CAMLAW: Complementary and Alternative Medicine Law Blog

CAM Best Evidence

The Institute of Medicine Report on Complementary and Alternative Medicine Use showcased the best available evidence regarding CAM therapies in its chapter entitled, "State of Emerging Evidence on CAM."

Summarizing Cochrane Reviews with Positive Effects, the IOM Report listed a number of conditions for which specified CAM therapies may be effective as follows:

Indication - Therapy
Age-related macular degeneration - antioxidant vitamin & mineral supplements
Anxiety - Kava
BPH - Saw palmetto and other dietary supplements
Cystic fibrosis - Omega 3 fatty acids
Depression - Folate and St. John's Wort
Headache - acupuncture
Low-back pain - massage
Jet lag - melatonin
Knee osteoarthritis - TENS
Osteoarthritis - electromagnetic fields
Preventing urinary tract infection - cranberries
Type 2 diabetes mellitus - fish oil

This is a summary of Table 5-3 of the IOM Report. The full table and text contain a number of qualifications that may be of interest (for example, "insufficient evidence of an effect was determined for a larger proportion of CAM therapies (56.6 percent for CAM versus 21.3 percent for conventional medicine");" on the other hand, "CAM reviews were less likely to be classified as harmful .. or as having no effect").

The Cochrane Library is an international collaboration to review therapies and modalities; the Cochrane Complementary Medicine Collaboration, based at the University of Maryland Center for Integrative Medicine, coordinates CAM-related activites including development of a database with information on more than 7,000 controlled trials of CAM therapies. Cochrane Reviews apply the same standards of evidence whether reviewing conventional or CAM therapies. The Cochrane Collaboration defined its conclusion category of "Positive Effect" to mean that: "treatment is more beneficial/effective than control for the positive outcome." (IOM Report, chapter 5).

Following its citation of results from the Cochrane Collaboration, the IOM Report also cited CAM Evidence Reports and Technology Assessments of the US Agency for Health Care Research and Quality, including the following:

Acupuncture for fibromyalgia
Acupuncture for osteoarthritis
Antioxidant supplements, prevention and treatment of cancer
Antioxidant supplements, prevention and treatment of cardiovascular disease
Ayurvedic interventions for diabetes mellitus

The Report concluded:

"Although CAM therapies are often criticized for being used despite a lack of evidence, hundreds of systematic reviews have, in fact, evaluated specific CAM therapies; of these, some have been well conducted and have shown that the CAM therapy offers a clear benefit."

Suggestions were offered regarding possible avenues of exploration in basic science, cost-effectiveness studies, and cross-disciplinary research.

In a later chapter, the IOM Report cited a study showing that 37.6 to 98.4 of physicians in family and general practice had used or would use CAM practices from among the following: diet, exercise; counseling, psychotherapy; behavioral medicine; biofeedback, relaxation; massage, therapeutic touch; prayer, spiritual direction; vegetarianism; meditation; hypnotherapy; chiropractic; megavitamin; acupuncture; acupressure; herbal medicine; homeopathic medicine; art therapy; electromagnetic applications; Native American medicine; traditional oriental medicine.

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Michael H. Cohen, Esq.; 468 North Camden Dr. | Beverly Hills, California 90210 | 310-844-3173