High-Quality Studies in Complementary and Alternative Medicine are Necessary
The authors describe a trial on the treatment of chronic back pain with leeches (1). Clinical research on complementary medicine is certainly welcome, but quality must be respected. The primary criticism of the trial is the unbalanced symptom load of the patients between the groups. While >90% had already had negative experiences with complementary and alternative medicine in the control group, the proportion was about 50% in the treatment group. Additionally, there was a significantly higher use of medications in the control group prior to the intervention.
Another point of criticism relates to the authors’ statistical plan, which contains no information on key performance indicators. The more scales and questionnaires are used, the blurrier it becomes. The bias in assessing effects does not become diminished by the authors seeking to postulate it away.
Patients who take part in a trial invest a lot: time, hope, forgoing other therapies outside the trial. It must be ensured that this investment makes sense: the trial should provide good treatment for the patients in all arms, and the results should contribute to increasing knowledge. An erosion of the smart practices of evidence-based medicine harms all medical specialties and increases the patients’ uncertainty as well as distrust of physicians and “the system”.
The publication (and recognition) of low-quality studies in the field of complementary medicine also leads to a systematic devaluation of the subject (2). By creating special therapeutic fields (homeopathy, anthroposophy and phytoptherapy) that therefore lack evidence for therapy effectiveness, this can in the extreme case lead to making it difficult to develop a high-quality research culture for complementary medicine.
Prof. Dr. med. Jutta Hübner
Klinik für Innere Medizin II
Hämatologie und Internistische Onkologie
Prof. Dr. med. Oliver Micke
Prof. Dr. med. Jens Büntzel
Conflict of interest statement
Prof. Büntzel is a member of the WG “Prevention and Integrative Oncology” (PRIO) of the German Cancer Society.
The remaining authors declare that no conflict of interest exists.
|1.||Hohmann CD, Stange R, Steckhan N, Robens S, Ostermann T, Paetow A, Michalsen A: The effectiveness of leech therapy in chronic low back pain—a randomized controlled trial. Dtsch Arztebl Int 2018; 115: 785–92 VOLLTEXT|
|2.||Huebner J, Micke O, Muecke R, Prott FJ, Stoll C, Muenstedt K: Comparison of reviews in complementary and alternative medicine (CAM) in oncology: do results depend on methodology? Trace Elem Electrolytes 2013; 30: 139–45 CrossRef|