Abstract
Healthcare is changing as evidence-based medicine (EBM) is incorporated into education and practice. This article considers the hierarchy of evidence, the validation of evidence for decision making and the extent to which this includes aspects of cultural and social constructs of health. We review the influence and the methodology of EBM as it is applied to complementary and alternative medicine (CAM), and suggest that there is an uneasy relationship as the two approaches to health have divergent understandings of health and evidence. There are fundamental philosophical and epistemological differences between orthodox and complementary medicine and we suggest that EBM is limited in how it can be applied to CAM. We question how the two approaches to healthcare can work together to create optimal outcomes in practice.
The movement towards evidence-based practice underscores the division between biomedicine and CAM. Historically, there has been little scientific research into CAM, largely because of its place as a ‘fringe’ profession. Most research is funded by private sector interests who might see the economic benefit of a certain procedure or product. The research culture that has developed has been one that emphasises an evidence-based approach to establishing the efficacy of single herbs and nutrients, which overlooks the way that complementary therapists use these substances. The review concludes with a concern that the relationship between EBM and complementary medicine may become unbalanced, and the proponents of one system ignore or dismiss the values of the other. This lack of cross-paradigmatic respect is the wellspring for division and suspicion that is currently permeating the arranged marriage between CAM and EBM.
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References
Strauss S. What’s the E for EBM? BMJ 2004 Mar 6; 328(7439): 535–6
Sackett DL, Richardson WS, Rosenberg WM, et al. Evidence-based medicine. London: Churchill Livingstone, 1997: 2
Charlton BG, Miles A. The rise and fall of EBM. QJM 1998; 91(5): 371–4
Clarke JB. Evidence-based practice: a retrograde step? The importance of pluralism in evidence generation for the practice of healthcare. J Clin Nurs 1999; 8(1): 84–94
National Health and Medical Research Council (NHMRC). A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra (ACT): NHMRC Publications, 1998: 8 [online]. Available from URL: http://www.csp.nsw.gov.au/nhmrc/downloads/pdfs/NHMRC%20Clinical%20Practice.pdf [Accessed 2006 Apr 12]
Gupta MA. Critical appraisal of evidence-based medicine: some ethical considerations. J Eval Clin Pract 2003; 9(2): 111–21
Tonelli MR, Callahan TC. Why alternative medicine cannot be evidence-based. Acad Med 2001; 76(12): 1213–20
Willis E, White K. Evidence-based medicine and CAM. In: Tovey P, Easthope G, Adams J, editors. The mainstreaming of complementary and alternative medicine. London: Routledge, 2004: 50
White K, Willis E. Positivism resurgent: the epistemological foundations of evidence-based medicine. Health Soc Rev 2002; 11(1 & 2): 5–15
Richardson J. Evidence-based complementary medicine: rigor, relevance and the swampy lowlands. J Altern Complement Med 2002; 8(3): 221–3
MacLennan AH, Wilson DH, Taylor AW. The escalating cost and prevalence of alternative medicine. Prev Med 2002; 35(2): 166–73
Eisenberg DM, Kessler RC, Van Rompay MI, et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med 2001; 135(5): 344–51
Bensoussan A, Lewith GT. Complementary medicine research in Australia: a strategy for the future. Med J Aust 2004; 181: 331–3
Myers SP, Hunter A, Snider P, et al. Naturopathic medicine. In: Robson T, editor. An introduction to complementary medicine. Sydney: Allen & Unwin, 2003: 48–66
Verhoef M, Casebeer AL, Hilsden RJ. Assessing efficacy of complementary medicine: adding qualitative research to the gold standard. J Altern Complement Med 2002; 8(3): 275–81
Wilson K, Mills EJ, for the Evidence-based Complementary Medicine Group. Introducing evidence-based alternative and complementary medicine: answering the challenge. J Altern Complement Med 2002; 8(2): 103–5
Delbanco T. Leeches, spiders, and astrology: predilections and predictions. JAMA 1998; 280(18): 1560–2
Pelletier K. Mind as healer, mind as slayer: MindBody medicine comes of age. Adv Mind Body Med 2002; 18(1): 4–14
Mills EJ, Hollyer T, Guyatt G, et al. Teaching evidence-based complementary and alternative medicine: 1. A learning structure for clinical decision changes. J Altern Complement Med 2002; 8(2): 207–14
Brody H, Rygwelski JM, Fetters MD. Ethics at the interface of conventional and complementary medicine. In: Jonas WEB, Levin JS, editors. The essentials of complementary and alternative medicine. Philadelphia (PA): Lippincott Williams and Wilkins, 1999: 46–56
Thorne S, Best A, Balon J, et al. Ethical dimensions in the borderland between conventional and complementary/alternative medicine. J Alt Complement Med 2002; 8(6): 907–5
Wharton JC. The history of complementary and alternative medicine. In: Jonas WEB, Levin JS, editors. The essentials of complementary and alternative medicine. Philadelphia (PA): Lippincott Williams and Wilkins, 1999: 16–30
Feinstein AR, Horowitz MD. Problems in the ‘evidence’ of evidence-based medicine. Am J Med 1997; 103: 529–35
Kleinman A. The illness narratives: suffering, healing and the human condition. New York: Basic Books, 1988
Fontarosa P, Lundberg G. Alternative medicine meets science. JAMA 1998; 280(18): 1618–9
Sigerist HE. A history of medicine. Vol. 1. Primitive and archaic medicine. Oxford: Oxford University Press, 1987
Lewith G, Jonas WB, Walach H, editors. Clinical research in complementary therapies principles, problems and solutions. Edinburgh: Churchill Livingstone, 2002: 4
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Hunter, A., Grant, A. Complementary Medicine and Evidence-Based Practice. Evid-Based-Integrative-Med 2, 189–194 (2005). https://doi.org/10.2165/01197065-200502040-00002
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DOI: https://doi.org/10.2165/01197065-200502040-00002