Qualitative and quantitative research in integrative medicine

Daniel Weber (PhD MSc) is a pioneer in complementary oncology, accomplished international lecturer, author and CEO of Panaxea Medicine. Daniel holds the Vice-Chairmanship in Oncology for the World Federation of Chinese Medicine Societies. Daniel has a BA in Acupuncture, a post-graduate diploma both in Somatic Psychotherapy and in Adult Education, a MSc in Chinese herbal medicine, a PhD in traditional Chinese medicine, and is currently enrolled in a Doctor of Health Science at Charles Sturt University in complementary oncology. He has been in private practice in Sydney, Australia since 1977.

“Your health is determined not only by your genes, after all, but also by your environment” (Tsou, cited in Mitchell, 2009, p. 34) as the living, suffering patient resides within the context of his/her life.

The patient is not a trial or a research project but a complex of personal, social experiences that comes to the clinic with a variety of co-morbitities. Orr (2009, p. 34), in The New York Review of Books, declares that “science is the defining intellectual enterprise of our age” but the difficulty is in how science is defined. In medicine it ranges from the narrow and restrictive approach in randomised controlled trials (RCTs) to the more loosely constructed empirical science of traditional medicine (TM). TM is a clinical and empirical medicine that has evolved over millennia.

The major criticisms and limitations of evidence-based medicine (EBM) appearing in the literature over the past decade can be summarised and categorised into five recurring themes. The themes include: reliance on homogeneity rather than heterogeneity, narrow definition of evidence, lack of evidence of efficacy, limited usefulness for individual patients, and threats to the autonomy of the doctor/patient relationship (Cohen, Stavri, & Hersh, 2004). The major advantages of EBM is its use of the scientific model, which vastly improved medical practice by defining the pathophysiology of disease. However, this progressively better understanding of human biology with an enhanced ability to improve survival has come at the cost of the patient-physician relationship (Snyderman & Weil, 2002, p. 395). Integrative medicine is a new movement being driven by the desire of the consumer, which calls for a restoration of the focus of medicine on health and healing where technology does not dominate the critical relationship, which brings it into alignment with TM.

The integrative medicine movement is also fuelled by the growing discontentment of many medical doctors with the direction of their profession and the inability of the current system to deliver the best healthcare available (Snyderman & Weil, 2002, p. 396).

In the Journal of Alternative and Complementary Medicine, Yeung writes that medical researchers need a broad range of skills to choose a path of inquiry that will most adequately provide understanding of Traditional Chinese Medicine (TCM) but also to the unique predisposition of each individual and he calls for qualitative research rather than quantitative research (Yeung, 2009, p. 5).

In qualitative research the aim is a complete, detailed description while in quantitative the aim is to classify features, count them, and construct statistical models in an attempt to explain what is observed. In the qualitative, researchers may only know roughly in advance what s/he is looking for but in the quantitative researchers know clearly in advance what is looked for. Quantitative data is more efficient, able to test hypotheses, but may miss contextual detail while qualitative data is richer, more time consuming, and less able to be generalised. The process of qualitative research is inductive in that the researcher builds abstractions, concepts, hypotheses, and theories from details (Merriam, 1988, p. 18). The issues invoke classic paradigm war over what is real science.

The need for integrative medicine is real and is driven by the consumer, the suffering patient. Complementary medicine has improved training standards and is now in the University system in Australia. TCM is registered in Victoria and there are plans to register all complementary practitioners in NSW by 2011. Increasingly, medical schools are moving away from admitting only the highest scores to interviewing applicants and looking at students with more ‘people skills’. These Universities are also including CAM training in their curriculum. Even complementary alternative medicine (CAM) critic Edvard Ernst (2009, p. 51) estimates that approximately 5,000 clinical trials of CAM have been published during the last decade.

References

• Cohen, A. M., Stavri, P. Z., & Hersh, W. R. (2004). A categorisation and analysis of the criticisms of Evidence-Based Medicine. International Journal of Medical Informatics, 73(1), pp.35-43.
• Ernst, E. (2009). Research Into Complementary/Alternative Medicine: A Personal Comment. Complementary Health Practice Review, 14(1), Pp.51-4.
• Merriam, S. B. (1988). Case study research in education: A qualitative approach. San Francisco: Jossey-Bass.
• Mitchell L. (2009). Sick in the Head. Harper’s Magazine, 318(1905), February.
• Orr, H. A. (2009). Which Scientist Can You Trust? [Review of the book The Scientific Life: A Moral History of a Late Modern Vocation by Steven Shapin]. The New York Times Review of Books, 56(5), March 26. Retrieved from http://www.nybooks.com/articles/article-preview?article_id=22491
• Snyderman, R., & Weil, A. T. (2002). Integrative Medicine. Archives of Internal Medicine, 162(4), 395-397.
• Yeung, W. (2009 ). Qualitative Research Approach in Traditional Chinese Medicine. The Journal of Alternative and Complementary Medicine, 15(1), Pp.5-7.