Complementary And Alternative Medicine: The Evidence Debate
November 15, 2018
A diverse group of treatments has been in use for hundreds of years but is still embroiled in debate between staunch supporters on the one hand and equally vocal sceptics on the other. These treatments are grouped under a category of Complementary and Alternative Medicine (CAM) which is defined by the National Institute of Health as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine.”
CAM treatments are used in several conditions including cancer, arthritis, diabetes, cardiovascular and neurological disorders. Examples of these treatments include nutritional supplements and herbal medicines; mind, body and touch therapies such as massage, meditation, acupuncture, and biofeedback therapies; chiropractic and osteopathic manipulations; and a continuously evolving list of alternate systems. Wherein lies the problem. With a wide range of treatments falling into this category, there is also great variation in how their impact is studied and the type of results available to the wider population to make an informed decision. Examples of organized studies and publications that prove these treatments are safe and effective choices are limited and often do not follow the widely accepted evidence-based guidelines for randomized, controlled trials that is the norm for studies performed for conventional medicine.
Does this mean that CAM therapies are not effective? That’s a difficult perspective to accept when some of these systems have been around for multiple centuries and surveys indicate that in the US alone, more than 80 million adults and approximately 30-40% cancer patients use some form of complementary and alternative medicine. However, it cannot be overlooked that this category of treatments has a shortage of well-designed research studies based on statistically significant sample sizes. This has resulted in a lack of sufficient scientific evidence to support claims of effectiveness and inadequate understanding of critical information such as side effects, proper usage or dangerous interactions.
Some experts argue that randomized, controlled trials that work extremely well for conventional medicine isn’t the right approach for studying CAM treatments and that alternate approaches such as observational, qualitative or outcomes-based studies are more appropriate. Others have suggested a model that incorporates a combination of approaches and looks at data collected from multiple methods to gain a more holistic picture. The approach may be debated but what is clear is that there is a strong need for more well-designed trials with appropriate sample sizes that study CAM therapies. With large numbers of population utilizing some form of CAM therapy, it is time that we come together on gathering high quality data for this domain so that clinicians and patients alike can make informed decisions based on appropriate evidence.