The role of rigorous scientific evaluation in the use and practice of complementary and alternative medicine.
Complementary and alternative medicine (CAM) is the set of health care systems, products, and practices not considered part of conventional medicine. The increase in CAM use among the general public in recent decades led Congress to establish the Office of Alternative Medicine under the National Institutes of Health in 1992. In 1998, the Office of Alternative Medicine became the National Center for Complementary and Alternative Medicine (NCCAM), an independent institute that aims to use rigorous scientific research to evaluate CAM practices and products. Several policy changes are necessary to ensure that the results of NCCAM-funded research are used to provide the best possible health care to patients and to facilitate the integration of safe and efficacious CAM therapies into conventional medicine. First, NCCAM must commit to fund only studies that use rigorous methodology. Second, to ensure the purity and consistency of dietary supplements, a federal law should be passed to establish a new regulatory framework for dietary supplements. Finally, the results of NCCAM-funded clinical trials should be used to modify conventional and CAM practices. Treatments that are unsafe and inefficacious should be abandoned, and those that are both safe and efficacious should become standards-of-care for conventional medicine; the use of therapies that are either safe or efficacious but not both should be based on the risk/benefit ratios of the therapies. Rigorous scientific research must be used to evaluate the safety and efficacy of CAM therapies to ensure that patients receive care with the most favorable risk/benefit ratio.
Kantor
Molly
M
Harvard Medical School, Boston, Massachusetts 02115, USA. molly-kantor@hms.harvard.edu