Research is too important to be left to the scientists

Within complementary medicine there is a lack of capacity in research. There are thought to be up to 50,000 complementary practitioners in the UK, yet this is not reflected in the number of researchers, research projects undertaken or published reports.

The Prince of Wales 2002

I have been involved in medical research for more than 30 years – my entire professional life. I am convinced that clinical research can create better health care for tomorrow’s patients. This hope is the main driving force behind the work my team and I do.

For the last 15 years, my research focus has been CAM. When I started, this was viewed by many scientists as a bizarre waste of time, talent and money. This attitude has changed gradually but surely. Today, most people seem to agree that CAM deserves to be researched fairly, rigorously and systematically. Consequently the number of journals publishing this type of research has risen exponentially, and research funds are slowly increasing as well. I estimate that, each year, about 4000 original research articles are being published in CAM.

Despite all these positive developments, we are confronted with a most puzzling phenomenon: practitioners of CAM have shown a stubborn disinterest in CAM research. For instance, only a few CAM practitioners are aware of our journal FACT – and even fewer subscribe to it. Similarly it is fair to say that most CAM practitioners read little or no primary research papers – not even those on their own subject.

How can we explain this extraordinary discrepancy between buoyant research activity and disinterest of CAM practitioners in research? Could it be due to the fact that practitioners are slightly afraid of research? Recent qualitative research from the UK seems to suggest this.¹

There are, of course, many types of research addressing many types of research questions. For instance, we might ask:

• What is the best treatment for condition x?
• Who uses treatment x?
• How can I improve my practice?
• Why do people use treatment x?
• For what conditions is treatment x effective?
• How safe is treatment x?
• Is treatment x more effective than a conventional therapy for the same condition?
• Does treatment x save money?
• Which treatments do patients prefer?
• Why do they prefer it?

I fail to understand why practitioners should be afraid of asking any of these questions. In fact, I believe they have a duty to ask them! But, of course, some might fear that the answers will not show what they had hoped, particularly if the question relates to therapeutic effectiveness and safety.² Practitioners may feel that the research is done in such a way that the truth is not discovered. They might even fear that researchers are determined to drive them out of business.

Even if this were true (and I don’t think it is), I would see this as a powerful argument for making sure that research is conducted fairly and objectively so that it does establish the truth. This means that CAM practitioners have to understand the essentials about research and get involved in it. Simply not caring about research can only make matters worse. If practitioners want to make sure research is conducted in the way they like, they have to grasp the nettle.

Some might claim that CAM cannot be researched at all or that a different type of science should be applied.³ This clearly is a myth. Rather than going into the tedious details of the arguments and counter-arguments around this issue, I will just state two simple points. First, the fact that hundreds of research projects are being conducted every year and thousands already exist² shows that CAM can be submitted to research. Second, there is no alternative science or alternative research methodology. There are only research tools that are well suited to answer specific questions and others that are perhaps better suited for other types of questions.

I also suspect that practitioners of CAM are less than enthusiastic about research because they have been told wrong or misleading things about it. Again, by far the best solution to overcome this problem would be to get a good understanding of what research is about.⁴

Others may feel that research is far too difficult and complex for them. In fact, this is one of the misunderstandings I mentioned above. Research is really not all that complicated – its basic principles are relatively straightforward. Essentially research applies common sense, and surely that is given to most of us.

In conclusion, the future of CAM will be determined by the research we do today. I urge CAM practitioners to get involved in scientific investigation of their own subject. Research, I might even say, is too important to be left to the scientists.

References

1. Jackson S, Scambler G. Perceptions of evidence-based medicine: traditional acupuncturists in the UK and resistance to biomedical modes of evaluation. Soc Health Illness 2007; 29: 412–29.
2. Ernst E, Pittler M, Wider B, Boddy K. The Oxford Handbook of Complementary Medicine. Oxford: Oxford University Press, 2008.
3. Milgrom LR. Are randomised controlled trials (RCTs) redundant for testing the efficacy of homeopathy? A critique of RCT methodology based on entanglement theory. J Altern Complement Med 2005; 11: 831–8.
4. Ernst E. Understanding Research in Complementary and Alternative Medicine. London: EMS Publishing, 2007.