Evidence-based complementary medicine: A contradiction in terms?

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Abstract
Complementary medicine (CM) has been defined as: “diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine.”1 It comprises well over 100 different therapies, each of which has little in common with the others, and proclaims to be a veritable panacea.2 Some of the most prevalent treatments are acupuncture, aromatherapy, herbalism, homoeopathy, reflexology, and spinal manipulation (chiropractic and osteopathy). To put it mildly, CM is a notoriously controversial area.3 At the same time, CM is immensely popular and increasingly profitable (for example, MacLennan et al .4) Up to one half of the general population is using some form of CM.4 5 With rheumatological patients, this figure is even higher.6 It is therefore timely to ask whether CM is, at all, evidence based. The apparently simple key question is, does it work? CM is often perceived as effective by those who use it. Perceived effectiveness can be viewed as being composed of specific and non-specific effectiveness,7 that is, therapeutic success can be brought about by a specific mechanism of the given treatment, for example, endorphin release after acupuncture, or by factors not directly related to the therapy itself, for example, empathy, time spent with the patient, expectation, etc. Each of the two elements can vary in size from almost 0–100% of the total therapeutic effect.7 It seems obvious therefore, that rigorous research should differentiate the non-specific from the …