Prof. Dr. H. Walach, European University Viadrina, Institute of Transcultural Health Studies, Frankfurt (Oder), Germany.

The received model of medical research methodology is the hierarchical one: at the base of a pyramid of increasing methodological rigour are expert opinions, then simple case studies, case control and cohort studies. They all provide evidence of a lesser kind. The only evidence worthwhile, so the mainstream story goes, is evidence from randomised controlled clinical trial, preferably placebo controlled ones. These data can be combined through meta-analyses into true and robust effect sizes, telling us whether a treatment is efficacious.

This mainstream model is grossly inadequate for most purposes for various reasons. For one, the presuppositions it makes are nearly all wrong and can be shown to be wrong. Second, the model is predicated on one particular paradigm of medicine, namely the pharmacological model, which again is dependent on the metaphor of the body as a machine and the doctor as its mechanic.

It is more adequate to conceive of methodology – and of many other things in life – as a circular array of different ways of answering different and equally important questions. While randomised studies are of prime importance to answer questions of efficacy of isolated agents, other studies are more useful to find out, whether treatments work in real life and in context.
Thus, it is more convincing to combine different methods in a circle of methods which, in its totality, gives us an idea as to whether a particular treatment works and under which circumstances.

It is high time to challenge the mainstream view. This workshop will present the major ideas, and participants are invited to bring their own research questions, ideas and proposals to discuss.