Shadow Medicine

Shadow Medicine: The Placebo in Conventional and Alternative Therapies

JOHN S. HALLER
Copyright Date: 2014
Pages: 288
https://www.jstor.org/stable/10.7312/hall16904
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  • Book Info
    Shadow Medicine
    Book Description:

    Can Evidence Based Medicine (EBM) and Complementary and Alternative Medicine (CAM) find common ground? A distinguished historian of medicine, John S. Haller Jr., explores the epistemological foundations of EBM and the challenges these conceptual tools present for both conventional and alternative therapies. As he explores a possible reconciliation between their conflicting approaches, Haller maintains a healthy, scientific skepticism yet finds promise in select complementary and alternative (CAM) therapies. Haller elucidates recent research on the placebo effect and shows how a new engagement between EBM and CAM might lead to a more productive medical practice that includes both the objectivity of evidence-based medicine and the subjective truth of the physician-patient relationship.

    Haller's book tours key topics in the standoff between EBM and CAM: how and why the double blinded, randomized clinical trial (RCT) came to be considered the gold standard in modern medicine; the challenge of postmodern medicine as it counters the positivism of evidence-based medicine; and the politics of modern CAM and the rise of the National Center for Complementary and Alternative Medicine. He conducts an in-depth case study of homeopathy, explaining why it has emerged as a poster-child for CAM, and assesses CAM's popularity despite its poor performance in clinical trials. Haller concludes with hope, showing how new experimental protocols might tease out the evidentiary basis for the placebo effect and establish a foundation for some reconciliation between EBM and CAM.

    eISBN: 978-0-231-53770-4
    Subjects: Health Sciences, Psychology, Public Health

Table of Contents

  1. Front Matter
    (pp. I-VIII)
  2. Table of Contents
    (pp. IX-X)
  3. ACKNOWLEDGMENTS
    (pp. XI-XII)
  4. ABBREVIATIONS
    (pp. XIII-XIV)
  5. INTRODUCTION
    (pp. XV-XXXII)

    Consider for a moment these varying scenes: a graduate of Barbara Ann Brennan’s School of Healing draws upon the forces in the universe to balance the multilayered fields of aura emanating from a patient; a homeopath, after a lengthy consultation, treats the symptoms of alopecia with sulfur serially diluted and succussed to 30°C to release its dynamized energies; a nurse creates an energy exchange using therapeutic touch to restore a patient’s self-healing abilities; and, finally, a chiropractor applies spinal manipulative therapy to treat a child with attention deficit hyperactive disorder. Each of these modalities is representative of unconventional healing practices...

  6. 1 EVIDENCE-BASED MEDICINE
    (pp. 1-30)

    Much of what passes today as orthodox medicine struggled to define itself in the early nineteenth century by separating its beliefs and practices from those of the competition. The task was neither easy nor inevitable. Until the therapeutic revolution in the second half of the century and the triumph of clinical medicine, the prevailing characterization of healing had been its diversity because wide differences existed in clientele, philosophy, treatment, training, professional status, regulation, and licensing. Even though the medical majority used political muscle to oppose its competitors by blocking them from equal access to the law, Abraham Flexner astutely identified...

  7. 2 POSTMODERNIST MEDICINE
    (pp. 31-60)

    Medicine’s golden age of modernity came to an end in the late 1960s and early 1970s when its authority was challenged by an amalgam of diverse cultural trends, heady intellectual discourse, consumerism, a service and information economy, a culturally based approach to knowledge, and a shift in autonomy from doctors to patients. As in literature, art, history, philosophy, architecture, and even fiction, the assumed certainty of an objective reality came under fire with new interpretations intent on substituting unrepresentable intuitions in place of ultimate principles. In this new age of postmodernism, nothing was beyond questioning; no principle was self-sustaining. The...

  8. 3 “THE POWERFUL PLACEBO”
    (pp. 61-88)

    As noted earlier, when Descartes conceived of the mind, whose essence is thought, as a nonphysical substance existing independently of the body, the mind–body dichotomy became one of the predominant features in European science and philosophy. It posed the question how an immaterial mind could cause any action in a material body and vice versa. Left without a satisfactory explanation for how two ontologically distinct entities could interact, Western science proceeded on a course that left a void between the body’s physical or corporeal properties and the immaterial mind. Its choice of a more materialistic and depersonalized study of...

  9. 4 POLITICS OF HEALING
    (pp. 89-120)

    With medical costs growing exponentially from the 1970s on, there was mounting evidence that Americans were turning in increased numbers to unconventional therapies, spending billions each year on interventions ranging from dietary supplements to homeopathy, crystal healing, anthroposophy, therapeutic touch, high-energy perception, and meditation. Thus, it came as no surprise that political pressure would be levied on the NIH to find and justify the substitution of alternative therapies for orthodox medicine’s more costly treatments. In 1991, Senator Thomas R. Harkin (D–IA), chair of the appropriations subcommittee with oversight of the NIH and a strong advocate of bee pollen for...

  10. 5 COMPLEMENTARY AND ALTERNATIVE MEDICINE’S CHALLENGE: A Case Study
    (pp. 121-152)

    Given the political and ideological pressures that mounted in the 1960s and continued into subsequent decades urging the NIH and its affiliate centers and institutes either to accept the historical validity of CAM therapies or to produce evidence that they were capable of positive health outcomes, it was not surprising that the RCT’s status at the top of the evidence-based pyramid would come under attack. As noted in previous chapters, the proponents of unconventional therapies offered a smorgasbord of arguments that the RCT contained within it a plethora of biases that diminished its objectivity. The most serious indictment grew from...

  11. 6 REASSESSMENT
    (pp. 153-160)

    Given what has been presented in this study, several observations are worth noting. First and foremost is the fact that conventional biomedical research and practice fail to account for the full measure of human experience in health and disease. With approximately 80 percent of the world’s population, including half the US population, using some form of CAM, the scientific community can no longer view these therapies as simply a fringe interest among consumers. However, because CAM therapies diverge sharply from reductionist science, the nature of their evidence and the subjective manner of their production create substantive problems for evidence-based medical...

  12. APPENDIX: U.S. CENTERS FOR THE STUDY OF COMPLEMENTARY AND ALTERNATIVE MEDICINE
    (pp. 161-164)
  13. NOTES
    (pp. 165-214)
  14. BIBLIOGRAPHY
    (pp. 215-242)
  15. INDEX
    (pp. 243-256)