Medicandus

Medicandus

‘Integrative’ sewing: trying to make a silk purse out of a sow’s ear

The announcement of a new research centre at UTS Sydney to perform research on CAM raises some interesting issues for discussion. The first and most obvious question is why there needs to be a separate Australian Research Centre in Complementary and Integrative Medicine at all. Really, the term ‘Integrative Medicine’ is just lipstick on the ideological pig of CAM. How is it different? Honestly, how is Integrative Medicine any different from the confused welter of often contradictory and incompatible pseudo-treatments that band together to market themselves as Complementary or Alternative. Aren’t all science-based healthcare practitioners willing to go to battle firing arrows that earn their place in our therapeutic quivers because we know they fly truly?

The National Center for CAM (NCCAM) in the USA has been in existence for over a decade and has produced virtually nothing innovative or useful to mainstream practice despite funding to the tune of more than $1bn during this time. This has been for a number of reasons, but at the end of the day pseudoscience is inherently a sterile pursuit. Being fundamentally flawed, it can never be right in a useful way that translates into scientific progress. It’s hard enough to do science right, without getting diverted into attractive dead ends. A research scientist can only progress her career by navigating around piles of failed hypotheses to go forward with the ones that survive scrutiny and can be replicated.

The range of complex issues with having a large, sectarian money pit like NCCAM are well-described in several posts on the Science-Based Medicine blog. One compelling problem is how to decide what to spend time and money studying. In its early years, NCCAM funded studies into such flaky ideas as intercessional prayer therapy, reiki, therapeutic touch and homeopathy. While a purist may claim that every good idea deserves to be tested, the reality is that there is only so much money and effort available. Surely it makes economic and ethical sense to put money into research hypotheses that are likely to bear fruit? Discarding research areas that are incompatible with the known laws of physics and chemistry would be a good start. There goes homeopathy, ‘energy healing’ and reiki. Avoiding mildly plausible areas that have been thoroughly studied and found ineffective would be great as well. There would go acupuncture, most herbs and supplements. Trying to co-opt proven interventions like Cognitive Behaviour Therapy and exercise would at least result in them doing research that might conceivably have some practical use. But do they fit the rubric of ‘CAM’? Or are they already too ‘integrated’ to be of interest?

The thing I’d like to see would be to have research done on interventions which are likely to be feasible based on an accurate representation of reality, but which can’t find mainstream funding. Wait a minute….that’s most cutting edge science isn’t it?

Noodling around the UTS website, I can see some other scientists there who could do spectacular things with that much money. Like these guys who may have elucidated a vital mechanism in diabetes. Or this researcher who has made a substantial leap in cancer research with just $120K a year over 3 years! Not to mention The Conversation’s own Dr Rachael Dunlop, whose team may just have cracked the mechanism of motor neuron disease, one of the most feared and poorly understood diseases of the current day.

I welcome the proposition that the new ARCCIM is intending to take a rigorous and critical approach to their field. I expect this will extend to making evidence-based recommendations about which CAM treatments should be discontinued or not recommended based on the available evidence. Having attracted over $7 million in NHMRC funding, one expects to see some seriously good research, targeted in areas that could unequivocally yield lasting results. Time will tell whether their funding could have been put to better use or not, but they have several more deserving competitors inside their own gates doing really exciting science who could surely use that money as well.

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