gms | German Medical Science

It is accepted that different concepts exist in medicine such as Complementary Medicine (CM) and Scientific Medicine (SM). It is also accepted that these concepts include different goals. The conflict between CM and SM emerges at the level of explicit definition of the goals and of methods that are necessary to confirm the attainment of the intended goals. CM includes the patient’s right to realise his personal view (preference) in the management of the disease. An essential part of the concept is the patient’s own contribution. The concept of SM inherits the demonstration of “efficacy”, i.e. the demonstration of an effect under the ideal conditions of a clinical trial. “Efficacy” has to be distinguished from “effec-tiveness”, i.e. the demonstration of an effect under day-to-day conditions. Demonstration of efficacy and effectiveness represent the view of clinical epidemiology but not the patient’s view, which is focussed on the emerging benefit. Therefore, two aspects are different in SM and CM, the ideal versus real condition and the effect of a vehicle (drug, radiation, surgery) versus effect of the patient himself. At the level of explicit description of the goals the conflict between SM and CM emerges. When different goals are intended it is plausible that different methods are necessary to dem-onstrate the goal attainment. Clinical trials are ideal methods to demonstrate the efficacy of a vehicle, e.g. drug under ideal conditions. If the effectiveness under day-today conditions is to be shown the clinical trial is not useful because the sequence of decisions in a clinical trial is different from the sequence of decisions in day-to-day medicine. Clinical trials are also not useful to assess the influence of patient’s preferences as they are explicitly designed to ex-clude the doctor’s and patient’s preferences. The results of clinical trials will be only one of several criteria that influence preferences. In CM we investigate the influence of different preferences on the final outcome based on comparable baseline risks of the treatment groups. The second aspect of CM is related to the perspective. Clinical trials reflect only the perspective of clinical epidemiology while the methods of CM reflect the patient’s perspective. Providing evidence means to provide data that support the attainment of the intended goals. Once the goals and dimensions and conditions of goal attainment are defined it is no longer difficult to provide the evidence in CM.