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From page 327... ... Index A Alternative medical systems, 18, 42 American Association of Naturopathy, 180 Academic Health Centers for Integrative American Chiropractic Association, 180 Medicine, 22, 149�150 American Herbal Pharmacopoeia, 268 Accountability, 171�173 American Herbal Products Association, 268 Acupuncture, 16, 38�39, 133, 202 Anderson Cancer Center, 202 analgesia effects, 147 Antioxidants, 261 attitudes of conventional physicians, Anxiety, 64 203, 206 Aromatherapy, 133 cost-effectiveness, 49�50 Assessment, 180�181 ethical practice, 180 Asthma, 45, 46 insurance coverage, 47, 206 Attention and hyperactivity disorders, 45 NIH consensus statement, 141�142 Attribute-treatment interaction analyses, 3, practice characteristics, 63 118 regulation, 20�21 strategies for improving research quality, 144�145 B Acupuncture and Oriental Medicine Commission, 180 Back problems, 38, 45 Adherence, 10, 11, 60�61, 65, 66, 161 cost-effectiveness of CAM, 49 Advertising, 263 Basic research, 120�122, 147 Advocate model of integrative medicine, Basic science excellence model of research, 219 122 Age, consumer Behavioral medicine, 203 CAM use patterns and, 44�45, 48 Behavioral Risk Factor Surveillance Survey, dietary supplement use and, 256 154 Agency for Healthcare Research and Belmont Report of the National Quality, 29, 267 Commission for the Protection of evidence reports, 141 Human Subjects in Biomedical and AIDS/HIV, 45, 244�245, 248�249 Behavioral Research, 174�175 327 Read the entire page →
From page 328... ... 328 INDEX Biofeedback ethnic and cultural subgroups, 43�44, attitudes of conventional physicians, 64�65, 152, 162, 278 203, 206 gender, 10, 41, 63, 64, 278 education and training in, 227 health beliefs, 55 patterns of use, 48 Conventional medicine Biologically based therapies, 18, 42 CAM interactions, 45, 61, 66, 115 Black cohosh, 262 consumer perceptions, 56 Bundled therapies, 3, 108, 115 effectiveness research, 17�18, 145, 230 ethical issues regarding reimbursement, 172�173 C gaps in outcomes research, 146�147, 161 Canada, 263�264 patient disclosure regarding CAM use, Cancer, 44, 45 34, 35�38, 44, 63, 65 CAM therapies, 6�7, 202 patterns of CAM use and, 34, 39�40, NIH CAM research, 26�27 54�55, 62, 203�206 sources of information about CAM quality improvement goals, 14 therapies, 59 See also Integration of CAM and Cardiovascular disease, 46, 133 conventional medicine Case-control studies, 3, 82, 114 Cost-effectiveness of CAM, 5 Children, use of CAM by, 44, 63 analytic method, 88�90 Chiropractic treatment, 16 current understanding of, 49�50 attitudes of conventional physicians, 206 research model, 123 defining features, 18�19 research needs, 148 ethical practice, 180 Cost of care insurance coverage, 47, 206 CAM spending, 1, 34 licensure, 237 chronic illnesses, 46 patterns of use, 38�39, 44, 202 conventional medicine spending, 35 practice characteristics, 63�64 dietary supplement spending, 35, 253 reimbursement, 23 distribution by medical condition, 46 research in, 240, 241 ethical issues regarding CAM healing, treatment goals, 64 172�173 Chondroitin sulfate, 21, 262 health-seeking behavior and, 40 Chronic illnesses, 46, 48 integrative medicine, 218, 219�220 Classification of CAM modalities, 18�19 out-of-pocket spending, 13, 34, 35, 41� Cochrane Library, 132�140 42 Cohort studies, 3, 81�82, 113�114, 152�154 systematic reviews of research, 142�143 Co-morbid conditions, 92�93 See also Cost-effectiveness of CAM Compliance. See Adherence Cross-disciplinary research, 148, 149 Concierge model of integrative medicine, in CAM Research Centers, 159 219 Cross-sectional studies, 83 Confidence intervals, 90�91 Cultural contexts, 43�44 CONSORT guidelines, 144 concept of causality in research, 99 Consortium of Academic Health Centers for research needs, 66 Integrative Medicine, 22, 231 Consultant model of integrative medicine, 217 D Consumer characteristics, 41�45 age, 44�45, 48, 256 Dana-Farber Cancer Institute, 7, 202 economic status, 41�42 Data collection and management educational attainment, 10, 41, 42, 254� in CAM research model, 152, 154, 159� 256 160, 161�162 Read the entire page →
From page 329... ... drug interaction risk, 13, 23, 35, 270 good manufacturing processes, 266 acceptance of new therapies and, 196� label claims, 260�262 198 AHRQ evidence reports, 141 NIH research activities, 28 off-label use, 261 attribute-treatment interaction analyses, patterns of use, 13, 35, 44, 253�257 3, 118 basic research, 120�121, 147 quality control, 4, 5, 265�270, 274, 280 recommendations for regulation and challenges in CAM research, 103�105, research, 4�5, 274�275 108�111, 115�116, 123 Cochrane Library data, 134�140 regulation, 4, 5, 190�191, 256�260, 263�265, 270�271 conventional therapies, 17�18, 145, 230 research, 272�274 criteria for establishing cause-and-effect relationships, 99�100 safety, 265�272, 274 spending, 35, 253 determinants of, 79 See also Herbal medicine disincentives to CAM testing, 173, 273� 274 Read the entire page →
From page 330... ... 330 INDEX efficacy studies, 91�92, 98, 103�104, informed consent issues, 177�178 120 in integration of CAM and conventional ethical issues in prescribing, 184 medicine, 179�183 expectation effects in, 117�118 issues of concern, 168 framework for medical decision making, legal issues and, 183�192 213�215 nonmaleficence in, 169 goals of CAM healing, 171�172 in prescribing CAM therapies, 181�182 information needs for clinicians, 101� professional codes and guidelines, 179� 102 180, 187 instruction in CAM based on, 230 public accountability and, 171�173 insurance providers' concerns, 102 recognition of medical pluralism, 169� levels of evidence for, 94�98, 103, 124� 171, 184�185 127 in research, 174�179 measurement error, 92 respect for patient autonomy, 169 NIH consensus statements, 141�143 sociocultural context, 192 observational studies, 113 Ethylenediaminetetraacetic acid, 262 patient perceptions, 38, 51, 197�198, Evidence-based practice, 2, 11, 77�79, 85� 199�200 86 placebo effects in, 110, 117�118 commitment to medical pluralism and, predictive modeling, 86�87 184�185 prescription drug regulation, 76�77 conceptual development, 77�78, 85�86 qualitative research, 119 in development of CAM practice quality of research, 143�146 guidelines, 246�247 recommendations for research, 5�6, goals, 78 124�127, 279 status of CAM research, 145 research challenges, 2�3 Evidence-Based Practice Centers, 29, 267 research designs, 79�83, 111�120 Expectation effects, 84 sources of consumer information, 103 CAM research challenges, 110 standards of evidence for, ix�x, 2, 99� informed consent for research and, 177� 103, 124�125, 184, 230 178 systematic reviews of research, 129�130 research design for, 3, 117�118 technical and conceptual development of research on, 74�76 therapeutic relationship factors, 109� F 110, 126 training of practitioners in, 100�101 Fatigue disorders, 133 Federal Food, Drug, and Cosmetic Act, 77, See also Cost-effectiveness of CAM; Outcomes research 269, 270 Efficacy studies, 91�92, 98, 103�104, 120 Federation of Practice Based Networks, 156 Federation of State Medical Boards of the Energy therapies, 19, 42 outcomes measurement, 110 United States, 7, 22, 187, 203 patterns of use, 48 Fitness center model of integrative medicine, 217 Ephedra, 59, 258 Ethical practice, 8, 16 Folic acid, 261 access to research participation, 179 Food and Drug Administration, 20, 77 dietary supplement regulation, 4, 256, commitment to public welfare, 169 conceptual basis, 168�171 257, 258, 260�261, 263, 266, 270� definition and scope of CAM, 174 271 Framington Heart Study, 154 duty of nonabandonment, 184�185 evidence of therapeutic efficacy required France, 265 for prescribing, 184�185 Read the entire page →
From page 331... ... See St. John's wort Hypertension, 38, 46 spectrum model, 210 Hypnotherapy, 173, 203, 206 trends, 6�7, 196, 201�206, 278 virtual model, 217 See also Translating research findings I into practice International Ethical Guidelines for Indinavir, 23 Biomedical Research Involving Informed consent, 177�178, 181, 183 Human Subjects, 174�175 patient preference for CAM therapy in Internet, 58�59, 66 absence of proof of effect, 184�188 Isoflavone formononetin, 147 Institute of Medicine, 29�31, 270�271 Insurance. Read the entire page →
From page 332... ... 332 INDEX L goals of integrative medicine, 211�213, 220 Labeling of dietary supplements, 260�262 knowledge-based, 15 Legal issues, 8, 59, 183�192 models of integrative medicine, 217�220 assumption of risk, 188�189 patient-centered, 15 food and drug law, 190�191 patient participation in, 55 health care fraud, 191 research needs, 10�11, 62 informed consent, 183�184 sources of CAM information, 58�60, 66, malpractice liability, 188�190 103 patient preference for CAM therapy in types of illnesses treated with CAM, 34, absence of proof of effect, 185�188, 45�46, 63, 64 214�215 See also Use of CAM therapies referral obligation, 189�190 Meditation, 18 sociocultural context, 191�192 attitudes of conventional physicians, 206 Licensing and certification, 61 education and training in, 227 of CAM practitioners, 16, 237 immune function and, 149 characteristics of CAM practitioners, patterns of use, 44 63�64 MEDLINE, 130�132 institutional credentialing for integrative Memorial Sloan-Kettering Cancer Center, medicine, 216�217 6�7, 202 recommendations for, 9�10, 249�250 Menopause, 45 state authority for, 188 Mental healing, 18 Licorice root, 147 Meta-analysis, 129, 130, 144 Longitudinal studies, 83, 152�154 Mind-body medicine, 18, 147, 148�149 holistic approach, 211 Modalities of CAM M classification, 18�19 Malpractice liability, 188�190 concurrent use of multiple modalities, Manipulative and body-based therapies, 18� 108, 115 consumer socio-demographic 19, 42 cost-effectiveness, 50 characteristics and use of, 42 See also Massage therapy medical school curricula, 226�227 patterns of use, 38�39 Manualized therapies, 115�116 Massage therapy, 16, 38�39 practitioner training in, 237�238 attitudes of conventional physicians, Mood disorders, 46, 64 Motivation to investigate or use CAM 203, 206 cost-effectiveness, 49 health care provider, 208�209, 218 education and training in, 227 patient, 40, 46, 48�49, 50�58, 65�66, 161 insurance coverage, 47, 206 licensure for, 238 Musculoskeletal disorders, 133 patterns of use, 48 practice characteristics, 63�64 N treatment goals, 64 Measurement error, 91, 92 National Center for Complementary and Medicaid, 42 Alternative Medicine (NCCAM) , 1, Medical decision making, 14, 278 9, 17, 21, 23, 121 cost of care as factor in, 40 classification of CAM modalities, 18�19 decision models, 76 dietary supplement policies, 267, 272, efficacy�safety framework for, 213�215 273 ethical practice, 8 education projects, 233�234 Read the entire page →
From page 333... ... Natural Medicines Comprehensive Database, 268�269 Natural Standard, 269 P Naturopathy, 16, 63 ethical practice, 180 Pain licensure for, 237 acupuncture analgesia, 147 outcome measurement, 84, 110�111 patterns of use, 48 NCCAM. See National Center for placebo effects, 147 Complementary and Alternative Patent law, 173, 273�274 Patient autonomy, 8, 183�184 Medicine Neck pain, 50 framework for medical decision making, New England Journal of Medicine, 21 213 informed consent and, 177�178 N-of-1 trials, 112 Nuremberg Code, 174�175 preference for CAM therapy in absence Nurses' Health Study, 154 of proof of effect, 184�188, 214�215 principle of ethical practice, 169, 178� Nurses/nursing, 204�206 CAM education for, 227, 229, 232, 235 179 Patient-centered treatment, 15, 20, 220 in CAM, 238 O as core competency of health care, 228 research needs, 238 Observational studies, 3, 80�81, 113�114 Patient�healer relationship, 109�110, 126 Office of Alternative Medicine, 20, 21 ethical practice, 181�182 Office of Cancer Complementary and in integrative medicine, 209�210 Alternative Medicine, 26�27 as patient motivation for CAM therapy, Office of Dietary Supplements, 28, 272�273 182 Office of Unconventional Therapies, 20 Pharmacotherapy Omega-3 fatty acids, 261 CAM instruction for pharmacists, 227 Osteopathy, 201, 218 concurrent dietary supplement use, 254 Outcomes research drug interactions, 13, 23, 35, 270 in case-control studies, 82 regulation, 76�77 Read the entire page →
From page 334... ... 334 INDEX Physician's Desk Reference, 269 R Placebo effects analgesia, 147 Race/ethnicity of consumers, 43�44, 64�65 CAM research challenges, 110 survey of health practices among early research on, 22, 23 minority populations, 152, 162 research design for, 3, 117�118 Randomized controlled trials, 3, 79�80, 96, Practice-based research, 5�6 98, 120, 184 Practice-based research networks alternative research designs, 3, 111�119 definition, 156 basic features, 129 in model of CAM research, 155�158, challenges in CAM research, 103�105, 160 108 organizational structure, 156�157 Cochrane Library data, 132�140 origins and development, 156 MEDLINE data, 130�132 practitioner training in, 158 preference studies, 112�113, 123 recommendations for, 6, 162 preventive and wellness treatments, 105� research activities, 157�158, 160 106 Practice guidelines, 7, 8, 9�10, 22, 203�204 quality of studies, 143�144 acceptance of new therapies, 200 strategies for improving quality, 144� development of, 246�248, 249�250 146 for ethical practice, 179�180, 187 Recursive partitioning, 115 goals for, 246 Red clover, 262 rationale, 246 Referrals, 63, 215 recommendations for, 249�250 legal obligations, 189�190 Prayer, 18, 40, 42 models of integrative medicine, 217 Preventive care Regulation levels of evidence for research on, 94�98 dietary supplements, 4, 5, 190�191, NCCAM research, 24 256�260, 263�265, 270�271 research challenges, 105�106 evolution of CAM, 20�22 research needs, 11, 66 international comparison, 263�265 use of CAM for, 48�49, 51�54, 64, 65 prescription drugs, 76�77 Prospective research, 80, 114 public opinion, 256�257 Psychiatric problems, 45, 47 See also Legal issues; Licensing and Public awareness and understanding, 10, 11 certification dietary supplement use and, 254, 256� Reiki therapy, 19 257, 265 Reimbursement, 102 NCCAM outreach efforts, 24�25 acceptance of new therapies, 200 perceptions of health care providers, 56 CAM coverage, 23, 206�208 sensitivity to scientific evidence, 254, ethical issues regarding CAM healing, 256 172�173 sources of CAM information, 1, 58�60, evidence of treatment effectiveness and, 66, 103, 161 102 PubMed, 23 for integrative practice, 219 Pure Food and Drug Act, 76 potential problems of CAM coverage, 207 utilization and, 35, 47, 64, 207 Q Relaxation techniques, 16 Cochrane Library data, 133 Qi gong, 19 patterns of use, 38�39, 44 Qualitative research, 119 Religious-spiritual practices, 44 Quality-adjusted life years, 89�90 ethical and legal considerations, 191 Quality of evidence model of research, 122 measurement of CAM effectiveness and, QUOROM guidelines, 144 171�172 Read the entire page →
From page 335... ... INDEX 335 Research centers respect for research subjects in, 178�179 in model of CAM research, 6, 158�160, risk-benefit considerations, 177 162 simulation of CAM use patterns in NCCAM, 24, 158 clinical trials, 62 Research methodology special needs for CAM research, 99 case-control studies, 82, 114 standards of evidence, 99�103 case series studies, 82�83 strategies for improving quality, 144� challenges in CAM research, 2�3, 103� 146 105, 108�111, 123 subject selection, 176�177 cohort studies, 81�82, 113�114 superiority/noninferiority trials, 92 conceptual models, 122�123 technical and conceptual development of conceptualization and measurement of effectiveness research, 74�76 health, 210�211 validity in, 176 control of confounding variables, 80�81 See also Outcomes research cost constraints, 120 Research personnel criteria for establishing causality, 99� education and training of, 9, 239�245, 100 248�249, 279 cross-disciplinary efforts, 148, 149 interdisciplinary teams, 5 cross-sectional studies, 83 shortages of, 5, 239 education of health professionals in, 9, sources of, 239 239�244, 248�249 strategies for expanding CAM research, efficacy studies, 91�92, 98 148�151 ethical practice, 8, 174�179 Research settings evidence-based medicine, 77�79, 85�86 funding, 25 hierarchies of evidence, 94�98, 103, National Institutes of Health CAM 124�127 programs, 23�28 independent review, 178 practice-based, 5�6 individualization of treatments and, 109, recommendations for, 6 111, 115�116 See also Research centers; specific informed consent issues, 177�178 organization innovative designs for CAM research, 3, Research topics 111�120, 123�124 basic research, 120�122, 147 longitudinal studies, 83 in CAM Research Centers, 158�159 N-of-1 trials, 112 CAM use and outcomes, 10�11, 151� observational studies, 80�81, 113�114 154 in practice-based research networks, 157 dietary supplements, 5, 272�274 preference randomized controlled trials, disincentives to CAM testing, 173 112�113, 123 gaps in CAM research, 146�151, 161 for preventive and wellness treatments, health-seeking behaviors 105�106 integration of CAM and conventional qualitative methods, 119 medicine, 7�8, 221�222 quality of studies, 143�144 in NCCAM Research centers, 158 quantification of CAM treatment in practice-based research networks, elements, 109�110, 111, 115�116, 157�158, 160 125�126 recent evolution of CAM research, 20� randomized studies, 79�80 23 recommendations for standardization, 2, recommendations for, 5�6, 66�67, 124, 124�125 279 research goals and, 120 selection criteria, 3�4, 199, 279 for research on widely used treatments, social or scientific value in, 175 104 Read the entire page →
From page 336... ... Pharmacopeia-National Formulary, Surveillance 269�270 in CAM research model, 155, 159�160 U.S. Preventive Services Task Force, 94�98 passive/active, 155 Use of CAM therapies, 1, 13, 34�41, 64�65 purposes, 154�155 clinical supervision for, 61�62, 65 recommendations for, 6, 162 concurrent use of multiple modalities, sentinel sites, 6, 155 108, 115 Surveys, health care, 6 cost as decision factor in, 40 in CAM research model, 152 data sources, 31�32, 34, 39, 40, 44�45 components, 152 dietary supplements, 13, 35, 44, 253� frequency, 152 257 minority populations in, 152 ethical practice in prescribing, 181�182 recommendations for, 162 for health promotion or disease Systematic reviews of research, 129�130, prevention, 48�49, 51�54, 64, 65 142�143 high-frequency users, 46�47, 64 Cochrane Library data, 132�140 insurance coverage and, 47, 64, 207 MEDLINE data, 130�132 long-term trends, 47�49 quality of studies, 143 medical conditions, 34, 45�46, 64, 65 strategies for improving quality, 144�146 national surveys, 6, 152�153 Systematic reviews of reviews, 141 in nursing practice, 204�206 patient disclosure to medical doctor regarding, 34, 35�38, 44, 63, 65, T 278 patient motivation, 46, 50�58, 65�66, Therapeutic misconception, 177�178 161 Therapeutic relationship. Read the entire page →
From page 337... ... INDEX 337 use of conventional therapies and, 34, W 39�40, 45, 54�55, 61, 62, 203�206 See also Consumer characteristics White House Commission on Utility, health state, 89�90 Complementary and Alternative Medicine, 21�22 Women's use of CAM, 10, 41, 63, 64 V World Health Organization, 269 Vitamin use, 35, 254 consumer characteristics, 42 patterns of, 44 Read the entire page →

From page 327...

... Index A Alternative medical systems, 18, 42 American Association of Naturopathy, 180 Academic Health Centers for Integrative American Chiropractic Association, 180 Medicine, 22, 149�150 American Herbal Pharmacopoeia, 268 Accountability, 171�173 American Herbal Products Association, 268 Acupuncture, 16, 38�39, 133, 202 Anderson Cancer Center, 202 analgesia effects, 147 Antioxidants, 261 attitudes of conventional physicians, Anxiety, 64 203, 206 Aromatherapy, 133 cost-effectiveness, 49�50 Assessment, 180�181 ethical practice, 180 Asthma, 45, 46 insurance coverage, 47, 206 Attention and hyperactivity disorders, 45 NIH consensus statement, 141�142 Attribute-treatment interaction analyses, 3, practice characteristics, 63 118 regulation, 20�21 strategies for improving research quality, 144�145 B Acupuncture and Oriental Medicine Commission, 180 Back problems, 38, 45 Adherence, 10, 11, 60�61, 65, 66, 161 cost-effectiveness of CAM, 49 Advertising, 263 Basic research, 120�122, 147 Advocate model of integrative medicine, Basic science excellence model of research, 219 122 Age, consumer Behavioral medicine, 203 CAM use patterns and, 44�45, 48 Behavioral Risk Factor Surveillance Survey, dietary supplement use and, 256 154 Agency for Healthcare Research and Belmont Report of the National Quality, 29, 267 Commission for the Protection of evidence reports, 141 Human Subjects in Biomedical and AIDS/HIV, 45, 244�245, 248�249 Behavioral Research, 174�175 327

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From page 328...

... 328 INDEX Biofeedback ethnic and cultural subgroups, 43�44, attitudes of conventional physicians, 64�65, 152, 162, 278 203, 206 gender, 10, 41, 63, 64, 278 education and training in, 227 health beliefs, 55 patterns of use, 48 Conventional medicine Biologically based therapies, 18, 42 CAM interactions, 45, 61, 66, 115 Black cohosh, 262 consumer perceptions, 56 Bundled therapies, 3, 108, 115 effectiveness research, 17�18, 145, 230 ethical issues regarding reimbursement, 172�173 C gaps in outcomes research, 146�147, 161 Canada, 263�264 patient disclosure regarding CAM use, Cancer, 44, 45 34, 35�38, 44, 63, 65 CAM therapies, 6�7, 202 patterns of CAM use and, 34, 39�40, NIH CAM research, 26�27 54�55, 62, 203�206 sources of information about CAM quality improvement goals, 14 therapies, 59 See also Integration of CAM and Cardiovascular disease, 46, 133 conventional medicine Case-control studies, 3, 82, 114 Cost-effectiveness of CAM, 5 Children, use of CAM by, 44, 63 analytic method, 88�90 Chiropractic treatment, 16 current understanding of, 49�50 attitudes of conventional physicians, 206 research model, 123 defining features, 18�19 research needs, 148 ethical practice, 180 Cost of care insurance coverage, 47, 206 CAM spending, 1, 34 licensure, 237 chronic illnesses, 46 patterns of use, 38�39, 44, 202 conventional medicine spending, 35 practice characteristics, 63�64 dietary supplement spending, 35, 253 reimbursement, 23 distribution by medical condition, 46 research in, 240, 241 ethical issues regarding CAM healing, treatment goals, 64 172�173 Chondroitin sulfate, 21, 262 health-seeking behavior and, 40 Chronic illnesses, 46, 48 integrative medicine, 218, 219�220 Classification of CAM modalities, 18�19 out-of-pocket spending, 13, 34, 35, 41� Cochrane Library, 132�140 42 Cohort studies, 3, 81�82, 113�114, 152�154 systematic reviews of research, 142�143 Co-morbid conditions, 92�93 See also Cost-effectiveness of CAM Compliance. See Adherence Cross-disciplinary research, 148, 149 Concierge model of integrative medicine, in CAM Research Centers, 159 219 Cross-sectional studies, 83 Confidence intervals, 90�91 Cultural contexts, 43�44 CONSORT guidelines, 144 concept of causality in research, 99 Consortium of Academic Health Centers for research needs, 66 Integrative Medicine, 22, 231 Consultant model of integrative medicine, 217 D Consumer characteristics, 41�45 age, 44�45, 48, 256 Dana-Farber Cancer Institute, 7, 202 economic status, 41�42 Data collection and management educational attainment, 10, 41, 42, 254� in CAM research model, 152, 154, 159� 256 160, 161�162

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From page 329...

... drug interaction risk, 13, 23, 35, 270 good manufacturing processes, 266 acceptance of new therapies and, 196� label claims, 260�262 198 AHRQ evidence reports, 141 NIH research activities, 28 off-label use, 261 attribute-treatment interaction analyses, patterns of use, 13, 35, 44, 253�257 3, 118 basic research, 120�121, 147 quality control, 4, 5, 265�270, 274, 280 recommendations for regulation and challenges in CAM research, 103�105, research, 4�5, 274�275 108�111, 115�116, 123 Cochrane Library data, 134�140 regulation, 4, 5, 190�191, 256�260, 263�265, 270�271 conventional therapies, 17�18, 145, 230 research, 272�274 criteria for establishing cause-and-effect relationships, 99�100 safety, 265�272, 274 spending, 35, 253 determinants of, 79 See also Herbal medicine disincentives to CAM testing, 173, 273� 274

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From page 330...

... 330 INDEX efficacy studies, 91�92, 98, 103�104, informed consent issues, 177�178 120 in integration of CAM and conventional ethical issues in prescribing, 184 medicine, 179�183 expectation effects in, 117�118 issues of concern, 168 framework for medical decision making, legal issues and, 183�192 213�215 nonmaleficence in, 169 goals of CAM healing, 171�172 in prescribing CAM therapies, 181�182 information needs for clinicians, 101� professional codes and guidelines, 179� 102 180, 187 instruction in CAM based on, 230 public accountability and, 171�173 insurance providers' concerns, 102 recognition of medical pluralism, 169� levels of evidence for, 94�98, 103, 124� 171, 184�185 127 in research, 174�179 measurement error, 92 respect for patient autonomy, 169 NIH consensus statements, 141�143 sociocultural context, 192 observational studies, 113 Ethylenediaminetetraacetic acid, 262 patient perceptions, 38, 51, 197�198, Evidence-based practice, 2, 11, 77�79, 85� 199�200 86 placebo effects in, 110, 117�118 commitment to medical pluralism and, predictive modeling, 86�87 184�185 prescription drug regulation, 76�77 conceptual development, 77�78, 85�86 qualitative research, 119 in development of CAM practice quality of research, 143�146 guidelines, 246�247 recommendations for research, 5�6, goals, 78 124�127, 279 status of CAM research, 145 research challenges, 2�3 Evidence-Based Practice Centers, 29, 267 research designs, 79�83, 111�120 Expectation effects, 84 sources of consumer information, 103 CAM research challenges, 110 standards of evidence for, ix�x, 2, 99� informed consent for research and, 177� 103, 124�125, 184, 230 178 systematic reviews of research, 129�130 research design for, 3, 117�118 technical and conceptual development of research on, 74�76 therapeutic relationship factors, 109� F 110, 126 training of practitioners in, 100�101 Fatigue disorders, 133 Federal Food, Drug, and Cosmetic Act, 77, See also Cost-effectiveness of CAM; Outcomes research 269, 270 Efficacy studies, 91�92, 98, 103�104, 120 Federation of Practice Based Networks, 156 Federation of State Medical Boards of the Energy therapies, 19, 42 outcomes measurement, 110 United States, 7, 22, 187, 203 patterns of use, 48 Fitness center model of integrative medicine, 217 Ephedra, 59, 258 Ethical practice, 8, 16 Folic acid, 261 access to research participation, 179 Food and Drug Administration, 20, 77 dietary supplement regulation, 4, 256, commitment to public welfare, 169 conceptual basis, 168�171 257, 258, 260�261, 263, 266, 270� definition and scope of CAM, 174 271 Framington Heart Study, 154 duty of nonabandonment, 184�185 evidence of therapeutic efficacy required France, 265 for prescribing, 184�185

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From page 331...

... See St. John's wort Hypertension, 38, 46 spectrum model, 210 Hypnotherapy, 173, 203, 206 trends, 6�7, 196, 201�206, 278 virtual model, 217 See also Translating research findings I into practice International Ethical Guidelines for Indinavir, 23 Biomedical Research Involving Informed consent, 177�178, 181, 183 Human Subjects, 174�175 patient preference for CAM therapy in Internet, 58�59, 66 absence of proof of effect, 184�188 Isoflavone formononetin, 147 Institute of Medicine, 29�31, 270�271 Insurance.

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From page 332...

... 332 INDEX L goals of integrative medicine, 211�213, 220 Labeling of dietary supplements, 260�262 knowledge-based, 15 Legal issues, 8, 59, 183�192 models of integrative medicine, 217�220 assumption of risk, 188�189 patient-centered, 15 food and drug law, 190�191 patient participation in, 55 health care fraud, 191 research needs, 10�11, 62 informed consent, 183�184 sources of CAM information, 58�60, 66, malpractice liability, 188�190 103 patient preference for CAM therapy in types of illnesses treated with CAM, 34, absence of proof of effect, 185�188, 45�46, 63, 64 214�215 See also Use of CAM therapies referral obligation, 189�190 Meditation, 18 sociocultural context, 191�192 attitudes of conventional physicians, 206 Licensing and certification, 61 education and training in, 227 of CAM practitioners, 16, 237 immune function and, 149 characteristics of CAM practitioners, patterns of use, 44 63�64 MEDLINE, 130�132 institutional credentialing for integrative Memorial Sloan-Kettering Cancer Center, medicine, 216�217 6�7, 202 recommendations for, 9�10, 249�250 Menopause, 45 state authority for, 188 Mental healing, 18 Licorice root, 147 Meta-analysis, 129, 130, 144 Longitudinal studies, 83, 152�154 Mind-body medicine, 18, 147, 148�149 holistic approach, 211 Modalities of CAM M classification, 18�19 Malpractice liability, 188�190 concurrent use of multiple modalities, Manipulative and body-based therapies, 18� 108, 115 consumer socio-demographic 19, 42 cost-effectiveness, 50 characteristics and use of, 42 See also Massage therapy medical school curricula, 226�227 patterns of use, 38�39 Manualized therapies, 115�116 Massage therapy, 16, 38�39 practitioner training in, 237�238 attitudes of conventional physicians, Mood disorders, 46, 64 Motivation to investigate or use CAM 203, 206 cost-effectiveness, 49 health care provider, 208�209, 218 education and training in, 227 patient, 40, 46, 48�49, 50�58, 65�66, 161 insurance coverage, 47, 206 licensure for, 238 Musculoskeletal disorders, 133 patterns of use, 48 practice characteristics, 63�64 N treatment goals, 64 Measurement error, 91, 92 National Center for Complementary and Medicaid, 42 Alternative Medicine (NCCAM) , 1, Medical decision making, 14, 278 9, 17, 21, 23, 121 cost of care as factor in, 40 classification of CAM modalities, 18�19 decision models, 76 dietary supplement policies, 267, 272, efficacy�safety framework for, 213�215 273 ethical practice, 8 education projects, 233�234

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From page 333...

... Natural Medicines Comprehensive Database, 268�269 Natural Standard, 269 P Naturopathy, 16, 63 ethical practice, 180 Pain licensure for, 237 acupuncture analgesia, 147 outcome measurement, 84, 110�111 patterns of use, 48 NCCAM. See National Center for placebo effects, 147 Complementary and Alternative Patent law, 173, 273�274 Patient autonomy, 8, 183�184 Medicine Neck pain, 50 framework for medical decision making, New England Journal of Medicine, 21 213 informed consent and, 177�178 N-of-1 trials, 112 Nuremberg Code, 174�175 preference for CAM therapy in absence Nurses' Health Study, 154 of proof of effect, 184�188, 214�215 principle of ethical practice, 169, 178� Nurses/nursing, 204�206 CAM education for, 227, 229, 232, 235 179 Patient-centered treatment, 15, 20, 220 in CAM, 238 O as core competency of health care, 228 research needs, 238 Observational studies, 3, 80�81, 113�114 Patient�healer relationship, 109�110, 126 Office of Alternative Medicine, 20, 21 ethical practice, 181�182 Office of Cancer Complementary and in integrative medicine, 209�210 Alternative Medicine, 26�27 as patient motivation for CAM therapy, Office of Dietary Supplements, 28, 272�273 182 Office of Unconventional Therapies, 20 Pharmacotherapy Omega-3 fatty acids, 261 CAM instruction for pharmacists, 227 Osteopathy, 201, 218 concurrent dietary supplement use, 254 Outcomes research drug interactions, 13, 23, 35, 270 in case-control studies, 82 regulation, 76�77

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From page 334...

... 334 INDEX Physician's Desk Reference, 269 R Placebo effects analgesia, 147 Race/ethnicity of consumers, 43�44, 64�65 CAM research challenges, 110 survey of health practices among early research on, 22, 23 minority populations, 152, 162 research design for, 3, 117�118 Randomized controlled trials, 3, 79�80, 96, Practice-based research, 5�6 98, 120, 184 Practice-based research networks alternative research designs, 3, 111�119 definition, 156 basic features, 129 in model of CAM research, 155�158, challenges in CAM research, 103�105, 160 108 organizational structure, 156�157 Cochrane Library data, 132�140 origins and development, 156 MEDLINE data, 130�132 practitioner training in, 158 preference studies, 112�113, 123 recommendations for, 6, 162 preventive and wellness treatments, 105� research activities, 157�158, 160 106 Practice guidelines, 7, 8, 9�10, 22, 203�204 quality of studies, 143�144 acceptance of new therapies, 200 strategies for improving quality, 144� development of, 246�248, 249�250 146 for ethical practice, 179�180, 187 Recursive partitioning, 115 goals for, 246 Red clover, 262 rationale, 246 Referrals, 63, 215 recommendations for, 249�250 legal obligations, 189�190 Prayer, 18, 40, 42 models of integrative medicine, 217 Preventive care Regulation levels of evidence for research on, 94�98 dietary supplements, 4, 5, 190�191, NCCAM research, 24 256�260, 263�265, 270�271 research challenges, 105�106 evolution of CAM, 20�22 research needs, 11, 66 international comparison, 263�265 use of CAM for, 48�49, 51�54, 64, 65 prescription drugs, 76�77 Prospective research, 80, 114 public opinion, 256�257 Psychiatric problems, 45, 47 See also Legal issues; Licensing and Public awareness and understanding, 10, 11 certification dietary supplement use and, 254, 256� Reiki therapy, 19 257, 265 Reimbursement, 102 NCCAM outreach efforts, 24�25 acceptance of new therapies, 200 perceptions of health care providers, 56 CAM coverage, 23, 206�208 sensitivity to scientific evidence, 254, ethical issues regarding CAM healing, 256 172�173 sources of CAM information, 1, 58�60, evidence of treatment effectiveness and, 66, 103, 161 102 PubMed, 23 for integrative practice, 219 Pure Food and Drug Act, 76 potential problems of CAM coverage, 207 utilization and, 35, 47, 64, 207 Q Relaxation techniques, 16 Cochrane Library data, 133 Qi gong, 19 patterns of use, 38�39, 44 Qualitative research, 119 Religious-spiritual practices, 44 Quality-adjusted life years, 89�90 ethical and legal considerations, 191 Quality of evidence model of research, 122 measurement of CAM effectiveness and, QUOROM guidelines, 144 171�172

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From page 335...

... INDEX 335 Research centers respect for research subjects in, 178�179 in model of CAM research, 6, 158�160, risk-benefit considerations, 177 162 simulation of CAM use patterns in NCCAM, 24, 158 clinical trials, 62 Research methodology special needs for CAM research, 99 case-control studies, 82, 114 standards of evidence, 99�103 case series studies, 82�83 strategies for improving quality, 144� challenges in CAM research, 2�3, 103� 146 105, 108�111, 123 subject selection, 176�177 cohort studies, 81�82, 113�114 superiority/noninferiority trials, 92 conceptual models, 122�123 technical and conceptual development of conceptualization and measurement of effectiveness research, 74�76 health, 210�211 validity in, 176 control of confounding variables, 80�81 See also Outcomes research cost constraints, 120 Research personnel criteria for establishing causality, 99� education and training of, 9, 239�245, 100 248�249, 279 cross-disciplinary efforts, 148, 149 interdisciplinary teams, 5 cross-sectional studies, 83 shortages of, 5, 239 education of health professionals in, 9, sources of, 239 239�244, 248�249 strategies for expanding CAM research, efficacy studies, 91�92, 98 148�151 ethical practice, 8, 174�179 Research settings evidence-based medicine, 77�79, 85�86 funding, 25 hierarchies of evidence, 94�98, 103, National Institutes of Health CAM 124�127 programs, 23�28 independent review, 178 practice-based, 5�6 individualization of treatments and, 109, recommendations for, 6 111, 115�116 See also Research centers; specific informed consent issues, 177�178 organization innovative designs for CAM research, 3, Research topics 111�120, 123�124 basic research, 120�122, 147 longitudinal studies, 83 in CAM Research Centers, 158�159 N-of-1 trials, 112 CAM use and outcomes, 10�11, 151� observational studies, 80�81, 113�114 154 in practice-based research networks, 157 dietary supplements, 5, 272�274 preference randomized controlled trials, disincentives to CAM testing, 173 112�113, 123 gaps in CAM research, 146�151, 161 for preventive and wellness treatments, health-seeking behaviors 105�106 integration of CAM and conventional qualitative methods, 119 medicine, 7�8, 221�222 quality of studies, 143�144 in NCCAM Research centers, 158 quantification of CAM treatment in practice-based research networks, elements, 109�110, 111, 115�116, 157�158, 160 125�126 recent evolution of CAM research, 20� randomized studies, 79�80 23 recommendations for standardization, 2, recommendations for, 5�6, 66�67, 124, 124�125 279 research goals and, 120 selection criteria, 3�4, 199, 279 for research on widely used treatments, social or scientific value in, 175 104

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... Pharmacopeia-National Formulary, Surveillance 269�270 in CAM research model, 155, 159�160 U.S. Preventive Services Task Force, 94�98 passive/active, 155 Use of CAM therapies, 1, 13, 34�41, 64�65 purposes, 154�155 clinical supervision for, 61�62, 65 recommendations for, 6, 162 concurrent use of multiple modalities, sentinel sites, 6, 155 108, 115 Surveys, health care, 6 cost as decision factor in, 40 in CAM research model, 152 data sources, 31�32, 34, 39, 40, 44�45 components, 152 dietary supplements, 13, 35, 44, 253� frequency, 152 257 minority populations in, 152 ethical practice in prescribing, 181�182 recommendations for, 162 for health promotion or disease Systematic reviews of research, 129�130, prevention, 48�49, 51�54, 64, 65 142�143 high-frequency users, 46�47, 64 Cochrane Library data, 132�140 insurance coverage and, 47, 64, 207 MEDLINE data, 130�132 long-term trends, 47�49 quality of studies, 143 medical conditions, 34, 45�46, 64, 65 strategies for improving quality, 144�146 national surveys, 6, 152�153 Systematic reviews of reviews, 141 in nursing practice, 204�206 patient disclosure to medical doctor regarding, 34, 35�38, 44, 63, 65, T 278 patient motivation, 46, 50�58, 65�66, Therapeutic misconception, 177�178 161 Therapeutic relationship.

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From page 337...

... INDEX 337 use of conventional therapies and, 34, W 39�40, 45, 54�55, 61, 62, 203�206 See also Consumer characteristics White House Commission on Utility, health state, 89�90 Complementary and Alternative Medicine, 21�22 Women's use of CAM, 10, 41, 63, 64 V World Health Organization, 269 Vitamin use, 35, 254 consumer characteristics, 42 patterns of, 44

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Index Pages 327-338

Index
Pages 327-338