How much of orthodox medicine is evidence based?
BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39388.393970.1F (Published 08 November 2007) Cite this as: BMJ 2007;335:951
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I wonder how many research trials John Garrow and David Colquhoun have completed recently: £1.3 million buys a single multicenter moderately sized clinical trial. Perhaps they misunderstood the remit of the relevant Department of Health Committee; this allocation was designed to fund individuals at doctoral and post-doctoral level who would contribute to research capacity in this controversial area. It did not have the intention, resource or structure to fund the sort of large clinical trials they suggest. These awards were established with the same guiding principles, and to achieve the same outcome, as similar departmental award schemes in both primary and secondary care. Future correspondence in relation to the structure and relevant research outputs might be directed to the Committee’s chairman, Tony Butterworth (tbutterworth@lincoln.ac.uk), or the responsible Department of Health official (Lisa Cotterill, Lisa.Cotterill@nccrcd.nhs.uk).
On a matter of fact, the University of Exeter has received funding for one post-doctoral and one doctoral award within the CAM scheme (in 2004) and was also represented on the Award panel. As to whether universities other than Exeter have a poor research track record, I would be very happy to draw attention to our research track record as an example of what other departments have achieved (www.cam-research-group.co.uk). I would also draw attention the fact that some of our published studies are negative. We have two clinical trials underway with the help of these awards and both required substantially more funding than the Department of Health provided. Both are currently incomplete and so are unpublished.
Competing interests:
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I agree entirely with John Garrow's response. A corollary of his analysis is that, if there is to be any more funding for research in alternative medicine, it is essential that the allocation of the money should not be in the hands of alternative medicine people. The reason for that is that past experience has shown that they will give the money to projects that don't answer the real questions.
If no applications are received that address the proper questions with rigorous experimental design then the money should be clawed back and spent on something that has a better chance of being a real advance.
I am perpetually amazed by the reluctance of advocates of alternative medicine to subject their claims to proper tests. The only interpretation that I can see of this failure is that they themselves believe, deep down, that the tests would be failed. I hope that isn't the explanation though, because if they were convinced that the tests would fail, it would mean that we are dealing with fraud, not just delusion.
Competing interests:
None declared
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Dr Lewith wants clarification of my view about public funding of CAM
research. It has changed over the last 7 years. In 2000 the House of Lords
Select Committee (HLSC)advised the Department of Health to fund research
on acupuncture, chiropractic, herbal medicine, homeopathy and osteopathy
to see if these therapies were safe, more effective than placebo and good
value for money, At the time I supported this decision. However in 2003
it was disclosed that £1.3m had funded 8 research projects, at the
Universities of Leeds, Southampton, Bristol, Brunel, Sheffield and York,
but none of these were directly testing the safety, efficacy or value-for-
money of the main CAM therapies.[1] I noted that these Universities did
not have as good a record of research into the efficacy of CAM as Exeter,
which had applied but failed to get funding. It was also noticable that
the panel awarding the grants tended to work at the funded Universities.
CAM research is not so impoverished as Dr Lewith implies. The onus is
now upon the researchers who received £1.3m from the taxpayer, and more
from the Foundation for Integrated Health, to tell us what answers they
have found to HLSC's very pertinent questions. Only in the light of these
answers can we judge if they deserve further public funding. If initially
the Government had an "obligation" to fund CAM research I think the £1.3m
discharged it, and now there is an obligation on CAM practitioners to show
that they have not misappropriated these funds.
[1]Garrow JS et al. UK government funds CAM research. FACT 8:397-402,
2003
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I remain unclear about John Garrow and David Colquhoun’s position with respect to “funding CAM”. Are they suggesting that there should be no funding for CAM research or are they suggesting this embargo should apply to the provision of CAM services within the NHS? If the former, how do they justify this position with respect to the many UK taxpayers who use CAM each year and for whom the government has some obligation to provide information?
Competing interests:
None declared
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Re: Funding for alternative medicine research
I suppose David Colquhoun would prefer that funds for research into
the benefits of gas appliances in domestic use be paid to the electrical
appliance assocations - to achieve unbiased results?
What is the Professor of Pharmacology afraid of?
It is most sensible, and equitable, that alternative medicine
practitioners - being those who in general understand and use their
methods most effectively and safely - should receive adequate PUBLIC (let
us not forget) funds to demonstrate the characteristics of their
interventions.
Regards
John H.
Competing interests:
Traditional Chinese Medicine Specialist
Competing interests: No competing interests