Research in complementary medicine is essentialBMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7288.736 (Published 24 March 2001) Cite this as: BMJ 2001;322:736
- Michael A Cornbleet (), medical director,
- Catriona S K Ross, specialist registrar in palliative medicine
EDITOR—Nahin and Straus highlight the problems of conducting clinically rigorous research in complementary medicine.1 They are right, though, to emphasise the need for such research; in an era of evidence based medicine it is difficult to justify deploying resources in the absence of convincing benefit. Complementary treatments have many advocates in palliative medicine, and many hospice services offer, or are under pressure to offer, such treatments. We have reported a pilot study of a randomised prospective study of reflexology (C S K Ross et al, proceedings of the first congress of the research network of the European Association for Palliative Care, Berlin, December 2000).
The rationale for reflexology depends on the “reflection” of organs or body parts on the soles of the feet, which can be palpated to diagnose functional imbalances and correct them. Patients received either reflexology or standard foot massage; a criterion for eligibility for randomisation was that they had not had either treatment before. Both treatments were administered weekly for six weeks by any one of three therapists, who had agreed standardised methods. The therapists could not be blind to the treatment they were administering, but bias was minimised by using different therapists and having the assessments conducted by an independent research nurse, who was unaware of the treatment received.
Although all patients greatly enjoyed the treatments, there was no discernible difference in outcome between those receiving reflexology and those receiving standard foot massage. The pilot study was small (only 17 patients), but it was clear that large numbers of patients would be required to prove the null hypothesis and we decided not to proceed. The conclusion was that the employment of a reflexologist could not be justified but that nursing staff or volunteers could be trained in the skills of simple foot massage, which was popular with both patients and staff.
In the current climate of suspicion surrounding medical science, we believe it essential to continue to look critically at all candidates for resources. An open mind is a prerequisite to a credible outcome of research in this area, and research design is problematic for the reasons given by Nahin and Straus. But to allow ourselves to be pressured into supporting the introduction of any treatment, complementary or conventional, that cannot be shown to have the benefits claimed would be an abdication of responsibility.