Methodological issues in complementary and alternative medicine research: A personal reflection on 10 years of debate in the United Kingdom
There are certain immediate and obvious problems in using conventional research techniques for the evaluation of complementary and alternative medicine (CAM). These have led some to argue that alternative medicine requires alternative methodologies. The experience in the United Kingdom has been that existing methodologies can be adapted and do not have to be discarded wholesale. Conventional research has developed a set of powerful techniques for generating reliable knowledge and these have been used with considerable success in a variety of different settings. In retrospect, the call for new methodologies appears to have been a reaction against the perceived dominance of the randomized controlled trial (RCT). This stemmed from the misperception that the RCT inevitably involves features, such as placebo controls or double-blinding, which are not feasible in many CAM therapies. There was also a desire to ask questions about medicine, the answers to which, it was felt, could not be decided by the RCT. A variety of different research designs need to be used to answer the variety of questions important in CAM. However, research designs do not have to be reinvented: appropriate methodologies can normally be found in one or another of the diverse branches of medical research. Successful research has been conducted in CAM using conventional research techniques and this refutes the claims that such techniques are inappropriate for CAM. Solving methodological problems in CAM is a matter of following simple guidelines, not the creation of complex and esoteric research designs.