Equal Treatment

Holding Complementary and Alternative Medicine and Conventional Medicine to the
Same Standards

These days it is not unusual for people to take herbal remedies along with their prescription drugs, or for physicians to field questions from patients about how well acupuncture alleviates arthritis pain. About one-third of all American adults have used some form of complementary and alternative medicine (CAM). As the popularity these treatments has grown in the United States, debate has flared over how much is known about their safety and efficacy, whether they can and should undergo clinical testing, and the extent to which CAM and conventional medicine can and should be integrated.

In a recent report, a committee of the Institute of Medicine examined these issues from the perspective of what is needed to improve the quality of health care delivery in America. The goal is to achieve care centered on patients' needs and preferences and based on the best available scientific evidence.

"Health professionals and patients need sufficient information about safety and efficacy to take advantage of all useful therapies," said committee chair Stuart Bondurant, interim executive vice president for health sciences and executive dean, Georgetown University Medical Center, Washington, D.C. "What matters is not a particular therapy's origins, but rather that there is evidence that it is safe and that it works."

To that end, the committee called for conventional treatments and complementary and alternative treatments to be held to the same standards for demonstrating clinical effectiveness. While this means that both types of therapies should undergo some form of clinical testing, innovative methods may have to be used to test some treatments that do not lend themselves to randomized controlled trials -- the gold standard for developing reliable evidence. This is as much the case for a surgical procedure that depends upon the administering professional's skills as for naturopathy, for example, the committee noted. Data from other types of studies, such as observational and case-controlled studies, can provide useful information about safety and effectiveness, the report says.

CAM practitioners who know the methods and goals of a particular product or therapy should be involved in its testing to ensure that it is applied correctly and in the right context. To prepare them for this new role, CAM training programs should begin teaching students research skills and principles. At the same time, health professional schools should provide future doctors, nurses, and other health providers with education about CAM.

Testing of dietary supplements -- among the most frequently used forms of CAM -- runs into particular difficulties because these products are regulated as foods rather than drugs. There is no requirement and little incentive for supplement manufacturers to conduct safety and efficacy tests of their products, and quality control in supplement manufacturing is often lacking, leading to inconsistency among and within brands. Consistent products are essential to do studies that yield reliable and broadly applicable results. Health practitioners need to know that the supplements their clients use are safe and effective, so the report calls on Congress to implement quality-control standards for each step of the supplement manufacturing process and to enforce more accurate labeling and disclosures and other consumer protections.

Resources to conduct testing of medical therapies are finite, however. The report offers several criteria to help guide decisions about which CAM therapies to prioritize for study. These criteria apply equally well to help prioritize untested conventional treatments.
  -- Christine Stencel