The committee believes that it is necessary and desirable to use a variety of study designs to research CAM therapies. Given the limited funding, the committee suggests that the following criteria be used when considering the CAM therapies to be selected for testing. No intervention will meet all criteria, and a therapy should not be excluded from consideration because it does not meet any one particular criterion, for example, biological plausibility.

• A biologically plausible mechanism for the intervention exists, recognizing that the science base on which plausibility is judged is a work in progress and that potential science bases for some CAM therapies have not been well studied scientifically.

• Research could plausibly lead to the discovery of biological mechanisms of disease or treatment effect.

• The condition is highly prevalent (e.g., diabetes mellitus).

• The condition causes a heavy burden of suffering.

• The potential benefit is great.

• Some evidence that the intervention is effective already exists.

• Some evidence that there are safety concerns exists.

• Research design is feasible and likely to yield an unambiguous result.

• The target condition or the intervention is important enough to have been detected by existing population surveillance mechanisms.

Ideally, potential new treatments go through a series of scientific challenges that, if met, lead to acceptance of the test or treatment and integration into clinical practice. Many CAM therapies and many conventional medical therapies, however, are already in widespread use without such validation. The committee therefore concluded that, in addition to research aimed at determining efficacy and uncovering mechanisms of action, research aimed at investigating what is occurring in practice (that is, effectiveness) is also needed. This report proposes that such research be conducted within a research framework with four major components: practice-based research networks, a sentinel surveillance system, CAM research centers, and input from national surveys.

To ensure that research reflects as much as possible the actual ways in which CAM therapies are practiced, it is important to have CAM practitioners involved. However, most CAM practitioners do not have research training. CAM institutions focus primarily on training for practice; research training is rarely a part of CAM curricula. Investments in such training are crucial.

The widespread use of CAM therapies has implications not only for research but also for the education of conventional health care profession-