I’m not sure where to start. Whole books have been written about the subjects you raise. I think I agree with most of the points you’ve raised. And I concentrated on the evidentiary approach rather than the ideological because I think it’s the only way into the solipsism of extreme postmodernism. If you stick to ideologies, you end up in eternally circular arguments.

Thanks for posting this long and interesting discussion. I appreciate the lucidity of your critique of Barry. My own interest in this debate comes out of researching philosophy of science, and also exposure to the critique of medical interventionism in childbirth.

I think that your critique of alternative therapies from an evidentiary standpoint could be coupled with a critique from an ideological perspective. Barry argues that the medical distrust of alternative therapies is a political maneuver designed to buttress the medical profession – thereby making use of a critique of medicine originally used to point out the exclusion of other forms of knowledge (womens’ and ethnic knowledges, specifically). But the marginalised group she is defending, here, is simply complementary medicine practitioners, who as you rightly point out are doing quite well, as the beneficiaries of an enormous consumeristic Orientalism in western countries. This discursive hijacking has its corollary in the belief systems of many alternative therapies: they are generally all about individualistic explanations and transformations (which nonetheless encompasses the whole universe) and themselves exclude political and social explanations of illness (exposure).

(The “Orientalism” of this movement interests me as well, for although there are ties with the tests on remote prayer etc., it is perhaps more common that liberals who laugh at prayer as a healing therapy (and are offended at the potential threat to the separation of church and state in the notion of spending taxpayers’ money on researching or providing it) are much more open to the funding of ‘Eastern’ spiritual therapies.)

What they avoid is delineating what domain a specific treatment is supposed to act upon. For as you show, by claiming that the physiological dimension should not be separated from the psychological or spiritual or whatever (what Barry calls the “[m]ythological, ritualised and culturally embedded aspects” of a healing system), the placebo effect is allowed to cover for the potential lack of any (extra) physiological effect of a remedy given. When of course the separation of different effects is the precise scientific goal of RCTs. Reason cuts. If the alternative medicine claim is that holistic attention to lifestyle, belief, etc. can have curative effects, the question of course is on what – on physical health, or on lifestyle, belief, etc.?

Matt