The meaning of evidence: can practitioners be researchers?

Our research group at Southampton contains a combination of non-clinical researchers as well as CAM and conventional clinicians who have become researchers. The transition from practitioner to practitioner-researcher has led us to question, challenge and re-consider the paradigmatic differences in our practices compared to conventional medicine and how we might understand and interpret evidence derived from both quantitative and qualitative research. We very much value the randomised controlled trial (RCT) but have all come to understand its limitations and constraints when trying to encapsulate a complete, rigorous, and honest understanding of our complex interventions and how they are delivered in practice. Equally, our expertise in qualitative research leads us to understand the patient's perspective and to value a more individual agenda. We believe that we share these tensions with clinicians working in primary care. We appreciate that we need to understand contextual effects so we can better utilise and research them appropriately, rather than dismiss them as mere placebo. These issues represent both personal and transcendent conflicts that we have expressed as a series of vignettes each written by a practitioner/researcher working in that filed. Our principle aim in writing this essay is to offer our practical experience and insight as issues for thoughtful debate for those clinicians and academics involved in clinical research in controversial areas such as CAM.