well as their efficacies, when deciding whether or not to offer them to patients (Friedman et al., 1995; Lorig et al., 1999). A recent systematic review of economic analyses of CAM therapies showed that, for the most part, “there is a paucity of rigorous studies that could provide conclusive evidence of differences in costs and outcomes between CAM therapies and orthodox medicine” (White and Ernst, 2000).

As the discussion above makes clear, a substantial base of information comprising the results of RCTs and systematic reviews evaluating the effectiveness of CAM therapies now exists. The quality of these studies varies however, and the lower-quality RCTs have exaggerated CAM treatment effects (Juni et al., 2001; Schulz et al., 1995). Thus, the evaluation of study quality is of utmost importance to determine the validity of study results. Quality evaluations, already well under way in conventional medicine, are important to ensure the validity and quality of the research and should therefore become standard practice in CAM as well. To address this important issue, researchers have begun devising methods for the optimal conduct of RCTs of CAM therapies, as well as for evaluation of the quality of the research already conducted.

Because quality varies across studies and it was found in RCTs of conventional medicine therapies that lower-quality RCTs have exaggerated treatment effects (Juni et al., 2001; Schulz et al., 1995), it is important to establish standards for evaluation. Study quality can be evaluated by various strategies, but any instrument used to evaluate quality must take into account randomization, blinding, dropouts, and allocation concealment. For example, the Jadad Scale (Jadad et al., 1996) evaluates the quality of reporting by asking a variety of questions: Was the study described as randomized? Was the study described as double-blind? Was there a description of the study participants who withdrew and dropped out? These questions help to ascertain whether the conduct and reporting of the trial are adequate. It is also important that RCTs have a sample size large enough to determine the effectiveness of the intervention. Systematic reviews are evaluated on the basis of whether they undertake a comprehensive literature search with unambiguous inclusion and exclusion criteria for studies, as well as on the basis of whether they use explicit and transparent methods to evaluate and summarize study data.

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)