Lionel Milgrom considers ridicule and integration

The Whole Story: Alternative Medicine on Trial? by Toby Murcott
(Macmillan, hardback 2005, paperback 2006)

It seems hardly a day goes by without a gaggle of emeritus professors haranguing some poor newspaper editor about the alleged waste of NHS resources on 'useless' complementary and alternative medical (CAM) therapies.

Columnists (some scientifically literate) ridicule 'wacky' CAM therapies, those who practice and those who partake of them.  ‘Where's the evidence CAMs actually work?’ they smirk. And herein lies the difficulty: for CAMs, such as acupuncture, osteopathy and homeopathy, are notoriously difficult to research using conventional science's tried and tested methods. So how does one find out if CAM therapies actually work or not?

This, in essence, is the subject of Toby Murcott's brilliantly researched and bravely written little book. A biochemist by training and science writer by occupation, The Whole Story represents Murcott's journey of discovery into the rapidly expanding world of CAM research. And what a seething cauldron of believers, sceptics and truth-seekers it turns out to be. Those of a more fundamentalist persuasion might well feel alarmed at how science's current monopoly on what constitutes evidence is being seriously challenged by the CAM research community.

Increasingly popular

Murcott rightly proclaims the successes of modern medicine. By eradicating the traditional big killers, for example infectious diseases and wound sepsis, it has delivered better health and longer life-spans in the developed world.

However, he points out, this apparent progress has to be viewed against a backdrop of rising chronic lifestyle complaints. These include cancer, heart disease, diabetes, and Alzheimer's, while not forgetting the huge increase in immune-system problems, such as asthma and rheumatoid arthritis, that doctors are increasingly unable to cope with. Consequently, many people world wide are turning to CAMs for succour from their ills.

The figures are quite staggering. Roughly half the populations of the UK, US and Australia have availed themselves of CAM therapies. Even more interesting is the number of conventional doctors all over the world who are prepared to work alongside CAM practitioners or use CAM themselves as an adjunct to their ordinary medical practice.

The evidence, albeit anecdotal, seems to be that CAMs work. The problem is only a small number of these therapies have been tested scientifically, leading some to vituperate against what they see as a gullible public being conned by 'hocus pocus'.

Methods and results

But hold on, Murcott warns. This isn't the whole story. For one thing, most doctors and CAM practitioners are more concerned with trying to make their patients better than understanding how a particular therapy might work. There are many serious-minded practitioners researching CAMs and different ways of acquiring evidence that do not necessarily chime with the demands of orthodox medicine's clinical trials methodology. So, what happens when the daily experience of practitioners' own eyes, in terms of satisfied, relieved  clients, clashes with the results of clinical trials telling them their CAM therapy doesn't work?

And then there is the placebo effect.

Placebo and evidence

Clinical trials, Murcott points out, use placebo as a mark of failure. So if a CAM modality works no better than a sugar pill, it is deemed ineffective. But the placebo effect has always been part of every doctor's kitbag, and is even enshrined in the Hippocratic Oath. Also, many CAM practitioners say their therapies work by encouraging the body to heal itself (in other words, a placebo effect), and suggest a far more humane appreciation than the rather pejorative meaning usually attached to this phrase. Ranged against this pragmatism, however, are the growing demands of evidence-based medicine (EBM).

In essence, EBM emphasises a particular kind of evidence: that gathered from clinical trials and sifted through systematic reviews, over the hard-won skill and experience gathered during practitioners' lifetimes. Hailed as a 'paradigm shift', staunch supporters of EBM are even calling for the 'ex-communication' of those who do not follow its precepts, even though many of the drugs and procedures currently used in orthodox medicine have yet to be clinically confirmed by EBM.

Humility all round

Dispassionately reviewing all the evidence, Murcott asks some penetrating questions. Could it be that CAMs are actually pointing the way towards more successful ways of treating chronic conditions? And if so, could it be that what a chronically ailing public really needs is properly integrated health care, not persistent and damaging trench warfare between the proponents of CAM and EBM?

Quoting from one of the UK's most respected and senior medical researchers, Professor Sir Iain Chalmers, Murcott finally concludes, ‘The most important resource required to promote the concept of integrated healthcare is likely to be humility among those whose practices will be put to the test, within both orthodox and complementary medicine.’

For all our sakes, may peace break out soon.

Dr Lionel Milgrom is a chemist, co-founder of an Imperial College biotech spin-out company (PhotoBiotics), science writer, and alternative health practitioner