The cavalier attitude towards evidence adopted by so many of the
proponents of Complementary and Alternative Medicine (CAM), and which
Professor Ernst has documented, is a cancer that must be removed from the
body physic.
The attitude of some proponents of CAM seems to be that, if certain
forms of alternative therapy are not proven to be effective, the problem
must lie, not in the therapies themselves, but in the standard methods of
scientific research. If clinical trials cannot prove that acupuncture is
no better than a placebo, then there must be a problem with the
methodology of clinical trials. Perhaps the effects of acupuncture and
other alternative methods are too ‘subtle’ for the ‘reductionist approach’
of orthodox medical research. Sometimes, this argument takes on almost
mystical overtones, in which the materialist approach of Western medicine
is contrasted unfavourably with the spiritual sensitivity of the various
alternatives.
The implication is that people holding different different views
cannot engage in rational debate. Doctors and alternative therapists must
simply agree to differ, because they work in different paradigms.
Evidence and argument are completely abandoned.
Clearly, this is not a recipe for progress. If we wish to heal the
rift between orthodox and complementary medicine, we must begin by finding
some common ground, and the methodology of the clinical trial is the
perfect candidate. Contrary to what some have claimed, the clinical trial
is not ‘biased’ towards any particular school of thinking in medicine. It
is grounded in very basic ideas about evidence that would, in any other
context, hardly be in dispute. The principles of the clinical trial are
really just common sense writ large. Whether applied to tasting tea or
testing medicine, they involve no special commitment to any particular
‘paradigm’.
I was greatly heartened by Professor Ernst's letter to the BMJ. I
hope he keeps up the good work, and doesn't let the harassment get him
down.
Competing interests:
None declared
Competing interests:
No competing interests
28 October 2008
Dylan Evans
Lecturer
School of Medicine, University College Cork, Ireland
Rapid Response:
Removing the cancer
The cavalier attitude towards evidence adopted by so many of the
proponents of Complementary and Alternative Medicine (CAM), and which
Professor Ernst has documented, is a cancer that must be removed from the
body physic.
The attitude of some proponents of CAM seems to be that, if certain
forms of alternative therapy are not proven to be effective, the problem
must lie, not in the therapies themselves, but in the standard methods of
scientific research. If clinical trials cannot prove that acupuncture is
no better than a placebo, then there must be a problem with the
methodology of clinical trials. Perhaps the effects of acupuncture and
other alternative methods are too ‘subtle’ for the ‘reductionist approach’
of orthodox medical research. Sometimes, this argument takes on almost
mystical overtones, in which the materialist approach of Western medicine
is contrasted unfavourably with the spiritual sensitivity of the various
alternatives.
The implication is that people holding different different views
cannot engage in rational debate. Doctors and alternative therapists must
simply agree to differ, because they work in different paradigms.
Evidence and argument are completely abandoned.
Clearly, this is not a recipe for progress. If we wish to heal the
rift between orthodox and complementary medicine, we must begin by finding
some common ground, and the methodology of the clinical trial is the
perfect candidate. Contrary to what some have claimed, the clinical trial
is not ‘biased’ towards any particular school of thinking in medicine. It
is grounded in very basic ideas about evidence that would, in any other
context, hardly be in dispute. The principles of the clinical trial are
really just common sense writ large. Whether applied to tasting tea or
testing medicine, they involve no special commitment to any particular
‘paradigm’.
I was greatly heartened by Professor Ernst's letter to the BMJ. I
hope he keeps up the good work, and doesn't let the harassment get him
down.
Competing interests:
None declared
Competing interests: No competing interests