Can CAM have social value?

[Guest guest]

The National Institutes of Health have spent more than $2 billion

researching complementary and alternative medicine (CAM). However, these

studies may have little influence on mainstream physicians and even CAM

providers, according to a survey reported in the April 13 issue of the

Archives of Internal Medicine.

" In this study we wanted to know, 'Can CAM research have social value?' " Dr.

Jon C. Tilburt told Reuters Health. " We sought to answer this from the

perspectives of the clinicians who might benefit from the published clinical

trials of CAM. "

Dr. Tilburt, a bioethicist at the NIH in Bethesda, land, and at the Mayo

Clinic in Rochester, Minnesota, added, " Awareness of and willingness to

recommend a therapy based on new evidence are preliminary indicators of

whether or not CAM research is making its way into clinical practice. "

The research team mailed questionnaires to clinicians to assess awareness of

two " landmark, high-profile CAM studies " involving randomized, controlled

trials of interventions for osteoarthritis of the knee. A 2004 study of

acupuncture appeared in the ls of Internal Medicine, and a 2006 study of

glucosamine and chondroitin was published in the New England Journal of

Medicine.

Completed questionnaires were returned by 345 rheumatologists, 334 general

internists, 440 acupuncturists, and 442 naturopaths. Results showed that 59%

of all respondents were aware of at least 1 study, and 23% were aware of

both.

" We thought conventional clinicians would universally be more familiar with

both CAM trials, but that was not the case, " Dr. Tilburt said. " For

instance, acupuncturists were much more likely (than general internists) to

report being familiar with the acupuncture trial, which surprised us. "

The team also found that CAM providers believed more in the importance of

patient preferences than they did in research evidence, while conventional

clinicians -- especially rheumatologists -- put more emphasis on research

evidence.

Neither perspective is sufficient, the researcher noted. " Both research

evidence and patient preferences are critical to sound clinical decision

making and must be integrated. CAM and conventional clinicians probably have

a lot to learn from one another in figuring out how to integrate patient

preferences with research evidence. "

Dr. Tilburt believes science policy must change if CAM research is to affect

clinical practice.

" We need to make the evidence relevant to the practice of clinicians and

recognize the real questions they face in their practice, " he explained. " It

would be nice to see more uniform practical critical appraisal skill being

built into the clinical training of all clinicians, but the research needs

to be more relevant and digestible as well. "

To clinicians, he recommends, " Before you categorically dismiss CAM by

saying there is no reliable research on it, do a quick search of PubMed or

another reliable source. There are Cochrane reviews of CAM and many good

systematic reviews that offer reliable information. "

*Arch Intern Med* 2009;169:670-677.

http://www.medscape.com/viewarticle/591086?sssdmh=dm1.458806 & src=nldne

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Ortiz, MS RD

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