Individual patients generally do not have direct access to peer-reviewed journals, and most patients do not have the technical background to interpret the results of published treatment-effectiveness studies. This information tends to be filtered through someone else before it reaches the individual patient. In addition, patients (particularly those with chronic conditions) have their own experiences to draw on and can judge treatment effectiveness by the extent to which their own symptoms or functional status improve with treatment. Information on treatment effectiveness for individual patients, then, comes mainly from

• Information provided by a clinician(s) in one-on-one treatment encounters,

• Word of mouth from friends and relatives,

• The lay press or media,

• Direct-to-consumer advertising,

• Internet,

• Direct personal experience (particularly for patients with chronic conditions), and

• Communications from illness advocacy groups.

Although the concept of levels of evidence has generally been accepted and widely used in many domains of conventional medicine, some question its applicability to CAM therapies or to individual treatment decisions for specific patients. These questions particularly relate to the use of RCTs as the “gold standard” of evidence. Given the broad array of modalities that are included within the definition of CAM, it may be that some CAM therapies are more amenable to evaluation than others. Questions about the applicability of clinical research methods to CAM are described and discussed below.

As noted above, the distinction between efficacy and effectiveness refers to the extent to which a treatment has a measurable positive effect in highly controlled clinical trial contexts (efficacy) versus whether the treatment has a measurable positive effect in routine daily clinical practice with unselected clinicians and patients (effectiveness). Efficacy refers to what a treatment can do under ideal circumstances; effectiveness refers to what a

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)