The use of complementary and alternative medicine (CAM) has increased considerably in Western industrialized nations over the last 25 years. In the USA, the expenditure is approximately $30 billion per annum, surpassing current out-of-pocket expenditures for conventional treatments by primary care physicians [1,2]. CAM treatment modalities include a variety of approaches (i.e., acupuncture, homeopathy, herbal medicine, massage, reflexology, Reiki healing etc.), many of them based on theories that differ markedly from conventional Western biomedicine. The assessment and management of illness often includes a more detailed interest in patients' wellbeing, as well as recommendations concerning lifestyle and their quality of life as a whole [3].
Patients are selective in their choice of CAM treatments [4], usually abstaining from exclusive use of CAM in acute life-threatening conditions. Rather, CAM is mainly used in addition to conventional care for chronic and some acute health conditions, for disease prevention and for maintaining wellness. For example, more than half of all breast cancer patients use some form of CAM complementary to conventional medicine, most often with a palliative intent [5,6].
Many physicians do not understand why large segments of their patients use CAM when research generally has failed to provide decisive evidence of efficacy. Patients seem to make these treatment choices based on the qualities of the provider, desire for "individualized" treatments, and their perception of overall effectiveness rather than efficacy [7-11].
There is apparently a "gap" between the results of randomized controlled trials (RCT) showing little or no effect and the widespread use and reports of beneficial outcomes of CAM treatment [12,13]. If we were to assume that patients are not completely misguided, then we would need to look closely at the research strategies utilized in the CAM field and try to understand the reasons for the gap.
The purpose of this paper is therefore to
1. Explore the strengths and weaknesses of conventional biomedical research strategies and methods as applied to CAM
2. Suggest a new research framework for assessing these treatment modalities.
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