Stop testing Chinese and homeopathic treatments

 For these healing disciplines where the interaction between therapist and patient are so closely entwined and it’s difficult to show consistent benefit over sham or placebo, I propose we stop testing these treatments.

We would do better to test the therapists.

Here’s why

• 112 adults with knee osteoarthritis were randomly assigned to qigong therapy or sham treatment (control).
• Group 1 was treated by a qigong therapist.
• Group 2 was treated by different qigong therapist.
• Group 3 was treated by a pseudeotherapist (sham treatment group).
• Groups 1 and 2 improved significantly by the end of treatment.
• But Group 1 was significantly more improved vs. Group 2.
• At the end of the study, the improvement in Group 2 didn’t differ from Group 3 (sham).

The bottom line?
Improvement was related to the skill of the qigong therapist, not the treatment alone.

We usually think of clinical studies as being designed to test treatments (ie, drugs, surgical procedures). In Western medicine, once the diagnosis is made, in most patients the treatment is relatively routine and prepackaged. In Chinese and homeopathic medicine, treatment seems to require individual modifications and fine-tuning to the point that it’s difficult to document efficacy in the allopathic sense.

If it’s true that Chinese medicine and homeopathy are so highly based on the skill of the therapist, perhaps for these disciplines we’re testing the wrong thing. Why not test the therapist rather than the treatment?

Using the study above as an example, before permitting a qigong therapist to claim the ability to successfully treat osteoporosis of the knee, we might have that person pass a course followed by a demonstration study (practicum). The objective being to document that a significantly higher percentage of these patients when treated under controlled conditions, respond better to that qigong therapist than to an untrained (placebo) pseudotherapist?

This wouldn’t be part of the entry-level practice criteria — the number of patients needed would be too large. But it could serve as a form of advanced board certification. It would permit those who pass the placebo-controlled practicum to promote their expertise as board certified specialists in that specific area of treatment.

I’d be interested in comments, particularly as to the validity of the concept rather than the logistical issues.

4/20/09 14:54 JR