Building bridges to health

Complementary therapies can and should be studied with scientific rigour, argues David Peters, so that medicine as a whole may benefit

May 22, 2008

Edzard Ernst, Simon Singh and David Colquhoun were reported last month as saying that they wanted to "embarrass" universities for offering complementary therapies ("Experts criticise 'pseudo-scientific' complementary medicine degrees", 24 April).

We at the University of Westminster's School of Integrated Health are far from embarrassed. Our range of courses is an authentic attempt to bring the important areas of complementary therapies education, practice and research into the academic mainstream. We were among the first to do this more than a decade ago, and our aims are unchanged: to explore these therapies' role in augmenting conventional care and to produce the highest calibre of practitioners capable of critical thinking and safe practice and able to engage with the wider scientific and medical community. It is only through universities offering science-based complementary therapies degrees that the concerns of those such as Ernst, Singh and Colquhoun who worry that practitioners are merely tricking their patients, can be allayed.

Westminster's integrated health BScs include psychological and social science perspectives as well as biomedical sciences, alongside theories underpinning the specific therapy studied. Students use their acquired skills to explore these theories critically and to see what happens when they apply them in clinical practice, supervised by tutors who are themselves clinicians. To support this teaching, there is a strong emphasis within the courses on reflective practice, which also forms the backbone of staff development programmes and clinical teachers' supervision groups.

The bald assertion that complementary therapies are inherently "unscientific" is not useful; as phenomena of our time they deserve to be taught and researched in universities. But can a BSc in homoeopathy, for instance, ever be valid? Some scientists insist that homoeopathy cannot possibly work because its basic mechanisms remain elusive and evidence from clinical trials is equivocal. Yet clinical experience suggests that it can be effective; and implausible although some find it, various studies suggest that homoeopathy's outcomes cannot always be explained away as placebo responses. Moreover, because the range of complementary therapies is so diverse the question "do these therapies (as a whole) work?" is meaningless; although it is fair to say that there is insufficient negative research available to dismiss them out of hand. Meta-analyses of efficacy studies have generated more controversy than insight, largely because trials appropriately adapted for studying complementary therapies have been too few to fill the statistical mincing machine.

Complementary therapies underline philosophical problems - the mind-body relationship and the nature of experience - as well as hard scientific ones, such as how to research the therapeutic relationship and the organism's extraordinary capacity to self-regulate and occasionally heal itself against impossible odds. They raise sociological questions about complementary therapies' emergence and popularity, and about biomedicine's trajectory and sustainability. They also draw attention to the nature of complex interventions: how to teach and research approaches that - like complementary therapies, psychotherapy or physiotherapy - entail skill, individuality and engagement rather than just supplying pills.

It has been suggested that complementary therapies highlight medicine's deficits and downsides, and signify 21st-century aspirations for positive health and wellbeing. These are matters of significance at a time when conventional medicine is struggling with soaring costs and adverse publicity, lacks cures for chronic diseases and sees a declining commitment to traditional values of care. University departments where the practice of complementary therapies can be understood are ideal bases for the critical practice and research the field so badly needs. Although it takes time to develop a research culture and build bridges between disciplines, unless we succeed how will science come to accept (or finally reject) the potential of complementary therapies?

Science, because it can focus in on cells and organs or zoom out to explore "personhood" and culture, is a much broader church than Ernst, Singh and Colquhoun would have us believe. Must a science degree confine itself to "hard science", or can it embrace this whole territory? Westminster's School of Integrated Health has taken the wider view, and our graduates now achieve some of the university's highest employability ratings. Many students have gone on to postgraduate work in a range of health disciplines and a number are now undertaking doctoral degrees. Our graduates, as we set out to achieve, are engaging with the wider scientific and medical communities.

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