Value judgments are implicit in the term CAM itself. Just deciding what should be categorized as a CAM therapy—as distinct from a religious ritual or a cultural practice—from among the dozens of alternative practices is a decision with important value implications. The reasons for defining modalities as “CAM therapies” are not only scientific but also political, social, and conceptual (Jonas, 2002). These include a lack of a generally accepted explanatory model; the fact that the origin of the practice (e.g., acupuncture) is outside of the dominant system; the amount of data or the type of data is considered insufficient or otherwise inadequate (e.g., herbalism and megavitamin therapy); the use of the practice is marginalized in that it is not widely available within conventional hospitals (e.g., chiropractic); the teaching of the practice is marginalized in that it is not generally taught within medical, nursing, or graduate schools of the dominant institutions (e.g., nutritional therapy); the amount of research funding, infrastructure, and capacity for investigating the practice is low (e.g., massage); reimbursement for the practice is not provided by insurance companies and third-party payers; the practice is not readily used for feasibility, acceptability, or other reasons (e.g., clinical ecology and complex lifestyle programs); the practice is not regulated or licensed in most states (e.g., naturopathy); and an aspect of the therapy is marginalized, even though it is studied under other names or subdivisions (e.g., antineoplastons and shark cartilage). In brief, when something is labeled “CAM”: and when “CAM therapies” are sorted and differentiated, it is important to recognize the diverse social and political value judgments at work. These value judgments are sometimes embedded in the scientific, medical, and educational rationales for health taxonomies. Attending to these implicit value components will reduce the likelihood of miscategorization and misunderstanding.

The following sections address three sets of ethical issues in CAM research and practice: ethical issues in CAM research; ethical issues in the integration of CAM therapies into conventional practice; and related legal and regulatory issues. Some of the conclusions from this chapter are included in the recommendations of other chapters of the report. An additional aim of this chapter is to raise questions and flag areas that practitioners, researchers, and policy makers believe will need to be considered in greater depth.

Over the past 60 years the major sources for guidance on the ethics of research with human subjects in the United States have been the Nuremberg Code (1946), the Declaration of Helsinki (1964, revised in 1996), the Inter-