Double Standards and Double Jeopardy for CAM Research

Micozzi, Marc S.

Double Standards and Double Jeopardy for CAM Research

Marc Micozzi

2001, Journal of Alternative and Complementary Medicine

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THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 7, Number 1, 2001, pp. 13–14 Mary Ann Liebert, Inc. GUEST EDITORIAL Double Standards and Double Jeopardy for CAM Research MARC S. MICOZZI, M.D., Ph.D. T has he volunteered, to provide critiques of the scientific work of our distinguished Fellows. The paper by Morley et al. demonstrates that there is more of the debunker than one would have hoped to find in the occupant of the first endowed chair in CAM in the United Kingdom. On the threshold of the new century, the real problem underlying this bias is that the present biomedical paradigm (the goal of which is to encompass all knowledge and understanding of health and healing) is incomplete and inadequate to explain or interpret the vast diversity of healing phenomena routinely observed clinically and increasingly demonstrated scientifically. This cognitive dissonance for biomedicine leads to a great deal of thrashing about in an attempt to fit empirical observations into places where they cannot go. Attempts to “shoehorn” the science of CAM into a reductionist, materialist paradigm may be no more successful or satisfying than current attempts to “shoehorn” the practice of CAM into an ailing health care system. The Morley et al. paper focuses on the limitations of Ernst’s writings on spinal manual therapy (SMT). Fortunately, there are rigorous and reliable researchers providing well-substantiated results on SMT to which primary care physicians are increasingly paying attention in the interests of patient care (Micozzi, 1998). However, Ernst’s obfuscations are not confined to his writings on chiropractic. His design of “debunking experiments” on acupuncture, for example, have been obtuse in ac- he paper by Morley, Rosner, and Redwood (pp. 65–78) in this issue provides a clear illustration of a disturbing double standard in the mainstream medical literature regarding the reporting of research results in complementary and alternative medicine (CAM). It is often said that “extraordinary claims demand extraordinary results,” and biomedicine has often treated any positive result in CAM as extraordinary. A willingness to report negative findings (expected results) far exceeds the acceptance of positive findings (unexpected results) and there is clear evidence of bias against CAM research (Resch et al., 2000). Another aphorism of scientific research is that, “if you need statistics to show positive results, you should have done a better experiment.” With reference to the chiropractic literature reviewed in the Morley et al. paper, Professor Ernst might add, “if you get positive results, you should have done better statistics.” Another result of this bias is that investigations of claims of complementary medicine, all too often, take on the character and tone of “debunking” expeditions rather than scientific experiments. In what other field of medicine would a former magician without medical or scientific credentials (à la “Amazing Randi”) be given entrée and afforded credibility in the world of medical science? In Philadelphia we have welcomed Teller (the silent stage partner) of Penn and Teller to the College of Physicians, where he has been eloquent about the importance of medical science to society, but we have never invited him, nor 13 14 counting for, and attempting to control for, mechanisms of action postulated by acupuncturists themselves. Ernst’s imperative seems to be finding ways to reject experimental evidence that does not fit with a presumed, preexisting formula. Scientific empiricism does not demand mechanism. Our fellow Philadelphian, Benjamin Franklin, while chairing a royal commission under Louis XVI in France, designed sophisticated experiments to investigate claims of “animal magnetism” by the Viennese hypnotist working in Paris, Franz Anton Mesmer. Unfortunately, the commission degenerated into arguments about mechanism, the experiments were never completed, and some of the commission, including King Louis, literally lost their heads. Today, we still do not have answers about “animal magnetism” (which finds modern expression under the rubric of “energy healing”) or “mesmerism,” despite the proven and accepted success of clinical hypnosis. If something does not exist in a reductionist, materialist paradigm, how can we ask questions about it? On one occasion, during a conversation about complementary medicine with our Pennsylvania Senator Arlen Specter (R-Pennsylvania), he remarked that the National Institutes of Health does not believe in “bioenergy.” I suggested that he could ask the U.S. Department of Energy to study bioenergy; this organization cannot say it does not believe in energy nor can contemporary physicists at the cutting edge of a quantum science that must eventually influence our epistemology of health and healing. In a famous valedictory, the former editor of Nature claimed that his one great achievement GUEST EDITORIAL was to have laid the concept of “vitalism” to rest in the columns of his journal. As the former editor of this journal, I paraphrase Mark Twain that reports of vitalism’s death have been greatly exaggerated. The inaugural issue of this journal a halfdecade ago began with a poem written by the metaphysician-physician John Donne in 1611 at another time of philosophical transition. It contains the line, “and freely men [sic] confess that this world’s spent.” The double standard so ably demonstrated by Morley et al., while more of a “forced” than a “free” confession not only shows the potential for intellectual bankruptcy but shows the possibility of moral bankruptcy in some of the science behind the fin de siècle health care system of the latter half of the last century. REFERENCES Micozzi MS. Complementary care: When Is It Appropriate? Who will Provide It? Ann Int Med 1998;129(1): 65–66. Resch KI, Ernst E, Garrow J. A randomized controlled study of reviewer bias against an unconventional therapy. J Royal Soc Med 2000;93(4):164–167. Address reprint requests to: Marc S. Micozzi, M.D., Ph.D. Executive Director The College of Physicians of Philadelphia 19 South 22nd Street Philadelphia, PA 19103 E-mail: micozzi@collphyphill.org

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