Evidence based complementary and alternative medicine: promises and problems.
OBJECTIVE
The present paper examines the experience of establishing a center for evidence-based complementary and alternative medicine (EBCAM) practice. It examines both the difficulties and the challenges of doing research to establish EBCAM. The paper also examines the political context of the demand for evidence- based practice (EBP) for CAM.


METHODS
A center for EBCAM was funded for 3 years within the Southern California Evidence-Based Practice Center by the National Center for CAM and administered by the Agency for Health Research Quality. This experience provides the basis for this paper.


RESULTS
While the experience of creating an EBM Center for CAM has shown that much work can be accomplished by applying standard methods of EBP medicine, it also highlights the weaknesses of such an agenda. Many standard research methods are simply not applicable to CAM, and even where they are, effectiveness is a much more important means of assessing CAM than simply efficacy. Researchers however, must be conscious of the political motivations behind much of the demand for EBCAM. Where such demands are coming from allopathic medicine, they clearly form a continuing part of medical opposition to CAM and may be intended to perpetuate the dominance of the biomedical paradigm in healthcare. The challenge for CAM is to recognize the limitations of EBP but not to throw the 'baby out with the bathwater'. There is much in EBP that clearly should be emulated by the CAM community but only where it is appropriate.
Coulter
Ian D
ID
Samueli Institute, UCLA School of Dentistry, RAND, Santa Monica, Southern California University of Health Sciences, Corona del Mar, CA 92625, USA. coulter@rand.org
D000529:Complementary Therapies / Q000009:adverse effects* / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D011785:Quality Assurance, Health Care; D012106:Research / Q000458:organization & administration*