Message to complementary and alternative medicine: evidence is a better friend than power

Abstract

Evidence-based medicine (EBM) is being embraced by an increasing number of practitioners and advocates of complementary and alternative medicine (CAM). A significant constituency within CAM, however, appears to have substantive doubts about EBM and some are expressly hostile. Many of the arguments raised against EBM within the CAM community are based on a caricature radically at odds with established, accepted and published principles of EBM practice. Contrary to what has sometimes been argued, EBM is not cookbook medicine that ignores individual needs. Neither does EBM mandate that only proven therapies should be used. Before EBM, decisions on health care tended to be based on tradition, power and influence. Such modes usually act to the disadvantage of marginal groups. By placing CAM on an equal footing with conventional medicine - what matters for both is evidence of effectiveness - EBM provides an opportunity for CAM to find an appropriate and just place in health care.

Background

Evidence-based medicine (EBM) is being embraced by an increasing number of practitioners and advocates of complementary and alternative medicine (CAM). A significant constituency within CAM, however, appears to have substantive doubts about EBM and some are expressly hostile.

Discussion

Many of the arguments raised against EBM within the CAM community are based on a caricature radically at odds with established, accepted and published principles of EBM practice. Contrary to what has sometimes been argued, EBM is not cookbook medicine that ignores individual needs. Neither does EBM mandate that only proven therapies should be used. Before EBM, decisions on health care tended to be based on tradition, power and influence. Such modes usually act to the disadvantage of marginal groups.

Conclusion

By placing CAM on an equal footing with conventional medicine - what matters for both is evidence of effectiveness - EBM provides an opportunity for CAM to find an appropriate and just place in health care.

An evidence-based approach to EBM

]), EBM provides an explicit framework for incorporation of therapies where evidence is incomplete.

EBM and individualized care

]. These can be used for evidence-based care of patients experiencing or at risk for psychological distress.

EBM and conventional medicine

].

EBM: threat or opportunity for CAM?

Let us be clear: no one is proposing "1984". There are no EBM thought police snooping around waiting to burst through the clinic door and arrest clinicians caught using treatments not approved by an EBM "big brother". Clinical autonomy is not under threat from EBM. Similarly, no EBM institution is threatening anybody's right to practice: no laws are being proposed to ban those who use therapies not justified by current evidence. With respect to funding, it is hard to see the present as a golden age for CAM provision that will come to a close once EBM advocates get into positions of power.

Indeed, the freedoms and opportunities thought by CAM advocates to be under threat by EBM are far more vulnerable to pre-EBM modes of decision-making. Decisions in medicine have often been made on the basis of tradition, power and influence. Such modes of decision-making will inevitably work to the disadvantage of marginal groups. It was, after all, the American Medical Association (rather than a research institution) that was found guilty of a "conspiracy" against chiropractic by misuse of its power and influence. The reason why physiotherapy, but not acupuncture, is widely available on the UK National Health Service (NHS) is because the former was in common practice when the NHS was established whereas the latter was not. And what of the argument that medicine's disproportionate reliance of synthetic drugs is due to the financial influence of pharmaceutical companies? If CAM advocates believe that chiropractors should have the right to practice, that acupuncture should have a place in the NHS, and that CAM should replace the use of some pharmaceuticals, then EBM must surely be a welcome change.

Conclusion

]. By the same token, there are no good reasons to suggest that EBM is somehow incompatible with CAM, or that it works to CAM's disadvantage. Were the CAM community to reject EBM, its future would be decided in the closed-off back rooms of power. I hope instead that CAM advocates chose the open light of evidence and embrace EBM.

Pre-publication history

The pre-publication history for this paper can be accessed here: