WASHINGTON Complementary and alternative therapies should be held to the same standards as conventional treatments, according to a new report from the Institute of Medicine.
"Complementary and alternative medicine [CAM] use is widespread and here to stay," Stuart Bondurant, M.D., said at the institute's press briefing. "The same rules should apply for testing of effectiveness and safety regardless of the origin."
Already, the use of CAM therapies in the United States is widespread and amounts to $27 billion a year in out-of-pocket costs by consumers, a figure that is comparable with the projected out-of-pocket expenditures for all U.S. physician services, the report said. In 1997, the total number of visits to CAM providers (629 million) outpaced the total number of visits to all primary care physicians (386 million), according to a survey from that year.
But despite the increases in the use of CAM services, few patients disclose their use of CAM therapies to their physicians. Less than 40% of CAMusers told their physicians about their use of alternative therapies, according to surveys in 1990 and 1997.
The IOM committee defined CAM broadly as encompassing "health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period." The committee's definition also states that CAM includes resources that patients perceive as being associated with positive health outcomes.
While the same principles should be used in evaluating conventional and alternative treatments, some new methods may have to be devised for CAM therapies, said Dr. Bondurant, interim executive vice president and executive dean of Georgetown University Medical Center in Washington. Randomized controlled trials may not be appropriate for all CAM treatments. However, other designs include preference trials that include randomized and nonrandomized arms, observational and cohort studies, case-control studies, and studies of bundles of therapies.
Licensing boards and accrediting and certifying organizations should set competency standards for the use of conventional medicine and CAM, the committee said.
CAM practitioners also have a role to play by being trained as researchers. This would help ensure that research reflects the ways CAM therapies are used, the report said. CAM practitioners should also work to develop practice guidelines for CAM therapies, the report said.
"The intent of the report is not to medicalize or co-opt CAM but to sustain the existing forms of validated CAM therapies whether integrated into conventional practices or continuing as freestanding approaches," Dr. Bondurant said. "The committee urged that great care be taken to test CAM therapies in the ways that they are actually used."
The IOM report is available online at http://national-academies.org