Complementary and Alternative Medicine: the Consumer Perspective

Could I start this review by advising all members of the Prince of Wales’ Foundation for Integrated Health to turn the page and read another article? This could turn out to be unpleasant reading for them. The report (the authors mostly call it a ‘study’) is basically a summary of some (but by no means all) UK surveys related to CAM. Some have been published and we can thus evaluate their quality; others are unpublished and the reader learns nothing at all about their rigour. The authors ambitiously list eight research questions. Sadly, I am not convinced that they have conclusively answered any one of them.

Surveys are, at best, a very weak research tool. This applies to CAM surveys in particular. They are not normally validated, usually not representative and (as the authors acknowledge) the answers invariably depend on how the question is asked. This does not mean that all surveys are useless. (I fear, however, many are.) It means that one needs to look at each survey, assess its quality and subsequently draw careful conclusions.

The area of CAM is, as we all know, very fluid. Today’s media-hyped therapy is tomorrow’s old hat. In relation to CAM surveys, this means that, once the data are published, they are likely to be out of date.

These, and other reasons should make us seriously wonder about the value of surveys or of combining mostly unpublished surveys. In many cases, the value is dangerously close to zero. Combining weak data has, to the best of my knowledge, never generated strong data.

Given all this harsh criticism it is perhaps surprising that the authors came up with the main findings that the few good surveys (not necessarily from the UK) had already demonstrated. As devil’s advocate, I am bound to ask, why not simply study the methodologically sound surveys in the first place?

There is a final but important reason for my increasing discomfort with such publications: the logic that is often applied. For example, surveys usually, and unsurprisingly, show that the rich use more CAM than the poor. Up comes the finger pointing at inequality, and the eventual conclusion is that CAM needs to become part of the NHS so that this inequality is abolished. To me, that is deeply flawed logic. If the rich drink more Chateaux Latour than the poor (I have not yet done this survey but I am confident that this would be its result), does this mean we have to distribute this (£100 per bottle) wine on a population basis? What is missing is surely the demonstration of health benefits, such as efficacy (not satisfaction – Latour is also more satisfying than plonk!). It is obvious to me that poor people can only be disadvantaged through non-use of CAM if CAM can be shown to be efficacious.

Therefore, my conclusion is that CAM patients and everyone else would be better off if researchers could be convinced to conduct clinical research instead of doing one survey after the other, not to mention a summary of surveys of unknown quality.