Evidence-Based Medicine Complementary Alternative Therapies

Evidence-Based Medicine & Complementary & Alternative Therapies

The Convergence of Complementary,

Alternative & Conventional Health Care: Educational Resources

for Health Professionals

This publication is one in a series of educational resource materials on complementary and alternative health care issues published by the Program on Integrative Medicine, University of North Carolina at Chapel Hill, entitled:

The Convergence of Complementary, Alternative & Conventional Health Care:

Educational Resources for Health Professionals

Titles in the series include: Understanding the Convergence of Complementary, Alternative & Conventional Care in the United States

Concepts of Healing & Models of Care Evidence-Based Medicine & Complementary & Alternative Therapies Assessing the Effectiveness of Complementary & Alternative Medicine

Safety Issues in Complementary & Alternative Medicine Evaluating Information Sources for Complementary & Alternative Health Care

Information Sources for Complementary & Alternative Therapies Integrating Complementary & Alternative Therapies With Conventional Care

Copyright ? 2004 The Program on Integrative Medicine, Department of Physical Medicine & Rehabilitation

of the School of Medicine of the University of North Carolina at Chapel Hill With support from the National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health, U.S. Department of Health & Human Services Grant No. 5-R25-AT00540-01 This publication was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and is thus in the public domain; it may be quoted freely with proper credit. Please cite as follows: Curtis, PC. Evidence-Based Medicine & Complementary & Alternative Therapies. In S. Gaylord, S. Norton, P. Curtis (Eds.), The Convergence of Complementary, Alternative & Conventional Health Care: Educational Resources for Health Professionals. University of North Carolina at Chapel Hill, Program on Integrative Medicine, 2004.

SERIES EDITORS

Susan Gaylord, PhD, Director, Program on Integrative Medicine & Assistant Professor, Department of Physical Medicine & Rehabilitation, University of North Carolina at Chapel Hill

Sally K. Norton, MPH, Project Manager, Complementary & Alternative Medicine Education Project, Program on Integrative Medicine, Department of Physical Medicine & Rehabilitation, University of North Carolina at Chapel Hill

Peter Curtis, MD, Professor, Department of Family Medicine, University of North Carolina at Chapel Hill

SENIOR EDITOR

Sheilah N. Thomas, MS

ACKNOWLEDGMENTS

John Claydon, MS, Rebecca Coble, BA, Editorial Assistance

Program on Integrative Medicine Department of Physical Medicine & Rehabilitation, UNC School of Medicine

UNC-CH - CB# 7200, Chapel Hill, NC 27599-7200 phone: (919) 966-8586, fax: (919) 843-0164

website: , email: rcoble@med.unc.edu

Evidence-Based Medicine & Complementary & Alternative Therapies

Peter Curtis, MD, Professor Department of Family Medicine University of North Carolina at Chapel Hill

THE CONVERGENCE OF COMPLEMENTARY, ALTERNATIVE & CONVENTIONAL HEALTH CARE

SERIES EDITORS

Susan Gaylord, PhD Sally Norton, MPH Peter Curtis, MD

Evidence-Based Medicine & Complementary & Alternative Therapies is one publication in a series entitled The Convergence of Complementary, Alternative & Conventional Health Care, developed as an educational resource for health professionals by the Program on Integrative Medicine, University of North Carolina at Chapel Hill, with support from the National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health.

This series responds to the many questions raised as conventional health care practitioners encounter widespread and increasing use of complementary and alternative therapies. Each publication in the series highlights one or more of the key issues facing health professionals today--including assessing information, safety, effectiveness, and the integration of conventional, complementary, and alternative health care.

Evidence-based Medicine and Complementary and Alternative Therapies explores how complementary and alternative therapies may be assessed using the methodology of evidence-based medicine, and the issues raised when conventional research techniques are applied to non-conventional health care.

PROGRAM ON INTEGRATIVE MEDICINE ? DEPARTMENT OF PHYSICAL MEDICINE & REHABILITATION ? SCHOOL OF MEDICINE ? UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL ? ? 2004

PROGRAM ON INTEGRATIVE MEDICINE ? DEPARTMENT OF PHYSICAL MEDICINE & REHABILITATION ? SCHOOL OF MEDICINE ? UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL ? ? 2004

Evidence-Based Medicine & Complementary & Alternative Therapies

foreword

The complexity of contemporary health care poses new challenges for clinicians in all fields. One

such challenge has resulted from the dramatic increase over the last 10-15 years in the use of so-

called "CAM" (Complementary and Alternative Medicine) therapies--a

CONTENTS

trend that appears to be continuing. In fact, there is no single or unified health care "system" in the United States, but a great many overlapping organizations and approaches to care.

Acquiring the Evidence ............................................................................ 2 Evaluating the Evidence for CAM Efficacy & Effectiveness........................ 5 RCTs: The `Holy Grail' of Biomedicine ....................................................... 7

Clinical Research: What Is Being Measured? .................................... 10

These include not only conventional but complementary and alternative health care options. Patients typically use not one, but multiple approaches to their illnesses, often without informing the health care providers involved.

It is in this context that the

The Role of the Placebo in the Healing Process ...................................... 12 The History of the Placebo ............................................................... 12 How Does the Placebo Effect Work? ................................................. 13 Maximizing the Placebo Response ................................................... 16

Problems Facing Complementary & Alternative Medicine Research ........ 18 Research Methods ........................................................................... 18 Organization of Research ................................................................ 19

Association of American Medical

Evaluating the Delivery of Complementary & Alternative Care ............... 19

Colleges (AAMC) advises physicians

Evaluating CAM Therapy: The Experimental Approach ....................... 21

of their new responsibility to "be sufficiently knowledgeable about both traditional and non-traditional modes of care to provide intelligent guidance to their patients" (Medical Schools Objectives Report, 1998). This is

Evaluating CAM Therapy: The Clinical Reality ................................... 21

Summary .............................................................................................. 23

Case Scenario: Evaluating CAM Therapy: The Experimental Approach ....................................................... 24-25

References ............................................................................................ 26

a formidable challenge to clinicians

PROGRAM ON INTEGRATIVE MEDICINE ? DEPARTMENT OF PHYSICAL MEDICINE & REHABILITATION ? SCHOOL OF MEDICINE ? UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL ? ? 2004

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