MJA 2004; 180 (2): 95-96
Obstacles to Research in Complementary and Alternative Medicine
R Frank Gorman
PO Box 211 Marrickville, NSW, 1475.
To the Editor:
Ernst raises the matter of obstacles to research in complementary and alternative medicine.
With respect to spinal manipulation therapy as an alternative medical approach to constitutional ailments, such as migraine, the key evidence is the recovery of vision, which occurs with spinal manipulation in appropriately ill patients. These data have not been acknowledged by this Journal because randomised controlled trials have not been performed.
Ernst says, “Randomisation is only ethical if there is substantial uncertainty about the best treatment for that patient.” (1) Applied to the recovery of vision with spinal manipulation, this ethical principle prevents any randomised trials from being performed in studying that phenomenon.
In 1992, I sent 12 consecutive patients demonstrating constricted visual fields to four senior fellows of the then Royal Australian College of Ophthalmologists. The patients were examined by those consultant scrutineers, who agreed that the visual fields were constricted in all occasions. The patients were seen at independent locations, and I was present only on one occasion. The patients were then treated by spinal manipulation under anaesthesia, with immediate recovery of the visual fields being noted on wakening from anaesthesia. (2) This recovery of vision merely reiterated many earlier anecdotal demonstrations. (3-5) In every case, the scrutineers agreed that the vision had recovered when, at an independent location subsequent to the treatment, they saw the patients.
Further, when Stephens and his associates, including me, treated 17 patients by outpatient chiropractic spinal adjustments, that entire group showed immediate improvement in the visual fields, as measured by computerised static perimetry. (6)
Sletteberg and his associates found that 55% of patients with constricted visual fields of the type under discussion still had the visual disability on re-examination on a mean review period of 7 years after orthodox treatment. (7) Kathol and his associates also found that 55% of these patients still had the visual disability at a mean review period of 4 years. (8) When the 100 per cent improvement obtained by spinal manipulation is compared with results of orthodox medical treatment (45% improvement at mean review periods of 7 and 4 years), it is clear that spinal manipulation is more effective than orthodox medical treatment, so much so that to repeat the experiment would be unethical.
In my personal experience, the main obstacle to research of complementary medicine precepts has been the censorship of dissenting data from orthodox medical literature. The most blatant example of this is the studied neglect of the “tunnel vision information”: the knowledge that vision improves in appropriately ill patients when the spine is manipulated.
1. British Medical Association. Medical ethics today, its practice and philosophy. London: BMA, 1993
2. Gorman RF. The treatment of visual perception defect by spinal manipulation: a prospective peer-reviewed study of twelve consecutive patients. 24th Annual Scientific Congress of the Royal Australian College of Ophthalmologists. 1992 Nov 1-6; Sydney
3. Langford-Wilson A. New view of tunnel vision. The STAR (Mt Isa) 1982; 14 Sep
4. Howarth J. Claims of answer to vision scourge. The NT News (Darwin) 1982; 13 Nov: 17.
Morrison J. A dangerous twist. 60 Minutes. TCN Channel 9, NSW, 22 Jun 1986
5. Stephens D, Mealing D, Pollard H, et al. Treatment of visual field loss by spinal manipulation: a report on 17 patients. J Neuromusculoskeletal Sys 1998; 6: 53-66
6. Sletteberg O, Bertelsen T, Hovding G. The prognosis of patients with hysterical visual impairment. Acta Ophthal 1989; 67: 159-163
7. Kathol RG, Cox TA, Corbett JJ, Thompson ST. Functional visual loss — a follow-up of 42 cases. Arch Ophthalmol 1983; 101: 729-735
Director, Complementary Medicine,
Peninsula Medical School,
Universities of Exeter and Plymouth, UK.
Gorman’s story is characteristic of complementary/alternative medicine (CAM): someone makes an observation inconsistent with current medical teaching, and subsequently becomes convinced that therapy X is “100 per cent” effective. Yet clinical trials are never conducted and therapy X assumes somewhat of a cult status. Its proponents name various reasons why clinical trials are unavailable. In some instances (not in the case of spinal manipulation for recovery of vision), clinical trials do eventually emerge. These show that therapy X does not work. Proponents view this as a confirmation of their conspiracy theory. Eventually the cult status of therapy X becomes established.
This dangerous scenario would be avoidable if CAM proponents understood the role of science in testing emerging treatments. It is, of course, not unethical to conduct a randomised trial on spinal manipulation for recovery of vision. Sure, randomisation is only ethical if there is uncertainty, but to deny that uncertainty exists is unreasonable — as is the notion of “censorship of dissenting data from orthodox medical” journals. Gorman’s reference list shows that even CAM journals have resisted publishing the effects of spinal manipulation on vision recovery.
My conclusion is simple: science and medical publishing follow certain rules for good reasons. CAM should learn to follow them.
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