CUP Web site

RSS Feed

New Books

Author Interviews

Author Events

Keep track of new CUP book releases:

For media inquiries, please contact our
publicity department

CUP Authors Blogs and Sites

American Society of Magazine Editors

Natalie Berkowitz / Winealicious

Leonard Cassuto

Mike Chasar / Poetry and Popular Culture

Erica Chenoweth / "Rational Insurgent"

Juan Cole

Jenny Davidson / "Light Reading"

Faisal Devji

William Duggan

James Fleming / Atmosphere: Air, Weather, and Climate History Blog

David Harvey

Paul Harvey / "Religion in American History"

Bruce Hoffman

Alexander Huang

David K. Hurst / The New Ecology of Leadership

Jameel Jaffer and Amrit Singh

Geoffrey Kabat / "Hyping Health Risks"

Grzegorz W. Kolodko / "Truth, Errors, and Lies"

Jerelle Kraus

Julia Kristeva

Michael LaSala / Gay and Lesbian Well-Being (Psychology Today)

David Leibow / The College Shrink

Marc Lynch / "Abu Aardvark"

S. J. Marshall

Michael Mauboussin

Noelle McAfee

The Measure of America

Philip Napoli / Audience Evolution

Paul Offit

Frederick Douglass Opie / Food as a Lens

Jeffrey Perry

Mari Ruti / The Juicy Bits

Marian Ronan

Michael Sledge

Jacqueline Stevens / States without Nations

Ted Striphas / The Late Age of Print

Charles Strozier / 9/11 after Ten Years

Hervé This

Alan Wallace

James Igoe Walsh / Back Channels

Xiaoming Wang

Santiago Zabala

Press Blogs


University of Akron

University of Alberta

American Management Association

Baylor University

Beacon Broadside

University of California

Cambridge University Press

University of Chicago

Cork University

Duke University

University of Florida

Fordham University Press

Georgetown University

University of Georgia

Harvard University

Harvard Educational Publishing Group

University of Hawaii

Hyperbole Books

University of Illinois

Island Press

Indiana University

Johns Hopkins University

University of Kentucky

Louisiana State University

McGill-Queens University Press

Mercer University

University of Michigan

University of Minnesota

Minnesota Historical Society

University of Mississippi

University of Missouri


University of Nebraska

University Press of New England

University of North Carolina

University Press of North Georgia

NYU / From the Square

University of Oklahoma

Oregon State University

University of Ottawa

Oxford University

Penn State University

University of Pennsylvania

Princeton University

Stanford University

University of Sydney

University of Syracuse

Temple University

University of Texas

Texas A&M University

University of Toronto

University of Virginia

Wilfrid Laurier University

Yale University

Archive for the 'Health' Category

Friday, June 5th, 2015

Matthew Smith on History and Understanding Food Allergy

We conclude our week-long feature on Matthew Smith’s Another Person’s Poison: A History of Food Allergy with, fittingly enough, the book’s conclusion. In it, Smith examines what history can tell us about food allergy as well as some of the missteps by other experts in understanding the rise of allergies:

Thursday, June 4th, 2015

Matthew Smith on the Peanut Allergy

In the following video from the BBC, Matthew Smith, author of Another Person’s Poison: A History of Food Allergy, looks at what has become perhaps the most commonly discussed allergy: the peanut allergy.

Smith considers some of the explanations that have been offered for rise of peanut allergies. As he argues, many of these boil down to changes in modern life and perhaps peanut allergies are the price we pay for cleaner homes, fewer infections, and safer food:

Wednesday, June 3rd, 2015

What History Can Tell Us About Food Allergy — Matthew Smith

Another Person's Poison, Matthew Smith

“If we want to know anything about the health issues that face us today and will face us in future, the very first thing we should do is turn to the history of such issues.”—Matthew Smith

The following post is by Matthew Smith, author of Another Person’s Poison: A History of Food Allergy:

What can the history of medicine tell us about food allergy and other medical conditions?

An awful lot. History is essentially about why things change over time. None of our ideas about health or medicine simply spring out of the ground. They evolve over time, adapting to various social, political, economic, technological, and cultural factors. If we want to know anything about the health issues that face us today and will face us in future, the very first thing we should do is turn to the history of such issues. This is particularly important if we are dissatisfied with current ways of thinking about and treating particular conditions (as I have argued in the past with respect to ADHD or hyperactivity) or if we are bamboozled by the causes and deeper meaning of other conditions, such as food allergy. Otherwise, we are uninformed and highly likely to repeat the mistakes of the past.

A few weeks ago, my 16-month-old daughter broke out in spots. As the parents of two remarkably healthy children, my wife and I were bemused. Our first thought was that she may have come down with chicken pox, a real pain, but not the worst thing in the world. We looked up some of the early symptoms of chicken pox online, which appeared to confirm our suspicions and steeled ourselves for a week of scratching and crying.

The following morning however, the spots had disappeared. We were flummoxed. Could chicken pox be a 24-hour thing? No such luck. Then, I remembered that I was the author of a book on food allergy. Could it have been something she ate? I tried to think about what she had been eating and then it struck me: strawberries.

Scottish people are often maligned for never eating fruits or vegetables. While this is true for some people, the traditional Scottish diet is actually chock-full of healthy foods. The cold and rainy climate allows us to grow plenty of neeps (turnips) and tatties (potatoes), for instance, and there is also a thriving berry industry in places such as Perthshire, and strawberries are central to this. Every year, when the sun shows its face and the buds begin to emerge, the first punnets of strawberries emerge in supermarkets. And we dutifully buy them up, gobbling up strawberries as fast as we can.


Tuesday, June 2nd, 2015

Interview with Matthew Smith, author of Another Person’s Poison: A History of Food Allergy

“Do we really need to eat peanuts at AC/DC concerts? Of course not. We accommodate our society to be more livable for other vulnerable people, so I don’t see why we can’t for the severely allergic.”—Matthew Smith

The following is an interview with Matthew Smith, author of Another Person’s Poison: A History of Food Allergy

Question: What is a food allergy?

Matthew Smith: Well, that depends on who you ask. Allergy was originally defined in 1906 by Austrian pediatrician as “any form of altered reactivity,” a broad definition if there ever was. Early food allergists—and many still today—embraced this definition and described a wide variety of reactions to food, ranging from asthma and eczema to migraine headaches and hyperactivity, as allergy. More conservative allergists, however, chose to limit their definition of allergy to instances in which evidence of the immune system reacting against a foreign substance could be proven definitively. Since this is difficult to do for many food allergies, they believed that food allergy was much less common than their food allergists colleagues. Debates about this precise definition have fueled debates about food allergy for over a century.

Q: Do you have any food allergies?

MS: No, not a one. My children seem to get hives if they eat too many strawberries and my wife is allergic to penicillin, but I am, thankfully, food allergy-free. Unlike my previous books on hyperactivity, where I had a strong, personal connection to the topic, I was drawn to the history of food allergy primarily because it is so fascinating. I loved learning about immunology, not least because it is such a deeply personal facet of human physiology. On the surface, we all have immune systems that protect us from the same sorts of pathogens that we encounter in the environment. But at a deeper level, immunology is all about how the body distinguishes self from non-self, as Nobel Laureate Frank Macfarlane Burnet put it. For most people, the immune system sees food as “self” and takes no interest. But for the allergic, food is perceived as “non-self,” a threat that must be countered at all costs. The meaning of it all is bemusing, but also compelling.

Q: Why are rates of food allergy, and especially peanut allergy, increasing?

MS: No one knows. Many hypotheses have been put forth, but none have been conclusively proven, let alone explored in much depth, unfortunately. A few seem more plausible than others. If you think of when von Pirquet defined allergy, this was a time when children were getting vaccinated against once endemic infectious diseases and when improvements in water quality and sanitation mean that people weren’t habitually infected with helminthic parasites (worms). Perhaps with less to cope with, immune systems turned to something else. Similarly, the hygiene hypothesis speculates that children grow up in overly hygienic environments, meaning that their immune systems aren’t exposed to as many pathogens as before. More controversial theories implicate the peanut oil found in some vaccines and environmental pollutants. Of course, genetics play a role, too. I suspect that many factors are at play, as they are in other chronic conditions, but also believe that we need to spend more time investigating them.


Friday, May 22nd, 2015

The Journey Ahead

The Thirteenth Step

“[F]or now at least, any promise of “cure” is somewhere between naïve and dishonest, depending on who makes it and why. But it is equally true that these chronic relapsing disorders can now be managed so that most people with such disorders can decrease their risk for relapse, allowing them to live productive, good lives.” — Markus Heilig

This week our featured book is The Thirteenth Step: Addiction in the Age of Brain Science, by Markus Heilig. For the final day of our giveaway, we are happy to present an excerpt from “The Journey Ahead,” the final chapter of The Thirteenth Step.

Don’t forget to enter our book giveaway of The Thirteenth Step!

Thursday, May 21st, 2015

PTSD and addiction

The Thirteenth Step

“Here’s a dream: A future in which every patient with alcohol problems, man or women, is thoroughly evaluated for PTSD, treated with evidence based behavioral interventions, and given the opportunity to benefit from synergistic effects of psychotherapy and pharmacology. Wouldn’t that be something?” — Markus Heilig

This week our featured book is The Thirteenth Step: Addiction in the Age of Brain Science, by Markus Heilig. In today’s post, Heilig discusses the deep connection between PTSD and substance addiction which scientists are still trying to fully understand.

And don’t forget to enter our book giveaway of The Thirteenth Step!

PTSD and addiction
By Markus Heilig

The public is clearly waking up to the fact that much of the toll of PTDS comes from substance use. Hard drinking may appear as the only way to temporarily escape the intrusive memories of traumatic events, face people at the grocery store, or fall asleep without the torment of nightmares. Up to 75% of combat veterans with PTSD also have alcohol problems. Conversely, between a third and half of patients seeking treatment for alcohol problems have PTSD.

But here’s something else to think about: The vast majority of PTSD patients are actually not veterans of wars. Firefights or explosive devices are not the most common causes of PTSD. Rape, sexual assault, or intimate partner violence are. Even with the recent wars, PTSD is twice as common among women as it is among men, affecting 8 – 16% of adult females in the US. Yet women suffering from PTSD are not much talked about. When they seek treatment for alcohol problems, the questions that would allow a PTSD diagnosis to be made are rarely asked. And even if the diagnosis is obvious, people look the other way. Traumatic events are so hard to talk about. Excuses are plentiful. Maybe bringing back traumatic memories will trigger cravings and relapse? So this difficult material is left for a “later” that never comes. (more…)

Wednesday, May 20th, 2015

Us and Them

The Thirteenth Step

“In this book I will share some of the amazing advances the neuroscience of addiction has made over the years I have been in the field. I will offer a personal take on what addiction is: a malfunction of some of the most fundamental brain circuits that make us tick, and a disease that is not much different from other chronic, relapsing medical conditions. I trust it will be clear what addiction is not: a moral failing, a simple inability to say no, or a condition that can be cured by mystic incantations.” — Markus Heilig

This week our featured book is The Thirteenth Step: Addiction in the Age of Brain Science, by Markus Heilig. Today, we are happy to present an excerpt from “Us and Them,” the first chapter of The Thirteenth Step, in which Heilig explains his experiences working with addiction, and lays out his hopes for what his book will accomplish.

Don’t forget to enter our book giveaway of The Thirteenth Step!

Tuesday, May 19th, 2015

Why breakthroughs in addiction research have not changed addiction treatment

The Thirteenth Step

“But the size of the addiction research enterprise is dwarfed by a $35 billion a year or so treatment industry in this field. This is a booming entrepreneurial world, where treatment centers charge people tens of thousands of dollars for various offerings. And despite all the investment in science, few of those treatments make much use of the scientific advances in the area of addiction. In fact, treatment approaches have not changed much at all over the past quarter century.” — Markus Heilig

This week our featured book is The Thirteenth Step: Addiction in the Age of Brain Science, by Markus Heilig. To open the week’s feature, Heilig has written a powerfully argued guest post in which he contrasts the advances in the science of addiction and the stagnation in the way that addiction is actually treated.

Don’t forget to enter our book giveaway of The Thirteenth Step!

Why have breakthroughs in addiction research not changed addiction treatment?
By Markus Heilig

The US taxpayers fund the overwhelming majority of addiction research in the world. Every year, Congress channels about $1 billion to the National Institute on Drug Abuse (NIDA). An additional almost 0.5 billion is separately given to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), my own workplace for the past decade. That may sound impressive, and in many ways it is. With the help of these resources, there have been truly amazing advances in the understanding of how addiction works. “Brain reward systems” have become part of the general parlance. The NIDA director has become a celebrity who has appeared on 60 Minutes. New findings on how alcohol and drugs get people hooked have shown a rare ability to fascinate people far outside the circle of scientists. And there has been perhaps a more modest, but still significant progress in figuring out better treatments.

But the size of the addiction research enterprise is dwarfed by a $35 billion a year or so treatment industry in this field. This is a booming entrepreneurial world, where treatment centers charge people tens of thousands of dollars for various offerings. And despite all the investment in science, few of those treatments make much use of the scientific advances in the area of addiction. In fact, treatment approaches have not changed much at all over the past quarter century. If someone were to be pulled out of a 12-step meeting then and transported through time to one today, he or she would probably not notice much of a difference. Here is, perhaps unsurprisingly then, something that the investment in research has not bought us: Any measurable dent in the damage done by addictions.

Some basic facts: Alcohol continues to kill about 80,000 Americans each year. Death from prescription pain killers adds almost 20,000 more, and has been on the rise for over a decade. As we have begun clamping down on these prescriptions, heroin has become resurgent instead. Why is it that all the passionate research efforts by dedicated scientists have such a hard time producing much of a change in the lives of real people with addictions? Only about one in 10 people with alcoholism ever receive treatment. For most of those, that is synonymous with joining Alcoholics Anonymous (AA), a movement formed three-quarters of a century ago, when medicine had little to offer addicts beyond perhaps treating the shakes of acute alcohol withdrawal. (more…)

Friday, April 24th, 2015

The Drugs Do Work (Sometimes) — Nessa Carey on Junk DNA and Medicine

Junk DNA, Nessa Carey

“One day science will probably be able to interpret all the pos­sible epigenetic modifications that are found in the genome and predict precisely what their consequences will be for gene expres­sion. But unravelling the rea­sons behind the triumph of hope over experience in the investment community? Be realistic.”—Nessa Carey

In the final post for our week-long feature on Junk DNA: A Journey Through the Dark Matter of the Genome, by Nessa Carey, we’ve provided an excerpt from the penultimate chapter, “The Drugs Do Work (Sometimes). In the chapter Carey explains how drug companies are building on new discoveries relating to junk DNA to develop new drugs. However, as Carey points out, the time and money they’re willing to devote to research and development is not consistent and often results in slowing down progress:

Billions of dollars are spent every year by companies trying to cre­ate new drugs to treat human diseases. They hope to find ways to tackle unmet medical needs, a situation that is becoming ever more urgent with the increasing age profile of the global population. The breakthroughs in the understanding of the impact of junk DNA on gene expression and disease progression are triggering a slew of new companies seeking to exploit this field. Specifically, most of the new efforts are in using non-protein-coding RNAs as drugs in themselves. The basic premise is that junk RNA – long non-coding, smallRNAs or another form called antisense – will be given to patients, to influence gene expression and control or cure disease.

This is very different from the way we treat diseases at the moment. Historically, most drugs have been of a type known as small molecules. These are chemically created and are relatively simple in shape. More recently, we have learnt how to use proteins as drugs. Probably the most famous is insulin, the hormone that diabetics use to regulate their blood sugar levels. Antibodies are another very successful type of protein drug. These are engineered versions of the molecules we all produce to fight infections. Drug companies have found ways of adapting these so that they will bind to over-expressed proteins and neutralise their activities. The bestselling antibody is one that treats rheumatoid arthritis very effectively, but there are others that treat conditions as diverse as breast cancer and blindness.


Wednesday, April 15th, 2015

VIDEO: Peter Piot and the Science and Politics of AIDS

In the following video, Peter Piot, author of the just-published AIDS Between Science and Politics discusses with the Financial Times his experiences as an AIDS researcher and how communicable diseases can be prevented in the future:

Friday, October 3rd, 2014

How Poverty and Income Disparities Influences Doctor-Patient Relations — Dennis Rosen

Dennis Rosen, Vital ConversationsWe conclude our week-long feature on Vital Conversations: Improving Communication Between Doctors and Patients, with an excerpt from the book in which Dennis Rosen explores how socioeconomic disparities affect communication between doctor and patient:

Even when socioeconomic disparities between physician and patient are not glaringly obvious, they can and often do heavily influence the quality of physician-patient communication during the visit as well as its outcomes. Researchers have found that patients from lower socio­economic backgrounds tend to participate less in medical decision making, which … results in lower adherence and higher overall health-care costs. These patients are also generally provided with less information and socioemotional support by their physicians. In contrast, patients from higher socio­economic backgrounds tend to be much more involved in the man­agement of their own care. There are many possible explanations for this, including societal boundaries that limit the scope of communi­cation between people of different social stations and differences in education levels that can impede the ability of physician and patient to find a common language. Whatever the reasons, however, the fact remains that some patients are consistently less engaged by physicians than others, with consequent effects upon their participation in defin­ing the parameters of their care and, ultimately, their adherence with the treatment.

Disparities in socioeconomic status can also have profound effects on how disease is contextualized and understood. In some cases, these can lead to active resistance on the part of patients to public-health disease prevention and treatment efforts. Marilyn Nations of Har­vard and Cristina Monte of the Federal University of Ceara Medi­cal School, Brazil, interviewed the indigent residents of two favelas (shantytowns) that were hit hard by the 1993 cholera epidemic. Their aim was to understand more fully why there had been such a high degree of resistance by the favelados to governmental efforts to control the outbreak, such as water purification and the use of prophylactic antibiotics. Nations and Monte confirmed that in many instances the favelados’ refusal to cooperate with the campaign was a response to a longstanding sense of marginalization and stigmatization, which was potentiated by the use of certain metaphors in the prevention cam­paign that seemed to blame them for becoming sick in the first place. By rejecting the government-sponsored prevention efforts, the fave­lados were also rejecting the stigma of being made responsible for the epidemic.


Thursday, October 2nd, 2014

A Doctor, a Rabbi and a Chicken — Dennis Rosen

“Deeply held beliefs .. need not only to be recognized and respected, but also integrated into the therapeutic approach in order for treatment to succeed. It is a lesson that has served me well, and which has helped me to serve so many others over the years.”—Dennis Rosen, MD

Dennis Rosen, Vital ConversationsIn a recent New York Times op-ed entitled A Doctor, a Rabbi and a Chicken, Dennis Rosen, the author of Vital Conversations: Improving Communication Between Doctors and Patients, explores an odd yet pivotal moment in his medical career.

While working in a hospital in Israel, Rosen explained to the son of 75-year-old stroke victim what lay ahead for his father in terms of rehabilitation. The son then asked if a rabbi could enter his father’s hospital room. While such a request might not have been strange, what was different was that when the rabbi walked in the room he was carrying a live chicken and then proceeded to wave it above the patient’s head.

Rosen learned that it was a custom of the local Persian-Jewish community to help heal the sick. In describing the experience, Rosen writes:

I was very impressed by how deftly the son was able to maneuver between two very different belief systems explaining his father’s disease and paths towards possible recovery: biomedical and religious. As evidenced from our repeated discussions about tests and treatment plans for his father, he clearly understood — and valued — what modern medicine could offer. And yet, his belief in Divine mercy and intercession was unshakeable….


Wednesday, October 1st, 2014

Staying Out of the Hospital — Dennis Rosen

Vital Conversations, Dennis Rosen The following post is by Dennis Rosen, author of Vital Conversations: Improving Communication Between Doctors and Patients

Hopefully, all of you will live long and healthy lives that will end peacefully in your sleep sometime after seeing your youngest great-grandchild head off to college. Unfortunately, it will be a lot less rosy for most of us. Disease and illness are natural parts of our lives, and as science and technology advance people now live longer—and with more coexisting medical conditions—than ever before. As we get older we tend to consume more medications, and the likelihood of being hospitalized because of an acute health crises increases.

Unfortunately, the high cost of health care has resulted in growing pressure to shorten the length of stays in hospital as much as possible. And while there are many good reasons for doing this—reduced expense, lower likelihood of picking up a secondary infection or experiencing a medical error)—there can be significant downsides as well. Among these are the risks patients face when sent home from the hospital before they are well enough to care for themselves or before they understand how it is, exactly, that they are supposed to do so.

Almost one in five Medicare patients discharged from the hospital will be readmitted within the next thirty days. Interestingly, this also corresponds to the percentage of patients who experience an adverse medical event or complication, two thirds of which involve the medications they are taking. This suggests that better pre-discharge patient education needs to take place. And yet, one study of adult patients being discharged from a large academic hospital in New York found that only 28 percent could name all their discharge meds (on average, fewer than four), and that almost two thirds did not understand why they had been prescribed the medications in the first place.

Although this information is supposed to be included in a printed discharge summary, it is often not as clear as it should be, or even that easy to find among the many pages of small-font verbiage. Let’s not forget as well, that many patients are too anxious, in pain, or simply hazy from the meds they’re on to make sense of the discharge summary as carefully as they should. When you add in the fact that more than one third of Medicare patients possess marginal or insufficient health literacy skills, it’s surprising that the rate of adverse medical events following discharge is as low as it is.


Tuesday, September 30th, 2014

Interview with Dennis Rosen, author of “Vital Conversations”

Vital Conversations, Dennis RosenThe following is an interview with Dennis Rosen, author of Vital Conversations: Improving Communication Between Doctors and Patients:

Question: So what is Vital Conversations about?

Dennis Rosen: Vital Conversations is about why good communication between doctors and patients is so important to achieving better—and less expensive—health outcomes. It explores many of the reasons that this communication becomes compromised, such as cultural and socioeconomic differences; stigma and bias; and external meddling in the actual content of the medical visit that takes away from the direct face time between doctors and patients. Vital Conversations concludes with clear suggestions—for both patients and doctors—about ways each can improve the quality of their interactions in order to get more out of them. It also provides suggestions for how the health-care system can prioritize this issue in ways that will serve us all.

Q: I notice you spend a lot of time in Vital Conversations discussing how cultural differences between patient and physician influence the quality of their communication. What made you decide to focus on this?

DR: I’ve spent most of my own life moving among different cultures. I was born in the US, lived in Canada until I was 15, then in Israel for the next 19 years, and have been living in Boston since 2001. I completed my medical education and pediatric residency in Israel, and did additional training as a resident and fellow at Boston Children’s Hospital before becoming an attending physician eight years ago. I have also worked in Haiti and Guatemala several times over the last five years. All of these experiences have given me deep insight into how the ways we perceive and understand what happens to and around us influence our ability to explain it to others, and to understand their explanations in turn. When the underlying concepts are different, this can become very difficult.

Although magnified when working with people from different cultures—and let’s not forget that one quarter of American physicians were trained abroad—it is also true even when both doctor and patient are of the same culture. One issue that I explore in Vital Conversations is the differences between the objective disease, subjective illness as experienced by the patient, and sickness as defined by society. A person with a broken finger has obvious disease, and the illness process she is suffering as a result is likely to be straightforward to the physician. By virtue of this shared understanding, the doctor’s treatment recommendations are likely to be easily understood and carried out by the patient. However, a person who comes to the doctor’s office and is found to have high blood pressure may feel absolutely fine, i.e. have disease without illness. Unless the doctor is able to convince him of the need to take medications to keep the hypertension from leading to heart disease or stroke, he may be inclined to stop taking the medicine at the first sign of side effects, leading to progression of disease.

All throughout the book I’ve included numerous personal stories and vignettes from my career as a physician that illustrate these and other points I make. Even though I wish I could claim otherwise I still don’t always get it right, despite my best attempts to, as the stories make clear. As fascinating and entertaining as the stories themselves are, I think that they really drive home the central message of the book, which is that good communication between doctors and patients is vital for medical care to be effective.


Friday, July 25th, 2014

“The mind–body dualism has long overstayed its visit” — Concluding Thoughts from Shadow Medicine

“The mind–body dualism has long overstayed its visit. Western science needs to advance beyond the cur­rent reductionist model to some blending of the subjective and social aspects of healing.”—John S. Haller Jr.

Shadow Medicine, John S. Haller Jr.We conclude our week-long feature on Shadow Medicine: The Placebo in Conventional and Alternative Therapies with an excerpt, fittingly enough, from the concluding chapter. In “Reassessment,” Haller examines some of the challenges confronting alternative medicine as it tries to gain greater legitimacy as well as the need to integrate our understanding of what both alternative and conventional medicine offer:

With approximately 80 percent of the world’s population, including half the US population, using some form of [contemporary and alternative medicine] (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 knowledge. This suggests a remark­able similarity between CAM therapies and numerous nonspecific theo­ries and practices such as psychotherapy that, although difficult to explain in terms of their modus operandi, have proven beneficial to patients. The current tension between conventional therapies and unconventional ther­apies represents a collision of epistemologies. For the former, disease cau­sation constitutes the ideal form of evidence; for the latter, outcomes are of equal or greater importance. In our postmodern world, multifactorial causation has become more accepted as doctors and medical researchers adopt a more integrative role for unconventional therapies—a road that neither is straight nor accompanied by clear markers.

As the usage of homeopathy, acupuncture, herbals, chiropractic, and other CAM modalities amply demonstrate, their poor performance in clinical trials have caused little or no diminution in their popularity. They remain robust in their claims and ever anxious to expand their therapeu­tic applications. Even with increased consumer interest, however, only a small number of CAM therapies are expected to achieve legitimacy along­side conventional medicine. Unlike biomedicine, which is constantly jus­tifying its existence through replication and evidence-based research, most CAM modalities have yet to prove their efficacy or replicability, standing firmly on a static set of principles and practices that appear to “work,” albeit only marginally better than the placebo. To date, only a few have been able to build a scientific explanation for their efficacy. And for those that have achieved this status, the outcome has not always been to their benefit. The fact that the management of chronic disease constitutes 78 percent of medical expenditures in the United States explains why con­ventional medicine has been so aggressive in fighting CAM and, where possible, co-opting its more effective therapies.


Thursday, July 24th, 2014

Conventional vs Alternative Medicine — An Excerpt from Shadow Medicine by John Haller

“In addressing the standoff between the dueling protagonists of conventional and unconventional medicine, the placebo has served as both mediator and judge….” —John S. Haller Jr.

We continue our week-long feature on Shadow Medicine: The Placebo in Conventional and Alternative Therapies by John S. Haller Jr. by presenting an excerpt from the book . In the introduction, Haller examines the debate between proponents of conventional and alternative medicine and the role in which the placebo plays in challenging both positions.

Wednesday, July 23rd, 2014

An Interview with John Haller, author of Shadow Medicine

“The question at hand is not only whether conventional and unconventional therapies can stand on their own self-authenticating authority, but whether it is possible to modify the context of these two opposing camps into something both can benefit from sharing. To date, there is no hard-wired connection, but the bridge between them is nowhere as long, nor is the chasm beneath them as deep as it once appeared.”—John S. Haller Jr.

John Haller, Shadow MedicineThe following is an interview with John S. Haller Jr, author of Shadow Medicine: The Placebo in Conventional and Alternative Therapies. For more on the book, read John Haller’s essay The Medical Challenge:

Q: In Shadow Medicine, you use the term conventional medicine. What do you mean by that?

John Haller Jr.: Conventional (or reductionist) medicine identifies statistical baselines against which to measure its therapies, looking to physiological, pathological, biochemical, and molecular processes derived from physical matter and to treatment based on the calculus of probabilities. That is to say, conventional medicine draws its authority from the clinical trials and laws embedded in the natural sciences. At its best, conventional medicine encourages a healthy skepticism and urges various forms of sampling, followed by repeated experimentation to reaffirm a hypothesis. Its identity is thus based on the unambiguous application of normative science whose laws interpret the body as a materialistic system that can be reduced and analyzed according to its component parts.

Q: You seem to suggest, however, that conventional medicine has limits? How so?

JH: While conventional medicine continues to provide the most credible information for justifying a clinical judgment, its ultimate value remains uncertain because much of what happens in a clinical trial fails to capture the myriad of variables that affect the physician/patient encounter. For this and other reasons, the clinical trial remains an imperfect tool.

Calibrating the outcome of a medical procedure or the efficacy of a pharmacologic treatment defies certitude insofar as the organic side of medicine tends to be infused with psychotherapeutic interventions—some intended and, others, hidden. This suggests that conventional medicine has overestimated the value of the clinical trial in resolving the challenges presented in medicine and that more creative efforts are needed that compare “whole treatments.”

Q: How does conventional medicine contrast from complementary and alternative medicine?

JH: Today’s complementary and alternative healers focus their attention on forces or energies that, although undetectable by the tools of science, are thought to be real. Such phrases as “paradigm change,” “probability waves,” “string theory,” “chaos theory,” “new physics,” “ectoplasm,” “chakras,” and “spirit-release therapy” are used to anoint beliefs wholly distinct from empirically-based laboratory science. Challenging the discrete boundaries between objectivity and subjectivity by including consciousness in the reframing of reality, today’s unconventional healers insist that “life forces” can be transmitted or channeled into the patient to mediate physical, mental, or emotional needs. This secularized notion of body, mind, and spirit forms the basis of homeopathy, psychic healing, crystal healing, reiki, light therapy, acupuncture, qigong, aromatherapy, distant healing, transcendental meditation, therapeutic touch, and other paranormal healing systems.


Tuesday, July 22nd, 2014

The Medical Challenge — A Post by John S. Haller Jr.

Shadow Medicine, John S. Haller Jr.The following post is by John S. Haller Jr., author of Shadow Medicine: The Placebo in Conventional and Alternative Therapies:

“The placebo has undermined the positivist model of biomedicine by interjecting subjectivity, uncertainty, and ambiguity into the clinical encounter. It suggests that a specific disease or illness does not exist apart from the manner in which the society conceptualizes it and addresses it.”—John S. Haller Jr.

Conventional medicine is founded on the belief that the body is the outcome of material forces. Given this assumption, it looks to physiological, pathological, biochemical, and molecular processes derived from physical matter to diagnose and treat disease. Its basic tool is the randomized clinical trial, guided by the fact that its active pharmaceutical substances “work” (even when the patient is unaware of their administration) and that their effects can be demonstrated, measured, and replicated. As authority figures, conventional physicians not only project a certain level of scientific legitimacy but purport to have legal authority, political privilege, and cultural acceptance—entitlements that also come with obligations that include standardized training, accreditation, licensing, and regulation.

While the randomized clinical trial provides the most credible information for justifying a specific treatment, its ultimate value remains uncertain because much of what happens in a trial fails to capture the myriad of independent and/or related variables that affect the physician/patient encounter. For all its hype, the randomized clinical trial remains an imperfect tool. Although it informs individual clinical expertise, it does not (and should not) replace it. Conventional medicine has overestimated the value of its clinical trial and more creative methods are needed that compare “whole treatments” rather than just the normative components which biomedicine is most acquainted.

In contrast to conventional medicine, complementary and alternative medicine (CAM) defines health in psychological and spiritual terms and emphasizes patient individualization and self-healing. It is founded 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 spirit-like power that comes from beyond the material world to animate organic matter. Consisting of a mixture of religion, mysticism, cosmic energy, disbelief in Western reductionism, and an increased fascination with Eastern philosophies, CAM encourages a more metaphysical encounter with the world, one that questions the basic assumptions about the nature of reality. In this new setting the patient’s experience becomes intensely personal and compares strikingly to certain types of spiritual awakening. In its intuitive approach to healing, the goal of the healer is to assist the individual in finding harmony with nature.


Monday, July 21st, 2014

Book Giveaway! Win a Free Copy of Shadow Medicine, by John Haller

The Collapse of Western Civilization

This week our featured book is Shadow Medicine: The Placebo in Conventional and Alternative Therapies, by John S. Haller Jr.

In addition to features on our blog, we will also be posting about the book on twitter, and facebook.

We are also offering a FREE copy of Shadow Medicine to a lucky winner. To enter the contest please e-mail pl2164@columbia.edu and include your name and address. The winner will be selected Friday, July 25 at 1:00 pm.

“This provocative book is aimed at challenging the research community, and the questions it raises are important for patients and doctors alike.” — Publishers Weekly

Read the introduction to Shadow Medicine:

Friday, June 27th, 2014

Interview with Alfredo Morabia, author of Enigmas of Health and Disease

Enigmas of Health and DiseaseThe following is an interview with Alfredo Morabia, author of Enigmas of Health and Disease: How Epidemiology Helps Unravel Scientific Mysteries. You can also read Morabia’s blog post Michelle Obama and Epidemiology: An Inspiring Example

Question Your book offers a fascinating and frequently surprising history of epidemiology. How does our understanding of this history help us confront contemporary issues relating to medicine and public health?

Alfredo Morabia: If I have to isolate one key lesson of this historical voyage, it is that society’s success in confronting health issues depends on its ability to use epidemiology to identify medical and public health interventions that work. This was the great discovery of the 17th century, and it finally stopped and reversed the inexorable and millenary progression of the great epidemic diseases.

Q: As you looked back at the history, were there particular events or moments that you found particularly surprising and perhaps changed the way you think about epidemiology?

AM: I had always associated the history of epidemiology mostly with the history of public health but this is not true. The history of epidemiology belongs just as much to the history of clinical medicine. Group comparisons were used to assess the efficacy of treatments by clinical doctors throughout the 350 years of existence of epidemiology.

Q: Your book stresses the importance of group comparisons. Why is this so central to epidemiology?

AM: Comparison is the basic tool of science. In epidemiology, by comparing groups of people we can learn whether a specific drug works, whether an exposure is beneficial or deleterious, or whether a screening test can prolong life. Groups are predictable and comparable; individuals are not.