ing biomedical research policy. These perceptions and values will likely be at play in CAM research as well and may perhaps be at play in more pronounced ways. In the 1970s, when ethical guidelines and federal regulations governing clinical research were first codified, research was generally conceived of as a risky undertaking from which subjects needed protection. The late 1980s and early 1990s marked a major shift in public and scientific attitudes toward research “from protection to access” (Churchill et al., 1998; Mastroianni and Kahn, 2001). AIDS activism played a major role in this transition; eagerness to participate in clinical trials is now a common occurrence, even for Phase I research, in which the chances for benefit are remote or nonexistent (Daugherty et al., 1995, 2000). Some practitioners, patients, and policy makers regard all clinical research to be presumptively beneficial, so that being denied access to a trial is considered discrimination (King, 1995). In this climate, there is a need to consider carefully a balance that will “reconcile public safety with public demand” (Thorne et al., 2002). When public demand is fueled by commercial and entrepreneurial interests, as has been the case in gene therapy research, the task of achieving balance can be difficult (Churchill et al., 1998; Orkin and Motulsky, 1995; Ross et al., 1996). This is an ongoing challenge for all medical research, but it is a particularly important one for CAM research, especially research on those CAM modalities in which public assumptions about efficacy are prevalent and for which commercial forces are strong.

In summary CAM therapies should be rigorously evaluated for reasons of both public safety and health promotion. The ethical principles that guide conventional biomedical research should also be applied to CAM research (Miller et al., 2004). Yet, careful attention will be required to discern the applicability of these principles; and some of the key terms, such as “informed consent,” “equipoise,” and “risk-benefit” will sometimes have interpretations in CAM research different from those in research conducted by conventional medical protocols.

Although the major sources for modern research ethics have all been created within the past 60 years, some of the chief ethical precepts for conventional clinical practice enjoy a 2,500-year history. All Western ethical traditions for medical practice trace their origins to the Hippocratic Oath (sixth century B.C.E.), and many graduates of U.S. medical schools still mark their commencement with a recitation of some version of this oath. More recent ethical guidelines for medical practice can be found in Maimonides’ Daily Prayer for a Physician (1793), the American Medical Associations’ first Code of Ethics (1847) and its more recent Principles