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 good money. Let's start.

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So disease.

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our session.

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the response of health professions to complementary alternative medicine.

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and just to introduce. I would like to

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read the abstract when we create the the the session or proposed the session.

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Mike Sacks and me

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and health professions have often adopted an intolerant authoritarian, and and

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response to Cam.

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particularly when it is Exponents are not part of orthodox professional bodies. They have, for instance, intentionally intentionally sorry, behaved in discriminatory ways, being

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and discrimination and invalidate the and marginalized can practice.

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This is the main idea. When we

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presented this session. and then we received some papers.

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and we

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I had today 4 presentations, one from

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Mike Sucks. talking about the professionalization and the relationship between orthodox and unorthodox made seen in Britain.

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The other From eyes polite

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discussion, orchestrating, modern and alternative made this medicine challenges for our protectionists of can in Turkey.

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the third from Joan Omida. and others. and talking about perceptions of use of can therapy in women with breast cancer.

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and the last one from Paula F. The Buddhist. I am talking about how physical therapy's professional boundaries are contested. Following the enactment of the medical professionals Regulation Act in Israel.

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So we have these 4 presentations, and we will follow this

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for presentations, and we will have 20 min for each one. And after that we have the discussion. Right?

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So, Mike, would you like to invite to to start here?

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It's left kick, isn't it? Okay? Yeah, okay, that's great. Yeah.

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Well, thank you very much. And thanks to Nelson, who's done a great job, you know. with me putting this session together. And it's great to see a few of you have made it made it here, despite the Jack lag and other things. although it is Tuesday now. But it doesn't stop up Monday, anyway. I want to talk today about the relationship between professionalisation

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and the links between orthodox and unorthodox medicine. And in terms of doing this.

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I want to. just say something about my own background. I mean, I'm always been keen on metaphors. I love metaphors, in fact, going back. 7 years or so ago I wrote a book, the first book actually on Professions and Metaphors, which was an interesting subject of the time. plenty of stuff on organizations and metaphors, but not really on professions and and and metaphors so long applied metaphors to British medicine and professionals generally.

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and also, as I think most of you here will know that I'm a of a variant and basically, just to say, the main features, as you can see on the screen are that professions are defined in terms of exclusionary social closure. You know, I creating boundaries around themselves, link to trying to get striving to get increase income status and power in a competitive marketplace.

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And the whole conceptualisation is that we have lots of warring interest groups which is very relevant to my presentation today.

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and such battles among

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inside as an outside as important to this presentation are actually involved in ideological warfare.

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We'll see a bit more about this, but I would just say word or 2 that this is a presentation I made a few years ago, and I just wanted to expose it to a wider audience. I made a few tweaks and things, you know, in terms of contemporary developments. But I I sort of I feel quite weed to some of the themes here. because of my interest in cam.

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And basically, what I argue here is that cam is really defined, not in terms of substance, but is defined in terms of power relationships relative to orthodox medicine. So orthodox medicine gets support from the State. Typically

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it's dominated by biomedicine. It's focused heavily on drugs and surgery. Unorthodox medicine is not so widely supported by the State. And it's right. State support is very patchy

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and it's typically largely subordinated to biomedicine, particularly in the in the modern, in modern societies. And it encompasses a very wide diversity of approaches. You know, acupuncture homeopathy herbalism, you know, the whole shooting match.

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So these are the. These are quite important definitions moving forward, and that I it's very, very significant that we're talking here about definitions rated to a fluid political process. So you know, Cam is not defined in terms of oh, is there scientific evidence, or is that. Not? That's not the definition, although, you know. Obviously, some of these therapies in cam may be more or less effective. But we're not really concerned with that as sociologists.

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we are really very much concerned with stressing the political aspects of the relationship, and this can be highlighted very much by the British situation in terms of medical professionalisation, and in the eighteenth and nineteenth century, when

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you know the medical fashion got its sort of supremacy. There were no real disadvantages over their rivals, because this was rather a

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a confused position where? you know, there was. There was little difference. So in 19, in the nineteenth century, the up to the mid nineteenth century. It was a comparatively undifferentiated field, and there were great difficulties in distinguishing practitioners in terms of their methods. Reputes, status, theories, change training, and so on.

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And there wasn't a real, a monopoly. It was an an open pluralistic field.

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but from the early nineteenth century onwards. We have powerful political lobbies by what was subsequently to become the the British Medical Association to professionalise medicine and create create boundaries supported by the State. And this basically was underwritten by the 1,858 Medical Act and subsequent legislation which differentiated

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doctors from rival practitioners created a wider, you know. As time went on there was a wider state market shelter with the Nhs. And other other developments, and growing paradoxmatic unity in medicine and the expansion of a lot of subordinated health professions, you know, in terms of underwriting the power

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of of medicine, and in this process there were many ideological attacks, which is, I mean, really quite scathing, you know, quacks, and.

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you know, criticizing cam practitioners as what were to become can practitioners with the legislation and they were seen as devils from whom you know metaphorically as devils. That's the hence the title of the presentation from whom the public needed protection.

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and

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as a result of this unorthodox medicine became increasingly marginal. And so.

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you know, had common law rights, but no State legitimacy in Britain. It there were restrictions on what conditions could be treated, you know, so you couldn't sort of claim to be treating cancer, you know, as a camp practitioner

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ethics, medical ethics, restricted collaboration between Cam and medical practitioners. There were also basically informal medical colleague control stigma and such such light which which had tended to stifle the efforts of the unorthodox to professionalize and intensified attacks in medical and other media.

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This helps bring about a fall in the use of cam from the mid nineteenth to the mid twentieth century in Britain.

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And

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and then this was the other side, the other side of the coin that cam practitioners came to see orthodox medicine as the devil, you know. So having been demonized themselves that the boot was on the other foot in terms of how they regarded the situation, but the counterculture made a major difference in in the Uk. And it was really interesting. The attack on rational medical progress was so so-called

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and the promotion for of alternative lifestyles, and so on. And so we had this resurgence of cam even though it had been long demonized

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and

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interestingly. And this was the the other side of sympathy for the devil that actually there was. There were growing attempts. Post 19 seventies for cam itself to professionalize, you know. Sort of like. Oh, well, you you were condemning the professionalisation of medicine. And now Cam was was jumping on the same bandwagon to gain its place in the sun with increasing amounts of education and training, with

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Unorthodox therapy is a sort of the lowest common denominator introducing voluntary regulation, and then, subsequently, you had in the 1990 S. The Osiifata and the chiropractors actually created a situation of exclusionary social closure supported by the State.

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and there were growing numbers of cam therapists who themselves were health professionals. So so this is like a kind of vault fast, you know, in terms of what was happening in camp, which was really interesting, and you know it was quite fascinating, because usually camp practitioners are a law, and to themselves, you know, is for herding cats, and so on. And they love the individualism of practice, and not being necessarily in state.

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based organizations. But this, this moved to collegiality in terms of professional organisation was really that, you know, fascinating, actually. But there were limits, because there are many reluctant professionalizers. And so even those organisations that had voluntary regulation. They? Basically many of them, many individuals just didn't engage. You know, they didn't want to be part of

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any organisation that might exist. And there was quite a lot of resistance for various reasons, not least being the sustained attack by some members

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of the scientific community on Cam, which has made it a little bit uncomfortable, a rejection of government by individual therapy interests, and so on, and the pressures bought by other interest groups, such as drug companies. But there is a twist in the Devil's Tale, and this is that although

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you know, unorthodox practices were increasingly looking towards professionalism in one sense or another, orthodox medicine actually itself suffered an attack, you know. So, having been, you know, in its place in the sun, there were many attempts by government to actually.

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you know, sort of hunker down on medicine, and the governments actually saw the profession of medicine as a devil, you know.

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because there were increasing problems with scandals. high-child mortality rates in Bristol Royal and Furnbury, you know, just just going through here issues surrounding baby P. A child who was killed by his parents and professionals didn't really step in Harold Shipman, the serial killer, and so on. And so, increasingly.

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we've had various kinds of measures to restrict the powers of medicine. So it has become the devil in the Isa Government. And I mean just to tell you privately.

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I was doing a lot of work with the Department of Health at the time, and when shipment was killing all these people, and it wasn't detected by the Gmc. Over a 30 year period, they actually said to me, Mike, can you provide a scenario in which the medical profession doesn't exist? You know. What? What would the world be like? What would we do if there wasn't a medical profession with the Gmc. I mean they it was. It was so. They were so close to the edge, actually.

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And so we we got increased reaccitation of medical practitioners, because, you know, basically it was, you know, once they qualified, they could just continue forever a day and increased lame membership of the Gmc. And and basically the government sort of talking about statutory regulation of certain alternative medical practices, although that's rather been rode in recently.

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So you know, reduction in the size of the Gmc with equal numbers of layer medical personnel, the revalidation program for doctors. the facility for independent adjudication of complaints and the creation of a meta-regulator to oversee what medicine was doing.

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And all these kinds of things really meant that medicine was on the retreat as the devil. You know that basically, we've got to try and control medicine because it's not good enough not giving us the right sort of outcomes. And in terms of our Meta wars.

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I've written about zoos, circuses and safari parks, you know, which is basically the idea of the professions in their cages, you know, with boundaries moving to a circus with the ringmaster. The ringmaster is actually the state, and the safari park is where we encourage interprofessional working, which is to some extent erode it. The the dominance of of the medical profession, and

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this sort of spectre of increasing restrictions on autonomy of medicine is now being rolled out, or it has been ruled out in some cases to other professions, including nursing and other groups. And so this isn't just restricted to medicine.

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but the the the reforms themselves have certain shortcomings in terms of bringing the devils to heal

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A lot of the policies were not sort of do not seem to be from current evidence, seem to be fully implemented. It's still rare for doctors to be struck off. We can't afford to. In Britain. We haven't got enough doctors, so you know, that's a sort of a a snide, so you know, comment. But but but also, you know, revalidation seems to have not been done, you know, systematically, with with with with data in all cases.

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and into professional working still has some way to go. But but anyway, I think, just to conclude this is, there is a debate about, you know.

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as I said in terms of the Chatham house rules, you know. Stuff with the department felt. I think we are. We are 10 years on, so I can talk freely about it 10 or 15 years on. But there are debates about the best way to regulate orthodox and unorthodox medicine. But I'm not really going there. The main thrust of this paper is basically to say

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that the metaphoric concept of devil has been used in switchback fashion in the politics of professionalisation, between orthodox and unorthodox medicine.

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in historical and contemporary settings in Britain. I'm sort of fascinated by it, and I'm not going to play you any music, but I do. I do see this as being very, very resonant with the theme of the rolling stone song, sympathy for the devil. Hence the title.

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I'm sure you all know it well, but it applies very well in charting the relationship between professionalization and orthodox, and and also X medicine in Britain and the key facets of this song. you probably listen to it. We haven't analyzed it, but I think that Mick Jagger introduced himself as Lucifer in describing some of these terrible exploits, you know, in the course of human history, you know, eliminating the Tsar and his family, and so on. And all these things.

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So the notion in the song is, there's a lot of evil in the world.

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and we blame the devil for many of the atrocities. However, there is good and evil in every one of us, you know, and including the devil, you know himself or so herself, and that crossovers between the 2 can and do regularly occur. And I think this is what we see in the history, and contemporary manifestation of professionalisation between orthodox and unorthodox medicine. So I hope that

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you found that You found that helpful in terms of the political interface. And If you do want to see some of the words of the song, I mean, this is a young M. Big chatter. Who's who's changed somewhat in recent years. But you know this is when it when the song first came out.

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a cover of the

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of the single. But you see the devil is a man of wealth and taste. But having said this, there's this sort of like, you know.

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the the persecution of Jesus Christ, and you know all these kinds of things, and hanging around St. Petersburg and killing Anastasia and and The rest of her family, and so on so so the devil is kind of a mixed bag. And I think this really appeared this. This is how it appears to me in terms of looking at the professionalization of orthodox medicine, and to some extent

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not the deep professionalisation, but the move towards regulated self regulation which has happened in Britain.

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and and also the position of

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alternative medicine, you know, which has which has been, you know, sort of a bit of a bit of a switch back in terms of stances towards professional standing.

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So that's very good. So just to leave you with a with a few references.  you know.

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I think that one of the most interesting things I've written recently was

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this paper on Markets of Medicine, Orthodox Medicine.

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complementary and alternative Methods of religion in Britain. This is a book on it. It was the Rouge Handbook of

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Religion, Medicine, and health. And the reason why I particularly like this is that the the the the editor, the editors that suggested that we all went up to the Swiss mountains and had a workshop to discuss, and we spent a few days there, so I'm not sure we always talked about the papers, but you know no, but it was. It was an interesting interesting contribution to right.

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but the others are more sort of background stuff. So even a book like the professional state and medicine and the market actually doesn't just look at medicine. But it also looks at alternative medicine, because my lifelong kind of feeling has been that you can't study one without the other. They are genuinely 2 sides of the same point. You need to understand both.

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and to have a sort of holistic view of the field. And that's where I'm going to leave it so. Thank you very much, and look forward to hearing the other presentations.

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Thank you, Mike. And now, yeah.

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we

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for, like, I see.

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are you there.

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AyÅŸe Polat: Yes, can you? Yeah, good.

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So please give us your presentation.

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AyÅŸe Polat: Thank you. I also would like to start by thanking the planet organizes and participants for everyone. It's a great pleasure to be here today and to share our ongoing research. I shall just sorry find you. Okay. Here we go.

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AyÅŸe Polat: My talk today will be about the account practitioners and Turkey challenges for them is that is how the State regulated and has been regulating the temporary camp practices in Turkey, and I will just start with showing 2 images, the one on the on our right to the night time for almost the same. There is no attention to medicine, cannot have. An alternative is the is, it is an image from a lookshop organized by a Turkish association.

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AyÅŸe Polat: and the one and this was organized right after the Government

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AyÅŸe Polat: officially supported camp in different phase, and the one on the the one the image on the left is the is the cover of the if journal published on title and the the Journal on Anatolian Medicine.

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AyÅŸe Polat: And basically, as you can tell from the image here, there's a tree, and then it says, like, Okay, basically, the roots are going all the way. I mean, the the 3 has deep roots, and you'll see images for will ever send or others. And basically the it, it's just trying to give you a sense, give a meaning that

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AyÅŸe Polat: cam itself, or if we call it on those to put an on Antonian medicine is basically deep down. We have it. It's in. It's in our culture, it's in our history. We'll talk more about this in the in the of the the presentation. But I just want you to start here

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AyÅŸe Polat: with the images.

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AyÅŸe Polat: and so by theoretical question, is, actually is has 2 sites. I actually, I'm thinking, to a good deal. And one specific concept is the concept of habitats. And I, as we know, key for him. It's structured structuring dispositions that enable individuals to to act and to navigate in social work, but usually he uses it only in the singular. There are exceptional timeline. He uses it in polar.

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But the question that I ask if the if is how it is just singular, or it can be also the. And if the answer is the letter, then how to subjects or case rate is different. Happy to stay, and by the

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AyÅŸe Polat: so in that regard, if we if we're talking about pro professional, like practitioners of modern medicine, who perform, who both perform modern medicine but as well as can practices, how do they bring together this supposed in different grounds.

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AyÅŸe Polat: and the other questions regarding when he defines State as the combination of different types of capital, and not just an instrument ofersion, but also consensus producers. Then how can we think about the role between the conceptions of habit to state and power? I related, and how the individual individuals again, navigate the conflicts not just between different fields in this case, in the medicine itself.

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AyÅŸe Polat: And then so these are the main questions. And this is an ongoing research. So I would not be able to answer the questions. But these are the driving questions behind the behind the Andbreaker research. The. I will just give some brief background information about the current level of research in Turkey, about the camp. I should first underline, I think, over the since, like over the last 10 days, or is it 10 years, especially the last 5, 6 years? There is a growing interest.

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AyÅŸe Polat: but most of them most of the studies are just quant status studies, and they are usually carried on the public health departments. There are very few of conducted on their sausage or to the other social science programs. And they are usually hype. They are usually driven by

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AyÅŸe Polat: like quant state analysis meaning, they choose certain variables, and they just test the hypothesis with hypothesis, saying, like, where the agenda has an effect or income has an epic and all that stuff, and also the other issue they usually tend to focus on just on the demand side of camp meaning. They are more interested in the patients. Interest in camp practices rather than suppliers. In this case, doctors.

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AyÅŸe Polat: and even if they do any research about the doctors or nurses, or any supporting health professionals, it usually is about is a survey study. And if they are just measuring doctors, knowledge or exit about camp practices. So basically, there is really the number of qualitative deep in in in that interview and qualitative investigation is very little. And so the the aim of this project is so far I conducted about 6, 7, actually 7

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in interviews with promises, 5 pharmacies, and 2 doctors with conductors.

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AyÅŸe Polat: and also the. This is an ongoing project, and the aim is to come up with the ground. The terror based on this is why we can take into account multiple actors as well as Actons, and still both the the perspective of the State, but also different practitioners. And I will just talk about how there are so many different actors actually, and enroll in this whole area.

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AyÅŸe Polat: So regarding talking about the I'll just tell the story from the part of the State first, and then we'll get to the to the interviews, the, the, the emerging team, so far. So in Turkey. The first, if you exclude the more tradition treatment, such as copying and reaching, the more what we call today camp. And it might just underline. This is holy share. But what, what.

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AyÅŸe Polat: how do we name cam and modern medicine? And what do we count under? Can what we don't count? But in any case. So in Turkey, if we leave aside copying and reaching, the first legal legislation came for a puncture in 1,991,

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AyÅŸe Polat: and today a puncture is still the most common to use one, and this is like the general trend in other European countries as well, and in in 2,012, the the Under the Minister of Health, and this is very much in line with the H. O. policies and strategies for the development of

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AyÅŸe Polat: and in Turkish it's it's called, get tough meetings through. This is like traditional, complimentary and alternative medicine practice office, which is open in 2,012 under the Minister of Health in 22 years later they just dropped the name alternative, and today they also underline that they prefer not to use the term I tend to, because they are not trying to say that, you know this is not time to to modern medicine itself.

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AyÅŸe Polat: So today, to state officially recognizes 15 can practices which range from a puncture of the therapy heightness. This is which is only put to chiropractic, and not only read the list, but basically, as you can tell, they are really like, that's the whole issue. There. They include very different practices. And there is a debate about, you know. What

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AyÅŸe Polat: how is it for? Is it fair or like? How can we include what? To include, what to exclude under this practices? But today 15 camp, 15 practices of these ones are officially recognized by the State under the can practices.

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AyÅŸe Polat: And it's for the definition like, how does the State itself? In this case? It's sort of like this sorted at this over the last decade. It's kind of different than what Mike told us about written, in which case there's a huge debate going on in Turkey as well, and some people are. Some are just critical, especially to Doctors, Association and coach medical association. They are just critical and saying, like, you know, the the government, which is more conservative or sometimes semi religious and not really sacred enough.

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AyÅŸe Polat: They are basically just support. You can, because, you know, that's also so it goes with their religious perspective, or this calls with their unsignedly perspective on all that. But for as for the state in the official documents. How do they just legitimize and express their support for the camp? And so it's very it. It's interesting to underline the commonalities between the state perspective and

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AyÅŸe Polat: the perspective of practitioners on in the field themselves. So what's under line with Champ is as all this human story. It reflects. It includes our ancient knowledge and approaches. It includes multiple cultures and traditions. It's assets, or it's strong character, or it's advanced just come from having a holistic perspective.

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AyÅŸe Polat: Treating individuals in their entirety. It's very useful, is a preventive medicine, and especially useful, since modern medicine is not a is has limited effect in treating chronic illnesses. Camp has power in this in this regard.

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AyÅŸe Polat: and also just again with the in line with the, it's also on their slides, can is a cultural value. And this goes back to the first thing which I showed like how there's the anatomy. And, as you say, we didn't see anything about the unknown medicine here. But the the title of the journal is on a totally medicine, just to it's like saying, like, you know, can you cause all these different things, but they all, not all of us.

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AyÅŸe Polat: And part of the issue is just local culture, the support for local culture, but the the the, the the official documents about the can, and they also underline that can. And modern medicine should be integrated actually can be integrated into the modern medicine, and this might have to be with this whole question about subordination if I were talking about integration, or is there are talking about one? Isn't it getting integrated and meaning also getting subordinated.

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AyÅŸe Polat: But basically they underline that they can only one count system. So we cannot talk about multiple medicines, different medical practices. And the idea is to bring them together. But the second issue that lies at the heart is also this whole issue about science.

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AyÅŸe Polat: So can you might be effective might have very e effective treatments, but they are usually that you call. They are. Their techniques are. I'm enlightened or unexplainable until now, so they need to be scientifically proven, and the the official documents keep underlining it. That there should be more research about the can. We should do that. And they're also supporting research about the camp practices.

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AyÅŸe Polat: whether we can science scientific, it could create scientification of can and find the reasons how it works and how it's working to prove it's effectiveness. And also it's asking for modern medic practitioners to call into question their bias against the camp and to just putting together the synergies of these different techniques.

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AyÅŸe Polat: So this is basically the the definitions for the can. But also, then you look at the if you look at the charts or the table on the right. Again, this is just an image from one of the the documents that the so the state is basically issuing it. It certificates. And this training, providing training and education for those who want to practice can. And this is one of the courses about introduction to F of therapy, and, as you, as you can see, like they are, they really have like very

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AyÅŸe Polat: detailed information about like the the content. What is to be taught at every level, at each course, the way it is theoretical application. But what is the avatar, the content that they have? They provide detail information for all these gifts and practices, and also, they say, like to be able to get the certificate individuals to complete the courses, pass through the exams, and should prove that they have the certificate from the State should certificate to be able to practice so

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AyÅŸe Polat: clearly that creates a standardization of knowledge and education. And then we look at the international literature as well. That's at the heart of the

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AyÅŸe Polat: that's the main modernization drive. And as we you, if we all know some practitioners are just calling this into questions, saying whether they are just by creating standards are the also just this powering, or am not taking the power of can

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AyÅŸe Polat: beyond its hands and basic by standardization, because this is just against the against all logic. But that's that discussion. But for the State the idea is to make sure that knowledge and education, production standards, size, but also the practices themselves. They they should be checked and controlled and regulated. And so the States basically set standards for all, all camp practices that includes all rules about the you know how big are

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AyÅŸe Polat: champ offices can be me if you are list regarding also on therapy. But how big do you need to have a room? What kind of medical equipment do you need to have? What kind of certificate you need to have.

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AyÅŸe Polat: So then

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AyÅŸe Polat: sorry. But, on the other hand, when you look at the tables, when you look at the numbers over the last even less than a decade over the 8 years, and, as I thought, the the offices of opened in train to 12, but really starts functioning around 2,015, and there the so they they are talking about education centers, practice censors and units. Those are just different terms. Some of them are just created to to provide education. Others are just state universe. Some are on

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AyÅŸe Polat: around state, are run run on the State University, meaning they also do research. Some are just like regular clinics or hospitals, some belong to the state, some are private sector, but, as you can tell, there is a really a an incredible number of increase. And that's that's really yeah, rather remarkable or not, would you would be your position. But we can clearly see the increase. And even if you look at the numbers, not just over the years, but even

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AyÅŸe Polat: sorry here. So even, let us say in the so in January, the beginning of this year it was about like 1,984 Km. UN. By April date the number went up to 2 to 2,099, 93. So we can see even over the months. There is a chance for the increase. But also it should be highlighted that when we look. And this is the map from the of shell website itself. But the numbers are not peculiar to distributed. I think that should be highlighted, because.

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AyÅŸe Polat: as you can tell, Marmara region is the highest one, and normally in Turkey, mammal region is also the the richest. So the economy that's the reaches, the more most educated, most working to the and also the more most affluent part of the country. So it's exciting to see that here also cam is the highest percentage. It's followed by followed by Antonian region. But also, I think we can specifically say, like the eastern and southeast in an Italia, numbers really drove down.

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AyÅŸe Polat: And but here goes the question like, for those people like practicing traditional ways of literally so leaching or copying, probably they are not inputed here. So so what goes on there on? If it is not officially, officially approved by the State, you you do, don't get that reflected in the numbers, so that also tells some part of the story, but in any case stumble and Ankara have them.

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AyÅŸe Polat: or exit through this.

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AyÅŸe Polat: And also, then we look at the how the distribution. So, as I said that most of the hospitals play an important role. But 70% of the Pre places like chans practice are private medical practices. And I think it's regarding this policy about the market state

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AyÅŸe Polat: and those production practices that also tells a lot. Because also, beyond me look at the number, the percent of factors who are involved in this. The majority are general practitioners. And yes, the moderates are 60% are specialist. But they basically specialize from any field. So when you look at. But in general, if you call special, this is a general practition, that's why they definitely by part ex the rest.

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AyÅŸe Polat: And so also I might just skip this. But it seems like the recent research is showing that young doctors are getting more interested in learning and applying the camp. and

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AyÅŸe Polat: this has to do with the with the market dynamics. With the market demand. There is a higher demand from people as well, but also it might have to do with the conditions of the general health condition. sorry medicine, is it? Health systems changing and getting sometimes harder for doctors to to be trained to this, to get specialization and can't, can, since, like is get playing a role there to kind of be the name

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AyÅŸe Polat: unspecialized, but also a specialized area.

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AyÅŸe Polat:  am I doing good on time? There's no problem. Right?

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AyÅŸe Polat: Okay? So also for regarding actors.

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Ayşe Polat: we said, 20 min. Right?

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Ayşe Polat: 5 min more. Isa, okay? Okay? So regarding actors is so clear that state is the main actor, there is no doubt about that, but also Turkish Doctors. Association is a very strong, and they have all this political agenda between governments and the so it's very particular, active as well, and, as I said, they are usually not supporting of camp at all. Mostly, I mean, there might be exceptions. But that's the general they they're they're they're

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AyÅŸe Polat: but also specific, like civil society associations, you hear, like some old local, or sometimes nations like Homer, Pete Association or Ozone Turf Association, and sometimes they just like little Tiny. You want the group, just build it. But sometimes they might just go national. And they're, I think, important, because they are also providing education and training. And this brings us to the other question about the other major actor is the educators and trainers, and

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AyÅŸe Polat: here's some of them are just take personnel, but some of them are individual and business trainers, meaning, and they are national as well as international. So I was surprised to hear in the entire race that the parties kept underlining. How like they take courses online from A,

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AyÅŸe Polat: from A, from a home airport in England, or sometimes they just bring on home a bit in the home airport from India. And so it seems like, it's really international and getting much more global, especially with online education, with online sessions. So clearly that hospitals social media has a. It is also very important, as we all know regarding how

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AyÅŸe Polat: they. It's. It's it's it's it's it's, it's, it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's, it's, it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's it's

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AyÅŸe Polat: in as drugs. They don't contract. But I'm just going to say track. So they are usually being brought from Europe. So usually they are being brought from either England, Britain, or sometimes Germany, but that the legal regulation is not, is not completed yet, and this so, and the other issue that that's crazy to. So there is there all these different actors, but also rivalry between them. So the the pharmacist that I did interviews they kept complaining about how.

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AyÅŸe Polat: even though they are of even though they received this search for this to to perform to the at home a path they still cannot prescribe home and public remedies. So they are saying that it's just like any drug on this doctors right back to site and and prescription. And they done, we can give the remedy.

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AyÅŸe Polat: but otherwise we can really not prescribe it. And then what is the point about getting to education? Then? That's it's their complaint. And also they're complaining if efficiently the doctors are cannot sell any medical drugs in Turkey, including this, all this camp products, but they they they kept underlining, and I know from person as well. They they keep selling their in their offices a lot of, and I think that's one strong way for them to make money.

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AyÅŸe Polat: So I in the short remaining time, I'm just gonna very quickly go over the a couple of terms that a couple of teams they underlined in the the participants underlined. So if one issues, they didn't seem they don't care about naming. So for them, I ask them like what this is term that you use, and there's like, you know, get taught me and get an exact tradition, or for Stick Min. Since fine. With us it is the content that matters not the name. So it seems like regarding this problem.

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AyÅŸe Polat: the power of naming. They just play it the other way around and saying, naming doesn't really matter, but they are also rejecting, rejecting the term alternative, saying, like, we are not in rival limited modern medicine.

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AyÅŸe Polat: we are just a treatment on our own, and we can definitely sometimes benefit from modern medicine. So it is the modern.

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AyÅŸe Polat: So it is the modern me, this medicine which is ejecting us not to be, and they also keep saying like it, it just similar to the State narrative they keep underlining. It's common human heritage, it shows you in diverse, and which is.

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AyÅŸe Polat: And again, the basically, I'm just gonna complete here in the States, education states, educational models to end this. And in the narrative, they keep telling. This is all about case presentations. So they prove effectiveness through case studies. It's showing like this has been, in fact, effective in this specific case. And so they call it response based medicine. So the other one modern medicine. If if it's evidence space.

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AyÅŸe Polat: this one is response space. And so I I might just end here. This is about the different skills and all that. We don't need to necessarily go with that. But I think so basic. Just to complete. I think it's really crucial that we doubt. We do a more comprehensive analysis and study of the can and drink. With all these different actors different. Put different stakes at home, and try to understand who is who has power over whom and in that ways. Thank you very much.

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Thank you.

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And

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thank you again and join a place.

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Stop sharing. That's great.

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AyÅŸe Polat: Yes, Aesa, please stop sharing your screen, please. Oh, sorry, thank you. I was thinking, okay, thank you very much.

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You have a chance.

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So I'm doing this presentation on behalf of my colleagues. So this is

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collaborative work between me and Scari Charmer and John Anderson, and

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I forgot his first name. Sorry because he is a doctor, and actually was more a gatekeeper, but we included in in the study Dr. Simcock, and also

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John Cape.

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This is part of a project that we started a while ago before the pandemic about the experiences of women with breast cancer using or considering to use complementary complementary and alternative medicine.

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And

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so we are. I. I'm going to present their experiences in using these using cam. So I will start by defining. Come, it's a very controversial term, as we know those that work in the field. what should we concede I can.

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So I, for this presentation, let's stick to the World Health organization, definition of come, which is, which are those practices that are not part of the national health care system. Usually

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another another aspect of come is also controversial, because it includes a broad variety in a variety of chem practices

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those that are practitioner, orientated, for example, or those that are more self administrative. And also, are those that are more invasive ones, based on drag as well, such as on theopesy, or those that are less invasive, such as meditation, for example.

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So the market of come is growing according to the cam market share and trends analysis report from this year. which states that can use is expected to reach

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one for 4.6 7 6.5 million at this year.

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Okay.

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right? So in the context of cancer, can asking significant attention, the prevalence of come world wild and among cancer patients is 51%.

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So I actually put here 2 at different references, when from 2,012, which states that the use of Campbell cancer patients is 45. And this one is from 2,019 citing that it's 51%. So according to these is growing and more cancer patients using complementary and alternative machines.

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as my And the previous presenter said, it's not just in Turkey, the lack of qualitative studies since at least

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10 years ago. There's some studies done quantitatively and so quantitatively quantitative research then, on these. But qualitative research stopped more or less 10 years ago.

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So there is not much then, although there are still some things, for example, this study in Germany that looks at the use of come by breast and the ecological cancer. Patients or survivors in Germany. It says that

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most common chemical therapies used by them are vitamins, minerals, micronutrients, someiopathy and mystical cell therapy. I think it's very typical for New Zealand, and it's like a white berry plant. So it's a plant and a therapy based on that

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and Other studies also show. and we know the step cam is usually used alongside biomedical treatments, and patient use can to reduce the side effects of biomedical treatments and also to strength the immune system.

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in terms of evidence-based practice. There is some quantitative studies. Again, showing there is some evidence that acupuncture or acute acute pressure, tai chi hypnosis, some some therapies, those at least their meditation, etc. They help improving pain among cancer patients.

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and also other studies show. And this one is more psychological, psychological, orientated, showing the showing that they usually can. Can patients use cam as an active coping behavior, so to become more active in the treatment process and to cope with the disease.

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And and also this idea that patients become more empowered when they use come, and they want to avoid the passivity so becoming passive and not being included in the treatment process.

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However, we know that usually biomedical practitioners they lack information about come when they communicate with their patients. they are not very much interested. I'll build. They discuss them some, some some therapies with their patients, mainly those that are from ecologically based, such as on theopesy because of their interaction. So, and they only usually discuss this because of the interaction of these drugs with the biomedical drugs.

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So in the Uk breast, cancer is a health concern like everywhere. And it's the most common cancer and accounts for 15% of all new cases between 2,016 and 18. According to the cancer research. Yeah. Uk.

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99% of these patients. They are women.

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and and in women breast cancer is the most common cancer in the U. K.

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And most people, most of these women, and also the other one in the Uk. they have been treated with surgery, radiotherapy, and chemotherapy. Usually it's The biomedical treatment which prevails.

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and there is very literal research. As I said, among breast cancer survivors, experiences of cam and cancer research. If you go to the website, you will see that they recommend and recognize the importance of camp to improve quality of life, of cancer patients and the need to produce more research on chem and cancer.

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So now I will move to my theoretical background because I will be presenting the data from the study. So I'm not doing ground ground grounded brand a theory. I'm basing. My, so my! This study in some ideas, theoretical ideas that I'm going to talk now.

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So one of the books, one of the last books published on Kansas and Kam and Nisa Kem was, as I said, in 2,008 by Broome and Tovey.

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And they showed that cancer patients they seek or they they want to find, they they seek non-evident, some aspects. non-evident-based aspects of the the treating of the treatment

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and cancer is more for them. Cancer cancer is more than a disease. It impacts on the relationships. It impacts on jobs and impacts on the sense of the self as well. So it's not just the idea of the of the body and the disease, and Inside the bodies. More than that.

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and they also show, and the relationship between can use and income and gender and geographical location as well. which highlights inequalities in the use and access of come.

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So another aspect is cancer. We know that cancer, some, some cancers, let's say, probably most of them we can. And obviously these depends. But in in general, we can look at some kind of cancer as as chronic illness.

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people, many people, many patients. They have cancer, and they have to manage it for a long, many, many, many years, and it can come back. It can go. It can come back again. So we can look at cancer through the lens of chronic illness.

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In chronic illness studies, we have the well-known concept, various concept of biographical disruption, that when we have a chronic illness, our self is disrupt, and there is a break in the sense of the cells, and we have to reconstruct that self again after the diagnosis of a life-threatening disease.

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But there are others since then. So this concept is from 82. There are the concepts, alternative concepts, the biographical disruption which is biographical flow. In this instance, after we are diagnosed with a life-threatening disease or a chronic disease.

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this becomes normalized

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and and everyday life continues, and it's kind of ongoing flow instead of a disruption of the cells. Okay, so

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and there's also this idea of transitions that a transition that when we are diagnosed with a chronic illness, we

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face a kind of disorder which a crowded calls extraordinaryness, a sense of extraordinaryness, and we want to move to order from disorder to water. So there is this transition that we try to do in biomedical biomedical treatments. That's the idea. It is to move from disorder to order or from extraordinariness to ordinariness

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in the face of the turmoil of the disease. So transitions are not nonlinear, they can be cyclical and occurring again

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in these transitions. When we are doing this transition from disorder to order, self-help and self-management becomes very important.

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Finally, in terms of background. There's also this idea of paradox or tensions or dialectical dialectical tensions when cancer patients use biomedical treatments at the same time as they use chem treatments. There is distinction between these 2 treatments, because one

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pushes the biomedical treatment to the promotes or develop deep personalization because it's too much focused on medication and the body. And while come therapies, they focus on individuation or promote individuals so very individualized treatments and focusing on agency

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and the role of the patient in the treatment. So by.

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you know, presenting this conceptual framework. So now I'm presenting our research questions and what we were interested in when we interviewed these women

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first, which chem therapies do women with breast cancer use?

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Why and how do they use them

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and incorporate into biomedical treatment? So I should say that the old women that we interviewed they were under undertaking biomedical treatments and doing some form of biomedical treatment or chemotherapy or radiotherapy or

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surgery, and also orminal therapy. And what are the barriers to women with breast cancer that these women with breast cancer encounter when they are using come

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so very quickly. My methodology and I we we conducted 9 quite and structured interviews with women. with breast cancer, as I said they were. And they're taking biomed all of them biomedical treatments. We asked for ethics. We have ethical approval. these women were taking the war undertaking these treatments in a clinic in Brighton.

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And so I can talk about a bit more about these. So all of us with the different bits that the author is different bits of the

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the research.

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So presenting my findings. So the first one these are The the first question which chem therapies do women with breast cancer use? And this is a list of all the therapies that women stated they used, and while they were doing biomedical treatment, some of them.

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to be honest, I need to look at I I I don't know. For example, I didn't know about coffee and Emma which is very interesting. and I and and also others. so. But this is just to give you an idea of. And and they are just 9. So it's it's a 9 a women that we interviewed. So it's quite remarkable, remarkable. The number of chem therapies they were using.

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They also referred to these practices, and I didn't include. And this shows how chemotherapy is controversial. All chem definition to define can is not easy and controversial, because when we ask them what chemotherapies they use, they refer to the nature a lot, they refers to cycling, walking.

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psychotherapy, and volunteering in organic farms, for example.

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and self-examination as well.

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So I decided to leave this here because I found interesting. This contact with nature must mean something right.

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So moving to the second question, why? And how do women with breast cancer use them?

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So? The why? we are presenting here Cambridge as enablers.

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Okay, so we are present here, chemotherapy as enablers that enable women to move from disorder to water. Basically. So if we go back to the theoretical background I was presenting, so

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that what came out of the data was that they use them together with biomedical medication and treatments.

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but they also want to be active in this process, right? So enabling empowerment enabling control and participation in the treatment process not going to read. So these are quotes from them going to just stick to the last one or the bold bits in the quotes. So, for example, the last one says I'm not going to refuse mainstream treatment, but I need to be at the center of my treatment.

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So this shows the active side and the empowerment and the the will or the desire to be in control and participating.

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Another aspect is, how come enables women to return to normality. And to this sense of normality. Okay, again, to return to order of the self.

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so the first one, for example, the first codes I'm taking a lot of supplements to try and remove triggers from biomedical treatment, and I've used herbal extract to help calm me down. And the last one so it's taking some biomedical medication, but in the same way as the second one. But I think that the chiropractor working on me, it's allowing me to sleep longer at night.

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so it's clearly they use. They are using them to enable them to return to a normal life and to normality.

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And these chem therapies they also. So if they are enablers, they also need to be enabled by someone, and somehow they need to be enabled and to be used right?

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This is that the answering the question, How do they use them? Okay?

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so self-health, self-health, and self-management came out definitely, very clearly. and also so I don't have time. But it's very interesting how they use Internet as a self-health, resource

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and

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and self-management, learning how to self-examine themselves. And the last one, the last quote shows how and this woman is learning to self-examine. by an acupuncturist.

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another enabler of chemotherapy are open minded medical doctors. Okay. Although they criticize a lot. The medical doctors position When they they go to this therapeutic encounter they are open minded medical doctors that are that even recommend these and and send them to and refer the patients to them.

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And obviously can practitioners. They are probably the the big enablers of them.

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So just to go to the bar here is very quickly that so these women they they practice, come, they they use the scam, but obviously they find barriers just outlining some barriers. One of them is medication-centric approach.

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based on drags and the doctors. They cannot see beyond the dregs, so

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another one is lack of credible information and communication. This last one is very interesting because it talks about massage therapy and how patients avoid massage therapy. because they say it spreads the cancer in the body right? and this is, they say this is a myth.

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And I actually asked a medical doctor and a a pharmacist actually, recently, if massage therapy can spread. The cancer, and was quite ambiguous. And so that I got Which is interesting.

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Financial barriers which connect very well with Inequalities in excess income came out clearly, from the data

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and limited medical interest as well. So when the patients they want to engage in the in the encounter with the the biomedical practitioner. They want to talk about the use of come. And there is this lack of knowledge and lack of interest as well in interacting with them about this. So some conclusions very quickly.

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the potential of them as enablers of ordinariness and self-care. So to move from extraordinariness to ordinariness.

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And there are tensions, yes, definitely, between these 2 therapeutic processes, between the personalization and vibration and these barriers. The bargers that I presented by a confirmed distinctions.

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this is all that. There's a link, also a clear link here with post modernity. Okay? Because, they at the same time they criticize biomedical knowledge, they embrace it as well. And this combination of biomedical knowledge with scam inequalities, yes, and there is a need to think about integrated cancer care more thoughtfully and continuing care, and how can can contribute to weights?

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And I finish my references and thank you.

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Paula.

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Paula Feder-Bubis: Hello! Good morning.

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please. Could you give us your presentation.

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Paula Feder-Bubis: Yes, I think that you have to allow me to share.

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It's little.

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Could you please talk?

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Paula Feder-Bubis: Let me see. Can you hear me?

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We're here. But not so we.

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Paula Feder-Bubis: okay, can you see my screen?

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We can see, yeah, is it in presentation mode for you? It is, yes.

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Paula Feder-Bubis: it is okay, great. Okay.

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Paula Feder-Bubis: good. So good morning. And thank you very much for the opportunity. and first of all, thank you to you, Anderson and my for organizing this this session.

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Paula Feder-Bubis: and

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Paula Feder-Bubis: thank you for the organizers of the Conference and for the volunteers doing the work behind the scenes. over there and worldwide.

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Paula Feder-Bubis: my presentation today is about how physical setup is professionals values. I can test the following, the enactment of the Medical Professions Regulation Act in Israel, and I'm presenting this

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Paula Feder-Bubis: work in progress on the name. Also my my partner.

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Paula Feder-Bubis: So I would like to to start with a few theoretical background

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Paula Feder-Bubis: notions.

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Paula Feder-Bubis:  do you see my screen moving or not yet?

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Paula Feder-Bubis: Not yet. Okay, just

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Paula Feder-Bubis: let me.

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Paula Feder-Bubis:  okay, do you see the second slide? Now?

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Paula Feder-Bubis: Okay, thank you very much.

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Paula Feder-Bubis: So they professionalization projects. we generally aim to regulate over a field of of practice and access of the practice maybe led from above or for from within

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Paula Feder-Bubis: professionalization from above, or

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Paula Feder-Bubis: top down professionalization, as it is called. Sometimes it's generally led by by governments and can be undertaken with or without The professional groups themselves.

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Paula Feder-Bubis: professionalization processes may shape the distribution of areas of practice and the expertise. And this paper describes an example of professionalization process project from a bomb one that proposed proposedly aimed not to attend closure

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Paula Feder-Bubis: between the professional groups included in it.

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Paula Feder-Bubis:  Just to To describe a little bit about the our research setting. So the medical Professionals Regulation Act 2,008 I will call it The the law

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Paula Feder-Bubis: is actually the legal basis for the professionalization of physical therapy, of physiotherapy in Israel, and

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Paula Feder-Bubis: as well as the professionalization of occupational therapy speech, therapy and nutrition after it's sanctioning other Allied health professions. We are included in the law. for example, optometrists

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Paula Feder-Bubis: get clinical criminologists and po the address

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Paula Feder-Bubis: this law includes chapters about the professional credentials, the conditions that entitle obtaining the the professional title, for example, the academic studies.

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Paula Feder-Bubis: and and passing a mandatory national examination.

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Paula Feder-Bubis: we will go back to the academic studies a little bit later. It's It has a chapter about ethics and a national advisory committee, and etc.

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Paula Feder-Bubis: since the sanctioning in a 2,009

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Paula Feder-Bubis: regulations, additions, amendments, and temporary provisions were stipulated further further contesting the boundaries of the profession.

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Paula Feder-Bubis: After 10 years after the regulation of the law, we decided to undertake a research to identify the stakeholders, the issues and the ways in which physical therapy, professional boundaries?

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Paula Feder-Bubis: we are contested. This is a specific question from a larger project that looked into the 4 original professions that we are regulated by the same by the same law. Today, I'm talking specifically about physical therapy, despite the fact that there are actually some common denominators among the 4 professions that we're originally

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Paula Feder-Bubis: regulated by by the law.

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Paula Feder-Bubis: what we did is we took a qualitative study

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Paula Feder-Bubis: and and a that included several several parts. But today I'm going to present the part about the data, a, that we collected from publicly available documents.

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Paula Feder-Bubis: such as the regulations themselves, amendments, temporary provisions, legal deliberations, and disciplinary complaints. all of them. we are issued from 2,008 to 2,020.

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Paula Feder-Bubis: The law Steve continues to develop, especially when you have a government in place which is not typically the case in Israel. For the last few years.

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Paula Feder-Bubis: And we conducted some of the content analysis to all of these documents.

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Paula Feder-Bubis: and we conducted pia de briefing sessions to develop and review the analysis. the bulk of it was during COVID-19. So zoom was worked very, very hard during we during this time

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Paula Feder-Bubis: I'm quickly switching to the findings, because I want to share with you quite a few of them.

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Paula Feder-Bubis: so

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Paula Feder-Bubis: The first findings have to do with. Who are the stakeholders who are actually the involved in this? in this process of boundary contesting following the law

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Paula Feder-Bubis: and these are all these stakeholders that we found in the different documents analyzed.

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Paula Feder-Bubis: As you can see, they are both from the public arena, like the ministries ministries, government ministries, authorities, health providers, such as

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Paula Feder-Bubis: public Hmos and hospitals and a academic institutions. And and we have to take into account that physical therapy is study in is studied in publicly founded universities only

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Paula Feder-Bubis: third sector organizations, such as voluntary associations like the professional unions, patient advocacy organizations.

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Paula Feder-Bubis: and the associations for immigrant groups.

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Paula Feder-Bubis: but also some of the stakeholders are from the private sector, such as privately funded academic institutions and freelance professionals.

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Paula Feder-Bubis: And I will show you now part of the contesting stakeholders. with a few examples from the analyzed documents.

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Paula Feder-Bubis: so

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Paula Feder-Bubis: the first example is amendment number 4 to the law

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Paula Feder-Bubis: that was sanctioned in 2,016,

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Paula Feder-Bubis: and that stipulated that physical therapies who are immigrants from countries in which this profession is not acquired in academic institutions, one

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Paula Feder-Bubis: be recognized as applicants

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Paula Feder-Bubis: eligible to undertake the required examination to enter the profession.

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Paula Feder-Bubis: And this this amendment was at the time at the time a great. They had a great impact because, the law was understood as part of the professionalization project

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Paula Feder-Bubis: of physical therapy. And one of the it's main basis was the academic the academic the academic academic studies. So once this amendment was put in place.

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Paula Feder-Bubis: it! It was It was quite an orte earthquake, I would say, for the for the professionals that have done all their their studies in academic institutions in Israel.

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Paula Feder-Bubis: So this amendment was provide was actually Was promoted by the ministry by the ministry in charge of the migrants, which which is called the ministry of Absorption, and by immigrant professional lobbyists.

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Paula Feder-Bubis: that we are ultimately ultimately backed by the legislative authority, and lately and unwishingly also by the Ministry of Health.

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Paula Feder-Bubis: Now, as I said before, this amendment obviously undermines the professionalization project and serves to this day as a mechanism

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Paula Feder-Bubis: for avoidance of of a professional closure.

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Paula Feder-Bubis: the next example about the contesting stakeholders. and as you see, the the the colors are are different, because other on stakeholders are involved here

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Paula Feder-Bubis: and is a legal suit if filed by the physical therapist union against a private university, a that established a degree in sports therapy

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Paula Feder-Bubis: So 2 issues to pay attention here. first, a private university. There are very few private universities in Israel. So that was the first, the first contesting characteristic, I would say, and also sports therapy. That was a degree that was not established as what the first time it was put up on the air.

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Paula Feder-Bubis: The main argument of the Feature Therapies Association

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Paula Feder-Bubis: was that this program will undertake

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Paula Feder-Bubis: physical therapy core activities. for example, sports sports injuries without the appropriate academic training.

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Paula Feder-Bubis: what happened later was that the court ruled that the academic institution

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Paula Feder-Bubis: may grant such a degree.

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Paula Feder-Bubis: but that degree won't be categorized as a health profession.

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Paula Feder-Bubis: so, despite this

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Paula Feder-Bubis: the the suite established that sport therapists can provide treatment in sports settings, and I will come. Will come back to this a little bit later, so I'll supposed to have, like via the the.

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Paula Feder-Bubis: The. This, this traditional decree gained a specific setting for for their practice.

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Paula Feder-Bubis: the last example, I would like to quote here, is one that has to do with something that may look a little bit like I would say technical

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Paula Feder-Bubis: but in 2,011, and there was an amendment to the law that decreed that the physical therapies who studied in Israel before the sanctioning of the law.

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Paula Feder-Bubis: where granted recertification in depth indefinitely without the mandatory examination. So, despite that this may seem like a technical issue

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Paula Feder-Bubis: and a we see that this legal close shows that those that did not request a certification in due time, that is, within the 3 year period after the sanctioning of the law.

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Paula Feder-Bubis: we're generally a person who did not practice physical therapy. and we're not aware of the log change.

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Paula Feder-Bubis: So by allowing indefinite recertification. The Ministry of Health.

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Paula Feder-Bubis: backed by the legislative, legislative, and adjusted authorities and and physical therapies, open the practice of the profession to persons who were

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Paula Feder-Bubis: generally disconnected from the profession for many, many years.

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Paula Feder-Bubis: It must be said that physical therapies backed this amendment

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Paula Feder-Bubis: mainly due to cases of physical therapies who relocated to other countries, and practice physiotherap and and practice as physiotherapies, and return to Israel to the new licensing modality, and they were not aware of the fact that they have to do some bureaucratic procedure in order to regain their their licensing.

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Paula Feder-Bubis: I will switch now to share with you the contested issues about the The the borders of of the profession.

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Paula Feder-Bubis: and specific professional practices have to do with the fact that the law in A, in one of its chapters, and is stipulated that the scope of of the practice of each one of the a of the professions.

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Paula Feder-Bubis: and what you may see here. I know that your Hebrew is not very good at this time of the day. It will improve later, probably, but not now. the the arrow is now appointing to appendix number 2 in the law that was really supposed to include the practices that specific practices that are pertinent to each one of the 4 health professions.

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Paula Feder-Bubis: but, as you may see with a in this arrow you, you see that there are just titles here. and there is no content. You see a title, and and then there's there's another title, which is the next, the next item of the appendix, the the third appendix of the law.

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Paula Feder-Bubis: so

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Paula Feder-Bubis: This living without context that that was supposed to be

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Paula Feder-Bubis: a a they

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Paula Feder-Bubis: yes, 5 min more. Please. Thank you very much, Nelson. So in this appendix we were supposed to see what specific professional practices are are to be granted to each one of the professions, meaning, what is the scope of their practice? But it was left what it was left without any detail.

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So why this they did. It happened because, the stakeholders who were involved with the sanctioning of the law

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Paula Feder-Bubis: could not agree on what specific concrete professional actions

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Paula Feder-Bubis: for example, treatment for the improvement of balance or treatment for the For for swallowing issues belong to each of the 4 professional groups, one.

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Paula Feder-Bubis: So thus to today. Any person not only health professionals can perform any of the activities originally. included in these professions. as long as this person does not call him or herself. If a therapist.

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Paula Feder-Bubis: so you can do exactly what it. What a visual therapy does. The important thing is that you don't call yourself a a physical therapist.

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Paula Feder-Bubis:  So the the second issue, as I said before, as I mentioned before, is the professional settings. as I said before, with the sports therapy, the sports therapies actually acquired to themselves a specific setting. For example, the the sports sports arenas

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Paula Feder-Bubis: in in which they can exercise their profession without a like interfering or or questioning the.

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Paula Feder-Bubis: the, the the professionalism of the physical therapist. I will skip the next to a contested issue, and we'll just say that the contestation was around the values of of of of of of of of the amendments of the law, and of course, the the the academization

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Paula Feder-Bubis: as I explained before. regarding the the

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Paula Feder-Bubis: e, the the the immigrants no

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Paula Feder-Bubis: The the optimization actually was proposed as a mechanism to which a public can be safeguard in view of the increasing numbers of professionals that could provide services is as proposing 2,020 a college education, college education students.

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Paula Feder-Bubis: And we choose a relevant truck in non academic institutions.

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Paula Feder-Bubis: And now, to the contesting ways. We saw in the documents quite a few contesting ways of the limits of the physical therapies. first of all, authorities reacted and or initiated changes in the law. many of them did not consider the physical therapies, not the target, regulate to the mystery of health perspectives.

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Paula Feder-Bubis: the language, the use of the titles the phase of therapist

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Paula Feder-Bubis: So the low safeguards appropriate titles for the professionals included in it. But, as I said before, Besides, this symbolic border keeping the practices of physiotherapies remain unprotected.

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Paula Feder-Bubis: what I call the the private bypass has to do with that modes of practice that curtail settings, practices, and professionals are applied in the private sector.

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Paula Feder-Bubis: such as freelance practices on, not medical. settings, for example, development that coaches which is turning to be more and more frequent here.

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Paula Feder-Bubis: is an occupation that gears towards in the improvement of psychomotor skills in the infancy offer their services in private kindergarten, for example, again, not a medical setting.

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Paula Feder-Bubis: but the fact that they offer them there turn it into a standard that is, see to also at the, at the, at the public service organizations like public Kindergarten.

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Paula Feder-Bubis: and regarding the presentation of sales. I also at the group level for example, movement therapies present themselves but also contest physical therapies, boundaries using collective action for reclaiming and professional status, and like duffel of the future therapies.

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you know.

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Paula Feder-Bubis: Sure. So my concluding remarks have to do with the with the fact that regulatory procedures have shaped the regional law established as a process of professionalization project.

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Paula Feder-Bubis: But, interestingly, a from the beginning it lacked occupational closure. many stakeholders from all the changes in the law due to competing social, economic and and and ideological value values and interests.

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Paula Feder-Bubis: similar to the case in the Uk physiotherapy's provisionalization projects protect public health, not the profession. It also allows the protection of professional titles, but not of the fields of practice of the profession.

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Paula Feder-Bubis: and at the end of the day, as we see today, it has indeed eroded the boundaries of physical therapy.

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Paula Feder-Bubis: So thank you very much for your attention and for the opportunity to present in a Harvard way.

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Paula Feder-Bubis: thank you very much.

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Thank you, Paul.

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and I would like to invite my

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place here.

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And wow! We have

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5 min to

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to have some discussion.

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and I would like to know somebody has a question or

392
01:26:52.080 --> 01:26:55.460
2. I 3. Presentation. Yes, please

393
01:26:58.290 --> 01:27:16.440
thank you very much for the other interesting presentation. My name is Anton from the University of Weina. I have a question about the the arena between different profession or semi professions. Maybe a question for Mike. Is there any space for

394
01:27:16.550 --> 01:27:23.949
relationship between semi-professional and and A/C work? That's I

395
01:27:24.580 --> 01:27:25.320
thank you.

396
01:27:26.380 --> 01:27:27.290
Thank you.

397
01:27:28.300 --> 01:27:30.360
Yes, please.

398
01:27:33.650 --> 01:27:44.470
Yeah. This is all an interesting question about semi-professions. I personally associate the notion of semi-professions with a functionalist approach

399
01:27:44.690 --> 01:27:49.620
rather than with a necessarily a neo-barian approach.

400
01:27:49.700 --> 01:27:57.370
because I think the the term that probably will be used in near Bavarianism is dual closure.

401
01:27:57.470 --> 01:28:00.719
which is a term derived from Franklin.

402
01:28:00.890 --> 01:28:04.930
and this, this is basically

403
01:28:05.020 --> 01:28:06.459
a.

404
01:28:06.610 --> 01:28:09.590
it indicates a kind of profession

405
01:28:09.720 --> 01:28:17.720
which is looking in 2 directions, you know. On the one hand, it's got some semblance of exclusionary closure.

406
01:28:17.770 --> 01:28:22.380
and on the other, it's also very much marked by unionization.

407
01:28:22.520 --> 01:28:39.700
So it's always like kind of a position from below and above. And it's it sits between the 2. And I mean, I think, classically, nurses are seen as being in that position, as you think, from physicians.

408
01:28:39.830 --> 01:28:55.910
and I think this has really been something that has run very true. not the theories of being true, really. But you know, it's sort of really yeah, being very resonant with the situation which you've had in Britain, you know, because I was talking about British

409
01:28:56.070 --> 01:28:58.719
health setting

410
01:28:58.810 --> 01:29:04.449
And in Britain we have for the first time seeing nurses go on strike.

411
01:29:04.760 --> 01:29:23.880
you know, quite extensively, because they've been lauded, you know, sort of during the pandemic, you know. Let's go out and clap for National Health Service workers, including very centrally paramedics and nurses, and so on. And and actually, they haven't really got their rewards. That would

412
01:29:24.140 --> 01:29:48.230
been anticipated, you know, in terms of salary rises, and you know, necessarily much sort of spatulation from the government. So so actually, I don't know if that answers your question, but I think that I prefer to use and use, as I say, the dual closure term rather than semi-professions, which is very much associated with, etcetera.

413
01:29:48.250 --> 01:30:05.529
Heetsione's work. from 1,968, and Etione Really, it was a bit of a put down because he was arguing that professions really gain their position in the universe from their functionality.

414
01:30:05.660 --> 01:30:34.219
in terms of functions within the social system. And he didn't really write. I mean, if we're taking nurses, and, for example, you know, is the the mainstream moments. He really didn't write nurses. They've reached their position, you know, because this is they're not really going to go any higher because of their lack of expertise and the the kind of subordinate position of their training. So I think we might want to reimagine that universe.

415
01:30:39.170 --> 01:30:40.040
Yeah.

416
01:30:40.420 --> 01:30:43.210
not really. I think my, except

417
01:30:44.060 --> 01:30:52.120
a lot about that. Yes, I absolutely agree with the attention, at least for you to the time of semi-professions.

418
01:30:52.230 --> 01:30:55.549
so yeah.

419
01:30:55.560 --> 01:30:57.349
I just didn't.

420
01:31:01.230 --> 01:31:05.789
Paula or Paula. Have you any comments?

421
01:31:07.550 --> 01:31:21.370
Paula Feder-Bubis:  I I I totally agree. I I really have trouble about talking about semi-professions. I don't know what the what side of the send me we are looking at. So.

422
01:31:21.410 --> 01:31:40.030
Paula Feder-Bubis: yeah, I, I generally do not use the yeah, the time of semi-profession, but rather looking into into into what? What? Like developmental stage of of of the organization of of a specific professional group. we talk about. Yeah.

423
01:31:40.170 --> 01:31:40.890
Thank you.

424
01:31:43.120 --> 01:31:44.160
Thanks.

425
01:31:45.180 --> 01:31:46.860
bullet.

426
01:31:47.560 --> 01:31:49.890
AyÅŸe Polat: No.

427
01:31:50.930 --> 01:31:53.740
Okay, thank you. Any other question.

428
01:31:54.390 --> 01:31:55.540
Yes, please.

429
01:32:00.000 --> 01:32:05.129
Good morning, everyone. I'm I'm sh! I'm from Brazil. I work for the Minister of Health there.

430
01:32:05.330 --> 01:32:29.250
and I'm really interesting to understand and to know. if you have, if it can. I don't like this idea of alternative medicines. It's it's it sounds very straight for me, called Yoga. As a out of the medicine, you know it's it. It is another way to understand. So if you say, if you call Ioga, for example.

431
01:32:29.250 --> 01:32:41.299
as a medicine, you say your medicine is the the best term. It's on the top of every other knowledge. So but anyway, that's not my question. So I want to know.

432
01:32:41.550 --> 01:32:45.739
I want to know how, if you have? this.

433
01:32:45.780 --> 01:33:07.230
there's alternative medicines, and how it is in your national health care system like, how is it? And if you. If you have a a camp policy in in Uk or in Turkey, or in in your Ohio, I just want to know. How is it? Part of the health system.

434
01:33:07.830 --> 01:33:17.349
Great. Thank you, Guido. Is it related, or very different subject? Okay, please answer this, and then we do. The

435
01:33:17.570 --> 01:33:19.450
would like to to start.

436
01:33:24.180 --> 01:33:31.610
You know I I have the Ken Guru next to me. So it's been the first one answering that this.

437
01:33:31.660 --> 01:33:33.130
and

438
01:33:33.440 --> 01:33:54.869
so, of course, that just in in terms of the Uk So in the Uk current practice and austerity, they are the only ones regulate it. and that but even though they are regulated, they are not part of the Nhs. The Commissioner, although actually, I think it was like one year ago.

439
01:33:54.890 --> 01:34:04.170
because I wasn't the one with the Forum. When I presented in the online for Brazil, I went to the website to an Nhs website and they wore

440
01:34:04.290 --> 01:34:23.020
advertising positions for Osteopaths which still today I'm not sure why. It seems that Osteopathy is being kind of integrated readily into the Nhs. But they are suicide, and they are going to in the Uk

441
01:34:23.130 --> 01:34:33.560
and regulated by by the State, although all the other ones are self-regulated. Right? Mark Mike, do you want to say it more about this? Sure? Yeah, thanks.

442
01:34:35.370 --> 01:34:41.299
Yeah. I think that in terms of the Uk. If you sort of making comparisons with Brazil.

443
01:34:41.470 --> 01:34:45.570
I don't think we've moved quite as far, you know, in terms of forward.

444
01:34:45.640 --> 01:34:50.170
But I think when you talk about what is the policy

445
01:34:50.380 --> 01:35:00.579
in relation to Cam, or whatever else we're going to call it, we might come back to that, but I think it has been a shifting field.

446
01:35:00.720 --> 01:35:08.589
So it isn't just. Oh, there's one policy over the last 20 years, or whatever it has actually moved quite considerably. So

447
01:35:08.690 --> 01:35:18.279
I think that John is quite right in highlighting Osteopathy and Chiropractic having got statutory regulation.

448
01:35:18.560 --> 01:35:20.979
But I think that

449
01:35:21.000 --> 01:35:27.229
there were times when the Government adopted I mean the past. In the 1,900 eightys.

450
01:35:28.010 --> 01:35:32.820
They said they weren't prepared to introduce statutory regulation

451
01:35:32.900 --> 01:35:41.189
in the in the 1,900 eightys, unless all the complementary medical practitioners got together

452
01:35:41.220 --> 01:35:51.800
as a group and actually formed a cohesive lobby. Well, you know, quite frankly, that was impossible, because there were so many splits and divisions about approaches.

453
01:35:51.990 --> 01:36:02.879
So it was really, you know, positive, from the viewpoint of cam that Osteopathy and Chiropractic got in there. But I think that we

454
01:36:02.930 --> 01:36:12.209
thereafter it has become very difficult for different kinds of aspects of of complementary medicine

455
01:36:12.390 --> 01:36:36.910
to become such, truly regulated because the Government has changed its starts in recent years just over the last few years, that it doesn't feel that statutory regulation is the way forward, no matter how convincing a case there is, and this doesn't just apply to can. But it also applies to other elements of the universe. So it's far more. sort of put it.

456
01:36:37.030 --> 01:36:39.529
it's weight behind

457
01:36:39.750 --> 01:36:42.619
a kind of voluntary

458
01:36:42.660 --> 01:36:54.169
regulatory approach where you have groups. As John is saying, I mean many groups in the Uk that actually self-regulate.

459
01:36:54.990 --> 01:37:02.549
Recently I was until actually December. I was the chair of the British acupuncture.

460
01:37:02.700 --> 01:37:08.659
Acupuncture has been striving for many years to get in statutory regulation without success.

461
01:37:08.710 --> 01:37:13.320
and now there is very little hope of it gaining statutory regulation.

462
01:37:13.460 --> 01:37:17.819
and so we have a body called the British Acupuncture Council.

463
01:37:17.890 --> 01:37:32.689
which actually exists as a bombing with several 1,000, that Cavantra so who are voluntary regulator except codes of ethics, and they accept all these kinds of things. But it is very much a kind of almost deregulated

464
01:37:32.990 --> 01:37:35.689
cest setting that killed within the Uk.

465
01:37:36.290 --> 01:37:47.790
Interesting. If I could just make one comment. I don't want to talk for too long, but the the issue about the names, you know. What do you use? Alternative medicine and so on, is really a theoretical issue.

466
01:37:47.820 --> 01:37:50.480
It's also a practical issue. And so you.

467
01:37:50.550 --> 01:37:58.899
back in the 1990 S. I was working with the person who is now King Charles in his integrated Health Foundation.

468
01:37:58.990 --> 01:38:16.050
And one of his steering groups and integrated health was that kind of you know. Oh, well, you know, you can't politically possibly reject it because it's it's it's not an alternative. And you know, whereas there are people out there who are actually practitioners who do actually.

469
01:38:16.500 --> 01:38:19.440
some of them, at least, you know, do like the alternative.

470
01:38:19.570 --> 01:38:41.369
kind of label, because they're they're kind of rebels against against conventional medicine, and so it very much depends where your way of coming from, and a lot of the specific therapies like we had a homeopathic hospital in London, but there were a whole series of them across the Uk.

471
01:38:41.370 --> 01:38:52.219
They now have started using the word integrated, integrated. We provide integrated care. They don't use the word homeopathy, because the political climate has turned against them.

472
01:38:52.260 --> 01:38:54.279
you know, even they would like to be.

473
01:38:54.660 --> 01:38:58.280
Thanks. Bike. Okay, A/C would like to

474
01:38:58.290 --> 01:39:06.810
AyÅŸe Polat: comment. Thank you. I think I should just maybe just I can see, I think, as my was on the line point is just to see how

475
01:39:06.810 --> 01:39:35.559
AyÅŸe Polat: the definition is that it's the legislation about the chem itself are very dynamic. So the list expands and shrinks. So it's not currently in Turkey. It's about like 15 practice recognizes camp, but, like functional therapy is, is they? Is debate just and limited. It should also be included under cam or not. I think so. It's crucial to see how over time government policies, changes, and in in touch case the Minister of Health is the main agent. But also, as Paul, I was mentioning about how

476
01:39:35.560 --> 01:39:51.189
AyÅŸe Polat: other ministers have a role that regarding the products, and it just to give it a complete example, like when I, if if if practitioners find it hard to get approval from the Ministry of Health that they they usually dive, if you just call them into agriculture, but it's usually easier

477
01:39:51.190 --> 01:40:16.130
AyÅŸe Polat: to get sanctioned or to get approval. So I think both the actors know the negotiate with the with the State agencies. The State agencies are also dynamic, and it depends on the the government. Current. Government policy is the the, the dive, the department itself, who is running to department, and also the pleasures on the on the Department on the the Minister of Health is is in the Turkish case, a Medical Association and Medical Doctors Association. Are you

478
01:40:16.130 --> 01:40:31.119
AyÅŸe Polat: usually against the camp? So the the so what gets included that gets excluded is a very dining process, and I think that depends on the current and ongoing points of the country itself, as well as the who, to what extent they are following the

479
01:40:31.310 --> 01:40:36.640
AyÅŸe Polat: no type, organizations, policies, and strategies. Thank you. Lisa.

480
01:40:37.230 --> 01:40:38.360
Paula.

481
01:40:39.100 --> 01:40:58.259
Paula Feder-Bubis: yes, so it is where and it is not regulated at all. And regarding self regulation, you you have all of this spectrum. So there are certain therapies, practices that are

482
01:40:58.390 --> 01:41:24.819
Paula Feder-Bubis: highly self-regulated, and others that are non self-regulated at all. notwithstanding, I must say that they in some parts of the health system. There is integrity of medicine, which is the the the joint practice of conventional and and camp, and a a. Especially because the cam is, is, is view as a source of income.

483
01:41:24.820 --> 01:41:43.020
Paula Feder-Bubis: So, for example, you have complementary packages in the public. Hmos, so the complementary packets are are out of pocket packets and and they do include some types of of of.

484
01:41:43.040 --> 01:42:00.360
Paula Feder-Bubis: And when this is the case, practitioners are generally, do provide their services in public hospitals or in the Hmos with something that was actually described quite a few years ago.

485
01:42:00.360 --> 01:42:15.039
Paula Feder-Bubis: by my Professor Juvan. in the professor that They actually showed that discount practices are actually supervised

486
01:42:15.040 --> 01:42:30.290
Paula Feder-Bubis: and completely regulated by a bio medical doctor. So you have to go in this in this public places that are partially covered by the only very partially covered by the

487
01:42:30.560 --> 01:42:44.639
Paula Feder-Bubis: by the National Health Service. a. You have always to go through a by your medical practitioner. who will derive you who will refer you to the

488
01:42:44.710 --> 01:42:52.639
Paula Feder-Bubis: the the that she or he considers the most suitable for your particular case.

489
01:42:53.850 --> 01:42:56.180
Thank you, Paula widow.

490
01:43:03.940 --> 01:43:10.580
I'm guilty from university manicure in Italy. I have a question.

491
01:43:10.600 --> 01:43:12.330
for at first.

492
01:43:12.690 --> 01:43:16.639
at the beginning of your interesting presentation.

493
01:43:16.800 --> 01:43:35.420
you introduced the concepts. It would be a concept of habitus in a pluralistic perception, but then it disappeared. I don't know where it was, because you couldn't finish your presentation, or what, so I would be interested to know which way you applied it.

494
01:43:35.720 --> 01:43:41.559
The second is a moral consideration for Joanna. I conducted

495
01:43:41.630 --> 01:43:45.220
project in Italy recently

496
01:43:45.310 --> 01:43:49.069
about the experimental integration of

497
01:43:49.220 --> 01:43:56.610
in Romania region. The Bologna region will be in the nation of the original

498
01:43:56.920 --> 01:44:07.110
and for breast cancer women who are problem after drug therapy

499
01:44:07.360 --> 01:44:10.930
and the main findings. After

500
01:44:11.030 --> 01:44:13.299
interviewing 42 women

501
01:44:13.770 --> 01:44:16.249
were submitted to the

502
01:44:16.480 --> 01:44:20.889
was that they didn't consider the coupon your session

503
01:44:21.160 --> 01:44:25.600
as a medical treatment. I even complementary on the

504
01:44:25.680 --> 01:44:31.580
but just as a pool of the ordinary life of their everyday life.

505
01:44:31.620 --> 01:44:36.480
There was a before and after. before we were suffering

506
01:44:36.580 --> 01:44:44.080
they name is sweating aloud, and most of them declared that after the treatment 10 sessions

507
01:44:44.090 --> 01:44:47.870
that could improve very much their quality of life.

508
01:44:47.900 --> 01:45:05.619
So in order to analyze, this comes with consideration. By D, I use the concept. but Fungic concept of liminality, of the rights of passages. Do you think that the same concept can be applied? We have a research findings. Thank you.

509
01:45:05.830 --> 01:45:12.859
Thank you. We do. we. We have only 4 min to close the session, so

510
01:45:12.930 --> 01:45:15.920
is please, would you like to start.

511
01:45:16.040 --> 01:45:28.909
AyÅŸe Polat: Yes, I shall just keep it. Pre. Actually, you are right. I mentioned that you didn't go to to talk that that's my theoretical background. I. That's my to tell it. Good question driving, but because it's an ongoing research, I cannot say yet

512
01:45:28.910 --> 01:45:53.580
AyÅŸe Polat: how I'm being that together. But for the preliminary preliminary marks. I can say that for some of the practitioners it seems like they are really dividing modern and can practice it's 2 separate first. So for some of them. They are really 2 different habits. They cannot be brought together, but for others they and some of them are just to code, was some people of the home ipods Doctors were just saying like, I only exist in

513
01:45:53.580 --> 01:46:05.489
AyÅŸe Polat: in the, in the boundaries of this office itself. But up for the outside, we're outside where I don't exist and they don't exist for me. So for her, in her case, committed to 2 practices are really very different.

514
01:46:05.490 --> 01:46:35.169
AyÅŸe Polat: They they need different skills, and they are practicing very different ways. But for others, I think for the mercury. Today, we will think they can grow together. And this is whole issue about how they are trying to integrate different skill sets different values, and even it can values about they are being trying to bring together both the modern medicine camp. But you're right. This because that's the whole issue that I'm trying to understand how we can think about the if multiple habit is just how individuals in practice really negotiate through them differently.

515
01:46:35.290 --> 01:46:36.260
AyÅŸe Polat: Thank you.

516
01:46:36.530 --> 01:46:38.410
Thank you, Joanna.

517
01:46:39.420 --> 01:46:54.490
just very quickly. Thank you. Very nice and suggestion and comment about the concept actually would like to have access to that study. Is it a recent one from this year?

518
01:46:54.850 --> 01:47:04.029
Oh, but maybe I can use Google translator or something. You know where it's just no, but I think it's worth having a look, even if it's in Italian.

519
01:47:04.120 --> 01:47:14.809
because it just confirms a very. You know what I showed here, and that transition and the concept of criminality is fascinating.

520
01:47:14.930 --> 01:47:19.740
And yes, yesterday I was in a session, not sure if it was here

521
01:47:19.760 --> 01:47:27.260
that someone brought the concept. And I actually thought, oh, this concept actually would work well.

522
01:47:27.360 --> 01:47:50.329
because this idea that you know When I was talking about transitions. There's a a criticism to these, which is, we, don't we? Never, there's never the transition. There's that state of criminality that we stay there right? And so definitely, I will be looking and have thank you for the suggestion. Thanks very much.

523
01:47:51.600 --> 01:48:01.339
I know we have about 2 min left, but I just wanted to ask Joanna, and I know John's here as well who is part of the study.

524
01:48:01.410 --> 01:48:23.810
I mean, it's a fascinating study, and really important to be doing work like this, you know, in terms of moving things forward. But I just wonder what you think the policy implications of the potential policy applications of your research might be. Or if you want to put it more in a kind of individual ground up, you know what the practical implications may be of your of your work as it develops

525
01:48:25.310 --> 01:48:31.549
30 min.  sorry. Just bring.

526
01:48:31.690 --> 01:49:01.660
And so the policy implication. So we have this. You talked about the integrated care system which is now in the Uk. Right? So I think that could be one. And what I said at the at the end that there's a need to look at this integrated cancer care and continuing care just not integrated care, because what many women talked about they leave. But they leave the clinic. They have some access to some very shortly. So through the Macmillan

527
01:49:01.730 --> 01:49:19.860
symmetries in the Uk. But very shortly. And then they feel abandoned. Basically. So I think there are some police implications there. Just to to look better at this idea of integrated care system. Another thing is to cancer act

528
01:49:20.140 --> 01:49:34.560
which actually one I didn't admit in my abstract when I submitted, but I didn't mention it here, and some of them they talked about. So the cancer Act, the need to change the that

529
01:49:34.990 --> 01:49:49.939
to to update these art because the cancer act says that only medical doctors can provide treatment for cancer. And so they, I think that probably in the Cancer Act, I think, is from

530
01:49:50.040 --> 01:50:04.849
the 60 or the fortys, 1,940. Right? Yeah. So it's quite, you know. It's an insight to look at these and preventing even for medical doctors who practice can

531
01:50:05.150 --> 01:50:19.110
right? So they they for them. So updating these I think that the police implications could go through these as well. And I know John wants to say anything about this. But

532
01:50:19.150 --> 01:50:22.610
no. so

533
01:50:22.860 --> 01:50:30.449
thank you all for coming. Thank you. sucks, Microsoft. Thank you, Mike.

534
01:50:30.510 --> 01:50:34.039
Thank you as a pilot. Thank you, Joanna

535
01:50:34.090 --> 01:50:39.280
and John, and thank you also, Paula, for the presentations

536
01:50:40.760 --> 01:50:41.700
finished.

537
01:50:42.220 --> 01:50:42.890
Thank you.

538
01:50:43.570 --> 01:50:44.570
Thank you.

539
01:50:54.170 --> 01:51:00.000
Thank you, Kia. Thank you very much.