Trustworthiness, Integration, and Standardization in SCAM – the desperate call for double standards in healthcare

An article entitled “Beyond the Appearance of Rigor: Trustworthiness, Integration, and Standardization in Traditional, Complementary, and Integrative Medicine” caught my eye. The name “Traditional, Complementary, and Integrative Medicine” is, I think, impressive as it demonstrates the seemingly infinite ability of SCAM-promoters to come up endlessly with new and ridiculous terms! Please allow me nonetheless to continue calling it so-called alternative medicine (SCAM).

The paper itself might be summarised as follows:

SCAMs struggles to fit into mainstream science. Trustworthiness isn’t just about flashy, individual study results; it requires a reliable system of transparent data and independent replication. However, forcing SCAM into mainstream healthcare via scientific scrutiny, standardisation and integration is a double-edged sword. It strips away the personalized, holistic essence of these therapies. Instead of abandoning science or changing the therapies, researchers need to use creative, flexible scientific methods that document the real-world complexity of SCAM without trying to force it into an artificial mold.

I have heard this argument often, particularly early on when I started applying science to SCAM. SCAM proponents were initially taken by the idea; later, when the results were often not what they expected, they were less impressed and argued that, because science failed to produce positive results, something must be wrong with it and in need of improvement. Specifically, the arguments were:

• SCAM is individualised,
• SCAM is holistic,
• SCAM is complex,
• SCAM is subtle,
• SCAM depends on the skill of the practitioner.

And therefore, SCAM cannot be fitted into the straitjacket of science, particularly not in the one imposed by the randomised clinical trial.

It took many years to convince some SCAM proponents that these notions were erroneous, that science is not always perfect but that no better method for testing exists, that many mainstream interventions (e.g. physiotherapy, psychotherapy) are just as complex, holistic, etc. as is SCAM. Eventually the argument that SCAM defies scientific evaluation disappeared – not totally, but almost.

Now, 30 years later, it is back!

One cannot even blame the SCAM enthusiasts for reviving it. Thirty years of research and very little of SCAM has been proven to work – unless one gives SCAM a huge ‘benefit of the doubt’ and pretends poor science constitutes proof. Even the treatments that SCAM proponents celebrate as evidence-based fall apart once we scratch the surface and discover how poor and irreproducible the evidence mostly is.

Yes, I do sympathise with the frustration of SCAM proponents as they gradually realise all this. Many of them know only too well that their most solid evidence can be taken apart by any first-year medical student with rudimentary skills of critical evaluation. Many of them therefore have long moved away from hypothesis testing research and prefer the type of investigation that never generates a negative finding (e.g. surveys, qualitative studies, sociological approaches). Others, including the two authors of the above-mentioned paper, prefer to go full circle and revive the notions we dealt with decades ago claiming we need different standards for SCAM than for the rest of medicine.

Perhaps someone should tell them that double standards are never a good idea?