Seguimiento y Control de Riesgos

In the UK CAM research has been gradually taking shape as a new arena of academic study emerged in the 1990s but largely operating without a funded institutional base. A new profile academic emerged with CAM practitioner-teachers in the post-1992 universities, whose expertise resided less in their academic and research profile than with their professional experience. Locating CAM practices within Higher Education has been contested as lacking academic rigor and scientific validity (Singh and Ernst, 2008). Research capacity building in CAM within Higher Education has been supported by a three year Department of Health initiative (awards made in 2003, 2004 and 2005). Academic inquiry into CAM practices is not restricted to dedicated university departments, but increasingly CAM is regarded as a legitimate field of academic inquiry within established departments of health, nursing, sociology and psychology. The field is diverse with the nature and role of research defined by the academic context or CAM modality. As a practitioner my interests are in contesting the imposition of biomedical research designs and in adapting research technologies that are congruent with and inform daily practice

Significantly it has taken authority figures from outside the medical profession to bring stakeholders into dialogue and consensus building. Integrated Healthcare: A way forward for the next five years? A discussion document (FIM, 1997) was the culmination of a series of working groups set up on the initiative of HRH Prince of Wales. The aims of the discussion document was to encourage greater research awareness and skills among the CAM professions, utilise a wider range of both quantitative and qualitative research methods, make funding available for CAM research and improve communication with the gatekeepers to NHS resources. The charity Foundation for Integrated Medicine with HRH Prince of Wales as president (re-launched as The Prince’s Foundation for Integrated Health in 2002 and closed 2008) was set up to promote the development and integrated delivery of safe, effective and efficient forms of healthcare through encouraging greater collaboration between all forms of healthcare.

The UK Government set up an inquiry into CAM’s regulatory structures, evidence base, information resources, training and potential NHS provision. Over 15 months, the inquiry received more than 180 written submissions and took evidence from 46 different bodies. The

House of Lords Select Committee on Science and Technology report on CAM (2000) represented a significant landmark in CAM research and has continued to act as a point of reference in debates on CAM regulation. In an attempt to differentiate between CAM therapies, three broad groupings were identified. Homeopathy was categorised in Group One, alongside osteopathy, chiropractic, acupuncture and herbal medicine. Group One was defined as professionally organised disciplines with their own diagnostic approach, with some scientific evidence of effectiveness and recognised systems of training.

The report highlighted the paucity of ‘high quality’ CAM research and cited commonly given reasons for this including lack of research training for CAM practitioners, inadequate funding, poor research infrastructure and methodological issues. The report reinforces the importance of large scale randomised controlled trials (RCTs) to establish efficacy. The role of qualitative studies and the use of patient satisfaction in evaluating treatment was recognised. The report argued that the controversy over the underlying mode of action in homeopathy, should not inhibit the principle of clinical freedom, especially, where a treatment has few, if any, adverse effects. A lasting contribution to develop CAM research was the call for Government backing to make funds available for CAM research and the dissemination of research and research skills from academic centres. This is seen as the first step in enabling CAM to build up an evidence base with the same rigor as that required of conventional medicine.

These recommendations became reality when in 2003 the Department of Health announced a research capacity building initiative over three years. Each year, through a bidding process, five Higher Education institutions could host CAM research projects. This had a direct impact in homeopathy with projects funded at the University of Sheffield for RCT design under the direction of Elaine Weatherley-Jones and Brunel University for an ethnographic study under the direction of Christine Barry (both of whom are referenced in this thesis). Unfortunately the whole initiative was cut before reaching completion, possibly indicating a lack of political commitment to CAM.

Another landmark in developing CAM research culture was the two day seminar ‘Assessing Complementary Practice: Building consensus on appropriate research methods’, jointly hosted by the King’s Fund and The Prince’s Foundation for Integrated Health in October 2007. This event brought together leading figures in biomedical and CAM research, including the Chairman of the National Institute for Health and Clinical Excellence. As a participant I gained a sense of an intention to move the debate forward into action. The most significant discussions began to unpack how clinical research is shaped by reliance on funding from pharmaceutical corporations. Whilst it is impossible to reduce the event to a series of outcomes, I came away with a sense that CAM researchers articulated a distinctive approach to research congruent with CAM practices, and that representatives of institutionalised biomedical power were beginning to recognise that it is not always appropriate to demand that biomedical research methods are applied to CAM.