Alternative and complementary therapy research needs open minds

Some publications about trials in homeopathy show an uncanny resemblance to the penicillin story. Stacey (1991) says it is a failure of Western scientific models to understand anything of alternative medicine, not just individual myopia, that gives rise to the refusal to accept that alternative medicine works.

For some time now alternative approaches to medicine have become increasingly popular, and numerous traditional methods are reappearing: 'All these ways of healing have burgeoned forth, like a stream re-appearing from underground in limestone country, a stream which had been eclipsed but was not eliminated' (Stacey, 1991). Brewin (1993), in a critical article, puts the popularity down to a series of factors. First, patients desire more time and attention from doctors, including more sympathetic understanding and, in some cases, hope. Then, they desire to be given causes and explanations. In the case of serious illness, the desire to try anything and everything is very strong, often accompanied with a desire to feel in control of the situation, instead of accepting circumstances and facing the unknown. Finally, alternative, or fringe as Brewin calls it, medicine appeals to that side ofour nature which prefers magic to logic, which he thinks is evidence of a basic instinct we all have that is trying to find other outlets since the decline of religious affiliation. He observes that fringe medicine is not logical, since it conducts very little testing of remedies, very little self-criticism or learning from mistakes, and is usually based on beliefs without adequate supporting evidence. He identifies fringe medicine's use of'bad magic' in its assumption that human life was healthier when it was more natural and less civilized, even though, as he points out, today we generally enjoy a safer life, a better quality of life, and a longer life than our ancestors (at any rate in the West).

Fringe medicine suffers from the belief that a healthy mind protects us from all ills, and it also takes the view that mainstream medicine has failed if it has not cured. In fairness, Brewin observes that mainstream medicine is as prone to believing in magic as fringe medicine is, so that claims by the World Health Organization to bring about 'health for all by the year 2000' seem as far fetched as the claim in the Oxford Handbook of Complementary Medicine that 'homeopathy can be successful in all diseases'. He runs through a series of propositions that mainstream medicine has failed to take account of in the past, leading to some really useless or downright harmful treatments being perpetuated in the firm belief that they work. He observes, for example, that if treatment A has better results than treatment B, then it may be that treatment A is useless and treatment B is harmful; also, if an assortment of widely different treatments all give broadly the same result, they may all be useless. The only way that mainstream medicine is to rid itself of its tendency to believe in magic is by carefully controlled comparison trials, starting with pilot trials. Brewin wonders why nobody thought of comparative trials before now. He throws down the gauntlet to fringe medicine to subject itself to just such comparisons; he asks, for example, why the Bristol Cancer Help Centre did not subject its very exacting special diet to a comparison trial, whereby all the participants received the same treatment from the Centre, but the treatment group received the special diet and the control group received an ordinary well-balanced diet. Would it be the case, though, that had such a trial taken place and the conclusion been that the diet did work, that that conclusion would have been discounted by those who start with an assumption such as that food is not medicine? This is the kind of obstacle that those who champion evidence-based medicine are up against.

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