On: Lewith G, Brien S, Barlow F, Eyles C, Flower A, Hall S, Hill C, Hopwood V: The meaning of evidence: Can practitioners be researchers? Forsch Komplementmed 2009;16:doi: 10.1159/000235542

The article by Lewith et al. is aimed at stimulating a ‘thoughtful debate’ by providing several vignettes about personal transitions from CAM practitioners to practitioner-researchers. The authors express their anxieties, uncertainties and selfdoubts, when ‘20 years of study and practice were called into question’, as one of the contributors put it. I do sympathize with such emotions but, at the same time, I am puzzled and concerned. After reading the article, the main questions that went through my mind was the following: To what extent are these anxieties preventable through adequate guidance and training during the transition? Any change from one role to another will create some degrees of anxiety. Good professional guidance is required to make sure that this process goes smoothly and results in the desired outcome of generating a capable scientist. Uncertainty is a normal experience (not just) in research; the secret is, I think, to make the best of it. When I read that the authors experience a ‘climate of academic mistrust between CAM and conventional medicine’ giving 4 references all of which merely reflect the level of critical evaluation and debate that is normal in academia and desirable for progress, I wonder whether these novices were well prepared for academic research. When I see how one contributor felt that ‘being involved in research ... adds recognition and academic credibility to the therapy...’, I wonder whether the author knows the true purpose of research. The final straw then came in the conclusion of this article: ‘... the RCT ... is certainly necessary for some research questions but not for all ...’ and ‘... we need to understand contextual effects so we can better utilise and research them appropriately, rather than dismiss them as placebo.’ Absolutely true, but potential researchers (from any background) should be taught these and other elementary lessons very early on during their ‘transition’ so that, later on when they should be doing science, they don’t feel the need to argue against notions that nobody holds in the first place – if not they are in danger of becoming pyromaniacs in a field of straw men. Edzard Ernst, Universities of Exeter & Plymouth