The July 16 issue of the Medical Journal of Australia (MJA) published an editorial addressing the debate as to whether complementary medicine courses should be taught in Australian universities. In many ways, the debate in Australia parallels debates here in the United States, and indeed debates on this blog.
Complementary and alternative health care practices, by definition, arise from outside the mainstream, and, not surprisingly, meet much appropriate skepticism. We at NCCAM share a skeptical mindset, but, as readers of this blog know, we believe scientific inquiry has an important place in the evaluation of some non-mainstream health practices. As noted in the MJA editorial, “Science sets out to rigorously eliminate bias, not to assert it.” This is a basic tenet of the scientific method, and one that requires us to pursue our work with objectivity and neutrality, and with a dose of both open-mindedness and skepticism.
As researchers, we pursue science through the formulation and testing of hypotheses, and we should approach our studies with equipoise. As we gather and analyze our data, we need to be open to the possibility that our hypotheses may not have withstood scientific scrutiny, or that the data may be leading us in an unexpected direction. At the recent third International Research Congress on Integrative Medicine and Health, Dr. David Eisenberg reminded us in his closing remarks that “An act of inquiry is not an act of advocacy.” In other words, we conduct research to learn about the effects, safety, and/or mechanisms of a product or practice, not to promote it.
Throughout the history of medicine, there are a number of examples of “quirky” ideas that encountered resistance from mainstream medicine, but eventually, through a combination of clinical experience and scientific pursuit, led to changes in health care. For example:
- Physical resistance training is good for people recovering from major physical trauma: Joseph Pilates, 1915
- Relaxation and breathing techniques help with the pain of childbirth: Fernand Lamaze, 1940
- Breastfeeding is good for babies, and mothers need help and support to establish successful breastfeeding: Edwina Froehlich, La Leche League founder, 1950s
- Extensive palliative support and reduced medical interventions should be provided to dying patients: Saunders, Wald, Kubler-Ross, 1960s
So, sometimes good things come from challenges to mainstream orthodoxy. With that said, I do not advocate that we study every “quirky” idea that is proposed, but we must be willing to cast a critical eye over these ideas before dismissing them out-of-hand.
At NCCAM, we often encounter new ideas and unique approaches that may challenge established thinking. But we try to maintain open minds and ask tough questions to tease out whether there is scientific promise, plausibility, and amenability to rigorous scientific inquiry; potential to change health practices; and a relationship to use and practice that addresses an important public health concern. Does the idea merit an investment in research? Does it aid us in the pursuit of our strategic goals?
Ultimately, being able to bring both an open mind and a skeptical eye to the long-term challenge of evidence building is crucial, and we must be willing to do so, no matter what perspective we bring to the scientific debate.