title: Placebo controls and epistemic control in orthodox medicine.
abstract: American orthodox medicine consolidated its professional authority in the early 20th Century on the basis of its unbiased scientific method. The centerpiece of such a method is a strategy for identifying truly effective new therapies, i.e., the randomized clinical trial (RCT). A crucial component of the RCT in illnesses without established treatment is the placebo control. Placebo effects must be identified and distinguished from pharmacological effects because placebos produce actual but unexplained therapeutic successes. The blinding necessary for a proper placebo-controlled RCT therefore introduces an epistemic bias into orthodox medicine: therapeutic successes that rely upon a direct link between knowing and healing, such as placebo effects, are discarded in favor of therapeutic successes that rely upon an indirect link between knowing and healing, such as pharmacological interventions. Where the capacity to produce therapeutic results once validated the method of clinical medical science, now method validates results. The clinical consequences of this method of testing therapies include a diminished vision of the therapeutic potential of the doctor-patient relationship and of the potential human resources available for healing.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195.
authors.forename: M D
authors.initials: MD
authors.lastname: Sullivan
mesh_terms: D015510:Clinical Medicine / Q000266:history; D005260:Female; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D015990:Placebo Effect; D010919:Placebos; D011361:Professional Competence; D016032:Randomized Controlled Trials as Topic / Q000266:history* / Q000592:standards; D014481:United States
chemical_list: D010919:Placebos