Professor Edzard Ernst outlines the common barriers faced by researchers studying complementary and alternative medicines.
Repeatedly during discussion on this blog we have reached a consensus that ‘more CAM research is needed’. Far from being original, this is usually what even diametrically opposed discussants can agree upon. CAM is an area where we have many more open questions than answers. So why don’t we get on with it?
During the last 17 years my team and I certainly did get on with it. But even this effort (we published in excess of 1000 articles in the peer-reviewed literature: www.pcmd.ac.uk/compmed/research.html) is only a drop in the large ocean of unanswered questions.
We need more teams applying science to CAM. This is easier said than done – the obstacles are formidable. Here I don’t want to list all (one could write a book about this) instead I merely want to describe four different mindsets that, in my experience, frequently prevent CAM research.
1/ We don’t need research
This seems to be the attitude of many CAM practitioners. To understand it, we need to remember that the CAM movement is profoundly anti-establishment. Science represents to a large degree the establishment. Therefore, much of CAM is often deeply anti-scientific.
This is not always plainly visible because the ‘we don’t need research’ argument comes in different guises. It can be voiced as the notion that thousands of years of experience are a more powerful proof than any scientific validation. Or it can be stated as the notion that CAM is too subtle, holistic, complex etc to fit into the straightjacket of scientific research.
Whatever the guise, the fact is that this section of the CAM community is against research in principle: they don’t understand its aims nor its methods and, what is worse, they don’t want to.
2/ We need different methods
Some ‘experts’ in CAM take an attitude which superficially seems all in favour of research. Yet they are against it in as far as they reject the generally accepted methodologies, e.g. the randomised control trial. These people have studied research methods to some degree – so much so that they are able to point out its limitations. Invariably they are able to find a fly in the soup and thus reject the soup altogether.
Instead of improving the methods they (perhaps rightly) criticise, they argue to adopt different methodologies altogether which regularly are not less but more biased. When an RCT, for instance, fails to confirm their aspirations, they suggest that observational data would show the true value of their therapy.
3/ Research is a waste of time
Opponents of CAM tend to believe that all CAM is so utterly implausible that investigating it must be a futile waste of time, talent and money. They insist that all of CAM is devoid of a solid theory which, in turn, would be a precondition for any proper scientific investigation. They are not impressed by the arguments that such generalisations are unhelpful, that some forms of CAM are biologically plausible and that, in some cases, one needs research to develop sound theories.
4/ We have no money
This is the ‘killer argument’ for all CAM research. It is clearly untrue – even in difficult times, we have plenty of money for medical research. Thus the true argument is that ‘we have no money for CAM research’ – our priorities are elsewhere. When one sends a grant application for CAM research to the Medical Research Council or a similarly prestigious body, this often is the response. The experts on the decision panels may concede that the application is well conceived, neatly written and cleverly designed, but who wants to know about acupuncture, Alexander technique, autogenic training etc? These experts are experts in far more important areas, and they want the research funds not to go astray.
As we see, there are many important obstacles to CAM research – and that, in my experience, is the main reason why progress is so unbearably slow.
Professor Edzard Ernst