CAN COMPLEMENTARY AND ALTERNATIVE MEDICINE BE EVALUATED WITHIN THE FRAMEWORK OF EVIDENCE-BASED MEDICINE?

摘要

There are many complications in fitting complementary and alternative medicine (CAM) into the hierarchy of evidence-based medicine, which favors “gold standard” RCTs and meta-analyses. Some argue that CAM practices that have been practiced for many years don’t need rigorous studies to verify them, or that the most rigorous scientific studies aren’t necessary as long as people get better. However, success over many years is not enough to validate a treatment. Also, pragmatic outcomes-focused arguments sidestep philosophical and scientific issues about whether the therapies “do anything” at all beyond non-specific and placebo effects. There are a number of reasons why randomization and placebo controls may not be appropriate to accurately study CAM therapies, such as studies where a subjects’ effects are dampened by the act of participating in a study, studies where a sham control is more effective than the best conventional treatment, or studies that miss important subsets. Some argue that CAM should meet the same high standards as conventional medicine. However, 1. This holds CAM to a double standard because most conventional medical practices have less-than-rigorous evidence to support them. 2. The gold standard inherent in the evidence-based medicine hierarchy is not always appropriate. 3. CAM resembles a scientific paradigm and it may not be possible for scientists in the current biomedical paradigm to understand and evaluate CAM. And 4. Even if CAM can be accommodated within the evidence-based medicine framework, the attitude and priorities of the evidence-based medicine movement are problematic. Less rigorous studies are not often considered to be acceptable types of evidence, and there are few financial incentives to study CAM treatments in a more focused manner.