Can complementary medicine be evidence based?

The editors of the New England Journal of Medicine recently declared: “It is time for the scientific community to stop giving alternative medicine a free ride.”1 Here were the voices of orthodoxy, loud and clear, sounding the death knell of complementary and alternative medicine (CAM). Echoing a long history of medical tribalism,2 CAM was once again under attack for being anti.scientific and grounded in unproven narrative.

Since that declaration, CAM practitioners and researchers have tried to defend their practices. They have begun to publish in peer reviewed biomedical journals, and they recently held an international congress addressing research methodology and quality management.3 A Cochrane collaboration will publish a series of papers, critically appraising systematic reviews of 30 CAM therapies.4 All this, despite minimal research funding or infrastructure.

So is the argument now over? Not quite, for there are still two fundamental conflicts between the “art” of CAM and the “science” of evidence based medicine. Resolving these is the key to distinguishing evidence based complementary medicine from practices based on anecdote.

The first conflict is between standardisation and individualisation. Evidence based medicine emphasises reproducibility. It attempts to define a universal “best practice,” based on large randomised controlled trials and meta.analyses. This is the antithesis …