the therapies in widespread use, the populations that use them, and what is known about how they are provided.

• Identify major scientific, policy, and practice issues related to CAM research and to the translation of validated therapies into conventional medical practice.

• Develop conceptual models or frameworks to guide public- and private-sector decisionmaking as research and practice communities increasingly conduct research on CAM, translate the research findings into practice, and address the barriers that may impede such translation.

Decisions about the use of specific CAM therapies should primarily depend on whether they have been shown to be safe and effective. But this is easier said than done, as there are extremes of belief about what counts as evidence. For some individuals, evidence limited to their own experience or knowledge is all that is necessary as proof that a CAM therapy is successful; for others, no amount of evidence is sufficient. This report will please neither of those extremes.

There are unproven ideas of all kinds, stemming from CAM and conventional medicine alike, and the committee believes that the same principles and standards of evidence should apply regardless of a treatment’s origin. Study results may then move useful therapies from unproven ideas into evidence-based practice.

The goal should be the provision of comprehensive care that respects contributions from all sources. Such care requires decisions based on the results of scientific inquiry, which in turn can lead to new information that results in improvements in patient care.

This report’s core message is therefore as follows: The committee recommends that the same principles and standards of evidence of treatment effectiveness apply to all treatments, whether currently labeled as conventional medicine or CAM. Implementing this recommendation requires that investigators use and develop as necessary common methods, measures, and standards for the generation and interpretation of evidence necessary for making decisions about the use of CAM and conventional therapies.

The committee acknowledges that the characteristics of some CAM therapies—such as variable practitioner approaches, customized treatments, “bundles” (combinations) of treatments, and hard-to-measure outcomes—are difficult to incorporate into treatment-effectiveness studies. These characteristics are not unique to CAM, but they are more frequently found in CAM than in conventional therapies. The effects of mass-produced, essentially identical prescription drugs, for example, are somewhat easier to

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)