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Innovation and rigour in integrative medicine: Encouraging inclusive debate
Advances in Integrative Medicine 2 (2015) 121–122
Contents lists available at ScienceDirect
Advances in Integrative Medicine journal homepage: www.elsevier.com/locate/aimed
Editorial
Innovation and rigour in integrative medicine: Encouraging inclusive debate
Integrative medicine practice is constantly under attack by detractors. As with all disciplines, there are areas of integrative medicine that require critical attention. However, integrative medicine as a discipline is consistently decried as pseudoscientific, dangerous and an affront to modern medicine above and beyond most others [1]. These dogmatic attacks extend to research on integrative medicine, with commentators even proposing that ‘science-based medicine’ replace the modern standard of ‘evidence-based medicine’ and that this new standard restrict clinical investigation only to those therapies that have positive basic science studies [2]. Such proposals do little to advance science or medical knowledge. Not only do they incorrectly insist that ‘traditional’ knowledge and ‘scientific’ knowledge cannot co-exist [3], they also ignore the basic tenets of advancing clinical knowledge – which requires research of all forms, and is severely weakened by arbitrarily (or ideologically) excluding some forms at the expense of others [4]. At Advances in Integrative Medicine it is appreciated that integrative medicine is a field which combines well-known and amply researched therapies with those that may be more esoteric. In some cases these ‘esoteric’ therapies may be drawn from traditional knowledge, with long histories of use that can guide clinical practice and inform future research, even where no research currently exists. In other cases, these therapies may represent the result of advances in knowledge, or even the testing of medical hypotheses. The often criticised early adoption by integrative practitioners [5] of the now well-recognised concept [6] of the impact of gut microbiome on broader health is one example of the latter. As such, Advances will never exclude publication of papers because a therapy is too ‘esoteric’ or because the subject matter is controversial or unusual. In fact, the rigorous scientific testing and examination of those therapies should be actively encouraged, not discouraged. Advances will always encourage research into any integrative therapy with only two caveats – that any research be conducted both ethically and rigorously. Clinical grudges against therapies can all too often stymie good medicine. Even therapies that are dangerous and wholly inappropriate in certain circumstances may have some value. Thalidomide, for example, when used inappropriately for morning sickness caused untold and unending suffering to not only thalidomide users – but their children as well – and publicity surrounding these adverse events led to the compound being not only ignored, but further research into it being discouraged [7]. Recently, however, clinicians may be more familiar with its use as one of the most effective front line therapies for the blood cancer, multiple http://dx.doi.org/10.1016/j.aimed.2016.02.001 2212-9588/ß 2016 Published by Elsevier Ltd.
myeloma [8]. The outrage at the initial regulatory failure that allowed a product to be used in an inappropriate and unsafe manner was entirely valid – even more so given the abhorrent treatment and lack of compensation of victims [9]. However, it is also unfortunate that the stigma associated with thalidomide meant that the work exploring its valuable role in myeloma management was delayed by over 30 years [8]. Many integrative therapies also carry a stigma within the scientific community – particularly those that may be esoteric, innovative or untested – and Advances will not let stigma or clinical grudges advise what should and should not be published. In this issue, we publish the results of a study into one of these esoteric, innovative and untested therapies [10] – or more correctly an innovative and untested integrative medicine diagnostic tool (live blood analysis) – which has attracted controversy. Despite the controversy surrounding this product having a relatively high profile in forums, social media and submissions to government, there has been very little actual research conducted. We contacted over three dozen potential reviewers in over one dozen countries with relevant dark field microscopy or biochemistry content expertise to review this paper. None felt qualified to comment on this paper and few could nominate others that may have such expertise. Those who had written critically of the diagnostic tool were considered – but were excluded for the same reasons that most of the tool’s proponents were – because they were not dark field microscopy or biochemistry content experts. Eventually it was decided to conduct a purely methodological review. Clinical research and methodology experts were asked to evaluate whether the paper was methodologically sound and rigorous. Their comments resulted in improvements, and ultimately publication. Despite live blood analysis being based on theories developed by Enderlein in 1925, being relatively commonly used in clinical practice [11], and its use being routinely criticised in the medical literature, there have only been two small studies ever conducted on live blood analysis – both focusing solely on cancer [12,13]. The papers published in Advances therefore represent some of the first papers published in this area – hopefully the first of many to come. In integrative medicine, there are few real content experts in many innovative and untested therapies [14], even though many may hold themselves out as such. Many of the critics who denigrate integrative medicine as being pseudoscientific offer their ‘expert’ services freely yet do not usually possess the suitable skills or content expertise to provide peer review for our articles. Similarly, uncritical integrative medicine proponents may also offer their services but may also lack these skills. Advances is not interested in
122
Editorial / Advances in Integrative Medicine 2 (2015) 121–122
‘taking sides’ in debates, but in advancing knowledge of integrative medicine. All articles published in Advances will have undergone rigorous methodological review by content and methodology experts – not critics or proponents. Its pioneering nature is one of the attributes that makes integrative medicine such an exciting discipline to work in, but it does bring with it its own challenges. Notwithstanding the broader controversy surrounding integrative medicine, this innovative nature also means that much of the work we publish will be controversial. We do hope all articles published in Advances will generate discussion and debate and welcome further correspondence from our readers on any articles published or topics covered in the journal. Where possible, we will attempt to get authors to directly reply to any correspondence relating to their manuscripts. We do not expect readers (or editors for that matter) to agree with every word of every article. Our open approach to topics covered also brings a relatively significant risk that, from time to time, we may make mistakes that require correction. The aim of scientific journals is not merely to inform, but to advance knowledge. Such advancement cannot be successful if communication only runs one way. Readers are just as integral to this aim as authors and editors. For this reason we welcome your letters and will publish each and every one of them, and we hope to receive a lot more of them as we progress our journey.
[2] D.H. Gorski, S.P. Novella, Clinical trials of integrative medicine: testing whether magic works? Trends Mol. Med. 20 (9) (2014) 473–476. [3] J. Wardle, Respecting science, respecting tradition: evidence-based care in the integrative medicine professions, Aust. J. Herb. Med. 27 (2) (2015) 47–55. [4] S. Vohra, H. Boon, Advancing knowledge requires both clinical and basic research, Focus Altern. Complement. Ther. 20 (1) (2015) 32–33. [5] M.P. Fink, Leaky gut hypothesis: a historical perspective, Crit. Care Med. 18 (5) (1990) 579–580. [6] G.A. Cresci, E. Bawden, Gut microbiome: what we do and don’t know, Nutr. Clin. Pract. 30 (6) (2015) 734–746. [7] G.J. Annas, S. Elias, Thalidomide and the Titanic: reconstructing the technology tragedies of the twentieth century, Am. J. Public Health 89 (1) (1999) 98–101. [8] P. Moreau, M. Attal, T. Facon, Frontline therapy of multiple myeloma, Blood 125 (20) (2015) 3076–3084. [9] M. Magazanik, Silent Shock: The Men Behind the Thalidomide Scandal and an Australian Family’s Long Road to Justice, Text Publishing, Melbourne, 2015. [10] K. Reeve, et al., A comparison of differential leucocyte counts measured by conventional automated venous haematology and darkfield microscopic examination of fresh capillary blood, Adv. Integr. Med. 2 (2015). [11] A. Bensoussan, S.P. Myers, S.M. Wu, K. O’Connor, Naturopathic and Western herbal medicine practice in Australia-a workforce survey, Complement Ther Med. 12 (1) (2004) 17–27. [12] M. Teut, R. Ludtke, A. Warning, Reliability of Enderlein’s darkfield analysis of live blood, Altern. Ther. Health Med. 12 (4) (2006) 36–41. [13] S. El-Safadi, H.R. Tinneberg, R. von Georgi, K. Munstedt, F. Bruck, Does dark field microscopy according to Enderlein allow for cancer diagnosis? A prospective study, Forsch. Komplementarmed. Klass. Naturheilkd. (Res. Complement. Nat. Class. Med.), 12 (3) (2005) 148–151. [14] J. Wardle, J. Adams, Are the CAM professions engaging in high-level health and medical research? Trends in publicly funded complementary medicine research grants in Australia, Complement. Ther. Med. 21 (6) (2013) 746–749.
References [1] R. Moynihan, Assaulting alternative medicine: worthwhile or witch hunt? BMJ 344 (2012) e1075.
Jon Wardle Available online 3 February 2016
Contents lists available at ScienceDirect
Advances in Integrative Medicine journal homepage: www.elsevier.com/locate/aimed
Editorial
Innovation and rigour in integrative medicine: Encouraging inclusive debate
Integrative medicine practice is constantly under attack by detractors. As with all disciplines, there are areas of integrative medicine that require critical attention. However, integrative medicine as a discipline is consistently decried as pseudoscientific, dangerous and an affront to modern medicine above and beyond most others [1]. These dogmatic attacks extend to research on integrative medicine, with commentators even proposing that ‘science-based medicine’ replace the modern standard of ‘evidence-based medicine’ and that this new standard restrict clinical investigation only to those therapies that have positive basic science studies [2]. Such proposals do little to advance science or medical knowledge. Not only do they incorrectly insist that ‘traditional’ knowledge and ‘scientific’ knowledge cannot co-exist [3], they also ignore the basic tenets of advancing clinical knowledge – which requires research of all forms, and is severely weakened by arbitrarily (or ideologically) excluding some forms at the expense of others [4]. At Advances in Integrative Medicine it is appreciated that integrative medicine is a field which combines well-known and amply researched therapies with those that may be more esoteric. In some cases these ‘esoteric’ therapies may be drawn from traditional knowledge, with long histories of use that can guide clinical practice and inform future research, even where no research currently exists. In other cases, these therapies may represent the result of advances in knowledge, or even the testing of medical hypotheses. The often criticised early adoption by integrative practitioners [5] of the now well-recognised concept [6] of the impact of gut microbiome on broader health is one example of the latter. As such, Advances will never exclude publication of papers because a therapy is too ‘esoteric’ or because the subject matter is controversial or unusual. In fact, the rigorous scientific testing and examination of those therapies should be actively encouraged, not discouraged. Advances will always encourage research into any integrative therapy with only two caveats – that any research be conducted both ethically and rigorously. Clinical grudges against therapies can all too often stymie good medicine. Even therapies that are dangerous and wholly inappropriate in certain circumstances may have some value. Thalidomide, for example, when used inappropriately for morning sickness caused untold and unending suffering to not only thalidomide users – but their children as well – and publicity surrounding these adverse events led to the compound being not only ignored, but further research into it being discouraged [7]. Recently, however, clinicians may be more familiar with its use as one of the most effective front line therapies for the blood cancer, multiple http://dx.doi.org/10.1016/j.aimed.2016.02.001 2212-9588/ß 2016 Published by Elsevier Ltd.
myeloma [8]. The outrage at the initial regulatory failure that allowed a product to be used in an inappropriate and unsafe manner was entirely valid – even more so given the abhorrent treatment and lack of compensation of victims [9]. However, it is also unfortunate that the stigma associated with thalidomide meant that the work exploring its valuable role in myeloma management was delayed by over 30 years [8]. Many integrative therapies also carry a stigma within the scientific community – particularly those that may be esoteric, innovative or untested – and Advances will not let stigma or clinical grudges advise what should and should not be published. In this issue, we publish the results of a study into one of these esoteric, innovative and untested therapies [10] – or more correctly an innovative and untested integrative medicine diagnostic tool (live blood analysis) – which has attracted controversy. Despite the controversy surrounding this product having a relatively high profile in forums, social media and submissions to government, there has been very little actual research conducted. We contacted over three dozen potential reviewers in over one dozen countries with relevant dark field microscopy or biochemistry content expertise to review this paper. None felt qualified to comment on this paper and few could nominate others that may have such expertise. Those who had written critically of the diagnostic tool were considered – but were excluded for the same reasons that most of the tool’s proponents were – because they were not dark field microscopy or biochemistry content experts. Eventually it was decided to conduct a purely methodological review. Clinical research and methodology experts were asked to evaluate whether the paper was methodologically sound and rigorous. Their comments resulted in improvements, and ultimately publication. Despite live blood analysis being based on theories developed by Enderlein in 1925, being relatively commonly used in clinical practice [11], and its use being routinely criticised in the medical literature, there have only been two small studies ever conducted on live blood analysis – both focusing solely on cancer [12,13]. The papers published in Advances therefore represent some of the first papers published in this area – hopefully the first of many to come. In integrative medicine, there are few real content experts in many innovative and untested therapies [14], even though many may hold themselves out as such. Many of the critics who denigrate integrative medicine as being pseudoscientific offer their ‘expert’ services freely yet do not usually possess the suitable skills or content expertise to provide peer review for our articles. Similarly, uncritical integrative medicine proponents may also offer their services but may also lack these skills. Advances is not interested in
122
Editorial / Advances in Integrative Medicine 2 (2015) 121–122
‘taking sides’ in debates, but in advancing knowledge of integrative medicine. All articles published in Advances will have undergone rigorous methodological review by content and methodology experts – not critics or proponents. Its pioneering nature is one of the attributes that makes integrative medicine such an exciting discipline to work in, but it does bring with it its own challenges. Notwithstanding the broader controversy surrounding integrative medicine, this innovative nature also means that much of the work we publish will be controversial. We do hope all articles published in Advances will generate discussion and debate and welcome further correspondence from our readers on any articles published or topics covered in the journal. Where possible, we will attempt to get authors to directly reply to any correspondence relating to their manuscripts. We do not expect readers (or editors for that matter) to agree with every word of every article. Our open approach to topics covered also brings a relatively significant risk that, from time to time, we may make mistakes that require correction. The aim of scientific journals is not merely to inform, but to advance knowledge. Such advancement cannot be successful if communication only runs one way. Readers are just as integral to this aim as authors and editors. For this reason we welcome your letters and will publish each and every one of them, and we hope to receive a lot more of them as we progress our journey.
[2] D.H. Gorski, S.P. Novella, Clinical trials of integrative medicine: testing whether magic works? Trends Mol. Med. 20 (9) (2014) 473–476. [3] J. Wardle, Respecting science, respecting tradition: evidence-based care in the integrative medicine professions, Aust. J. Herb. Med. 27 (2) (2015) 47–55. [4] S. Vohra, H. Boon, Advancing knowledge requires both clinical and basic research, Focus Altern. Complement. Ther. 20 (1) (2015) 32–33. [5] M.P. Fink, Leaky gut hypothesis: a historical perspective, Crit. Care Med. 18 (5) (1990) 579–580. [6] G.A. Cresci, E. Bawden, Gut microbiome: what we do and don’t know, Nutr. Clin. Pract. 30 (6) (2015) 734–746. [7] G.J. Annas, S. Elias, Thalidomide and the Titanic: reconstructing the technology tragedies of the twentieth century, Am. J. Public Health 89 (1) (1999) 98–101. [8] P. Moreau, M. Attal, T. Facon, Frontline therapy of multiple myeloma, Blood 125 (20) (2015) 3076–3084. [9] M. Magazanik, Silent Shock: The Men Behind the Thalidomide Scandal and an Australian Family’s Long Road to Justice, Text Publishing, Melbourne, 2015. [10] K. Reeve, et al., A comparison of differential leucocyte counts measured by conventional automated venous haematology and darkfield microscopic examination of fresh capillary blood, Adv. Integr. Med. 2 (2015). [11] A. Bensoussan, S.P. Myers, S.M. Wu, K. O’Connor, Naturopathic and Western herbal medicine practice in Australia-a workforce survey, Complement Ther Med. 12 (1) (2004) 17–27. [12] M. Teut, R. Ludtke, A. Warning, Reliability of Enderlein’s darkfield analysis of live blood, Altern. Ther. Health Med. 12 (4) (2006) 36–41. [13] S. El-Safadi, H.R. Tinneberg, R. von Georgi, K. Munstedt, F. Bruck, Does dark field microscopy according to Enderlein allow for cancer diagnosis? A prospective study, Forsch. Komplementarmed. Klass. Naturheilkd. (Res. Complement. Nat. Class. Med.), 12 (3) (2005) 148–151. [14] J. Wardle, J. Adams, Are the CAM professions engaging in high-level health and medical research? Trends in publicly funded complementary medicine research grants in Australia, Complement. Ther. Med. 21 (6) (2013) 746–749.
References [1] R. Moynihan, Assaulting alternative medicine: worthwhile or witch hunt? BMJ 344 (2012) e1075.
Jon Wardle Available online 3 February 2016