Oct 04 2013

CAM Research – Be Careful What You Wish For

Edzard Ernst is the first professor of complementary and alternative medicine (CAM). He began 20 years ago as a CAM enthusiast, and a trained homeopath, and genuinely wanted to point the critical eye of science onto CAM. Many CAM proponents claim this, but Ernst was different in a key respect – he wanted to use rigorous scientific research to find out if CAM worked, not to prove that it does.

He recently wrote about his 20 years of CAM research, and eloquently makes this point. He writes:

Unfortunately, we also had a few co-workers who, despite of our best efforts, proved to be unable of critical thinking, and more than once this created unrest, tension and trouble. When I analyse these cases in retrospect, I realise how quasi-religious belief  must inevitably get in the way of good science. If a person is deeply convinced about the value of his/her particular alternative therapy and thus decides to become a researcher in order to prove his/her point, serious problems are unavoidable.

Problems are indeed unavoidable. There is a problem with researcher bias and publication bias in medical research. Science magazine also reports on a “sting” operation in which an author submitted a hopelessly flawed paper to 304 open access journals, with more than half accepting the paper for publication. There are plenty of places to publish terrible research that proves whatever point you wish to make.

Researchers need to have a sincere desire to find out if something is really true, not just confirm their biases. They also need to have the technical knowledge to conduct rigorous research. This includes critical thinking skills and detailed knowledge of all the ways in which science can go wrong. Ernst came to his CAM research career, apparently, with these attributes.

After 20 years and more than 1000 papers published in the peer-reviewed literature, Ernst has come to the following conclusions:

  • The concepts that underpin alternative treatments are often not plausible and must be assessed critically.
  • Most claims made for alternative medicine are unproven and quite a few should be regarded as disproven.
  • Very few alternative therapies demonstrably generate more good than harm.

Looking back to those 20 years, I am struck by the frequency with which I encountered intellectual dishonesty and denial of facts and evidence. Medical research, I had previously assumed is a rather dry and unemotional business – not so when it comes to research into alternative medicine! Here it is dominated by people who carry so much emotional baggage that rational analysis becomes the exception rather than the rule.

Twenty years ago CAM proponents were clamoring for research funding so that they could prove to the world that their preferred magical treatments worked. They then used (and still use) the very fact that their treatments were being researched as an argument that they are respectable and plausible.

When the evidence showed that their treatments do not work, they blamed science, they blamed the researchers (in this case, Ernst), they tried to change the rules, and they argued that placebo effects are real. In effect, they got what they asked for, scientific attention to their claims. They did not like the results, however.

They very much proved Ernst’s point – my own experience with CAM proponents is that they are starting from a firm conclusion that CAM works (or at least their preferred CAM). They have “seen it work in their practice” and cannot conceive of a universe in which their anecdotal observations do not reflect reality.

Starting with that assumption, therefore, any research that shows otherwise must be flawed. The only point of research is to prove to the world that their claims are true (since they know their claims are true). So they keep changing the rules of science until it shows them the results they want.

Unfortunately, over the last 20 years CAM proponents have successfully infiltrated the institutions of science and medicine, and they are largely now their own keepers. They have their own journals, they are often deferred to as the “experts” and so fill panels and committees on CAM, and regulate their own professions.

All of this happened while the scientific evidence increasingly was showing what any scientifically literate person could have predicted – highly implausible claims are unlikely to be true, so it’s no surprise they turned out not to be true.

Homeopathy does not work. Acupuncture does not work. Most of what happens under the banner of chiropractic does not work, and what does work is just physical therapy.  Life energy is not real. The most popular supplements do not work as claimed. Craniosacral therapy is nonsense.

CAM is CAM because it is not science-based. If it were, it would not be “alternative” medicine, it would be medicine.

Ernst has produced an impressive body of quality scientific research that overwhelmingly shows CAM to be the pseudoscience it seems to be. CAM proponents are now doing everything they can to shoot the messenger. They appear to prefer their profitable fiction to scientific reality, and despise anyone who will point out that the Emperor has no clothes.

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