The remainder of this chapter discusses the context in which researchers will apply these established research methods, including the idea that CAM users may present particular needs for research, that CAM interventions may pose particular problems in applying research methods that have worked well for conventional medicine, and that such interventions may also expose some of the weaknesses of applying contemporary research practices to conventional medicine.

Lewith and colleagues (2001) have described the different decisions that various participants in health care make about treatments and how they use different kinds of information to make those decisions. Patients, providers, insurers, government policy makers, and others typically require different types of evidence and different amounts of certainty to decide for or against a particular treatment or treatment modality. The committee recognized that a discussion of evidence of CAM treatment effectiveness must be set in the context of the differences among users of information about CAM in terms of the decisions that they make, the information that they need to make those decisions, and the way(s) in which they think about treatment effectiveness.

Researchers are typically interested in understanding cause-and-effect relationships between underlying mechanisms of illness, treatments designed to alter those mechanisms, and patient outcomes. Researchers trained in Western cultures and scientific traditions generally think in terms of linear cause-and-effect and try to identify the simplest possible causal models (i.e., the fewest explanatory variables and the simplest relationships among those variables) that account for the observed associations (Nisbett, 2003). Scientists from other cultures, however, may be more likely to think in terms of more complex “system” models that involve multiple factors and multiple levels of relationships and highly interactive and iterative, rather than linear, relationships (Nisbett, 2003).

The results of a given study are taken as evidence of cause-and-effect relationships to the extent that certain criteria are met. These criteria typically include

• Features of the study design that allow strong inferences to be made about cause-and-effect relationships:

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)