0950211 - JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume...

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What's the point of rigorous research on complementary/alternative medicine? EE rns t PhD FRCP±Ed) J R Soc Med 2002; 95 :211²213 I have probably heard them allÐthe often weird and wonderful arguments against applying the principles of science to complementary/alternative medicine ±CAM) 1 . Speci®cally, the arguments against testing the ef®cacy of therapeutic approaches in CAM have worried me frequently and profoundly. Here I address eight arguments, all of which ®nd expression in many different ways. I hope that the views expressed, even though doubtless biased, will stimulate constructive debate. Argument No.1 `If it helps my patients, I don't need science to tell me that it works'. Understandably, this is a favourite argument of clinicians versus researchers. On the surface it looks patient-centred and politically correct. It may also be entirely correct when applied to the patients we try to help today. Clinicians must see their primary responsibility towards their present patients while researchers have a responsibility towards patients of the future. Thus researchers aim at re®ning or critically evaluating existing treatments, de®ning optimal treatments for given conditions and developing new therapies. The most ef®cient way of doing this is to conduct research. If medicine as a whole had adhered to the above argument during the past three hundred years, we would still indulge in blood-letting and purging to the detriment of our patients. The principle of merely doing the best one can, while not advancing therapeutics for future healthcare, stands in the way of progress. I believe argument No. 1 to be a non-argument, perpetuated by failure to recognize the different roles and perspectives of clinicians and researchers. Argument No.2 `Years of experience and tradition are more important than modern clinical trials'. This pertains to many ±but not all) branches of CAM. Obviously, traditional use and experience can teach us important lessons. However, experience and science are items with different ±not superior/inferior) values. Clinical medicine is founded on experience and to ignore it would be entirely foolish; few scientists would make this mistake. Unfortunately, experience can also be seriously misleading ±the history of medicine is littered with examples). Patients can get better despite rather than because of our therapeutic interventions, and dogmatic adherence to experience has killed thousands. Experience enables us to formulate hypotheses, but to test them requires rigorous science. As powerful as personal or collective experience often seems, it may lead us to draw wrong conclusionsÐthe plural of anecdote is anecdotes, not data. Argument No. 2 prevents us
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0950211 - JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume...

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