Medicine man

An expert, they say, is someone who knows very much about very little. I sometimes feel that I know too little about too much. As a clinician, I have practised in general and rehabilitation medicine, psychiatry and angiology. As a scientist, I have worked in basic research as well as several areas of clinical investigation. As a therapist I learned techniques such as massage, manipulation, autogenic training, acupuncture and homeopathy. I usually console myself by thinking that such diversity is a pretty good basis for what I'm doing today: researching complementary medicine.

It is hard to think of a discipline that is more diverse than this one. Complementary medicine reaches into most areas of healthcare. I receive invitations to lecture not just to medics or therapists but also to psychologists, sociologists, anthropologists, pharmacologists, epidemiologists, ethicists; even lawyers, dentists, politicians and bankers. Complementary therapies are used for virtually every condition you can think of, from abdominal pain to zoster.

No question, therefore; diversity is an asset. But what else is required? Louis Pasteur said: "My only strength is my tenacity." But is perseverance enough today? During the past 11 years, I've spent my time applying the rules of science to the often weird and sometimes wonderful area of complementary medicine. During this period, I have supervised about 50 researchers, so I should know what qualities are required to make a good one. Yet I find it difficult to predict.

Perhaps it is easier to spot characteristics that can be a hindrance. For instance, a closed mind is a less than ideal starting point. On the other hand, if your mind is wide open, how do you prevent your brains from falling out? What is needed, I think, is openness combined with scientific rigour, well anchored in common sense.

Having an axe to grind can also be a serious handicap. Most complementary therapists are aficionados, but when you are a researcher your enthusiasm should be first and foremost for good science, which is for testing hypotheses and not for proving pet theories. "If I set out to prove something, I am no real scientist - I have to learn to follow where the facts lead me. I have to learn to whip my prejudices." Even though scientists have confirmed the importance of this fundamental truth formulated by the 18th-century scientist Lazzaro Spallanzani 300 years ago, it is still regularly forgotten. Remember the recent hoo-ha about MMR? Some investigators involved in this drama seemed to be bent on proving a link between MMR and disease, rather than testing the possibility that one might exist. The difference may look small, but in reality, it is huge.

Complementary medicine is rife with stories of researchers who seem blissfully unaware of Spallanzani's rule. For years, I had an assistant who was a dedicated follower of acupuncture. Initially, his research skills were close to zero, but I was confident that he would learn. In particular, I was keen for him to comprehend that science is for testing things rather than fishing for evidence to support preconceived ideas. But when he left my unit for a research post with an acupuncture organisation, he stated: "We need to provide hard evidence to support what we all see in our clinics every day: that the modern approach to acupuncture works, and is highly relevant to the new, patient-centred NHS." Forgotten, it seems, were the rules of science.

Some people may think such stories are trivial, but in healthcare, bias is never inconsequential. We get all heated up when "big pharma" is accused of using promotional pseudo-research to sell their products. But rampant bias at the heart of complementary medicine seems to worry worryingly few.

When used correctly, science is an effective tool for getting at the truth, but it can be abused. In complementary medicine, we have regrettably little tradition of sound research and even less precedent of critical analysis. Thus some promoters employ science as a drunken man uses a lamppost - for support rather than enlightenment. Critical analysis remains an alien concept and is often denounced as something negative, threatening or even destructive. Yet critical analysis is a precondition for progress, and uncritical promotion leads precisely nowhere.

Therefore, it is the ability for critical thinking that makes a good researcher, in complementary medicine as much as in any other field. In the words of Pasteur: "Venerate the critical spirit ... without it all else is nothing. It always has the last word."

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