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EDITORIAL |
Department of Psychiatry, University of California, San Diego, La Jolla, Ca 92093-0804
Amygdalae have been firing all across the United States during the great "alternative medicine" fights. Note that I did not state ‘debates’ because that civilized discourse has been relatively missing on this topic. Instead, the arguments resemble the same degree of dispassionate, honest search for truth as has been displayed of late in Los Angeles courtrooms.
Advocates for alternative medicine argue that "traditional" medicine demeans patients and fails to treat chronic disease. They argue for a variety of alternatives, complements, or holistic remedies to traditional medicine. On the other side, opponents of alternative medicine argue that the field is filled with crackpots who deceive and defraud patients and wreak havoc by resorting to unscientific treatments.
With these kinds of opening premises, it is difficult to find a neutral ground for discussion. Perhaps if we turned back the clock to the time of James IV, King of Scotland from 1488 to 1513, and considered the fate of his alchemist John Damian, it might remind us that hypotheses are more valuable than indictments.
In the time of James IV, alchemy featured a curious blend of philosophy, mysticism, chemistry, and, on occasion, thievery (1). Part of the problem with the current controversy about alternative medicine is that medicine, like alchemy, consists of a blend of distinctly different ingredients—science and caring. Finding the right proportion of ingredients is crucial for forging a strong alloy, as the alchemists knew centuries ago and that search for the right balance of science and caring is the basis for some of the most vehement arguments between supporters of traditional and alternative medicine. Whereas the caring side of contemporary traditional medicine has always been crucial, increasingly it has been shadowed by medicine’s enormous scientific strides. In many ways, alternative medicine is the mirror image of traditional medicine—strong on caring and weak on science. The impassioned fights about alternative medicine would be unnecessary if one tested its claims empirically. Unfortunately, what is in short supply on both sides is a dispassionate examination of the efficacy of alternative medicine. If an odd intervention works, we need to understand why it works, rather than criticize it for doctrinal heresy (remember Galileo, after all). We REALLY could use some hypothesis testing as opposed to diatribes. Mind you, the hypotheses do not have to be confirmed; it would be sufficient to test them. Much can be learned from failed hypotheses.
The value of hypothesis testing was clear even in the time of James IV. He sponsored John Damian, a shadowy alchemist who tried to make gold (2). Despite royal backing and encouragement, Damian failed, and James IV became increasingly testy with the alchemist. As a result, Damian felt it necessary to rehabilitate himself by publicly demonstrating his abilities. He told the King he would invent functioning wings and fly away to France. High on the battlements of Stirling Castle, Damian strapped on his wings, paused to savor the wind in his face, and jumped—plummeting to the ground far below and fracturing his leg (3). The King made his way along the battlements, through the courtyard, and down the hill to where Damian lay (it is a long way down, as any Stirling Castle visitor can testify). As James hectored his alchemist for failing yet again, Damian replied that he miscalculated the lift necessary in his wing design. He told the King that he had mistakenly relied on feathers from barnyard hens, but he was sure that his plan would have worked if he had relied on the royal feathers of an eagle (3). Not a bad rejoinder, given that he had failed miserably, fallen 100 feet, and suffered a broken leg.
Damian had a hypothesis and the courage to test it. He was not a total fraud. It is true that he was not particularly "successful," but his hypothesis was testable. He had the wing design all wrong, but he had the courage to test it, and to test it very visibly in a location that for centuries has shimmered over the Scottish countryside. The photographer J. Craig Annan captures the spectral quality of light and darkness, of the heights and fields around Stirling Castle in his classic photograph published in 1907 (see Figure). Anyone willing to strap on wings of chicken feathers and jump off those ramparts was not a humbug.
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APPENDIX
Reviewers for Psychosomatic Medicine
The Editor acknowledges with appreciation the efforts of the following colleagues who reviewed manuscripts for this Journal from October 1, 1997, to September 30, 1998.
Susan Abbey
Gene G. Abel
James L. Abelson
Walid M. Abi-Saab
Henry D. Abraham
Sigurd Ackerman
Sally H. Adams
Robert Ader
Nancy Adler
Perry Adler
Rolf Adler
W. Stewart Agras
David F. Alexander
Michael Allen
Bruce S. Alpert
Carol L. Alter
Sonia Ancoli-Israel
David E. Anderson
Erling A. Anderson
Norman Anderson
Roger Anderson
Michael Andrykowski
Jules Angst
Hymie Anisman
Ad A. Appels
Lesley M. Arnold
Gordon J.G. Asmundson
J. Hampton Atkinson
Marilyn C. Augustyn
Frank J. Ayd
R. Michael Bagby
Donald Bakal
Brian Baker
Rudy E. Ballieux
John Bancroft
John C. Barefoot
Steven D. Barger
Christopher J. Barnard
Elizabeth Barrett-Connor
Stuart H. Bartle
Barbara Bartlik
Marco Battaglia
Russell Bauer
Andrew Baum
David Bear
Diane M. Becker
Lewis Becker
Jean Beckham
Iris Bell
Charles Benight
Robert Benschop
David Benton
Ivan Berczi
Howard Berenbaum
Isidore L. Berenbaum
Lisa F. Berkman
Charles C. Berry
Niels Birbaumer
Edward O. Bixler
Dan Blazer
Susan Block
Joan R. Bloom
James A. Blumenthal
Richard C. Boland
Michael H. Bonnet
Sarah W. Book
Jan Born
Jos A. Bosch
Dana Bovbjerg
W. Thomas Boyce
Gregory Boyle
Tom N. Bradbury
John Paul Brady
David L. Braff
Henk S. Brand
William Breitbart
David H. Broide
Jos F. Brosschot
Claus Buddeberg
Gunilla K. Burell
David M. Burns
John Burns
Angelika Buske-Kirschbaum
Michael P. Caligiuri
Oliver Cameron
John P. Capitanio
Donald Carek
Michael P. Carey
Robert M. Carney
Eugene J. Carragee
Victor Carrion
Charles Cartwright
Charles Carver
Pietro Castelnuovo-Tedesco
Stephanie Cavanaugh
David Cave
David F. Cella
J. Edmond Charlton
Edith Chen
Margaret Chesney
Nicholas Christenfeld
Alan Christensen
Donald S. Ciccone
Alice M. Clark
W. Crawford Clark
Sean Clarke
William L. Clarke
Jack L. Clausen
Daniel J. Clauw
Christopher Coe
Frances Cohen
Lewis M. Cohen
Mary Ann Adler Cohen
Nicholas Cohen
Sheldon Cohen
George Cohn
Eduardo A. Colon
Bruce E. Compas
Richard Contrada
Jody Corey-Bloom
Paul T. Costa, Jr.
Daniel J. Cox
James Coyne
John W. Crayton
Francis Creed
Michael H. Criqui
Catherine C. Crone
Michael D. Crowell
Jeffrey L. Cummings
W. Grant Dahlstrom
Mary B. Daly
Denis F. Darko
Charles S. Davis
John M. Davis
Mary Davis
William W. Deardorff
Alan Delamater
Edward DeMet
Johan Denollet
Leonard R. Derogatis
Hans-Christian Deter
Mary Amanda Dew
Firdaus S. Dhabhar
Blaine Ditto
Patricia L. Dobkin
Lawrence M. Dolan
Joel M. Dopp
Lorah D. Dorn
Gerhard Dotevall
William Dressler
Douglas A. Drossman
Steven Dubovsky
Jacqueline Dunbar-Jacob
David Dunner
Lynn Durel
Barry R. Dworkin
Paul H. Dworkin
Samuel Dworkin
Elaine Eaker
Ilana Eli
Merrill F. Elias
Peter T. Ellison
George Ellsworth
Charles Emery
Karen Emmons
Paul Enck
Jean Endicott
Bernard T. Engel
JoAnne Epping-Jordan
Leonard H. Epstein
Steven A. Epstein
Milton Erman
Brian Esterling
Richard Evans
Susan Everson
Ann Maxwell Eward
Craig K. Ewart
Pam Factor-Litvak
John L. Fahey
Bonita Falkner
Sherry Falsetti
Eugene Farber
Maurizio Fava
Armando R. Favazza
Fawzy I. Fawzy
Mark N. Feinglos
Francisco Fernandez
Marcello Ferrada-Noli
Roger B. Fillingim
Douglas H. Finestone
Per Fink
Jerry B. Finkel
Michael First
Benjamin Fischler
Edwin B. Fisher
Charles F. Flaherty
Joseph Flaherty
Mary Ann Fletcher
Kathleen M. Foley
David G. Folks
Charles V. Ford
Alfred Franger
Nancy Frasure-Smith
Lennart Fredstorp
Kenneth Freedland
Robert Freedman
Arthur Freeman
Ellen Freeman
Stephen R. Freidberg
Davina French
Douglas French
Gregory Fricchione
Richard G. Fried
Rollin M. Gallagher
Michael Gara
David M. Garner
Thomas R. Garrick
Thomas F. Garrity
Marc D. Gellman
William Gerin
Gail Germain
Frederick X. Gibbons
Mary Gick
David G. Gilbert
Gordon N. Gill
Chris Gillin
Susan Girdler
Leslie Hartley Gise
Ronald Glaser
Virginia L. Goetsch
Richard J. Goldberg
David Goldbloom
Iris Goldstein
Beatrice Golomb
Jeffrey Goodie
Elizabeth Goodman
Paul Goodnick
Igor Grant
Donna B. Greenberg
Catherine Greeno
Mary Banks Gregerson
Joel Grinker
Ted Grossbart
Paul Grossman
Sally K. Guthrie
Elizabeth A. Hahn
Uriel Halbreich
Martica Hall
Richard C.W. Hall
John F. Hansbrough
David L. Hare
Andrew Harver
Roger Haskett
E.M. Hay
Jennifer Haythornthwaite
Mark T. Hegel
Cobi J. Heijnen
Gary V. Heller
Dirk H. Hellhammer
Robert R. Henry
Ronald B. Herberman
J. Alan Herd
C. Peter Herman
Christoph Herrmann
David B. Herzog
Ellen Heyneman
Jules Hirsch
Paul Hjemdahl
Rudolf Hoehn-Saric
Myron A. Hofer
Stefan Hofmann
Eric Hollander
Valerie Holmes
Jean Holroyd
Kenneth Holroyd
Johan Hoogstraten
Mardi J. Horowitz
Richard L. Hough
Frank Hucklebridge
James Hudson
Kenneth Hugdahl
Adam Hurewitz
Fritz J. Huyse
Thomas R. Insel
Gail Ironson
Jane Irvine
Michael R. Irwin
Rolf G. Jacob
Sue C. Jacobs
Paul B. Jacobsen
Alan Jacobson
Gary James
Jack E. James
Larry D. Jamner
David Janowsky
C. David Jenkins
Christina Jern
Sverker Jern
Susan R. Johnson
Derek W. Johnston
Randall Jorgensen
Melissa Kalarchian
Thomas Kamarck
Berton H. Kaplan
George A. Kaplan
Stanislav Kasl
Edward S. Katkin
Wayne J. Katon
Ira R. Katz
Patricia Kaufert
Peter Kaufmann
Ichiro Kawachi
Walter H. Kaye
Julian Keil
Margaret E. Kemeny
John P. Kemph
Robert Kerns
Ronald C. Kessler
Mark Ketterer
Hani Raoul Khouzam
Steven Kick
Janice Kiecolt-Glaser
Johann F. Kinzl
Clemens Kirschbaum
Michael Klagg
Laura Klein
Sarah Knox
Kenneth Koch
Kyung Bong Koh
John Koo
George F. Koob
Jaap M. Koolhaas
Willem J. Kop
Alice Kornblith
Donald Kornfeld
Harry Kotses
Kyriaki Kouyanou
Lawrence Krakoff
David S. Krantz
Richard Kreipe
Daniel F. Kripke
Jean Kristeller
Stephen B. Kritchevsky
Ziad Kronfol
Joachim Kugler
Cynthia Kuhn
Lewis H. Kuller
David J. Kupfer
Friedhelm Lamprecht
William J. Lancee
Paul Landsbergis
James D. Lane
Richard Lane
Alan Langer
Wolf A. Langewitz
Kate L. Lapane
Kevin Larkin
Mark L. Laudenslager
James Lawler
Kathleen Lawler
Allen Lebovits
Margueitte S. Lederberg
Paul Lehrer
Hoyle Leigh
Lewis Leikin
Stephen J. Lepore
Francois Lesperance
Ira Lesser
Jeffrey C. Levenkron
James L. Levenson
Susan Levenstein
Elaine Leventhal
Howard Leventhal
Saul Levine
Anthony Levitt
Norman B. Levy
Richard Liberthson
Michael Liebowitz
Harold Lief
Kathleen C. Light
Keh-Ming Lin
Wolfgang Linden
Paul Links
Don R. Lipsitt
Mark Litt
Karley Little
Maria Llabre
James Lock
Peter T. Loosen
Juan Lopez
Joseph LoPiccolo
Rodney Lorenz
William Lovallo
Tanya Luhrmann
Mark Lumley
Ulf Lundberg
Patrick Lustman
Susan K. Lutgendorf
Patrick D. Lyden
Bruce Lydiard
Donald Lysle
Francois M. Mai
William Maixner
William B. Malarkey
Ulrik Fredrik Malt
Allan Mandel
Samuel J. Mann
George Mansoor
Steven B. Manuck
Joseph Marbach
Jurgen Margraf
Kyriakos S. Markides
Jerome Markovitz
Diana L. Marquardt
Paul Marshall
John Martin
Mary Jane Massie
Christopher Mathews
Karen Matthews
Tracy Mayne
Richard Mayou
Barbara McCann
Dennis McCarthy
Richard McCarty
Kevin D. McCaul
Robert McCrae
James McCubbin
Stephen T. McGarvey
Sara McGraw
F. Patrick McKegney
Dennis J. McKenna
Carlos Mendes de Leon
Mark Mennemeier
Harold Merskey
Catherine Messina
James L. Meyerhoff
David Michelson
Andrew Miller
Suzanne Miller
Todd Miller
Paul Mills
James E. Mitchell III
Christian Mittermaier
Murray A. Mittleman
Paul C. Mohl
Carol M. Moinpour
Harvey Moldofsky
Margaret Moline
Timothy Monk
Thomas R. Moore
James Morrison
Lisa Morrow
Joseph Mortola
David I. Mostofsky
David Mrazek
Elaine A. Muchmore
Matthew Muldoon
Havard Heith Mundal
Donna Murasko
Claire Murphy
Philip R. Muskin
Mark Myers
Madhavan P. Nair
Bruce D. Naliboff
Benjamin Natelson
Charles Nemeroff
Benjamin H. Newberry
Raymond Niaura
Perry Nicassio
Peter Nilsson
Alan Nissenson
Carol North
Dennis H. Novack
Russell Noyes
Frank M. Ochberg
Herbert N. Ochitill
Ira S. Ockene
Mary Alice O’Dowd
Donald Oken
Akiko Okifuji
Kevin Olden
Miranda Olff
Richard E. Olmstead
Karen Olness
Kristina Orth-Gomer
David G. Ostrow
Thomas E. Oxman
Massimo Pagani
Lawrence Palinkas
Carmine M. Pariante
Barbara Parry
Steven D. Passik
Stephen Patterson
Thomas Patterson
George C. Patton
James W. Pennebaker
James C. Perry
William Perry
Elaine Peskind
David P. Phillips
Thomas Pickering
Issy Pilowsky
Harold Pincus
F. Xavier Pi-Sunyer
Roger K. Pitman
Russell E. Poland
Harrison G. Pope, Jr.
Charles W. Popper
Stephen Porges
Lynda Powell
Seth Powsner
Sara Quandt
Frederic Quitkin
Bruce Rabin
James M. Raczynski
Ramesh Raghavan
Richard Rahe
Katri Raikkonen
Uma Rao
Mark Rapaport
Isabelle Rapin
David M. Rapoport
Judith L. Rapoport
Scott L. Rauch
Arun V. Ravindran
Peter Reaven
Susan S. Redline
Quentin Regestein
Alan Reifman
Victor Reus
Michelle Riba
Michael W. Rich
Joel E. Richter
Arthur Rifkin
Thomas Ritz
Michael Robbins
Robert Roberts
Gary Rodin
Peter Rosen
Raymond Rosen
Jerrold F. Rosenbaum
Walton T. Roth
Peter Roy-Byrne
Robert T. Rubin
David R. Rubinow
Peter Rudd
Heinz Rueddel
Teresa A. Rummans
Patrice G. Saab
Carl Salzman
Vicenzo Sanguineti
Joseph Sapira
Maria C. Savoia
James Scanlan
Jennifer Wilson Schaeffer
Manfred Schedlowski
Michael F. Scheier
Barbara Schindler
Steven J. Schleifer
Karen B. Schmaling
Peter Schmidt
Chester W. Schmidt Jr.
Lawrence J. Schneiderman
Neil Schneiderman
Daniel S.P. Schubert
Herbert C. Schulberg
Richard Schulz
Carolyn E. Schwartz
Joseph E. Schwartz
Steven M. Schwartz
Stephen L. Seagren
Mary V. Seeman
Teresa Seeman
Stuart Seidman
Sally K. Severino
David Shaffer
Arieh Shalev
Alvin P. Shapiro
David Shapiro
Peter Shapiro
Michael Sharpe
William S. Shaw
David Sheffield
David Sheps
John Sheridan
Andrew Sherwood
Nancy E. Sherwood
Carol Shively
John L. Shuster
Dennis Shusterman
William J. Sieber
Ilene C. Siegler
Aron W. Siegman
Johannes Siegrist
Gregory Simon
Eleanor M. Simonsick
David Sinyor
Richard P. Sloan
Kevin W. Smith
Timothy W. Smith
Hugh Smythe
George F. Solomon
Amnon Sonnenberg
Steven Southwick
J. David Spence
David Spiegel
James L. Spira
Howard Spiro
Robert Spitzer
Michael Stefanek
Dan Stein
Murray B. Stein
Phyllis K. Stein
Hans Steiner
Andrew Steptoe
Robert M. Stern
Esther Sternberg
Donna E. Stewart
Victor G. Stiebel
Frederick Stoddard
Arthur A. Stone
Catherine Stoney
Nada Stotland
Jon Streltzer
Kingman P. Strohl
Laura Stroud
Thomas Strouse
Margaret Stuber
Albert J. Stunkard
Edward C. Suarez
Mark D. Sullivan
Suzanne Sutherland
J. Robert Swenson
Michael R. Swenson
Robert M. Swift
Susan Tapert
C. Barr Taylor
Michael E. Thase
Julian F. Thayer
Dale E. Theobald
Tores Theorell
Carl Thoresen
Georg Titscher
Brenda Toner
Timothy Toomey
Frank A. Treiber
Ming T. Tsuang
Gary J. Tucker
Johanna H.M. Tulen
Larry Tune
Bert Uchino
Elliot Udell
Thomas W. Uhde
Susan Urrows
Lorenz J.P. Van Doornen
Craig Van Dyke
Lawrence F. Van Egeren
A.J.J.M. Vingerhoets
Barbara R. Visscher
Peter Vitaliano
Harold J. Wain
Edward Walker
Anne M. Wallace
David A. Waller
B. Timothy Walsh
J.M. Waterhouse
Lana Watkins
Michael Weber
Alan Weder
Gerdi Weidner
Douglas Weigent
Herbert Weiner
Lance Weinhardt
Michael Weisman
Simon Wessely
Sheila West
Peter D. White
William B. White
Wayne G. Whitehouse
Markus Wiegel
Charles Wilkinson
Redford B. Williams
Thomas Ashby Wills
John F. Wilson
Daniel Winstead
Thomas N. Wise
Catherine L. Woodman
Stephen C. Woods
Timothy Wysocki
Joel Yager
Kimberly A. Yonkers
Simon N.
Leonard S. Zegan
H. Zeier
Lonnie Zeltzer
Michael Ziegler
Sidney Zisook
Caron Zlotnick
Stephen J. Zyzanski
ACKNOWLEDGMENTS
We thank Professors Derek Johnston and Thomas Normand of St. Andrews University for the lead on the magnificent Annan photograph, which is reprinted with permission from the Royal Photographic Society of Bath. The Appendix to this editorial thanks those reviewers for Psychosomatic Medicine who have helped us test hypotheses regarding the numerous manuscripts submitted in the last year.
REFERENCES
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