CAM before the storm: authors' reply

Editor—Predictably, our editorial on the integration of complementary therapies (CAM) into the NHS failed to satisfy the enthusiasts or sceptics.¹

We do not think that the debate about appropriate evaluative methodologies has been resolved. For example, the distinction between contextual and specific effects is problematic, as is the choice of controls for complex interventions. The quality of the debate is not enhanced by rhetorical flourishes such as “scientific evidence ignored” in Canter and Ernst's letter, or the notion that we “appear nervous” at the National Institute for Health and Clinical Excellence (NICE) taking on the task of incorporating CAM into guidelines.² We would be delighted. We do not think that politics and scientific medicine are as distinct as they imply in their last sentence, as revealed in even a cursory look at the history of medicine or the social epistemology of science.³,⁴

We think that pragmatic randomised controlled trials do have greater external validity than explanatory trials⁵ and find the notion that they are “methodologically weaker” bizarre.

CAM's popularity continues to grow along with the call for its integration into the NHS. We repeat our view that CAM interventions should be subjected to rigorous evaluation using appropriate methodologies. We are convinced this needs to be a collaborative effort between trialists, health service researchers, complementary therapists and, not least, patients..