tion Act of 1994 and the current regulatory scheme for dietary supplements, with emphasis on strengthening:

• Seed-to-shelf quality-control (based on standards for each step of the manufacturing process—from planting to growth, harvest, extraction, and screening for impurities),

• Accuracy and comprehensiveness in labeling and other disclosures,

• Enforcement efforts against inaccurate and misleading claims,

• Research into how consumers use supplements,

• Incentives for privately funded research into the efficacies of products and brands, and

• Consumer protection against all potential hazards.

Evidence of the safety and efficacy of individual CAM treatments is essential, but it represents just one facet of the research that is needed. For example, there is a paucity of clinical research that compares CAM therapies with each other or with conventional interventions. Very little research has been done on the cost-effectiveness of CAM. And although there is great opportunity for scientific discovery in the study of CAM treatments, it is an opportunity largely missed.

Such investigations are hindered by shortages of established scientists engaged in CAM research, which tends to involve subject matter beyond the conventional scientist’s knowledge base. CAM also needs a cadre of new junior researchers. While major U.S. health-sciences campuses have long offered training in basic and clinical research for conventional medicine, the challenge is to induce these schools to embrace CAM research as well. One approach might be to add specific CAM content to conventional-medicine postdoctoral training programs.

Furthermore, CAM research will benefit from the contributions of more than one discipline. In addition to providers who have specialized knowledge of CAM treatments and methodologists who can address the challenges inherent in CAM study design, investigators with backgrounds in fields such as psychology, sociology, anthropology, economics, genetics, pharmacology, neuroscience, health services, and health policy can make important contributions. Interdisciplinary teams, grouped into “critical masses” at various locations, will be favorably positioned to probe the many factors that influence individuals to use CAM treatments and that determine the outcomes of those treatments.

Research on CAM is inextricably linked to practice. CAM therapies are already in widespread use today; it is reasonable to attempt to evaluate the outcomes of that use, and in the practice setting one can focus on research

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)