particular arguments about “essential” ideological differences between Western and Eastern medicine were embedded in substantive arguments in an ongoing professional rivalry. Though claims about essential untranslatability might seem to have particular affinity with KM, with its stress on esoteric tradition and nonmaterial forces, in the case of CT scanners it was WM proponents who invoked discontinuity in language and “seeing” in defense of their system of practice. Proponents of each system used such arguments at different times during decades of conflict between KM and WM. Just as Lawrence (1985) does not attempt to resolve questions of whether Victorian doctors really did possess an incommunicable knowledge that would be lost through changes in medical technology, we can offer no conclusion as to whether WM really is, or is not, incommensurable with KM. Our conclusion instead is that “incommensurability” is a conceptual resource, not only for scholars who investigate science and medicine, but also for practitioners who put forward distinctions that become institutionalized in legal and medical systems.