MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The volume of medical research, as listed on Medline, is huge and increases steadily each year. This phenomenon can easily be observed with simple Medline searches. If we use search terms related to conventional medicine, we find near linear increases in the number of articles (here I do not make a distinction between types of articles) published in each area over time, invariably with a peak in 2013, the last year for which Medline listing is currently complete. Three examples will suffice:

PHARMACOTHERAPY        117 414 articles in 2013

PHARMACOLOGY               210 228 articles in 2013

ADVERSE EFFECTS              86 067 articles in 2013

Some of the above subjects are obviously heavily industry-dependent and thus perhaps not typical of the volume of research in health care generally. Let’s therefore look up three fields where there is no such powerful industry to support research:

PSYCHOTHERAPY              7 208 articles in 2013

PHYSIOTHERAPY                7 713 articles in 2013

SURGERY                           154 417 articles in 2013

Now, if we conduct similar searches for topics related to alternative medicine, the picture changes in at least three remarkable ways: 1) there is no linear increase of the volume per year; instead the curves look flat and shapeless (the only exception is ‘herbal medicine’ where the increase even looks exponential). 2) The absolute volume does not necessarily peak in 2013 (exceptions are ‘acupuncture’ and ‘herbal medicine’). 3) The number of articles in the year with the most articles (as listed below) is small or even tiny:

ACUPUNCTURE                    1 491 articles in 2013

CHIROPRACTIC                      283 articles in 2011

HERBAL MEDICINE           2 503 articles in 2013

HOMEOPATHY                        233 articles in 2005

NATUROPATHY                         69 articles in 2010

You may think: so what? But I find these figures intriguing. They demonstrate that the research output in alternative medicine is minimal compared to that in conventional medicine.  Moreover, they imply that this output is not only not increasing steadily, as it is in conventional medicine, but in the case of chiropractic, homeopathy and naturopathy, it has recently been decreasing.

To put this into context, we need to know that:

  1. there is a plethora of journals dedicated to alternative medicine which are keen to publish all sorts of articles,
  2. the peer-review process of most of these journals seems farcically poor,
  3. as a result, the quality of the research into alternative medicine is often dismal, as regularly disclosed on this blog,
  4. enthusiasts of alternative medicine often see rigorous research into their subject as a dangerous threat: it might disprove their prior beliefs.

In their defence, proponents of alternative medicine would probably claim that the low volume of research is due to a severe and unfair lack of funding. However, I fail to see how this can be the sole or even the main explanation: areas of conventional medicine that do not have industry support seem to manage a much higher output than alternative medicine (and I should stress that I have chosen 5 sections within alternative medicine that are associated with the highest number of articles per year). Research in these areas is usually sponsored by charitable and government sources, and it needs to be stressed that these are open to any researcher who submits good science.

What follows, I think, is simple: in general, alternative medicine advocates have little interest in research and even less expertise to conduct it.

5 Responses to Intriguing statistics on the volume of alternative medicine research

  • “Research: The systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions.” (Oxford Dictionaries).

    “Research: A method whereby attempts are made to justify the otherwise un-justifiable.” (Dictionary of Camistry and Pseudo-science).

    Nuff said.

  • There is a lot more to this issue than just what is stated above. Friends who are non-medical researchers at Sydney University have expressed their regret that they are not medical based researchers as that is where the money is and many have lost their jobs or have gone overseas for work. The Danish model where a portion of every chiropractic consultation goes into a research fund is the way to go. Their research output reflects this increased funding. Secondly, a university environment where academic and research career pathways are available is essential. Even then the early career researchers need to be mentored and supported by well established late career researchers if their output is going to be taken seriously. Macquarie university has realised this and their PhD candidtes are working within the musculoskeletal division at The George Institute (Sydney University) with Prof Chris Maher.
    In regards to public funding options, the NHMRC here has had their funding reduced and private sources have also decreased, so you have more and more medical researchers chasing the same funding source. I’m sure you have had the delightful experience of chasing research grants and the politics of medical research. That is another reason why being mentored by a late career researcher who is adept at chasing the dollars is essential. There has been a recent discussion here about how early and late career researchers are both now chasing the same dollar and it doesnt look pretty for the young guns.
    I went to a seminar at Macquarie University earlier this year where John Sweeney gave a talk and it was on this exact subject. (John was involved in the World Federation of Chiropractic and the WHO in setting up chiropractic practice guidelines). He discussed that there has been a cultural shift in chiropractic where the number of PhD’s within the profession has increased markedly. I have noted a large increase in research over the last decade with many papers written in collaboration with medical and physiotherapy researchers, would these be acknowledged as chiropractic output in a medline search using medical terms and not subluxation or chiropractic? I did a quick search and many chiropractic papers in my library did not show up using those two terms. A quick look at chiropractic researcher Charlotte Leboeuf-Yde shows many articles that do not have chiropractic in the keywords. Currently she has 160 publications to her name!
    The Danish model is definitely the way to go and more countries should adopt it. I agree that the chiropractic profession needs to throw its support behind more research, but there is a lot more out there than your search shows!

    • Thinking_Chiro wrote: “…the chiropractic profession needs to throw its support behind more research”

      I think we know why it doesn’t. Bearing in mind that chiropractic was invented over 100 years ago, this is what the best research shows today:

      QUOTE
      “…it might be time to question for what conditions chiropractors and osteopaths, the two professions who use spinal manipulation/mobilisation most, do actually offer anything of real value at all. Back pain and SMT are clearly their domains; if it turns out that SMT is not evidence-based for back pain, what is left? There is no good evidence for anything else, as far as I can see. To make matters worse, there are quite undeniable risks associated with SMT. The conclusion of such considerations is, I fear, obvious: the value of and need for these two professions should be re-assessed.”
      Ref: http://edzardernst.com/2013/04/time-to-re-write-the-guidelines-on-spinal-manipulation-for-acute-low-back-pain/

      As for research funding, isn’t it strange that just as the Foundation for Chiropractic Education and Research (which funded for over 152 randomized controlled trials concerning chiropractic manipulation, and supported over 100 research fellowships leading to MS and/or PhD degrees) filed for bankruptcy…
      http://www.ebm-first.com/chiropractic/latest-news/1075-end-of-an-era-foundation-for-chiropractic-education-and-research-fcer-decides-on-self-liquidation-and-files-for-bankruptcy.html …the chiropractic marketing group, the Foundation for Chiropractic Progress, received *record* financial support of over $500K
      http://www.chiro.org/wordpress/?p=1151

      It would appear that the Foundation for Chiropractic Progress exists to conceal the fact that, despite decades of research, chiropractic cannot be recommended as an intervention for any condition.

      Interestingly, in 2011, a paper published in the Journal of the Canadian Chiropractic Association saw a chiropractor highlighting chiropractors’ real fears of the consequences arising from negative results of high quality research:

      QUOTE
      “I was recently bewildered when colleagues and chiropractic representatives feared the possible negative consequences of good quality research and of its dissemination within and outside the profession. Although I can understand the disappointment when negative results regarding spinal manipulation therapy are published, it should not come as a surprise that alternative therapeutic options may be as effective as chiropractic care, or that spinal manipulation may not be the most effective intervention for a given condition.”

      Ref: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154060/?tool=pubmed

      Funding for decent research might be an issue, but the main issue seems to be chiropractors’ deep apprehensions that such research could ultimately cost them their jobs.

  • Very interesting and very true.
    But we think That the lack of research is in large part due to from the past for the cultural war of the multinationals. Even in Religious hospitals not using herbs, That Are the mother of Medicine.

  • In reply to Blue Wode:
    “Funding for decent research might be an issue, but the main issue seems to be chiropractors’ deep apprehensions that such research could ultimately cost them their jobs.”
    If we can’t stand the research we should get out of the kitchen!
    These types of discussions are essential to the profession. Asking why, being prepared forward arguments, listening to counter arguments and being prepared to change is at the core of philosophy. That chiropractic futures document outlines several future paths for the chiropractic profession. For people like you and I Blue the most logical path is a no brainer.

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