no effect, whereas insufficient evidence was available for another 21 percent (Ezzo et al., 2001). Furthermore, “some CAM manufacturers adopt higher standards than are currently required in the United States and rigorously test their CAM products” (Kopelman, 2002).

Stipulative definitions (i.e., lists of therapies) are not successful in distinguishing CAM from conventional therapies, Kopelman argues, because they are not consistent from source to source and they provide no justification for the exclusion of therapies that are not included.

Given the lack of a consistent definition of CAM, some have tried to bring clarity to the situation by proposing classification systems that can be used to organize the field. One of the most widely used classification structures, developed by NCCAM (2000), divides CAM modalities into five categories:

1. Alternative medical systems,

2. Mind-body interventions,

3. Biologically based treatments,

4. Manipulative and body-based methods, and

5. 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. Examples of these systems include traditional Chinese medicine, ayurvedic medicine, homeopathy, and naturopathy.

The second category in the NCCAM classification scheme is mind-body interventions, which include practices that are based on the human mind, but that have an effect on the human body and physical health, such as meditation, prayer, and mental healing.

The third category, biologically based therapies, includes specialized diets, herbal products, and other natural products such as minerals, hormones, and biologicals. Specialized diets include those proposed by Drs. Atkins and Ornish, as well as the broader field of functional foods that may reduce the risk of disease or promote health. A few of the well-known herbals for which there is evidence of effectiveness include St. John’s wort for the treatment of mild to moderate depression and Ginkgo biloba for the treatment of mild cognitive impairment. An example of a nonherbal natural product is fish oil for the treatment of cardiovascular conditions.

The fourth category, manipulative and body-based methods, includes therapies that involve movement or manipulation of the body. Chiropractic is the best known in this category, and chiropractors are licensed to practice in every U.S. state. A defining feature of chiropractic treatment is spinal manipulation, also known as spinal adjustment, to correct spinal joint

Front Matter (R1-R22)

Executive Summary (1-12)

1 Introduction (13-33)

2 Prevalence, Cost, and Patterns of CAM Use (34-73)

3 Contemporary Approaches to Evidence of Treatment Effectiveness: A Context for CAM Research (74-107)

4 Need for Innovative Designs in Research on CAM and Conventional Medicine (108-128)

5 State of Emerging Evidence on CAM (129-167)

6 An Ethical Framework for CAM Research, Practice, and Policy (168-195)

7 Integration of CAM and Conventional Medicine (196-225)

8 Educational Programs in CAM (226-252)

9 Dietary Supplements (253-277)

10 Conclusion (278-282)

Appendix A: CAM Therapies, Practices, and Systems (283-292)

Appendix B: Consortium of Academic Health Centers for Integrative Medicine (293-294)

Appendix C: Table 1-1 List of Abbreviations (295-295)

Appendix D: Liaison Panel Organizations (296-297)

Appendix E: Model Guidelines for the Use of Complementary and Alternative Therapies in Medical Practice (298-306)

Appendix F: National Center for Complementary and Alternative Medicine Research Centers (307-309)

Appendix G: Public Meetings (310-318)

Appendix H: Committee Biosketches (319-326)

Index (327-338)