all CAM therapies that are of use while discarding the rest. This will require suspending any categorical disbelief in CAM therapies, at least long enough to consider the evidence for safety and efficacy dispassionately (and sometimes innovatively) and in their appropriate contexts rather than only within the framework of conventional medicine practice or the usual scientific norms. Thus, the committee suggests that the proper attitude is one of skepticism about any claim that conventional biomedical research and practice exhaustively account for the human experiences of health and healing, combined with diligent efforts to discern the significance, safety, and efficacy of CAM therapies.

5. The first four ethical commitments (to personal and public beneficence, to protection, to patient autonomy and consumer choice, and to medical pluralism in the service of these aims) provide the general framework for this chapter and inform the committee’s selection of areas that require more extensive exploration. In explicitly stating these commitments, the committee also implies a fifth commitment, namely, public accountability, both for this report and its findings and for the health care system in the United States. Were medical research and health care a private matter paid for by private funds and with few social consequences, such public accountability would not be required. Yet, health care, as well as the medical research that supports it, is a public trust that is largely funded with common resources and that has broad societal consequences. Accountability to the public for prudent and fair assessment and use of medical and health care resources is a necessary component of this report.

The committee recognizes the complexity of a commitment to public accountability for CAM therapies. For example, many consumers access CAM therapies outside the context of primary or other medical care; pay for such therapies out of pocket; do not consult with their physicians regarding such care; and use CAM therapies for relaxation, wellness, spiritual awareness, or reasons other than biomedical disease management (Eisenberg et al., 1993, 1998). Similarly, many CAM therapies are offered as part of a healing process that involves meaning and is attentive to the illness experience and perceptions of risk and vulnerability. Many CAM providers regard their therapeutic regimens to be other than and outside systems of conventional medical care, reimbursement, or even licensure, and are concerned with healing as distinct from curing (Young, 1982; Eisenberg et al., 2002). The question of whether licensure, reimbursement, and inclusion within hospital-based, integrative models of care would be a socially desired good or an undesirable compromise (or even a dilution of healing traditions) becomes especially significant when one considers that prayer, meditation, and other forms of spiritual healing exist within the rubric of CAM therapies. For many CAM providers offering services in these do-