they are currently labeled as conventional medicine or CAM. The next section presents a conceptual model for deciding when to translate new therapies (CAM or conventional medicine) into practice.

The committee believes that any framework for decision making should encourage patients and practitioners to engage in shared decision making about treatment. One of the 10 rules outlined in the IOM report Crossing the Quality Chasm (2001) is that the patient should be viewed as the source of control. The report states, “Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them. The health system should be able to accommodate differences in patient preferences and encourage shared decision making.” Such statements can be applied to the desire for shared decision making about CAM therapies as well as those of conventional medicine.

Eisenberg (1997) recommends a nine-step strategy for advising patients:

1. Ask the patient to identify the principal symptom.

2. Suggest that the patient keep a symptom diary.

3. Discuss the patient’s preferences and expectations.

4. Review issues of safety and efficacy.

5. Identify a suitable licensed provider.

6. Provide the patient with key questions to ask the provider during the initial consultation.

7. Schedule a follow-up visit (or telephone call) to review the treatment plan.

8. Follow up to review the response to treatment.

9. Provide documentation.

The fourth step of the process proposed by Eisenberg is a review of the safety and efficacy of the treatment under discussion. At this step Cohen and Eisenberg (2002) propose that practitioners may wish to guide their recommendations for treatment for both conventional and CAM therapies by evaluating whether the medical evidence:

• supports both safety and efficacy (option A);

• supports safety, but evidence regarding efficacy is inconclusive (option B);

• supports efficacy, but evidence regarding safety is inconclusive (option C); or

• indicates either serious risk or inefficacy (option D).

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)