Is evidence-based medicine suspect?

Dear Editor

Researchers into CAM must by now be aware that opinion surveys and patient audits are suggesting a far higher efficacy for CAM than formal RCTs. Those of us practising CAM look at the RCT outcomes in FACT and muse, ‘Why do researchers choose such useless therapists and clinics?’ Forty-four per cent general efficacy for ‘asthma’? Our experience in Sussex is ninety-something per cent with very occasional relapses, and no CAM therapist I’ve met estimates their own success figure with ‘asthma’, however reckoned, as worse than 75%. Yet when we read opinion survey and patient audit conclusions, these agree with our own perceptions. Something very strange is going on.

In my own line of business I rely entirely on structured intuition to arrive at remedial actions, which can take the form of kinesiology, dowsing or ‘direct cognition’ where the situation is modelled instantaneously as a global understanding in the mind. Verification of these practices in general is readily obtainable by conventional means in such matters as distantly viewed severe injuries and dysfunctional company cultures. If these faculties are directed to the business of CAM research, the strange thing that is going on is that the unconscious psychological premise of the exercise being examined is not distorted by surveys and audits, but is by RCTs. The premise in the first case is ‘watch this magic work as it always does’ and in the second is ‘this exercise is doubted’. These premises do not have to (although they may) be conscious or emotional, they rely on the unconscious assumptions of the majority controlling the exercise. This ‘world-view of the gathering’ – which of course is often a mixed one – controls what happens.

The same thing does not happen in drug trials because the CAM premise is still a minority one while pretty well everyone accepts that drugs have an effect even if it isn’t explained.

Of course, all this suggests that an unconscious mind does exist, which is still not a given. While in hypnotherapy and psychiatry it is studied as an essential feature of the discipline, in mainstream science its existence is scarcely recognised and certainly never studied. Until it is, it is not excessive to suggest that in CAM research ‘evidence-based medicine’ based on RCTs will always be suspect and that the only proper evidence of what happens in undisturbed treatment must be what happens in undisturbed treatment.