Inherent Bias? Patients Who Use the Internet to Find Information on CAM

Dear Sir, Krebskompass sounds like an exemplary platform for informing patients about the harms and benefits of complementary and alternative medicine (CAM) and the provision of a ‘chat room’ for dialogue between patients. Unfortunately, as the authors hint, there is a strong bias inherent in this website to use it as a basis for generalizable findings in qualitative research. Those involved are the younger, educated CAM users, and the forum appears to be dominated by a vociferous minority. Their results from an online questionnaire are based on a numerator of 80, but I have no idea of the denominator so I cannot work out the percentage of respondents. As a result, I have to conclude that however interesting the findings, they cannot be extrapolated beyond this very small, self-selected minority. I was appalled at the ignorance of the respondents concerning the basic principles of carcinogenesis, but perhaps that has to be a prerequisite for those who embark on treatments that are, for example, used to ‘boost the immune system’. I also believe that the ‘satisfaction index’ with the CAM experience has nothing to do with the specifics of the therapy as they are mostly placebos or of no proven efficacy; the satisfaction the patients experience therefore is more likely to be linked to the charisma of the practitioner, the time they are kept waiting, and the environment where the placebo is offered, rather than the treatment itself. I discount prayer from this generalization, as it should not be included in the lexicon of CAM. Prayer provides spiritual solace at a time of existential crisis and should be in the hands of the faith groups that the patients belong to and their priests or mullahs. Such services should be available in the context of support services for our clinics where evidence-based medicine is practiced. That aside, the only worthwhile message I take away from this paper is the failure of orthodox practitioners to be willing to enquire about their patients’ use of CAM, but even that might be based on a very small and biased sample who might have their own agenda. Finally, I find these words in the opening statement somewhat quaint: ‘…. use of CAM during or after the disease’. Surely that can only apply to acute conditions like bacterial infection or trauma.