care delivery, as well as the development of a research infrastructure within such organizations and clinical training programs to expand the number of providers able to work in integrated care.

The pursuit of such goals requires examination of the ethics of medicine, both in the provision of personal health services and the profession’s advocacy for public health. Medicine is continuously shaped by larger social, cultural, and political forces, and the integration of CAM therapies is another juncture in this evolutionary process.

The ethical principles that guide conventional biomedical research should also be applied to CAM research. Legal and ethical issues often arise and sometimes conflict with use of CAM therapies because the decision facing a conventional practitioner or institution may engender a conflict between medical paternalism (the desire to protect patients from foolish or ill-informed, though voluntary decisions) and patient autonomy. The Model Guidelines noted above seek to establish greater balance between physician and patient preferences. In addition, a number of legal rules—including state licensure laws, precedents regarding malpractice liability and professional discipline, state and federal food and drug laws, and statutes on health care fraud—protect patients by enhancing quality assurance, offering enhanced access to therapies, and honoring medical pluralism in creating models of integrative care.

Without rejecting what has been of great value and service in the past, it is important that these ethical and legal norms be brought under critical scrutiny and evolve along with medicine’s expanding knowledge base and the larger aims and meanings of medical practice. The integration of CAM therapies with conventional medicine requires that practitioners and researchers be open to diverse interpretations of health and healing, to finding innovative ways of obtaining evidence, and to expanding the medical knowledge base.

EDUCATING FOR IMPROVED CARE

Essential to conventional and CAM practitioners alike is education about the others’ field. Conventional professionals in particular need enough CAM-related training, the committee believes, so that they can counsel patients in a manner consistent with high-quality comprehensive care. Therefore the committee recommends that health profession schools (e.g., schools of medicine, nursing, pharmacy, and allied health) incorporate sufficient information about CAM into the standard curriculum at the undergraduate, graduate, and postgraduate levels to enable licensed professionals to competently advise their patients about CAM.



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