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The paper by Professor Ernst (April 2002 JRSM1) is a welcome addition to the debate on complementary/alternative medicine (CAM). However, even if the arguments on methodology and outcome measurement are accepted, the question of application remains. Is the whole spectrum of CAM to be researched or are specific areas to be chosen? Presumably, some justification will be required to gain access to funds and resources to carry out such projects and they will have to compete against other worthy causes. Research is a formalized and sophisticated form of argument, so that one study is seldom sufficient and the most that can be offered by even the best studies is a measure of probability. In addition to this, even seminal research may be overlooked by the ‘establishment’ for lack of a ‘respectable’ sponsor. Mendel's work languished for 40 years before it was recognized.
This is not a polemic against research and it would be tragic if research were to be stifled by over-regulation but the assumption implicit in the paper that it is an immaculate and robust creature is unfounded. In the present times every head of a research department is aware of the realpolitik of fund chasing and justifying one's existence. So, what is to be the target of Professor Ernst's methodology? Is it to uncover iatrogenic damage in a branch of CAM such as herbal medicine or is it to disprove the efficacy of all CAM? In the first instance, would not the funds be better allocated to the considerable iatrogenic disease existing in allopathic medicine. In the second instance, such a herculean task would absorb the resources of many research departments and could hardly be justified.
Before applying a scattergun approach to research on CAM it is worth examining the efforts that have been already made in several branches of CAM to institute courses of training and approved qualifications. Unfortunately, there is little effort to distinguish these trained practitioners from the untrained, and if some fault is discovered they are all tarred with the same brush.