Show me the evidence

Mainstream peer-reviewed medical/scientific journals rarely seem to publish articles on complementary/alternative medical (CAM) topics. This appears to be a paradox if we are to believe the statistics about the wide acceptance of these treatments by the public. If one does a quick trip into MEDLINE or PubMed and looks at any number of CAM topics, few of them appear in anything but journals dedicated to CAM. Most of the articles that appear in conventional journals that include reference to or are specifically dedicated to CAM seem to be primarily concerned with patients failing to disclose usage of non-physician prescribed pharmacoactive substance(s) resulting in an aberrant reaction (like Dr Wong’s recent article in BCMJ 2002;4[4]:184-187). There are quite a few case reports of significant physical side effects of CAM preparations as well as physical damage from some CAM devices. Most of these case reports make firm recommendations alerting physicians to the potential harm undisclosed CAM treatments may cause patients. There are in fact quite a few reviews, essays, and editorials dedicated to the topic of CAM, but few seem to be terribly positive about a polyglot of non–evidence-based treatment modalities that apparently 80% of our patients are investing their money in annually.

There seems to be a validity dichotomy; on the one hand you have huge amounts of money being spent on treatments by an apparent majority of our patients in spite of being told by their doctors that those treatments have no proven medical efficacy.

Are these individuals (some of whom are physicians) failing to disclose their CAM usage because the CAM practitioners are selling their treatments more effectively and faster than physicians/scientists can debunk them, or is it just that CAM practitioners have effectively been able to convince 80% of people that doctors are part of a huge conspiracy to keep CAM treatments out of mainstream medicine for economic reasons? I think neither is likely, although certainly there are elements in the CAM fraternity that seem willing to push the paranoia button rather than look to scientific methods to secure validity. I wonder if the startling economic success of CAM could be because some of it actually works? The problem is we evidence-driven types don’t know which ones work or why, and we keep waiting for someone to invest the enormous amounts of money it will take to do the necessary science.

More recently it appears that many of the more frustrated but scientifically grounded CAM practitioners are more interested in and vocal about seeking scientific validation of their treatments, and we are beginning to see some well-designed, statistically valid studies coming out of this group. In addition, in the US there appears to be more interest by some traditional scientists to take a look at some aspects of CAM as an arena worthy of proper scientific investigation. I think that if recognized medical journals begin to publish well-designed, properly crafted, scientifically/statistically validated studies, we will finally be able to answer some of those burning questions we all have about CAM but have been unable to answer for our patients or ourselves because there is just not enough evidence to provide an opinion.

—JAW