The Mismatch Between Personal Experience of Healing (in Patient or Therapist) and Currently Accepted Forms of Evidence

I t appears that conventionally, what our patients tell us day-to-day of their change in health for the better is not supported, and their experiences are not held to be valid “evidence,” but are written off as “anecdotal” instances and are therefore not reliable in judging a therapy. The oft-repeated maxim “the plural of anecdote is not evidence” comes to mind, and much of the development of methodology in randomized controlled trials (RCTs) over the years has been directed toward reducing “bias” potentially introduced into assessments of treatments by just such factors as people's expectations and wishes and their individual responses to therapies. It seems now that all medical interventions, in order to be judged worthwhile, must be tried in the fire of an RCT, which can only give a statistical answer and does not answer the question individuals will always have: “Has this intervention helped me personally?”

The important thing to do seems to be to read all that is available (www.facultyofhomeopathy.org/research/) and not just dismiss things because they don't coincide with your worldview. This works both ways. The tale of results in homeopathy offers an example from therapies regarded as CAM. The tale of selective serotonin reuptake inhibitors (SSRIs) in mild-to-moderate depression offers a comparable example in conventional treatment.

Homeopathy has been repeatedly “shown” to be no more than a placebo. For example, the British House of Commons select committee concluded this in 2008 (www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4509.htm), basing much of its opinions on the well-known article of Shang et al. ¹ in The Lancet. This article was written by researchers, at least one of whom has been notoriously “opposed” to homeopathy, and it has been much discredited in its bias, methods, and results. ^2,3 However, it is taken as the standard to effect a major change in attitudes to and provision of homeopathy within the British National Health Service (NHS).

Most psychiatrists and general practitioners have come to widely use SSRI antidepressants, but if the results (many of which were obtained using freedom-of-information legislation) of all RCTs using them in mild-to-moderate depression are amalgamated, they would appear to work no better than placebo. ⁴ It must be emphasized that these are RCTs, yet doctors do not stop using SSRIs because this evidence says so.

It is of great note that therapies that were long regarded as “alternative” have gradually made their way into the mainstream. For example, acupuncture is now practiced by many doctors and physiotherapists in the NHS, and the BMJ publishing group now runs a journal dedicated to it. This rise in “respectability” seems to me to be only in part due to the increased amount of trials done, although many will say the respectability has grown only because of trials. It also appears that acupuncture is increasingly perceived as solving clinical problems for which conventional medicine has not got an answer.

In light of some CAM helping some people some of the time when conventional evidence based medicine (EBM) cannot help, the vitriol directed at CAM by people who only seem to have experience with EBM is astonishing. The willingness of people to comment on things they have no direct knowledge of in this area is truly frightening. (See the comments after a well-worded piece about homeopathy ⁵ ).

The director of the National Institute for Clinical Excellence in Britain, the body responsible for deciding which therapies to recommend for use within the NHS, stated that RCTs should not be the form of evidence used to decide a therapy's validity in all cases. ⁶ This was certainly not said as an endorsement of homeopathy or other nonconventional treatments, but it does make the point that RCTs are not the only way of assessing treatments and in some cases, there might be more appropriate ways.

People practicing nonconventional therapies tend to learn about advances in their subject or of new techniques by studying case histories of individuals. They do not usually rely on average responses of large data sets and so big “n” numbers. For therapies that are very much individualized, such as homeopathy, an individualized method of assessment would seem appropriate. Such an example is the Delphi program in homeopathy (www.delphi-project.com), which collects well-documented cases and analyses from them. Of course, such a form of investigation is very time- and labor-intensive, but it would appear to be the main route toward changing the current received opinion about CAM and the applicability of RCTs.