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Letters to the Editor
Complementary and alternative medicines (CAM)
A pragmatic answer to consumer protection can be found
From Dr R. J. Woodward, MRPharmS
Recent years have seen an upsurge in demand for complementary and alternative medicines. Concomitantly, CAM research in academic institutions has increased. Yet results have been disappointing, inconclusive and have done CAM no favours.
The high-profile academic department in Exeter and its publications run by Edzard Ernst have demonstrated that resources for research are meagre because the CAM industry and profession are no match for big pharmaceutical companies and modern medicine. The truth is they never will be and I am puzzled why anyone wastes resources in the hopeless cause of trying to let CAM endeavour to emulate its giant competitor. Strict judgement of CAM by the criteria designed for modern drugs and medical interventions can never succeed.
Professor Ernst and his cohorts are clear in their demands that CAM treatments must be evidence-based with clinical trials that are independently replicated and validated. Practitioners of CAM who do not rely on such evidence are described as dishonest. That is disgraceful but should signal to the CAM movement that he is no friend. Much modern medicine does not meet these standards but does he describe doctors as dishonest? Misguided is a better word when all one is expressing is an opinion. Professor Ernst describes himself as a wishful thinking idealist — I would call him a blinkered academic with no grasp of reality.
Not long ago the organisation Healthwatch used the word “fraud” in one of its publications in connection with CAM and, rightly, heavy libel damages had to be paid. My experience of CAM practitioners is that most are decent, dedicated people who are passionate about what they are doing. Above all, their patients are usually satisfied.
Many advocates of CAM believe they can protect themselves by taking the regulatory route. Some demand a regulatory body for every area of CAM — resources for both regulators and researchers coming from where?
The philosophy behind CAM health care is different from modern medicine. The clinical treatment methods are too diverse even within each CAM group to make meaningful research results attainable with infinite financial and human resources. Since no patents are available for CAM treatments, the accumulation of significant research funds is impossible. The reference to the CHARM trial (PJ, 10 December, p714) showing adherence to medication, even placebo, improves outcomes is surely most relevant in the CAM context.
I believe a pragmatic answer to consumer protection could be found without hyper-regulation if all sides admitted that the resource problem was insoluble. If it is not then waste will continue to no avail except the benefit of Professor Ernst, bureaucrats and the army of CAM technical and legal advisers and consultants.
EDZARD ERNST replies:
Robert Woodward argues in favour of double standards: “judgement of CAM by the criteria designed for modern drugs and medical interventions can never succeed” because “the philosophy behind CAM … is different”. This seems a big step, albeit in the wrong direction. If we do not assess health care on the basis of reliable evidence, by what should we evaluate it? The answer probably is by belief.
Thus CAM becomes a belief system and not health care. In this case, we should place it in churches rather than hospitals. I am convinced that double standards, even though they may preserve the interests of certain CAM groups, are to the detriment of patients and the public.
Luckily this view is fast becoming accepted wisdom. The House of Lords Science and Technology Sixth Report (2000) states: “CAM practitioners and researchers should attempt to build up an evidence base with the same rigour as is required of conventional medicine.”