Conducting research in Traditional, Complementary and Integrative Medicine (TCIM) should be just as rigorous as mainstream healthcare, but aspects of TCIM mean that different approaches to research are often required, for a number of reasons.
Firstly, TCIM interventions are often complex interventions, for example herbal medicine prescriptions, or an aromatherapy massage, will contain multiple components, in contrast with usually single compounds used in a pharmaceutical intervention.
Secondly, TCIM interventions are usually personalised to the individual, so that even patients with the same health concern will receive an individualised intervention – for example an aromatherapist would assess each client’s needs and apply a personalised blend of essential oils to suit. In contrast, a pharmaceutical compound will be standardised and have defined dosage regimes, so studies of drugs would involve a high degree of standardisation – all patients receiving the standard dose.
Thirdly, TCIM interventions are delivered within a therapeutic relationship between client and practitioner, and this has an impact on the effects of the TCIM intervention – for example by helping relieve stress and even encouraging other healthy lifestyle choices by the client. Therapeutic relationships happen across many areas of mainstream healthcare as well, but they are a particular feature of TCIM.
Health research produces evidence of different types, from a single patient observation (a case report), to large studies of many hundreds, or even thousands of patients. Randomised controlled trials (RCT) are considered to be the highest quality of evidence for health interventions, they compare different interventions, or compare an intervention with a control group that has a ‘dummy’ intervention (placebo). Patients in the trial and the health professionals delivering the interventions are completely blinded to which patients actually receive the trial intervention or the placebo, to reduce the chances of inadvertent influence on the results, such as a psychological impact. This study design will measure a few defined health markers, such as blood pressure, or cancer survival rate, and generates results that are considered to be very reliable. This allows guidance to be developed for healthcare professionals to follow, and is the basis of Evidence-Based Medicine (EBM). However, RCTs are not always possible for TCIM interventions, for example, a patient would know if they had a massage or not. Also, the complex individualised interventions that are characteristic of TCIM are not easy to study with conventional RCT trial designs, although for single standardised herbal medicines, for example, it is more feasible to study in an RCT.
At SaTA, we support researchers to develop and implement research strategies and methods that generate reliable evidence, so that TCIM can be researched, giving results that the healthcare community and potential users of TCIM, can have confidence in.