Research is the process of discovering new knowledge. There are three somewhat overlapping types of research:
- Exploratory research tackles a problem that has not yet been clearly defined and aims to gain a better understanding of the nature of the issues involved with a view of conducting more in-depth investigations at a later stage.
- Descriptive research creates knowledge by describing the issues according to their characteristics and population. It focuses on the ‘how’ and ‘what’ rather than on the ‘why’.
- Explanatory research is aimed at determining how variables interact and at identifying cause-and-effect relationships. It deals with the ‘why’ of research questions and is therefore often based on experiments.
The motivation for doing research in medicine does, of course, vary. Sadly, for some it might be money, for others ambition or fame. But ideally it should be the wish to help advance our knowledge and thus create progress. The vast majority of scientists that I ever met lived up to this ideal.
I have been a researcher in several areas of medicine; my three main topics were: physical medicine and rehabilitation, blood rheology, and so-called alternative medicine (which I abbreviate SCAM these days). In all of them, my type of research was mostly explanatory, i.e. formulating a research question and trying to answer it, if possible with quantitative data. Looking back at my years as an active researcher, I find remarkable differences between doing research in SCAM and the other subjects.
New medical knowledge generated by research may be useful or useless but it should not regularly generate huge amounts of contention. Of course, there can be debates about the reliability of the findings; this is entirely legitimate, helpful, and necessary. We always need to make sure that results are valid, reproducible, and true. And of course, the debates about these issues can generate a certain amount of tension. Such tensions are stimulating, can create progress, and must be welcomed. I have been lucky to experience them in all areas of research I ever conducted.
The tension I experienced while doing SCAM research, however, was on a different scale and of a different nature – so much so that I would not even call it ‘tension’; often it seemed more like outright hostility. While doing non-SCAM research, it had never been in doubt that my work was honestly aimed at creating progress. Yet, this issue became the focal point after I had started SCAM research.
- When my research showed that homeopathy might not be effective, I got PERSONALLY attacked by homeopaths.
- When my research showed that homeopathy might not be safe, I got PERSONALLY attacked by homeopaths.
- When my research showed that chiropractic might not be effective, I got PERSONALLY attacked by chiropractors.
- When my research showed that chiropractic might not be safe, I got PERSONALLY attacked by chiropractors.
- When my research showed that acupuncture might not be effective, I got PERSONALLY attacked by acupuncturists.
- When my research showed that acupuncture might not be safe, I got PERSONALLY attacked by acupuncturists.
- When my research showed that herbalism might not be effective, I got PERSONALLY attacked by herbalists.
- When my research showed that herbalism might not be safe, I got PERSONALLY attacked by herbalists.
Essentially, doing SCAM research felt like doing research not FOR but AGAINST those who should have had the most interest in it.
But why? Isn’t research a good thing?
As I said, one way to describe research is as a process of discovering new knowledge and creating progress. For me, the main difference between doing research in SCAM and non-SCAM areas was perhaps this: in conventional medicine, most players are interested in discovering new knowledge and creating progress (historically, this was, of course, not always the case but in the era of evidence-based medicine it has become the predominant attitude). By contrast, in the realm of SCAM few players are truly interested in new knowledge. Much of SCAM is based on traditions, and traditions might be endangered by new knowledge. To put it bluntly: medicine tends to be open to research and its consequences, while SCAM is mostly anti-science and not interested in finding the truth or making progress.
But why? Isn’t progress a good thing?
To me, the answer seems obvious: in SCAM, finding the truth and making progress would be bad for the business. As rigorous research would discover the truth about SCAM and as the truth rarely favours SCAM, it must be resisted.
Two examples might make the contrast clearer.
- If researchers discover that a much-used conventional medicine, say Aspirin, can cause serious problems such as stomach bleeding, the average GP would welcome this knowledge and consider to be progress. They are henceforth able to take it into account, and might thus even save lives.
- If researchers discover that chiropractic spinal manipulation might cause a serious problem such as a stroke or death, the average chiropractor might worry about their livelihood. Typically they would deny a causal relationship, claim that conventional medicines are much more dangerous, and carry on as before.
To express it succinctly:
- Take the Aspirin away from a GP, and they will use other options.
- Take spinal manipulation away from a chiropractor, or the acupuncture needle from an acupuncturist, and they will go bankrupt.
From this perspective, much of the tension and hostility I experienced while doing SCAM research can be seen as a defensive reaction of SCAM practitioners who are afraid that research might threaten the status quo and thereby endanger their livelihood. This reaction might be defensive, but sadly it does not defend the best interest of the patient.