Commentary on Smith GD (2011) Editorial: Evaluation of CAM interventions. Journal of Clinical Nursing 20, 921–922

Abstract

I was stimulated by the recent editorial by Smith (2011) on the need for good quality research on complementary and alternative medicine (CAM) for nurses. The piece also highlighted the role of clinical nurses in actively conducting valid research into the effectiveness of CAM and advocating methodologies including ‘complex interventions’. Smith’s discussion and review of CAM research methods are a useful contribution. It will help to make practitioners and researchers aware of the inherent problems. Whether the problems are different where the research is being carried out by clinical nurses is debatable – it is the methods and conclusions that matter. There is, however, an important body of CAM research – not discussed in the editorial – that has emerged from the Peninsula College of Medicine and Dentistry led by Edzard Ernst, Professor of Complementary Medicine. Ernst et al. (2006) have used the rigorous method of systematic review (arguably still at the pinnacle of the evidence hierarchy) and a dedicated commitment to evidence-based practice, to produce, among other outputs, their handbook. This is intended to guide healthcare practitioners through the solid research evidence to assessment of the value of various CAM therapies. Searchable by therapy and disease/condition, the handbook offers nurses a substantial access to the research on CAM that has already been conducted. This and other work are important for any nurse to be aware of before undertaking original research including the complex interventions advocated in Smiths editorial (Smith 2011). It is also crucial to appreciate that the contribution to this field by the Peninsula Medical School comes from the inside of conventional mainstream medicine rather than from the media or alternative practitioners. Ernst’s approach is that of scientific medicine and ‘science’ having credibility and integrity (usually), a view strongly promoted again from the inside of orthodox healthcare (Goldacre 2009). For practitioners, an evidence-base of reliable assessment and recommendation is crucial. If reflexology and homoeopathy are demonstrated to be no more than placebo and chiropractic to be potentially dangerous, nurses need to be sure of the strength of the evidence. For the patient who comes with a printout from the internet recommending Therapy X, the nurse is offering an evidence-based review and needs to be confident. This case has been argued most persuasively by Gray (2008) when considering the position of 21st century clinicians in the face of the information explosion as it applies to health. Gray was then Chief Knowledge Officer to the NHS. CAM remains a key test-bed for the evidence-based approach. The author has no conflict of interest to declare.