Health: Just don't ask for evidence

WHICHEVER WAY you look at it, this week marked a watershed in medicine. The British Medical Journal, the most authoritative medical publication in the UK and across much of the world, has launched a guide to complementary medicine.

It is an extraordinary development. Richard Smith, the irrepressible editor of the BMJ, described it as a "new dawn". The series is intended to provide an evidence-based guide to which treatments work and which do not in the colourful world of unorthodox therapy.

Cynics, however, will see this as a triumph of superstition over science. It is barely a decade since the British Medical Association dismissed alternative medicine as a "passing fashion". That judgement owed more to wishful thinking than to accurate social observation. But it did reflect the disdain felt by many who regarded the entire enterprise as a fraud.

The argument ran that complementary techniques had not been tested. They were not scientific and had not been subjected to the rigour of controlled trials. Without hard evidence, how could anyone claim that these approaches worked?

No matter. The "passing fashion" of the Eighties has developed into one of the most powerful social trends of the Nineties. By 1994, so many GPs were seeking training in complementary therapies that the BMA was forced, grudgingly, to acknowledge that they might, for some patients, do some good. Now, in 1999, complementary medicine has been welcomed into the hallowed pages of the BMJ to take its place alongside orthodox medicine.

The move may surprise some of the BMJ's rivals. It is hard to imagine a similar series appearing in the New England Journal of Medicine. A year ago, that journal launched an attack on complementary medicine, warning that its uncritical acceptance posed a serious risk to patients' health.

One case cited was that of a nine-year-old girl with a brain tumour who died after her parents insisted that she be treated with shark cartilage instead of chemotherapy. The Journal thundered: "There cannot be two kinds of medicine - conventional and alternative. There is only medicine that has been adequately tested and medicine that has not."

This is what the opponents of complementary medicine fear: that after centuries of advance in orthodox medicine, the world is slipping back to a pre-scientific mindset. Disappointment with orthodox medicine at the end of the 20th century is understandable, but that is not a reason for embracing a belief in magic.

The BMJ insists that its series, written by two GPs based at the Research Council for Complementary Medicine, is rigorously evidence-based. But, it seems to me, there is a risk of confusing the medicine with its delivery. Complementary medicine consultations are lengthy and the therapists make it their business to listen, understand and offer support.

With that kind of treatment, is it so surprising that patients often get better?

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