The trials of alternative medicine.

Sir, Dr Charlton sets out strong theoretical objections to performing randomized clinical trials in the field of Alternative/Complementary medicine (A/CM). There are in addition practical implications. Pressure has recently been brought to bear from various directions that: (i) appreciable funds should be devoted to research into A/CM; (ii) that some kind of tuition in this field of activity should be routinely given to medical students; and (iii) that the various forms of A/CM be made more freely available within the NHS. The need for unquestioning faith which is common to the various forms of A/CM, imparts to them a quasi-religious character, and for this and other reasons, it is difficult to conceive that high-quality basic research will ever be carried out in this field. It follows that the only ‘research’ will be in the form of clinical trials of effectiveness. However, study of the literature of the last few years and in particular of the responses to published reports of controlled trials, e.g. Lewith et al., Abbot et al., leads one to conclude that, whatever the outcome of such trials, the practice of A/CM will not be affected in any way. It is important to appreciate this when considering policy with regard to all forms of A/CM. Neither patients nor practitioners of A/CM require objective evidence of efficacy. A sympathetic hearing, faith in the ability of the particular form of treatment to produce beneficial effects and the carrying out of the particular therapeutic rituals, are on the other hand essential features. One can therefore anticipate that financial and other resources spent on such trials will be largely wasted. It appears that the exposure of medical students to A/CM is at present on a limited scale. What is surely unacceptable is giving medical students, in the context of a university education, information with regard to various types of A/CM, without using the occasion to educate them in the need for a critical approach, based as much as possible on rational scientific principles. It is salutary to imagine the reaction if a university course in cosmology were to start including a module on the uses of astrology. The present difficulties in providing the highest standards of medical care within the NHS should cause us to take a very critical attitude to the diversion of important resources to the practice of A/CM within the NHS.