Evidence-Based Health Care and Complementary and Alternative Medicine
At the heart of the issue of what constitutes acceptable therapeutic practice is the question of what therapeutic practice should be based on. The ideal propounded by many in the medical profession is that scientific research is the basis of practice; invalid therapies are those that are scientifically untested, a criticism levelled at complementary and alternative medicine (CAM). Moreover, this ideal propounds that a practitioner must be suitably trained at a reputable scientific institution where training is based on the most up-to-date scientific research (Bosk 1986, Rosenthal 1995). Once trained, practitioners should keep up with developments in their field with mechanisms put in place to ensure this occurs. A number of problems arise if this view is held. Much of what medical practitioners do, like CAM, has not been subjected to rigorous scientific scrutiny. The uncertainties of medical practice (Wallis 2009) and research (Henry 2006), variability amongst practitioners (Eddy 1984), and the untested basis of much of medical practice (Smith 1991) have been well documented. Even where there is evidence that is regarded as authoritative by evidence-based medical standards, where interventions have been successfully tested using randomised controlled trials (RCTs), there is still the problem of applying it to ‘the specific circumstances of an individual patient’ (Klein, Day and Redmayne 1996: 92).