Complementary and Alternative Medicine in the United States (2005) / Chapter Skim
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1 Introduction
1 Introduction
Pages 13-33
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From page 13... ...
Hospitals, managed care plans, and conventional practitioners are incorporating CAM therapies into their practices. Medical schools, nursing schools, and schools of pharmacy are teaching their students about CAM.
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From page 14... ...
Therefore, an appreciation of both the strengths and the limitations of conventional medicine, especially as perceived by CAM users in the United States, is necessary context for development of conceptual models to guide public and private decision making about CAM research and practices. The principal conceptual model that the committee used to frame this report begins with the question, What do patients and health professionals need to know to make good decisions about the use of health care interventions, including CAM?
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From page 15... ...
These epistemological differences may be even greater among users of conventional and CAM interventions. Among clinicians who practice conventional medicine, there has been a marked shift over past decades from a reliance on professional experience to a greater emphasis on more rigorous quantitative evidence derived from randomized trials and systematic reviews of multiple trials.
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From page 16... ...
Should CAM include prayer, shamanism, or other therapies that may not be considered health care practices? As discussed further in Chapter 6, the reasons for defining modalities as "CAM therapies" are not only scientific but also "political, social, [and]
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From page 17... ...
proposes that CAM includes "practices that are not accepted as correct, proper, or appropriate or are not in conformity with the beliefs or standards of the dominant group of medical practitioners in a society." In 1993, Eisenberg et al. defined CAM as "interventions neither taught widely in medical schools nor generally available in hospitals." Kopelman (2002)
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From page 18... ...
Energy therapies. As the name implies, alternative medical systems is a category that extends beyond a single modality, and refers to an entire system of theory and practice that developed separately from conventional medicine.
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From page 19... ...
, psychological interventions, and nonnormative scientific enterprises (conventional therapies used in unconventional ways or unconventional therapies used by conventionally trained medical or scientific professionals)
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From page 20... ...
, to explore "unconventional medical practices." Two million dollars was appropriated, and OAM began to develop a baseline of information on CAM use in the United States. Alternative Medicine: Expanding Medical Horizons was released in 1995 (Workshop on Alternative Medicine, 1995)
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From page 21... ...
In 1999, the Cancer Advisory Panel for CAM was established for the purpose of assessing clinical data related to CAM treatment of cancer and the first Dietary Supplements Research Center was funded jointly by NCCAM and the NIH Office of Dietary Supplements. NIH funded nine Centers for Research of Complementary and Alternative Medicine to conduct interdisciplinary research and training.
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From page 22... ...
The mission of the consortium is "to help transform medicine and healthcare through rigorous scientific studies, new models of clinical care, and innovative educational programs that integrate biomedicine, the complexity of human beings, the intrinsic nature of healing and the rich diversity of therapeutic systems" (Consortium of Academic Health Centers for Integrative Medicine, 2004)
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From page 23... ...
. In 2002, NCCAM launched its Intramural Program to explore CAM treatment strategies for patients at the NIH Clinical Center, the world's largest facility dedicated to patient-oriented research.
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From page 24... ...
NCCAM's CAM-related research centers can be placed into several categories: Dietary Supplement Research, Developmental Centers that partner institutions where CAM is practiced and those where conventional medicine is practiced, Centers of Excellence, Centers for CAM Research, and Exploratory Program Grants for Frontier Medicine Research. The establishment of international centers for CAM research is also an initiative in development.
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From page 25... ...
The NIH institutes and centers conduct research in partnership with each other and independently, facilitating a broad scope of activity in both clinical and basic research. There is ongoing research on the safety and efficacy of CAM practices for disease treatment and prevention; mechanisms of therapies including dietary supplements such as soy isoflavones and acupuncture; placebo effects; the role of spirituality in health; as well as animal studies of alternative therapies for Parkinson's disease.
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From page 26... ...
The Research Development and Support Program funds research on CAM for the prevention, diagnosis, and treatment of cancer; CAM for cancer-related symptoms; and CAM modalities that can address the side effects of conventional treatment. Examples of recent activities include a methodology working group on research on cancer symptom management by the use of CAM, the provision of competitive supplementary funds for
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From page 27... ...
to build a dialogue between health practitioners and researchers about CAM and cancer issues. The Practice Assessment supports the Best Case Series Program for groups of cancer patients treated with CAM therapies.
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From page 28... ...
In the last 5 years, ODS has initiated many efforts to improve the quality of research on dietary supplements. For example, ODS established a program to enhance analytical methodologies and develop standard reference preparations of dietary supplements and also created two databases that are accessible to everyone: the Computer Access to Research on Dietary Supplements database (CARDS)
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From page 29... ...
The clinical topics must meet specific selection criteria including a high incidence; significance for the needs of Medicare, Medicaid, or other federal health programs; high cost; controversy about their effectiveness; and the availability of scientific data. On the basis of this process, reports on six dietary supplements1 have been reviewed as of October 2003.
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From page 30... ...
· Existing decision-making models used to determine whether or not to incorporate new therapies and practices into conventional medicine, including evidence thresholds. · Applicability of these decision-making models to CAM therapies and practices; that is, do they form good precedents for decisions relating to regulation, accreditation, or integration of CAM therapies?
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From page 31... ...
Chapter 7 reviews the growing integration of CAM and explores why such integration is occurring, and Chapter 8 discusses the education of both conventional practitioners and CAM practitioners. Chapter 9 focuses on dietary supplements, and Chapter 10 presents the conclusion of the report.
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From page 32... ...
a search of major health social science journals covering the fields of anthropology, sociology, psychology and geography, and (3) a library search of books and book chapters on CAM written by those holding advanced academic degrees and having academic positions in reputable U.S., Canadian, Australian, and British universities.
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From page 33... ...
2003. NCCAM Research: Measures of success, lessons learned, and opportunities.
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