The Other Medicine: Programme Two

FORD
Whilst the RCT offers the possibility of objectivity, few CAM practitioners are actively involved in research. We'll hear from some who are, later on, but what is common to many in the complementary and alternative scene, is the view that the randomised controlled trial simply isn't the appropriate tool for finding out if a therapy works or not.

MONTAGE
Evidence is important but I think there are limitations on how it's compiled, you know, and that's the point because where you're dealing with healing you're not having a repeatable result under the same physical conditions because every patient is different, there is plenty of statistical evidence for healing working. In our own centre, for example, we find that about 80% of the patients who come to us tell us that they're better in some way, that's purely anecdotal evidence, I accept that.

It depends who's carrying out these trials but yes I do believe that things should be validated scientifically. If somebody is using an alternative approach to illness of any form or description that you should be able to control by clinical testing what is happening to your patient.

I think that homeopathy is about individualisation, it's quite a difficult subject to research because we treat each person as they come in and there aren't any standard remedies really for a condition - the nearest you're going to get is arnica for bumps and bruises and falls and shock and trauma, which you can pretty much say is a specific remedy for those conditions.

MORRELL
This is one of the huge stumbling blocks - how can you have hundreds or thousands of people at a trial when you're individualising the treatment for every individual patient?

FORD
Peter Morrell is a medical historian at Staffordshire University and a firm believer in the power of homeopathy. He doesn't need evidence of a trial to tell him what he's already experienced and feels that the motivation for investigating CAM is not always pure.

MORRELL
If a person has eczema and they've had eczema for 10 or 15 years and you give them some sulphur and they have this two or three times a day, this is a personal story by the way, and then they come to you and say - I'm amazed, my eczema patches are getting smaller and smaller, the itching is disappearing, I feel fantastic, I feel like a seven year old child again. And they continue to improve, I mean it's a whole bogus question - this thing about evidence, you know homeopathy works, it works on individuals for individual totalities, or patient totality, it doesn't work for disease labels and it doesn't work in mass trials but it works for individuals. Another aspect of course is the evidence of mass trials financed by drug companies who have a vested interest in seeing homeopathy destroyed. So I would seriously question the word evidence because I think it's a loaded term.

FORD
The world of research into complementary therapy has its cynics and its zealots - those who feel that science is set on destroying CAM and those who believe only through science, can CAM gain credibility and respect.

ERNST
I believe I'm the true champion of complementary medicine because wherever it goes it will go only somewhere if it's based on science.

FORD
Edzard Ernst, as you might have guessed, is firmly in the science camp. The UK's first and until very recently, its only Professor of Complementary Medicine, is based at Exeter University's Peninsular Medical School. He arrived here 11 years ago from Vienna, where he was in charge of a large well-funded and prestigious medical research department. But his arrival here attracted criticism and controversy before he'd even unpacked his bags. His department has produced about 800 research papers - many of which are reviews of other studies, on therapies as diverse as spiritual healing, acupuncture and mistletoe for cancer. So what has he found?

ERNST
The evidence so far is that complementary medicine doesn't defy proper science. A lot of people 10 years ago and some people even today would say that science shouldn't touch complementary medicine because it will destroy it, complementary medicine cannot be squeezed into the straight jacket of a clinical trial and so forth. I think that's just a cliché - a tired cliché on top of it. Perhaps some people mean that our outcome measures - blood pressure, cholesterol levels, pain or whatever - do not capture the whole patient, that I agree with but there are other and perhaps better outcome measures that we can use in parallel - quality of life for instance or simple patient preference.

FORD
Now critics say that most of your research comes up with negative results - are they right?

ERNST
It depends what you mean by most. It's probably more than 50%, so technically speaking most is the correct word. It's by no means all our research negative, I think we have contributed a lot of positive results to the field. But more importantly my only and most biting argument against that is what do these critics want me to do? Should I falsify my data? I'm awfully sorry that this work doesn't produce always positive results but that's science, everything else is not science.

VICKERS
You've got to be sophisticated, you can't treat acupuncture just as if it's some kind of drug. By the same token you can't treat surgery or psychotherapy or speech therapy or nursing therapy or a whole wide variety of different conventional medical techniques cannot be treated or researched as if they're some form of pharmaceutical.

FORD
Andrew Vickers was a bright young researcher when he left the UK to pursue his research interests in the United States, where he now explores the efficacy of CAMs in treating conditions as diverse as cancer and headache at the Sloane-Kettering Memorial Hospital in New York. Rigorous scientific enquiry he says, can go hand in hand with complementary therapy provided you go about it in the right way and ask the right questions.

VICKERS
Imagine you're a patient with migraine headache and you've had it for 20 years and you take your drugs but you still have a lot of pain during the average month, what you want to know is if I was referred to an acupuncturist would this help me? What we did in our trial was we randomly assigned patients with a history of migraine to either go on with their usual care - in other words to avoid seeing an acupuncturist, I mean after all it might just be a waste of time and it would be inconvenient, or to actually go and have a referral to an acupuncturist to see if they could help the migraine. And then we measured their headache after about a year. What we found was that the headache scores - the amount of pain that patients were in - was reduced by about one third in the patients who saw the acupuncturist and by about one sixth in the patients who just carried on with their usual GP care. Now it doesn't sound like very much but these are people with very severe headache problems and so on average the people who saw the acupuncturist had about 22 or 23 fewer days of headache during the year of the study if they'd received the acupuncture.

FORD
So as a scientist is that proof enough for you that acupuncture can be said to work?

VICKERS
As a scientist what I would say is that one study never stands on its own, you always have to look at the evidence - the big picture - all the evidence that we have.

FORD
Let me put the point of view of some CAMs practitioners we've spoken to who say that the individual nature of the treatment defies scientific scrutiny.

VICKERS
That's absolutely fine, with many conventional therapies you individualise care, for example social work or psychotherapy - you don't have every patient come in and say you must ask them these sorts of questions and act in these sorts of empathetic ways. Indeed the trial I was involved in, the practitioners in that trial could treat the patients in any way that they felt was appropriate, so care was indeed individualised. And I think the proof really is in the pudding here - if you look in the medical literature you can find extremely standard clinical trials on complementary medicine, you'd read those, you'd think they were entirely fair, they were a good idea and they do give you information on which you can base a clinical decision - whether something works or whether it doesn't. And some of those have found that complementary therapies do indeed seem to help.

PATIENT
This is a wonderful story because I have suffered from hay fever and its symptoms for over 25 years. And I had a particularly difficult day one day, after sawing padauk, which is a hardwood. And I found myself sneezing and coughing and the remedy was what you might describe as potentised padauk - the actual wood dust that was causing me the problem. And I took it that evening and the next day my mates were completely surprised because really I wasn't coughing anymore, really wasn't spluttering, my eyes were clear, everything seemed to have disappeared and that was all I was interested in - something that would cure me and I was very pleased that it did.

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