Medicine: evidence-based versus complementary and alternative

(A variation on some words proffered, but unlikely to see the light of day elsewhere…)


Science is disingenuously misrepresented by those whose agenda rely on contra-scientific promotional tactics, such as devotees of ‘Complementary and Alternative Medicine.’ Refutation necessitates an appreciation of the psychology underlying people’s needs and preferences.

CAM appeals to our intuitive nature. We seek patterns and readily attribute cause and effect: post hoc ergo propter hoc (‘after this, therefore because of this’). If the personalised attention of a sympathetic CAM practitioner seemingly brings improvement in one’s condition, regression to the mean (improvement regardless) and the placebo effect (expectation of therapeutic beneficence) become inconsequential. When such subjective experience chimes with other positive testimonials the seeds of belief are sown.

By contrast, the scientific method eschews reliance on subjective (often delusional) explanation and the avoidance of (often counter-intuitive) facts. This presents challenge to the CAM mind-set, producing cognitive dissonance – the psychological discomfort arising when encountering arguments which conflict one’s beliefs. Criticism provokes defensive disregard of negative testimony and rejection of contrary evidence – so-called ‘confirmation bias’ – engendering resort to logical fallacies and contradictions.

Perhaps the most familiar example of the misappropriation of science is provided by homeopathy. Homeopathy is founded on the principle that disease is treatable by substances that would give rise to similar symptoms in the healthy – ‘like cures like.’ Moreover, repeat diluting of a substance until none remains in solution is claimed to increase its medicinal potency. This absurdity is explained by postulating that the water retains ‘memory’ of the substance – a concept for which there is no evidence whatsoever. This pseudo-scientific irrationality is coupled with the illogical dismissal of scientists’ perceived inability to grasp it. This ‘science doesn’t know everything’ attitude belittles the sine qua non of evidence-based medicine – the double-blinded Randomised Controlled Trial.

The RCT is so designed in order to minimise, as far as possible, subjective influence on the response of trial volunteers. Generally, subjects are randomly assigned into either of two groups, one of which receives the drug/therapy under test, the other a placebo dummy. Crucially, however, subjects are ‘blind’ as to which group they are in – i.e. they do not know whether they are being administered medicine or placebo. And, as patient response can also be affected by such knowledge on the part of those directly interacting with them, the medical staff also do not know which version of the drug they are administering – hence ‘double-blinded.’ Effectiveness is determined by evaluating the responses of large numbers of subjects. Only in this way can a drug’s real effects be determined. But when it comes to CAM, RCT evidence is, by and large, seriously wanting. This is explained away under the premise that the RCT is inapplicable to individualised CAM treatments, where the anecdotal (often unverifiable) testimonial holds sway as ‘evidence’ – a classic logical fallacy.

The marketing of CAM exploits a deficient lay appreciation of the scientific method and the rationale of the RCT. This is a challenge for science and scientists – not least to educate the layperson in the scientific method and its importance in determining the true efficacy of medical treatments.


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