The Editorial by MacPherson et al [1] is a masterpiece in
obfuscation. Defining integrative medicine (IM) as “medicine that
reaffirms the importance of the relationship between practitioner and
patient, focuses on the whole person, is informed by evidence, and makes
use of all appropriate therapeutic approaches, healthcare professionals
and disciplines (conventional and complementary) to achieve optimal health
and healing” is self-serving nonsense. The therapeutic relationship,
holism, evidence and multidisciplinarity are, of course, core values of
all types of medicine. They existed before IM was invented and will exist
when this fad has long disappeared. The fact that “patients’ preferences,
expectations and motivations” matter is undisputed but does not mean we
should (or are allowed to) use unproven or disproven treatments in routine
healthcare. The authors state that “the Cochrane Library currently lists
7679 clinical trails of complementary medicine and 674 systematic reviews”
[1]. These figures may seem impressive – what is unimpressive, however, is
the fact that this evidence shows that only very few of these treatments
are effective [2]. The authors therefore advocate lowering the bar of
scientific rigour by testing “integrative interventions” in pragmatic
trials. This might well generate less negative findings but at the risk of
producing false positives. We have recently shown that, provided one
conceives such studies cleverly, they have zero chance of generating a
positive result [3]. The design of such studies is thus fundamentally
flawed – and, as we all know, conducting flawed research is unproductive
and can be unethical.
To pretend that the therapeutic relationship, holism etc are unique
to IM is incorrect; to delegate these issues to IM deprives medicine of
its core values; to integrate unproven or disproven treatments is counter-
productive and will make healthcare not better but worse.
Rapid Response:
Integrative medicine
The Editorial by MacPherson et al [1] is a masterpiece in
obfuscation. Defining integrative medicine (IM) as “medicine that
reaffirms the importance of the relationship between practitioner and
patient, focuses on the whole person, is informed by evidence, and makes
use of all appropriate therapeutic approaches, healthcare professionals
and disciplines (conventional and complementary) to achieve optimal health
and healing” is self-serving nonsense. The therapeutic relationship,
holism, evidence and multidisciplinarity are, of course, core values of
all types of medicine. They existed before IM was invented and will exist
when this fad has long disappeared. The fact that “patients’ preferences,
expectations and motivations” matter is undisputed but does not mean we
should (or are allowed to) use unproven or disproven treatments in routine
healthcare. The authors state that “the Cochrane Library currently lists
7679 clinical trails of complementary medicine and 674 systematic reviews”
[1]. These figures may seem impressive – what is unimpressive, however, is
the fact that this evidence shows that only very few of these treatments
are effective [2]. The authors therefore advocate lowering the bar of
scientific rigour by testing “integrative interventions” in pragmatic
trials. This might well generate less negative findings but at the risk of
producing false positives. We have recently shown that, provided one
conceives such studies cleverly, they have zero chance of generating a
positive result [3]. The design of such studies is thus fundamentally
flawed – and, as we all know, conducting flawed research is unproductive
and can be unethical.
To pretend that the therapeutic relationship, holism etc are unique
to IM is incorrect; to delegate these issues to IM deprives medicine of
its core values; to integrate unproven or disproven treatments is counter-
productive and will make healthcare not better but worse.
Reference List
(1) MacPherson H, Peters D, Zollman C. Closing the evidence gap in
integrative medicine. BMJ 2009;
399(www.bmj.com/cgi/content/full/399/sep01_2/b3335).
(2) Ernst E, Pittler M, Wider B, Boddy K. The Oxford Handbook of
Complementary Medicine. Oxford University Press, Oxford: 2008.
(3) Ernst E, Lee MS. A trial design that generates only ''positive''
results. J Postgrad Med 2008; 54(3):214-216.
Competing interests:
None declared
Competing interests: No competing interests