Complementary and Alternative Regulation

Posted: July 17, 2009 by Tim Barclay in Science
Tags: ,

The University of Central Lancashire, one of the numerous universities in David Colquhoun’sfiring line for their disregard of science in offering BScs in homeopathy and traditional Chinese medicine, has held a review of issues associated with teaching alternative medicine subjects. The report from this review has been published online here (pdf).

The review came to a pleasing conclusion, that

“the University refrains from offering any CAM courses until such disciplines have achieved statutory regulation status.”

Since homeopathy, acupuncture and Chinese herbal medicine are not subject to statutory regulation, and are unlikely to become so, this means that the teaching of these subjects, and the conferring of BScs for them, should cease.

However, despite the encouraging conclusion reached, some of the arguments that got them there were, for an academic review board, bafflingly nonsensical.

In section 4.1 on efficacy, the report states:

“The debate on the efficacy and benefits of the various CAM disciplines and what constitutes an “acceptable” evidence base for CAM treatments can be viewed as a dichotomy between two differing ways of “knowing”, linked to the principles of supposed “holism” and “reductionism” in medicine…”

A dichotomy between different ways of “knowing”? This is the sort of thing I could imagine Deepak Chopra spouting at a critic. The issue here is whether it’s worth teaching acupuncture as a science degree and therefore whether it works. How many different ways of “knowing” whether something cures patients or not can there be? Well, of course according to alternative medicine proponents, there is the reductive, simplistic and possibly evil western way (or ‘randomised controlled trial’ for short) and then there is the wholly undefined, but undoubtedly better alternative/traditional/intuitive way.

This is an oft-quoted problem with the assessment of evidence for CAM modalities – that their methods of healing are beyond the reach of science – but is there any basis for it?

Well, no. Science, and specifically the RCT, is designed to test specific, predicted effects of interventions. If homeopathy claims to make people better, then it can be tested by science.

At its most basic, the method of an RCT involves giving one load of people a particular intervention (say, a homeopathic headache pill), giving another load of people a placebo, and then counting up the number of people who still have a headache a bit later on. The group with the fewer headaches wins. Once you get beyond the potentially confusing technical language, and the definitely confusing anti-science propaganda, the controlled trial is the simplest, most intuitive and most evidently effective way of testing the efficacy of a medicine there is.

It can also be altered to take into account any details of the modality being measured. For example, homeopaths often complain that their trade isn’t amenable to this method of testing because they offer personalised treatments. The prescription of homeopathic remedies, the say, isn’t just based on the symptoms presented, but on many more diverse and esoteric personal details gleaned from a lengthy consultation. However, this element of homeopathy can easily be factored into the clinical method. Imagine a study where 100 people with mild conditions all go to the same homeopathic practitioner for a consultation exactly as they would normally. The practitioner then chooses the correct remedy for them based on whatever details they normally would, and then tells the patient to collect their personalised treatment from a desk on their way out. At the desk, 50 people are given their personal prescribed treatment and the other 50 are given identical looking sugar pills. The personalisation and consultation parts of the treatment are maintained without compromising the blinding or the randomised elements necessary for it to be a fair scientific trial.

In short, scientific testing is perfectly able to test the claims of alternative medicine, and any discussion of different ways of “knowing” is pure smoke.

Nevertheless, the UCLAN review decided that:

“conclusions from research into the efficacy of the various CAMs are outside the remit of this report.”

This is simply baffling? When deciding whether acupuncture should be taught to people who may go on to tend to patients with real illnesses, surely the first and most important question to be answered is that of efficacy. However, this accomodationist stance that we shouldn’t rock the boat by demanding of alternative practitioners the same standard of evidence for efficacy expected in real medicine is very common. Recently HolfordWatchspeculated about what would happen if nutritionists were allowed a place in the NHS alongside Registered Dietitians. While RDs could be held accountable for any unevidenced or dangerous advice, as has happened recently in the case of Katie Peck who gave dubious advice to diabetic patients, nutritionists (astrologers to dieticians’ astronomers), would be unlikely to fall under the same scrutiny.

In the end, it is good that this report concluded that unregulated modalities should not be taught, but many of the finer details of the review are, I think, a cause for concern. Not least because in tip-toeing around the difficult and important questions of evidence and efficacy, it shows that even universities are being taken in by CAM’s anti-science hand waving. Real scientists in real universities should know better. Alternative medicine is just as testable as any other medicine and therefore there is no excuse for the by-passing of questions of evidence.

  1. Mike Eslea says:

    Well said!

  2. theenglishradical says:

    Things like this worry me. I have a feeling that the mess that University funding has found itself in, has a lot to do with the “odd” degrees they seem to be offering. If people will pay, then they will run a course, no matter how silly it is becoming.
    What is more worrying is of course that these treatments will be available on the NHS. If people want to buy homeopathic remedies then fine, but it does NOT belong on the NHS, nor does it warrant the subtle nod towards its authenticity that comes from CAM being associated with the health services.
    NICE is already a joke in England and the mess devolution has created with regards to how treatments are authorised in the NHS can only be made worst by pumping out CAM practitioners looking to divert limited resources to their “clinics”.

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