Qualitative methods are not an alternative design to address effectiveness questions but are a way to make better decisions about measurement, sampling, recruitment, and other aspects of a study design. Questions about treatment effectiveness in CAM and in conventional medicine are typically quantitative in nature and involve assessments of more or less of some defined outcome characteristics among patients treated in one way versus another. Evidence for treatment effectiveness in both CAM and conventional medicine therefore typically comes from quantitative studies that use the designs and methods discussed above.

Qualitative research (ethnographic studies, focus groups, and in-depth interviews) cannot generally provide direct evidence of treatment effectiveness because of the relatively small sample sizes, the retrospective versus the prospective nature of participant recruitment and sampling, the absence of random assignment of patients to treatment conditions, and the use of open-ended versus categorical or close-ended data collection formats.

Qualitative research can, however, provide extremely valuable information to help interpret the results of effectiveness studies or to design those studies in the best possible way. Qualitative methods can be used to

• understand the types of patients who use a particular CAM modality, their reasons for using that modality (including perceived effectiveness), and the circumstances or conditions of use;

• understand other treatments that those patients may be using in addition to the specific modality being studied;

• understand patients’ and practitioners’ definitions of and criteria for treatment effectiveness;

• identify factors that may predict better or worse effectiveness (e.g., different levels of patient expectations and better or worse therapist-patient interactions); and

• understand patients’ and providers’ models of health and illness and how those models influence CAM use and assessment of treatment effectiveness.

The committee does not wish to recommend a single study design that is inevitably superior to others or to recommend that studies of treatment effectiveness in CAM always be conducted in a specific way. Alternative study designs have combinations of strengths and weaknesses; the richest information source will be the combined results of studies with several

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)