Index

A

Academic Health Centers for Integrative Medicine, 22, 149–150

Accountability, 171–173

Acupuncture, 16, 38–39, 133, 202

analgesia effects, 147

attitudes of conventional physicians, 203, 206

cost-effectiveness, 49–50

ethical practice, 180

insurance coverage, 47, 206

NIH consensus statement, 141–142

practice characteristics, 63

regulation, 20–21

strategies for improving research quality, 144–145

Acupuncture and Oriental Medicine Commission, 180

Adherence, 10, 11, 60–61, 65, 66, 161

Advertising, 263

Advocate model of integrative medicine, 219

Age, consumer

CAM use patterns and, 44–45, 48

dietary supplement use and, 256

Agency for Healthcare Research and Quality, 29, 267

evidence reports, 141

AIDS/HIV, 45, 244–245, 248–249

Alternative medical systems, 18, 42

American Association of Naturopathy, 180

American Chiropractic Association, 180

American Herbal Pharmacopoeia, 268

American Herbal Products Association, 268

Anderson Cancer Center, 202

Antioxidants, 261

Anxiety, 64

Aromatherapy, 133

Assessment, 180–181

Asthma, 45, 46

Attention and hyperactivity disorders, 45

Attribute-treatment interaction analyses, 3, 118

B

Back problems, 38, 45

cost-effectiveness of CAM, 49

Basic research, 120–122, 147

Basic science excellence model of research, 122

Behavioral medicine, 203

Behavioral Risk Factor Surveillance Survey, 154

Belmont Report of the National Commission for the Protection of Human Subjects in Biomedical and Behavioral Research, 174–175



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

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

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Complementary and Alternative Medicine in the United States on CAM use, 31–32, 40, 44–45 Cochrane Library data, 132–140 cultural considerations, 43–44 on dietary supplements, 28, 272–274 gaps in CAM research, 146–151, 161 MEDLINE data, 130–132 national surveys, 6, 152–154 for outcomes research, 76 recommendations for, 6, 10–11, 145–146 sentinel surveillance system, 154–155, 159–160 sources of CAM information, 1, 58–60, 66, 103, 130, 161 Declaration of Helsinki, 174–175 Definition of CAM, ix, 16–20, 40, 44–45, 64 value judgments in, 174 Definition of health, 210–211 Department of Health and Human Services, 7–8, 29, 222 Department of Veterans Affairs, 7–8, 23, 222 Depression, 64 Diabetes, 46 Diagnostic classification, 126 Dietary Supplement Health and Education Act (1994), 4–5, 20, 59, 190, 257–260, 271, 274–275, 280 Dietary supplements, 18 adherence issues, 61 advertising claims, 58–59, 258, 260–261, 263 consumer beliefs, 256–257 consumer characteristics, 254–256 definition, 257–258 drug interaction risk, 13, 23, 35, 270 good manufacturing processes, 266 label claims, 260–262 NIH research activities, 28 off-label use, 261 patterns of use, 13, 35, 44, 253–257 quality control, 4, 5, 265–270, 274, 280 recommendations for regulation and research, 4–5, 274–275 regulation, 4, 5, 190–191, 256–260, 263–265, 270–271 research, 272–274 safety, 265–272, 274 spending, 35, 253 See also Herbal medicine Dietetic practices, 43–44 Dose-response relationship, 100 Double-blind trials, 126–127 Drug interactions, 13, 23, 35, 270 E Echinacea, 133, 262, 266 Ecological model of health, 210–211 Economic status of consumers, 41–42 Education and training of health professionals for AIDS/HIV research, 244–245 in CAM modalities, 237–238 CAM training in medical schools, 17, 22, 226–227, 230–237, 248, 279–280 career development grants, 151 core competencies, 228 in geriatric medicine, 242–244 model programs in research training, 150–151 NCCAM funding, 24 in practice-based research networks, 158 rationale for CAM instruction, 228–230 recommendations for, 8–10, 248, 249–250 for research, 9, 239–245, 248–249 standards of evidence for research and, 100–101 trends, 226 Educational attainment of consumers, 10, 41, 42 dietary supplement use and, 254–256 Effect size, 98 Effectiveness of treatment(s) acceptance of new therapies and, 196–198 AHRQ evidence reports, 141 attribute-treatment interaction analyses, 3, 118 basic research, 120–121, 147 challenges in CAM research, 103–105, 108–111, 115–116, 123 Cochrane Library data, 134–140 conventional therapies, 17–18, 145, 230 criteria for establishing cause-and-effect relationships, 99–100 determinants of, 79 disincentives to CAM testing, 173, 273–274

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

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Complementary and Alternative Medicine in the United States G Garlic, 262 Gastroenterological disease, 45 Geriatric medicine, 242–244, 248–249 Germany, 264–265 Ginkgo biloba, 21 Glucosamine, 21, 262 Guided imagery, 173, 206 Gynecologic problems, 45, 203 H Headache treatment, 38 cost-effectiveness of CAM, 49–50 Health food stores, 59–60 Herbal medicine, 16, 18, 147 Cochrane Library data, 133 patterns of use, 35, 44, 48, 254 pharmacist education in, 227 sources of information about, 58–59 See also Dietary supplements Holistic care, 211 Homeless people, 42 Homeopathy, 16, 109 attitudes of conventional physicians, 203 insurance coverage, 47 licensure for, 238 N-of-1 research studies, 112 Hypericum. See St. John’s wort Hypertension, 38, 46 Hypnotherapy, 173, 203, 206 I Indinavir, 23 Informed consent, 177–178, 181, 183 patient preference for CAM therapy in absence of proof of effect, 184–188 Institute of Medicine, 29–31, 270–271 Insurance. See Reimbursement Integration of CAM and conventional medicine, x CAM-centric services model, 218 CAM training in medical schools, 17, 226–227, 230–237, 248 cancer treatment, 202 complementary services model, 218 conceptualization of health in, 210–211 concierge model, 219 consultant model, 217 consumer demand and, 208–209 continuity of care concerns, 219 definition, 209, 210 ethical and legal considerations, 8, 179–192 financial considerations, 218, 219–220 fitness center model, 217 goals, 7, 211–213, 220, 280 implementation models, 217–220 in institutions, 201–202, 208, 215–217 integrative medical doctor/DO-centric service model, 218 motivation of health care practitioners for, 208–209, 218 NCCAM efforts, 25 patient oriented delivery system, 219 patient–physician relationship in, 209, 210 patient preference for CAM therapy in absence of proof of effect, 184–188, 214–215 physician characteristics and, 209 primary-care model, 217 recognition of medical pluralism in, 169–171 recommendations for research, 7–8, 221–222 referral issues, 189–190, 215 reimbursement patterns, 206–208 spectrum model, 210 trends, 6–7, 196, 201–206, 278 virtual model, 217 See also Translating research findings into practice International Ethical Guidelines for Biomedical Research Involving Human Subjects , 174–175 Internet, 58–59, 66 Isoflavone formononetin, 147 J Journal of the American Medical Association, 21 K Knowledge-based medicine, 15

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

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Complementary and Alternative Medicine in the United States integration activities, 25 legislative mandate, 23 outreach efforts, 24 research activities, 23–25 research centers, 24, 158 research funding, 24 National Center for Health Statistics, 152 National Health and Nutrition Examination Survey, 154 National Institutes of Health, 9, 20, 21 basic research spending, 121 consensus statements, 141–143 dietary supplement research, 272–273 recommendations for, 6, 7, 10–11, 66, 162 research activities, 25–28. See also National Center for Complementary and Alternative Medicine in translating research findings into practice, 199 National Library of Medicine, 11, 23, 67 Natural Medicines Comprehensive Database, 268–269 Natural Standard, 269 Naturopathy, 16, 63 ethical practice, 180 licensure for, 237 patterns of use, 48 NCCAM. See National Center for Complementary and Alternative Medicine Neck pain, 50 New England Journal of Medicine, 21 N-of-1 trials, 112 Nuremberg Code, 174–175 Nurses’ Health Study, 154 Nurses/nursing, 204–206 CAM education for, 227, 229, 232, 235 O Observational studies, 3, 80–81, 113–114 Office of Alternative Medicine, 20, 21 Office of Cancer Complementary and Alternative Medicine, 26–27 Office of Dietary Supplements, 28, 272–273 Office of Unconventional Therapies, 20 Omega-3 fatty acids, 261 Osteopathy, 201, 218 Outcomes research in case-control studies, 82 clustering of outcomes, 94 in cohort studies, 82 cointervention effects, 92–93 co-morbidity effects, 92–93 confidence intervals, 90–91 gaps in CAM research, 146–147, 161 goals, 76 intermediate and distal outcomes, 87–88 measurement error, 91 measurement of health state preferences, 90 multicenter studies, 92–93 national surveys of CAM use, 152–154 objective outcomes, 83, 84 origins and development, 74–76, 77–79 research needs for integrative medicine, 7, 221–222 standardized measures, 88 subjective outcomes, 83–84, 105, 110–111, 126, 171–172 See also Effectiveness of treatment(s) P Pain acupuncture analgesia, 147 outcome measurement, 84, 110–111 placebo effects, 147 Patent law, 173, 273–274 Patient autonomy, 8, 183–184 framework for medical decision making, 213 informed consent and, 177–178 preference for CAM therapy in absence of proof of effect, 184–188, 214–215 principle of ethical practice, 169, 178–179 Patient-centered treatment, 15, 20, 220 in CAM, 238 as core competency of health care, 228 research needs, 238 Patient–healer relationship, 109–110, 126 ethical practice, 181–182 in integrative medicine, 209–210 as patient motivation for CAM therapy, 182 Pharmacotherapy CAM instruction for pharmacists, 227 concurrent dietary supplement use, 254 drug interactions, 13, 23, 35, 270 regulation, 76–77

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

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

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Complementary and Alternative Medicine in the United States See also Data collection and management; Research methodology Retrospective research, 80, 114 Rheumatology problems, 45 Rhinosinusitis, 45 S Safety of dietary supplements, 265–272, 274 framework for medical decision making, 213–215 standards of evidence for, ix–x, 2 Society for Integrative Oncology, 202 Society of Teachers of Family Medicine Group on Alternative Medicine, 231 Soy isoflavones, 147 St. John’s wort, 21, 23, 60, 133, 254, 262 drug interactions, 270 STRICTA guidelines, 144–145 Subjective outcomes, 83–84, 105, 110, 126 Surveillance in CAM research model, 155, 159–160 passive/active, 155 purposes, 154–155 recommendations for, 6, 162 sentinel sites, 6, 155 Surveys, health care, 6 in CAM research model, 152 components, 152 frequency, 152 minority populations in, 152 recommendations for, 162 Systematic reviews of research, 129–130, 142–143 Cochrane Library data, 132–140 MEDLINE data, 130–132 quality of studies, 143 strategies for improving quality, 144–146 Systematic reviews of reviews, 141 T Therapeutic misconception, 177–178 Therapeutic relationship. See Patient–healer relationship Traditional healers, 43 Cochrane Library data, 133–134 ethical issues regarding reimbursement, 172–173 Translating research findings into practice acceptance of new therapies, 199–200 in CAM research model, 159–160 challenges to, 158 ethical issues, 168 hypothesis generation and testing, 197, 198–199 insurance coverage, 200 pathways, 196–198, 200–201 patient demand as factor in, 197–198, 199–200 role of practice-based research networks, 158 selection of interventions for testing, 199 See also Integration of CAM and conventional medicine Transpersonal psychology, 173 U U.S. Pharmacopeia-National Formulary, 269–270 U.S. Preventive Services Task Force, 94–98 Use of CAM therapies, 1, 13, 34–41, 64–65 clinical supervision for, 61–62, 65 concurrent use of multiple modalities, 108, 115 cost as decision factor in, 40 data sources, 31–32, 34, 39, 40, 44–45 dietary supplements, 13, 35, 44, 253–257 ethical practice in prescribing, 181–182 for health promotion or disease prevention, 48–49, 51–54, 64, 65 high-frequency users, 46–47, 64 insurance coverage and, 47, 64, 207 long-term trends, 47–49 medical conditions, 34, 45–46, 64, 65 national surveys, 6, 152–153 in nursing practice, 204–206 patient disclosure to medical doctor regarding, 34, 35–38, 44, 63, 65, 278 patient motivation, 46, 50–58, 65–66, 161 recommendations for research, 10–11, 162 referral patterns, 63 research needs, 66–67, 151–154, 161 spending, 1, 13, 34, 35, 64

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

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