Response to Letter by Gibson

I am obliged to Nathaniel Gibson (1) for his letter in this issue of Diabetes Care because his comments enable me to clarify several points. He is correct in calling part of the evidence I quoted “anecdotal.” This pertains particularly to the cases where providers of complementary and alternative medicine (CAM) have hindered access to essential conventional treatments. Sadly, at the current time, such information can only be considered anecdotal because there is, to the best of my knowledge, no systematic research into this area. At my department, we are all in favor of being systematic; we have published >50 systematic reviews of CAM (a full list is available from me free of charge). But in this case, I fear that the onus is on the providers of CAM to systematically demonstrate that the anecdotal reports that have been published are in fact rarities.

Mr. Gibson also argues that I neglect the evidence about the benefit of CAM, and he cites a number of recent studies. Several (systematic) reviews of this area exist (2–5), but none of them conclude that CAM has an established place in the treatment of diabetes. Even Gibson categorizes the evidence he quotes as “preliminary.” To me, this indicates that reliable risk-benefit assessments are not currently possible.

In my view, Mr. Gibson’s most interesting point is that he accuses me of being “hostile.” A commentary on the hidden risks of CAM obviously has the purpose of critically discussing certain issues. Perhaps Mr. Gibson, like many proponents of CAM, confuses hostility with criticism. I believe that in any area of medicine, productive (internal) criticism is an essential element that generates progress and credibility. Thus, I intend to continue conducting critical analyses of CAM in the conviction and hope that they are a credit (not a discredit) and a step forwards (not backwards) for CAM.