The scientific basis of integrative medicine—Clinical research

Despite limited funding and research infrastructures, the amount and quality of clinical research in the area of complementary and integrative medicine have increased dramatically in the last two decades. Examples of interventions will be given for which there is now good evidence of specific effects over placebo, and of some others where there is evidence of no effect. However, in many areas the picture is not easy to interpret. For example, there is now a considerable number of large high-quality trials of acupuncture for chronic pain syndromes. The findings of trials comparing acupuncture with sham acupuncture interventions suggest only small or even no “specific” effects. On the other hand, trials comparing acupuncture to routine care or waiting list consistently show clinically relevant benefits, and in several areas these benefits seem to be at least equivalent to that of guideline-based standard treatments. Such findings put scientists and decision-makers into a dilemma: according to common thinking acupuncture might be “only a placebo”, but still it seems to be as or even more effective as proven therapies. While such challenging evidence is strongest in the area of acupuncture, studies on other complementary or integrative therapies suggest that so-called non-specific factors such as expectations, preferences and beliefs might have an important impact on trials outcomes. Future clinical trials have to take into account that the mechanisms postulated by proponents of many complementary and integrative therapies might only be one factor relevant to clinical effects. On a political level it has to be discussed whether pragmatic proofs of effectiveness are sufficient for accepting a therapy or whether the “scientific proof of specific effects over placebo” is always needed.

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