What other methods does science offer us to look at CAM treatments and are they a suitable way of looking at CAM and its effects? One of the most excellent tools of medical research is the randomised double-blind controlled trial (RCT).

In the field of medical research RCTs are intended as a fair comparison of different treatments. They can be used to test a new drug and to see whether it's any more effective than a dummy pill by giving some people a dummy pill and others the real pill (without anyone apart from the researchers knowing who gets what) and seeing if there's any difference between groups of people in terms of who gets better. The RCT is known as the "gold standard" of medical research and has allowed many thousands of new drugs to be tested.

So can we apply this gold standard test to CAM? This would at first seem a very obvious and useful thing to do – compare people who get real acupuncture to people who get "pretend" or dummy acupuncture, or compare people who get real homeopathic medicines to people who get identical, but completely inactive, placebo pills. Some people do use this method to study the effects of CAM, but people who are knowledgeable about the CAM practices themselves, both practitioners and researchers are concerned about the placebo RCT and challenge whether it's really testing the treatment.

This is because of two major features of CAM therapies – firstly that each person treated has a different treatment – treatment isn't determined by the name of the person's disease, but rather by how that person is showing disturbances in the vital force, or the qi. The second major problem for doing the placebo RCT in CAM is that most CAM consultations are lengthy and people talk at length and in depth about their problems. Recently, Cartwright and Torr reported in the Journal of Health Psychology what other researchers have also been finding about people who go to CAM practitioners - that the patient-practitioner relationship is important and central to the healing process.

This is particularly true in cases of chronic, or long-standing, disease. Of course, this is also true of conventional medicine, but researchers are finding that there's something different in the CAM consultation. Many people with long-standing problems turn to CAM because mainstream medicine doesn't have any answers to their problem, or because they're not happy at the thought of taking prescribed medicine for a long time, possibly the rest of their lives. Once people have begun to consult CAM practitioners, they may find that they change their views of health and illness and find that the wider benefits they experience from the process of having treatment is more important than whether the treatment worked for their original problem.

When we turn back to the question of whether we can research CAM using the scientific tool of the placebo RCT, we're faced with the problem that it's very difficult to tease out the effect of the consultation from the medicine: the consultation affects the extent to which the specific treatment works and when the patient goes back for a follow-up treatment, the nature and content of the consultation will be affected by how the specific treatment acted on the patient.

So the two parts of CAM – the characteristic effect of the acupuncture/homeopathic medicine/herbal medicine and the incidental effects of the patient-practitioner relationship (that is so valued by patients) are inextricably linked in most cases of long-standing disease. Trying to use the placebo RCT to scientifically study them means that, because we can't factor out the 'placebo effect', we end up with results from research that are difficult to interpret or are misleading in their conclusions.

Initially, this seems to leave us in an unsatisfactory position in terms of applying scientific methods of study to CAM – it's not possible with conventional science to test whether the underlying principles exist and we can't use the best tool of modern medical science to test whether, in a real-life treatment situation, the treatments are better than a 'placebo effect'. It is some consolation that we can test whether the treatments have an effect on the body's cells and systems. Is there any other science that will help us test CAM and come up with some satisfactory answers?

Yes! One way to do this is, rather than use a placebo RCT – which is essentially asking the question "Is the treatment better than placebo?" – we can compare two treatments – compare acupuncture to routine GP care for lower back pain and see whether one's as good as the other. This asks a different question: "Which of the two treatments is better?" and this may well be a question that's more relevant to patients, acupuncturists and doctors than whether the treatment is different from a placebo effect. Another way that science can ask questions about CAM is to use the methods from medical anthropology, psychology and sociology to understand what's going on not only in the outcomes of treatment, but also the processes that happen in the consultations and between them.

We can then understand many things about these processes including what's important to people about the experience of having CAM, how this is different from conventional medicine and what impact this has on whether they get better. Researchers are already working in these fields and results of such science will help us devise more sophisticated clinical trials of CAM.

For example, researchers in Wisconsin (Barrett and colleagues) interviewed patients who'd had CAM treatments and asked them about the experience. Patients told them they liked the more holistic approach of CAM and felt more powerful in terms of decisions about treatment and controlling their own lives than with conventional medicine. Other research, by Thorne and colleagues, has found that for some, CAM is seen as part of people's self-care and taking personal responsibility for their own health, especially for those with long-term problems.

Scientists using MRI scans of people undergoing acupuncture treatment have shown that the principles of Traditional Chinese Medicine (TCM) acupuncture are backed up by modern science (Parrish and colleagues): according to TCM acupuncture, stimulation of specific points is part of the treatment for problems in areas of the body that are apparently unconnected.

For example, stimulating a TCM point "BL60" can be part of the treatment for visual problems. BL60 is on the outside of the ankle. Using functional magnetic resonance imaging (fMRI), scientists have shown that putting acupuncture needles in BL60 does indeed stimulate that part of the brain that is to do with visual functioning. Putting acupuncture needles in other points (eg Spleen 6, which has nothing to do with treating visual problems) doesn't alter the visual functioning part of the brain.

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