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Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
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Index

A

Academic Health Centers for Integrative Medicine, 22, 149–150

Accountability, 171–173

Acupuncture, 16, 38–39, 133, 202

analgesia effects, 147

attitudes of conventional physicians, 203, 206

cost-effectiveness, 49–50

ethical practice, 180

insurance coverage, 47, 206

NIH consensus statement, 141–142

practice characteristics, 63

regulation, 20–21

strategies for improving research quality, 144–145

Acupuncture and Oriental Medicine Commission, 180

Adherence, 10, 11, 60–61, 65, 66, 161

Advertising, 263

Advocate model of integrative medicine, 219

Age, consumer

CAM use patterns and, 44–45, 48

dietary supplement use and, 256

Agency for Healthcare Research and Quality, 29, 267

evidence reports, 141

AIDS/HIV, 45, 244–245, 248–249

Alternative medical systems, 18, 42

American Association of Naturopathy, 180

American Chiropractic Association, 180

American Herbal Pharmacopoeia, 268

American Herbal Products Association, 268

Anderson Cancer Center, 202

Antioxidants, 261

Anxiety, 64

Aromatherapy, 133

Assessment, 180–181

Asthma, 45, 46

Attention and hyperactivity disorders, 45

Attribute-treatment interaction analyses, 3, 118

B

Back problems, 38, 45

cost-effectiveness of CAM, 49

Basic research, 120–122, 147

Basic science excellence model of research, 122

Behavioral medicine, 203

Behavioral Risk Factor Surveillance Survey, 154

Belmont Report of the National Commission for the Protection of Human Subjects in Biomedical and Behavioral Research, 174–175

Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
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Biofeedback

attitudes of conventional physicians, 203, 206

education and training in, 227

patterns of use, 48

Biologically based therapies, 18, 42

Black cohosh, 262

Bundled therapies, 3, 108, 115

C

Canada, 263–264

Cancer, 44, 45

CAM therapies, 6–7, 202

NIH CAM research, 26–27

sources of information about CAM therapies, 59

Cardiovascular disease, 46, 133

Case-control studies, 3, 82, 114

Children, use of CAM by, 44, 63

Chiropractic treatment, 16

attitudes of conventional physicians, 206

defining features, 18–19

ethical practice, 180

insurance coverage, 47, 206

licensure, 237

patterns of use, 38–39, 44, 202

practice characteristics, 63–64

reimbursement, 23

research in, 240, 241

treatment goals, 64

Chondroitin sulfate, 21, 262

Chronic illnesses, 46, 48

Classification of CAM modalities, 18–19

Cochrane Library, 132–140

Cohort studies, 3, 81–82, 113–114, 152–154

Co-morbid conditions, 92–93

Compliance. See Adherence

Concierge model of integrative medicine, 219

Confidence intervals, 90–91

CONSORT guidelines, 144

Consortium of Academic Health Centers for Integrative Medicine, 22, 231

Consultant model of integrative medicine, 217

Consumer characteristics, 41–45

age, 44–45, 48, 256

economic status, 41–42

educational attainment, 10, 41, 42, 254–256

ethnic and cultural subgroups, 43–44, 64–65, 152, 162, 278

gender, 10, 41, 63, 64, 278

health beliefs, 55

Conventional medicine

CAM interactions, 45, 61, 66, 115

consumer perceptions, 56

effectiveness research, 17–18, 145, 230

ethical issues regarding reimbursement, 172–173

gaps in outcomes research, 146–147, 161

patient disclosure regarding CAM use, 34, 35–38, 44, 63, 65

patterns of CAM use and, 34, 39–40, 54–55, 62, 203–206

quality improvement goals, 14

See also Integration of CAM and conventional medicine

Cost-effectiveness of CAM, 5

analytic method, 88–90

current understanding of, 49–50

research model, 123

research needs, 148

Cost of care

CAM spending, 1, 34

chronic illnesses, 46

conventional medicine spending, 35

dietary supplement spending, 35, 253

distribution by medical condition, 46

ethical issues regarding CAM healing, 172–173

health-seeking behavior and, 40

integrative medicine, 218, 219–220

out-of-pocket spending, 13, 34, 35, 41–42

systematic reviews of research, 142–143

See also Cost-effectiveness of CAM

Cross-disciplinary research, 148, 149

in CAM Research Centers, 159

Cross-sectional studies, 83

Cultural contexts, 43–44

concept of causality in research, 99

research needs, 66

D

Dana-Farber Cancer Institute, 7, 202

Data collection and management

in CAM research model, 152, 154, 159–160, 161–162

Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
×

on CAM use, 31–32, 40, 44–45

Cochrane Library data, 132–140

cultural considerations, 43–44

on dietary supplements, 28, 272–274

gaps in CAM research, 146–151, 161

MEDLINE data, 130–132

national surveys, 6, 152–154

for outcomes research, 76

recommendations for, 6, 10–11, 145–146

sentinel surveillance system, 154–155, 159–160

sources of CAM information, 1, 58–60, 66, 103, 130, 161

Declaration of Helsinki, 174–175

Definition of CAM, ix, 16–20, 40, 44–45, 64

value judgments in, 174

Definition of health, 210–211

Department of Health and Human Services, 7–8, 29, 222

Department of Veterans Affairs, 7–8, 23, 222

Depression, 64

Diabetes, 46

Diagnostic classification, 126

Dietary Supplement Health and Education Act (1994), 4–5, 20, 59, 190, 257–260, 271, 274–275, 280

Dietary supplements, 18

adherence issues, 61

advertising claims, 58–59, 258, 260–261, 263

consumer beliefs, 256–257

consumer characteristics, 254–256

definition, 257–258

drug interaction risk, 13, 23, 35, 270

good manufacturing processes, 266

label claims, 260–262

NIH research activities, 28

off-label use, 261

patterns of use, 13, 35, 44, 253–257

quality control, 4, 5, 265–270, 274, 280

recommendations for regulation and research, 4–5, 274–275

regulation, 4, 5, 190–191, 256–260, 263–265, 270–271

research, 272–274

safety, 265–272, 274

spending, 35, 253

See also Herbal medicine

Dietetic practices, 43–44

Dose-response relationship, 100

Double-blind trials, 126–127

Drug interactions, 13, 23, 35, 270

E

Echinacea, 133, 262, 266

Ecological model of health, 210–211

Economic status of consumers, 41–42

Education and training of health professionals

for AIDS/HIV research, 244–245

in CAM modalities, 237–238

CAM training in medical schools, 17, 22, 226–227, 230–237, 248, 279–280

career development grants, 151

core competencies, 228

in geriatric medicine, 242–244

model programs in research training, 150–151

NCCAM funding, 24

in practice-based research networks, 158

rationale for CAM instruction, 228–230

recommendations for, 8–10, 248, 249–250

for research, 9, 239–245, 248–249

standards of evidence for research and, 100–101

trends, 226

Educational attainment of consumers, 10, 41, 42

dietary supplement use and, 254–256

Effect size, 98

Effectiveness of treatment(s)

acceptance of new therapies and, 196–198

AHRQ evidence reports, 141

attribute-treatment interaction analyses, 3, 118

basic research, 120–121, 147

challenges in CAM research, 103–105, 108–111, 115–116, 123

Cochrane Library data, 134–140

conventional therapies, 17–18, 145, 230

criteria for establishing cause-and-effect relationships, 99–100

determinants of, 79

disincentives to CAM testing, 173, 273–274

Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
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efficacy studies, 91–92, 98, 103–104, 120

ethical issues in prescribing, 184

expectation effects in, 117–118

framework for medical decision making, 213–215

goals of CAM healing, 171–172

information needs for clinicians, 101–102

instruction in CAM based on, 230

insurance providers’ concerns, 102

levels of evidence for, 94–98, 103, 124–127

measurement error, 92

NIH consensus statements, 141–143

observational studies, 113

patient perceptions, 38, 51, 197–198, 199–200

placebo effects in, 110, 117–118

predictive modeling, 86–87

prescription drug regulation, 76–77

qualitative research, 119

quality of research, 143–146

recommendations for research, 5–6, 124–127, 279

research challenges, 2–3

research designs, 79–83, 111–120

sources of consumer information, 103

standards of evidence for, ix–x, 2, 99–103, 124–125, 184, 230

systematic reviews of research, 129–130

technical and conceptual development of research on, 74–76

therapeutic relationship factors, 109–110, 126

training of practitioners in, 100–101

See also Cost-effectiveness of CAM;

Outcomes research

Efficacy studies, 91–92, 98, 103–104, 120

Energy therapies, 19, 42

outcomes measurement, 110

patterns of use, 48

Ephedra, 59, 258

Ethical practice, 8, 16

access to research participation, 179

commitment to public welfare, 169

conceptual basis, 168–171

definition and scope of CAM, 174

duty of nonabandonment, 184–185

evidence of therapeutic efficacy required for prescribing, 184–185

informed consent issues, 177–178

in integration of CAM and conventional medicine, 179–183

issues of concern, 168

legal issues and, 183–192

nonmaleficence in, 169

in prescribing CAM therapies, 181–182

professional codes and guidelines, 179–180, 187

public accountability and, 171–173

recognition of medical pluralism, 169–171, 184–185

in research, 174–179

respect for patient autonomy, 169

sociocultural context, 192

Ethylenediaminetetraacetic acid, 262

Evidence-based practice, 2, 11, 77–79, 85–86

commitment to medical pluralism and, 184–185

conceptual development, 77–78, 85–86

in development of CAM practice guidelines, 246–247

goals, 78

status of CAM research, 145

Evidence-Based Practice Centers, 29, 267

Expectation effects, 84

CAM research challenges, 110

informed consent for research and, 177–178

research design for, 3, 117–118

F

Fatigue disorders, 133

Federal Food, Drug, and Cosmetic Act, 77, 269, 270

Federation of Practice Based Networks, 156

Federation of State Medical Boards of the United States, 7, 22, 187, 203

Fitness center model of integrative medicine, 217

Folic acid, 261

Food and Drug Administration, 20, 77

dietary supplement regulation, 4, 256, 257, 258, 260–261, 263, 266, 270–271

Framington Heart Study, 154

France, 265

Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
×

G

Garlic, 262

Gastroenterological disease, 45

Geriatric medicine, 242–244, 248–249

Germany, 264–265

Ginkgo biloba, 21

Glucosamine, 21, 262

Guided imagery, 173, 206

Gynecologic problems, 45, 203

H

Headache treatment, 38

cost-effectiveness of CAM, 49–50

Health food stores, 59–60

Herbal medicine, 16, 18, 147

Cochrane Library data, 133

patterns of use, 35, 44, 48, 254

pharmacist education in, 227

sources of information about, 58–59

See also Dietary supplements

Holistic care, 211

Homeless people, 42

Homeopathy, 16, 109

attitudes of conventional physicians, 203

insurance coverage, 47

licensure for, 238

N-of-1 research studies, 112

Hypericum. See St. John’s wort

Hypertension, 38, 46

Hypnotherapy, 173, 203, 206

I

Indinavir, 23

Informed consent, 177–178, 181, 183

patient preference for CAM therapy in absence of proof of effect, 184–188

Institute of Medicine, 29–31, 270–271

Insurance. See Reimbursement

Integration of CAM and conventional medicine, x

CAM-centric services model, 218

CAM training in medical schools, 17, 226–227, 230–237, 248

cancer treatment, 202

complementary services model, 218

conceptualization of health in, 210–211

concierge model, 219

consultant model, 217

consumer demand and, 208–209

continuity of care concerns, 219

definition, 209, 210

ethical and legal considerations, 8, 179–192

financial considerations, 218, 219–220

fitness center model, 217

goals, 7, 211–213, 220, 280

implementation models, 217–220

in institutions, 201–202, 208, 215–217

integrative medical doctor/DO-centric service model, 218

motivation of health care practitioners for, 208–209, 218

NCCAM efforts, 25

patient oriented delivery system, 219

patient–physician relationship in, 209, 210

patient preference for CAM therapy in absence of proof of effect, 184–188, 214–215

physician characteristics and, 209

primary-care model, 217

recognition of medical pluralism in, 169–171

recommendations for research, 7–8, 221–222

referral issues, 189–190, 215

reimbursement patterns, 206–208

spectrum model, 210

trends, 6–7, 196, 201–206, 278

virtual model, 217

See also Translating research findings into practice

International Ethical Guidelines for Biomedical Research Involving Human Subjects , 174–175

Internet, 58–59, 66

Isoflavone formononetin, 147

J

Journal of the American Medical Association, 21

K

Knowledge-based medicine, 15

Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
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L

Labeling of dietary supplements, 260–262

Legal issues, 8, 59, 183–192

assumption of risk, 188–189

food and drug law, 190–191

health care fraud, 191

informed consent, 183–184

malpractice liability, 188–190

patient preference for CAM therapy in absence of proof of effect, 185–188, 214–215

referral obligation, 189–190

sociocultural context, 191–192

Licensing and certification, 61

of CAM practitioners, 16, 237

characteristics of CAM practitioners, 63–64

institutional credentialing for integrative medicine, 216–217

recommendations for, 9–10, 249–250

state authority for, 188

Licorice root, 147

Longitudinal studies, 83, 152–154

M

Malpractice liability, 188–190

Manipulative and body-based therapies, 18–19, 42

cost-effectiveness, 50

See also Massage therapy

Manualized therapies, 115–116

Massage therapy, 16, 38–39

attitudes of conventional physicians, 203, 206

cost-effectiveness, 49

education and training in, 227

insurance coverage, 47, 206

licensure for, 238

patterns of use, 48

practice characteristics, 63–64

treatment goals, 64

Measurement error, 91, 92

Medicaid, 42

Medical decision making, 14, 278

cost of care as factor in, 40

decision models, 76

efficacy–safety framework for, 213–215

ethical practice, 8

goals of integrative medicine, 211–213, 220

knowledge-based, 15

models of integrative medicine, 217–220

patient-centered, 15

patient participation in, 55

research needs, 10–11, 62

sources of CAM information, 58–60, 66, 103

types of illnesses treated with CAM, 34, 45–46, 63, 64

See also Use of CAM therapies

Meditation, 18

attitudes of conventional physicians, 206

education and training in, 227

immune function and, 149

patterns of use, 44

MEDLINE, 130–132

Memorial Sloan-Kettering Cancer Center, 6–7, 202

Menopause, 45

Mental healing, 18

Meta-analysis, 129, 130, 144

Mind-body medicine, 18, 147, 148–149

holistic approach, 211

Modalities of CAM

classification, 18–19

concurrent use of multiple modalities, 108, 115

consumer socio-demographic characteristics and use of, 42

medical school curricula, 226–227

patterns of use, 38–39

practitioner training in, 237–238

Mood disorders, 46, 64

Motivation to investigate or use CAM

health care provider, 208–209, 218

patient, 40, 46, 48–49, 50–58, 65–66, 161

Musculoskeletal disorders, 133

N

National Center for Complementary and Alternative Medicine (NCCAM), 1, 9, 17, 21, 23, 121

classification of CAM modalities, 18–19

dietary supplement policies, 267, 272, 273

education projects, 233–234

Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
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integration activities, 25

legislative mandate, 23

outreach efforts, 24

research activities, 23–25

research centers, 24, 158

research funding, 24

National Center for Health Statistics, 152

National Health and Nutrition Examination Survey, 154

National Institutes of Health, 9, 20, 21

basic research spending, 121

consensus statements, 141–143

dietary supplement research, 272–273

recommendations for, 6, 7, 10–11, 66, 162

research activities, 25–28.

See also National Center for Complementary and Alternative Medicine

in translating research findings into practice, 199

National Library of Medicine, 11, 23, 67

Natural Medicines Comprehensive Database, 268–269

Natural Standard, 269

Naturopathy, 16, 63

ethical practice, 180

licensure for, 237

patterns of use, 48

NCCAM. See National Center for Complementary and Alternative Medicine

Neck pain, 50

New England Journal of Medicine, 21

N-of-1 trials, 112

Nuremberg Code, 174–175

Nurses’ Health Study, 154

Nurses/nursing, 204–206

CAM education for, 227, 229, 232, 235

O

Observational studies, 3, 80–81, 113–114

Office of Alternative Medicine, 20, 21

Office of Cancer Complementary and Alternative Medicine, 26–27

Office of Dietary Supplements, 28, 272–273

Office of Unconventional Therapies, 20

Omega-3 fatty acids, 261

Osteopathy, 201, 218

Outcomes research

in case-control studies, 82

clustering of outcomes, 94

in cohort studies, 82

cointervention effects, 92–93

co-morbidity effects, 92–93

confidence intervals, 90–91

gaps in CAM research, 146–147, 161

goals, 76

intermediate and distal outcomes, 87–88

measurement error, 91

measurement of health state preferences, 90

multicenter studies, 92–93

national surveys of CAM use, 152–154

objective outcomes, 83, 84

origins and development, 74–76, 77–79

research needs for integrative medicine, 7, 221–222

standardized measures, 88

subjective outcomes, 83–84, 105, 110–111, 126, 171–172

See also Effectiveness of treatment(s)

P

Pain

acupuncture analgesia, 147

outcome measurement, 84, 110–111

placebo effects, 147

Patent law, 173, 273–274

Patient autonomy, 8, 183–184

framework for medical decision making, 213

informed consent and, 177–178

preference for CAM therapy in absence of proof of effect, 184–188, 214–215

principle of ethical practice, 169, 178–179

Patient-centered treatment, 15, 20, 220

in CAM, 238

as core competency of health care, 228

research needs, 238

Patient–healer relationship, 109–110, 126

ethical practice, 181–182

in integrative medicine, 209–210

as patient motivation for CAM therapy, 182

Pharmacotherapy

CAM instruction for pharmacists, 227

concurrent dietary supplement use, 254

drug interactions, 13, 23, 35, 270

regulation, 76–77

Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
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Physician’s Desk Reference, 269

Placebo effects

analgesia, 147

CAM research challenges, 110

early research on, 22, 23

research design for, 3, 117–118

Practice-based research, 5–6

Practice-based research networks

definition, 156

in model of CAM research, 155–158, 160

organizational structure, 156–157

origins and development, 156

practitioner training in, 158

recommendations for, 6, 162

research activities, 157–158, 160

Practice guidelines, 7, 8, 9–10, 22, 203–204

acceptance of new therapies, 200

development of, 246–248, 249–250

for ethical practice, 179–180, 187

goals for, 246

rationale, 246

recommendations for, 249–250

Prayer, 18, 40, 42

Preventive care

levels of evidence for research on, 94–98

NCCAM research, 24

research challenges, 105–106

research needs, 11, 66

use of CAM for, 48–49, 51–54, 64, 65

Prospective research, 80, 114

Psychiatric problems, 45, 47

Public awareness and understanding, 10, 11

dietary supplement use and, 254, 256–257, 265

NCCAM outreach efforts, 24–25

perceptions of health care providers, 56

sensitivity to scientific evidence, 254, 256

sources of CAM information, 1, 58–60, 66, 103, 161

PubMed, 23

Pure Food and Drug Act, 76

Q

Qi gong, 19

Qualitative research, 119

Quality-adjusted life years, 89–90

Quality of evidence model of research, 122

QUOROM guidelines, 144

R

Race/ethnicity of consumers, 43–44, 64–65

survey of health practices among minority populations, 152, 162

Randomized controlled trials, 3, 79–80, 96, 98, 120, 184

alternative research designs, 3, 111–119

basic features, 129

challenges in CAM research, 103–105, 108

Cochrane Library data, 132–140

MEDLINE data, 130–132

preference studies, 112–113, 123

preventive and wellness treatments, 105–106

quality of studies, 143–144

strategies for improving quality, 144–146

Recursive partitioning, 115

Red clover, 262

Referrals, 63, 215

legal obligations, 189–190

models of integrative medicine, 217

Regulation

dietary supplements, 4, 5, 190–191, 256–260, 263–265, 270–271

evolution of CAM, 20–22

international comparison, 263–265

prescription drugs, 76–77

public opinion, 256–257

See also Legal issues;

Licensing and certification

Reiki therapy, 19

Reimbursement, 102

acceptance of new therapies, 200

CAM coverage, 23, 206–208

ethical issues regarding CAM healing, 172–173

evidence of treatment effectiveness and, 102

for integrative practice, 219

potential problems of CAM coverage, 207

utilization and, 35, 47, 64, 207

Relaxation techniques, 16

Cochrane Library data, 133

patterns of use, 38–39, 44

Religious-spiritual practices, 44

ethical and legal considerations, 191

measurement of CAM effectiveness and, 171–172

Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
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Research centers

in model of CAM research, 6, 158–160, 162

NCCAM, 24, 158

Research methodology

case-control studies, 82, 114

case series studies, 82–83

challenges in CAM research, 2–3, 103–105, 108–111, 123

cohort studies, 81–82, 113–114

conceptual models, 122–123

conceptualization and measurement of health, 210–211

control of confounding variables, 80–81

cost constraints, 120

criteria for establishing causality, 99–100

cross-disciplinary efforts, 148, 149

cross-sectional studies, 83

education of health professionals in, 9, 239–244, 248–249

efficacy studies, 91–92, 98

ethical practice, 8, 174–179

evidence-based medicine, 77–79, 85–86

hierarchies of evidence, 94–98, 103, 124–127

independent review, 178

individualization of treatments and, 109, 111, 115–116

informed consent issues, 177–178

innovative designs for CAM research, 3, 111–120, 123–124

longitudinal studies, 83

N-of-1 trials, 112

observational studies, 80–81, 113–114

in practice-based research networks, 157

preference randomized controlled trials, 112–113, 123

for preventive and wellness treatments, 105–106

qualitative methods, 119

quality of studies, 143–144

quantification of CAM treatment elements, 109–110, 111, 115–116, 125–126

randomized studies, 79–80

recommendations for standardization, 2, 124–125

research goals and, 120

for research on widely used treatments, 104

respect for research subjects in, 178–179

risk-benefit considerations, 177

simulation of CAM use patterns in clinical trials, 62

special needs for CAM research, 99

standards of evidence, 99–103

strategies for improving quality, 144–146

subject selection, 176–177

superiority/noninferiority trials, 92

technical and conceptual development of effectiveness research, 74–76

validity in, 176

See also Outcomes research

Research personnel

education and training of, 9, 239–245, 248–249, 279

interdisciplinary teams, 5

shortages of, 5, 239

sources of, 239

strategies for expanding CAM research, 148–151

Research settings

funding, 25

National Institutes of Health CAM programs, 23–28

practice-based, 5–6

recommendations for, 6

See also Research centers;

specific organization

Research topics

basic research, 120–122, 147

in CAM Research Centers, 158–159

CAM use and outcomes, 10–11, 151–154

dietary supplements, 5, 272–274

disincentives to CAM testing, 173

gaps in CAM research, 146–151, 161

health-seeking behaviors

integration of CAM and conventional medicine, 7–8, 221–222

in NCCAM Research centers, 158

in practice-based research networks, 157–158, 160

recent evolution of CAM research, 20–23

recommendations for, 5–6, 66–67, 124, 279

selection criteria, 3–4, 199, 279

social or scientific value in, 175

Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
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See also Data collection and management;

Research methodology

Retrospective research, 80, 114

Rheumatology problems, 45

Rhinosinusitis, 45

S

Safety

of dietary supplements, 265–272, 274

framework for medical decision making, 213–215

standards of evidence for, ix–x, 2

Society for Integrative Oncology, 202

Society of Teachers of Family Medicine Group on Alternative Medicine, 231

Soy isoflavones, 147

St. John’s wort, 21, 23, 60, 133, 254, 262

drug interactions, 270

STRICTA guidelines, 144–145

Subjective outcomes, 83–84, 105, 110, 126

Surveillance

in CAM research model, 155, 159–160

passive/active, 155

purposes, 154–155

recommendations for, 6, 162

sentinel sites, 6, 155

Surveys, health care, 6

in CAM research model, 152

components, 152

frequency, 152

minority populations in, 152

recommendations for, 162

Systematic reviews of research, 129–130, 142–143

Cochrane Library data, 132–140

MEDLINE data, 130–132

quality of studies, 143

strategies for improving quality, 144–146

Systematic reviews of reviews, 141

T

Therapeutic misconception, 177–178

Therapeutic relationship. See Patient–healer relationship

Traditional healers, 43

Cochrane Library data, 133–134

ethical issues regarding reimbursement, 172–173

Translating research findings into practice

acceptance of new therapies, 199–200

in CAM research model, 159–160

challenges to, 158

ethical issues, 168

hypothesis generation and testing, 197, 198–199

insurance coverage, 200

pathways, 196–198, 200–201

patient demand as factor in, 197–198, 199–200

role of practice-based research networks, 158

selection of interventions for testing, 199

See also Integration of CAM and conventional medicine

Transpersonal psychology, 173

U

U.S. Pharmacopeia-National Formulary, 269–270

U.S. Preventive Services Task Force, 94–98

Use of CAM therapies, 1, 13, 34–41, 64–65

clinical supervision for, 61–62, 65

concurrent use of multiple modalities, 108, 115

cost as decision factor in, 40

data sources, 31–32, 34, 39, 40, 44–45

dietary supplements, 13, 35, 44, 253–257

ethical practice in prescribing, 181–182

for health promotion or disease prevention, 48–49, 51–54, 64, 65

high-frequency users, 46–47, 64

insurance coverage and, 47, 64, 207

long-term trends, 47–49

medical conditions, 34, 45–46, 64, 65

national surveys, 6, 152–153

in nursing practice, 204–206

patient disclosure to medical doctor

regarding, 34, 35–38, 44, 63, 65, 278

patient motivation, 46, 50–58, 65–66, 161

recommendations for research, 10–11, 162

referral patterns, 63

research needs, 66–67, 151–154, 161

spending, 1, 13, 34, 35, 64

Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
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use of conventional therapies and, 34, 39–40, 45, 54–55, 61, 62, 203–206

See also Consumer characteristics

Utility, health state, 89–90

V

Vitamin use, 35, 254

consumer characteristics, 42

patterns of, 44

W

White House Commission on Complementary and Alternative Medicine, 21–22

Women’s use of CAM, 10, 41, 63, 64

World Health Organization, 269

Suggested Citation:"Index." Institute of Medicine. 2005. Complementary and Alternative Medicine in the United States. Washington, DC: The National Academies Press. doi: 10.17226/11182.
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Integration of complementary and alternative medicine therapies (CAM) with conventional medicine is occurring in hospitals and physicians offices, health maintenance organizations (HMOs) are covering CAM therapies, insurance coverage for CAM is increasing, and integrative medicine centers and clinics are being established, many with close ties to medical schools and teaching hospitals. In determining what care to provide, the goal should be comprehensive care that uses the best scientific evidence available regarding benefits and harm, encourages a focus on healing, recognizes the importance of compassion and caring, emphasizes the centrality of relationship-based care, encourages patients to share in decision making about therapeutic options, and promotes choices in care that can include complementary therapies where appropriate.

Numerous approaches to delivering integrative medicine have evolved. Complementary and Alternative Medicine in the United States identifies an urgent need for health systems research that focuses on identifying the elements of these models, the outcomes of care delivered in these models, and whether these models are cost-effective when compared to conventional practice settings.

It outlines areas of research in convention and CAM therapies, ways of integrating these therapies, development of curriculum that provides further education to health professionals, and an amendment of the Dietary Supplement Health and Education Act to improve quality, accurate labeling, research into use of supplements, incentives for privately funded research into their efficacy, and consumer protection against all potential hazards.

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