ticularly those that depend on variable practitioner approaches and the customization of interventions to individual patients, there are significant obstacles to use of the methods that have gained dominance in testing and advancing the knowledge base for conventional medical practitioners.

Despite the evident differences between conventional clinical practice and CAM, perhaps the most promising way to find common ground is to ask the question, What kind of knowledge do people need to make good health care decisions, and how can that knowledge be continuously tested and improved? This question provides the framework for considering the appropriate clinical and policy responses to the widespread use of CAM by the American public.

Furthermore, this framework is based on a set of ethical commitments that informed the work of the committee as it proceeded with its task. These commitments are explored in detail in Chapter 6:

1. a social commitment to public welfare,

2. a commitment to protect patients and the public,

3. respect for patient autonomy,

4. a recognition of medical pluralism, and

5. public accountability.

One of the first questions that the committee considered was, What is CAM? The following section explores this issue.

One of the difficulties in any study of CAM is trying to determine what is included in the definition of CAM. Does CAM include vitamin use, nutrition and diets, behavioral medicine, exercise and other treatments that have been integrated into conventional medical systems? Should CAM include prayer, shamanism, or other therapies that may not be considered health care practices? As discussed further in Chapter 6, the reasons for defining modalities as “CAM therapies” are not only scientific but also “political, social, [and] conceptual” (Jonas, 2002). In the United States, some of the most frequently used and well-known therapies that are recognized as CAM are relaxation techniques, herbs, chiropractic, and massage therapy (Eisenberg et al., 1998). Chiropractic, acupuncture, and massage therapy are licensed in most states. Naturopathy and homeopathy are licensed in fewer states. Numerous other therapies and modalities are considered unlicensed practices and at present few or no formal regulations apply to these therapies and modalities. The New York State Office of Regulatory Reform and CAM has identified more than 100 therapies, practices, and systems that could be considered CAM (see Appendix A for a list of therapies).

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)