Medicine is susceptible to periodic swings in enthusiasm for and belief in various healing modalities. Notable examples have been St. John's wort for depression, saw palmetto for prostate cancer, echinacea for colds and, in the minds of some, homeopathy, acupuncture and chiropractic.

The past two decades or so have seen increasing interest in complementary and alternative medicine (CAM), including homeopathy, osteopathy, chiropractic, acupuncture, massage therapy, aromatherapy, naturopathy and traditional Chinese medicine.

Government Research on CAM

In the late 1990s, the NIH opened the National Center for Complementary and Alternative Medicine as the lead agency for scientific research on the diverse systems, practices and products not generally considered conventional medicine. Some saw the establishment of this office amid the conventional biomedical research institutes as giving CAM a certain degree of legitimacy.¹

In 2004, the Institute of Medicine defined CAM as "a broad domain of resources that encompasses 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."²

The definition adds this qualification: "CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries . between the CAM domain and the domain of the dominant system are not always sharp or fixed."

The IOM report was a balanced (although some might say equivocal) examination, stating that deciding to use a specific CAM therapy should depend on its proven safety and effectiveness, but that "this is easier said than done, as there are extremes of belief about what counts as evidence. For some individuals, evidence limited to their own experience or knowledge is all that is necessary as proof that a CAM therapy is successful; for others, no amount of evidence is sufficient. This report will please neither of those extremes."

Clearly, the report did not please CAM critics.

Debunking Dubious Science

In his recent book, Snake Oil Science, R. Barker Bausell, PhD, takes dead aim at CAM.³ Medicines of marginal benefit in the 19th century often were called "snake oil," a reference to sales pitches claiming that exotic ingredients were responsible for products' supposed benefits. Bausell has selected a title designed at the outset to cast doubt on the ostensible evidence supporting CAM modalities.

Bausell, a biostatistician at the University of Maryland in Baltimore, for five years directed that institution's NIH-funded Complementary Medicine Program, where he evaluated many of the NIH-supported studies of the effectiveness of various CAM interventions. As the book's title suggests, he is dubious about much of the supposed science demonstrating the benefits of CAM modalities, and he spends much of the book debunking CAM.

Whether or not one agrees with Bausell's conclusions, his point that CAM must be held to the same standard as allopathic medicine is strong. While it may be unfashionable to be skeptical about CAM, we must accept what the scientific evidence tells us-and in this case, it shows that most CAM approaches remain unproven.

Some feel that the trend of CAM is nothing more than a rebellion against conventional medicine and physician authority, and that it is related to the larger consumer-driven health care movement. Many physicians oppose this trend, believing that consumer-driven health care is a dangerous erosion of medical professionalism.⁴

Evidenced-Based CAM

With this book's arrival, and recent research showing little or no efficacy for certain herbal medicines, the evidence casting doubt on some of the most revered forms of CAM appears to be mounting.

While as clinicians we need to have an open mind about new and nontraditional approaches, we also have a responsibility to apply the same tests of evidence, safety and effectiveness to CAM that we would apply to conventional medical and surgical approaches, and to avoid the temptations of medical faddism.

James F. Cawley is professor and director of the PA/MPH program at the School of Medicine and Health Sciences at The George Washington University in Washington.

References

1. Kopelman LM. The role of science in assessing conventional, complementary, and alternative medicines. In: Callahan D, ed. The Role of Complementary & Alternative Medicine: Accommodating Pluralism. Washington, DC: Georgetown University Press; 2004:36-53.

2. Institute of Medicine. Complementary and Alternative Medicine in the United States. Committee on the Use of Complementary and Alternative Medicine by the American Public, Board on Health Promotion and Disease Prevention. Washington, DC: National Academies Press; 2004: 19

3. Bausell RB. Snake Oil Science: The Truth About Complementary and Alternative Medicine. New York, NY: Oxford University Press; 2007.

4. Berenson RA, Cassel CK. Consumer-driven health care may not be what patients need-caveat emptor. JAMA. 2009;301(3):321-323.