School of Historical and Philosophical Studies - Theses

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    The placebo mystique : biomedical implications
    Clifford, Vanessa ( 2005)
    The 'placebo effect' is a medical enigma. It lies at the heart of modem medical research but remains an amorphous concept; used either as a weapon to dismiss the subjective successes of alternative therapies or to bolster medical claims to scientific 'truth'. In a paradoxical fashion, mainstream medicine overtly rejects the significance of the placebo effect, whilst simultaneously using its existence as justification for the use of placebos in clinical trials. This study aims to explore the complex relationship between biomedicine and the 'placebo effect'. Specifically, I aim to understand how dispute about the meaning of the 'placebo effect' developed and how it currently impacts upon clinical and research work. The study is structured in two parts; the first part contains a discussion of the historical background to confusion about placebos; the second part contains a report on a survey conducted to assess current understanding(s) of the placebo effect amongst Australian medical practitioners. The survey demonstrates that confusion persists amongst clinicians and researchers as to the nature of placebos and the placebo effect. There is disagreement about when placebos should be used, when placebo effects are involved and what conclusions should be drawn from the studies that are performed. The survey made it clear that many doctors are uncertain about the indication for placebo use in clinical trials; many doctors were under the mistaken impression that placebos are essential to control for the placebo effect. I argue that this misconception may well have its origins in Henry Beecher's incorrect assertion that the placebo effect makes placebos an essential component of randomised controlled trials. I discuss the implications of this, mostly particularly in influencing researchers to use placebo controls in situations where they are not methodologically essential.
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    Healing without hospitals : homeopathy and medical pluralism in nineteenth century New South Wales (1840-1880)
    Bak, Tao ( 2000)
    As in the neighbouring colony of Victoria, homeopathy in colonial New South Wales attracted the support and attention of a wide cross section of society. In this thesis I concentrate on the varying ways in which homeopathy made its presence felt within New South Wales - with particular focus on the period 1840-1880. Linking itself with colonial ideals of progressive social reform, homeopathy in New South Wales, much like its counterpart in the United States, managed to establish itself in opposition to the `conservative' element within nineteenth century society. In a colony which has been described as `excessive' in its preoccupation with liberalism, the New System of homeopathy in New South Wales fitted neatly with both the anti-orthodox sentiment prevalent within New South Wales society, as well as the vision of a better, more egalitarian world which many colonists brought with them to the new country. During the 1850s the homeopaths and their supporters concentrated their efforts on the Sydney Homeopathic Dispensary both as a symbol of progress of the New System within the colony and as a means by which to extend the social benefits of this cheaper, milder and (for many) more effective medicine to the broader community. During the 1860s, with the Dispensary struggling to remain viable, the homeopaths attempted to secure legal support for the New System, petitioning the government to provide homeopathic treatments in government funded hospitals. During the 1870s, the homeopaths made their presence felt primarily through their role in blocking the repeated attempts of the regular medical profession to secure regulatory (restrictive) medical legislation within the colony. Focussing in particular on the public and political debates surrounding Sir Alfred Stephen's 1875 Medical Bill, I focus in the last section of my thesis on the nature of the opposition to restrictive legislation in the colony. I argue that this opposition needs to be understood not only in terms of the lack of unity within the regular medical profession itself, as has often been emphasised, but on the existence of a coherent and self-conscious defence of medical pluralism within the colony - a campaign within which the homeopathic movement in New South Wales played a central role. Working primarily outside of the bounds of the symbolic markers of professionalism (institutions, journals, societies,) often associated with a mature and influential medical tradition, homeopathy in New South Wales was less visible than in many comparable places during the nineteenth century, but no less influential.