John S. Haller Jr. - Shadow Medicine: The Placebo in Conventional and Alternative Therapies

SHADOW MEDICINE

JOHN S. HALLER JR.

SHADOW MEDICINE

The Placebo in

Conventional and

Alternative

Therapies

COLUMBIA UNIVERSITY PRESS

NEW YORK

For Clio,

Phil B. Fontanarosa and George D. Lundberg, Alternative Medicine Meets Science (1998)

Lewis Thomas, The Medusa and the Snail (1979)

CONTENTS

S pecial thanks go to Michael Flannery, professor and associate director for historical collections at the Lister Hill Library at the University of Alabama at Birmingham; Dennis B. Worthen, former Lloyd Scholar at the Lloyd Library and Museum in Cincinnati; Kyle Perkins, associate dean for academic affairs at Florida International University; and Marc Katchen and Debra Katchen, who gave generously of their time for support and guidance. My gratitude extends as well to Columbia University Press editor Patrick Fitzgerald, assistant editor Bridget Flannery-McCoy, copyeditor Annie Barva, and the presss anonymous reviewers, all of whom saw merit in my approach not to lay waste one side or the other in the ongoing feud between proponents of evidence-based medicine and those supporting unconventional therapies. Others to whom I am indebted include former colleagues David Werlich, John Dotson, Howard Allen, Mark Foster, Don Rice, and David Wilson; the librarians and staff of the Lloyd Library and Museum in Cincinnati, the Morris Library of Southern Illinois University at Carbondale, the Southern Illinois University School of Medicine in Springfield, the National Library of Medicine, Boston Medical Library, Harvard College Library, the Francis A. Countway Library of Medicine at Harvard Medical School, the John Crerar Library of Chicago, the New York Academy of Medicine Library, New York Public Library, Northwestern University, the Stanford University Library, the University of Illinois Library at Champaign-Urbana, the University of Wisconsin Library, the University of Kansas Library, the University of Michigan Library, the Yale University Cushing/Whitney Medical Library, Google Books, and JSTOR.

As always, I am grateful to my wife, Robin, who offered inspiration, encouragement, criticism, and substantial assistance, including the reading of numerous drafts and the indexing of the book. Those errors of fact or interpretation that remain are mine alone.

C onsider for a moment these varying scenes: a graduate of Barbara Ann Brennans 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 30C to release its dynamized energies; a nurse creates an energy exchange using therapeutic touch to restore a patients 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 common across the United States. Whereas reductionist biomedicine draws its authority from the randomized clinical trial (RCT) and laws embedded in the natural sciences, these and other unconventional therapies rely on a philosophy of organism known as vitalism, which explains life not by the laws of physics and chemistry, but by a principle, force, or spiritlike power that comes from beyond the material world to animate organic matter.

Serving as a counterforce to conventional medicines reliance on academically trained physicians whose therapies are based principally on the materia medica (pharmacopoeia), unconventional medicine chooses a healing encounter that defines health in a psychological and spiritual manner attuned to notions of patient individualization and self-healing. Scarcely hidden in this encounter is a significant change in the healers role. Rather than someone with access to rational scientific knowledge, training, and competence in special skill sets, the unconventional healer is someone who relies on intuitive insight and at the same time encourages a more egalitarian relationship with his or her patientsreplacing reductionist thinking with notions of spirituality, meditation, insight, attitude, and behavioral modification. In this new setting, the patients experience becomes intensely personal and compares strikingly to certain types of spiritual awakening outside the material world of reductionist science.

Overtly metaphysical in their view of the causal forces, unconventional healers conceive of a spiritual encounter that includes the individuals inner capacity to find harmony with nature. This has become the countervailing voice of unconventional medicine in its stand against the medical establishment with its empirically tested system of medicine. For unconventional medicine, nonmaterial (paranormal) agents work in unison with the body to achieve an inner harmony. In sharp contrast to orthodox medicine, it encourages practitioners to exercise their metaphysical imaginations, identifying with a thinly veiled vitalism that not only reduces the universe to a single set of governing principles but articulates a philosophy that aligns the patients recuperative powers with providential laws and purposes.