Whose Evidence, Which Methods?

Ethical Challenges in Complementary and Alternative Medicine Research
Part of the Biomedical Ethics Reviews book series (BER)


This chapter provides an overview of ethical issues in research on complementary and alternative medicine (CAM). Such a discussion must include commonly accepted ethical concepts from research ethics combined with an understanding of some specific features of CAM research and practice. This chapter adopts the definitions of CAM used by the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (Table 1 [1]).


Ethical Challenge Conventional Medicine Public Accountability Medical Pluralism Plural Medicine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    NCCAM (National Center for Complementary and Alternative Medicine). Online.. Accessed March 8, 2006.Google Scholar
  2. 2.
    Kaptchuk TJ, Eisenberg DM. Varieties of healing. 1: medical pluralism in the United States. Ann Intern Med 2001;135(3):189–195.PubMedGoogle Scholar
  3. 3.
    Astin JA. Why patients use alternative medicine: results of a national study. JAMA 1998;279(19):1548–1553.PubMedCrossRefGoogle Scholar
  4. 4.
    Haynes RB, Devereaux PJ, Guyatt GH. Clinical expertise in the era of evidence-based medicine and patient choice. ACP Journal Club 2002;136:A11Google Scholar
  5. 5.
    United States, National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont report: ethical principles and guidelines for the protection of human subjects of research: appendix. no. (OS) 78-13-78-14 ed. Washington, DC: Dept. of Health, Education, and Welfare, National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978.Google Scholar
  6. 6.
    Beauchamp TL, Childress JF. Principles of biomedical ethics, 5th ed. Oxford: Oxford University Press, 2001.Google Scholar
  7. 7.
    Richardson HS. Specifying, balancing, and interpreting bioethical principles. J Med Philos 2000; 25(3):285–307.PubMedCrossRefGoogle Scholar
  8. 8.
    Emanuel EJ, Wendler D, Grady C. What makes clinical research ethical? JAMA 2000; 283(20):2701–2711.PubMedCrossRefGoogle Scholar
  9. 9.
    Nicholi AM. Definitional and significance of a worldview. In:Josephson AM, Peteet JR eds. Handbook of Spirituality and Worldview in Clinical Practice. Washington, DC: American Psychiatric Publishing, 2003.Google Scholar
  10. 10.
    Miller FG, Emanuel EJ, Rosenstein DL, Straus SE. Ethical issues concerning research in complementary and alternative medicine. JAMA 2004;291(5):599–604.PubMedCrossRefGoogle Scholar
  11. 11.
    IOM (Institute of Medicine). Complementary and Alternative Medicine in the United States. Washington, DC: National Academies Press, 2005.Google Scholar
  12. 12.
    IOM (Institute of Medicine). Dietary Supplements: A Framework for Evaluating Safety. Washington, DC: National Academies Press, 2004.Google Scholar
  13. 13.
    Carrese JA, Rhodes LA. Western bioethics on the Navajo reservation. Benefit or harm? JAMA 1995;274(10):826–829.PubMedCrossRefGoogle Scholar
  14. 14.
    Faden RR, Beauchamp TL, King NMP. A History and Theory of Informed Consent. New York: Oxford University Press, 1986.Google Scholar
  15. 15.
    Sugarman J. Informed consent, shared decision-making, and complementary and alternative medicine. J Law Med Ethics 2003;31(2):247–250.PubMedCrossRefGoogle Scholar
  16. 16.
    Leslie C. Medical pluralism in world perspective. Soc Sci Med [Med Anthropol] 1980;14B(4):191–195.CrossRefGoogle Scholar
  17. 17.
    Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med 1993;328(4):246–252.PubMedCrossRefGoogle Scholar
  18. 18.
    Taylor JS. Confronting “culture” in medicine’s “culture of no culture.” Acad Med 2003;78(6):555–559.PubMedCrossRefGoogle Scholar
  19. 19.
    Paasche-Orlow M. The ethics of cultural competence. Acad Med 2004;79(4):347–350.PubMedCrossRefGoogle Scholar
  20. 20.
    Callahan D. The Role of Complementary and Alternative Medicine: Accommodating Pluralism. Washington, DC: Georgetown University Press, 2002.Google Scholar
  21. 21.
    Cardini F, Weixin H. Moxibustion for correction of breech presentation: a randomized controlled trial. JAMA 1998;280(18): 1580–1584.PubMedCrossRefGoogle Scholar
  22. 22.
    Angell M, Kassirer JP. Alternative medicine —the risks of untested and unregulated remedies. N Engl J Med 1998;339(12):839–841.PubMedCrossRefGoogle Scholar
  23. 23.
    Defining and describing complementary and alternative medicine. Panel on Definition and Description, CAM Research Methodology Conference, April 1995. Altern Ther Health Med 1997;3(2):49–57.Google Scholar
  24. 24.
    Kaptchuk TJ, Eisenberg DM. Varieties of healing. 2: a taxonomy of unconventional healing practices. Ann Intern Med 2001;135(3):196–204.PubMedGoogle Scholar
  25. 25.
    Zollman C, Vickers A. ABC of complementary medicine: What is complementary medicine? BMJ 1999;319(7211):693–696.PubMedGoogle Scholar
  26. 26.
    Schneiderman, LJ. Alternative medicine or alternatives to medicine? A Physician’s Perspective. Camb Q Healthc Ethics 2000;9(1);83–97.PubMedCrossRefGoogle Scholar
  27. 27.
    Sampson W, Atwood K. Propagation of the absurd: demarcation of the Absurd revisited. Med. J Aust 2005: 18311-12):580–581.PubMedGoogle Scholar
  28. 28.
    National Center for Complementary and Alternative Medicine. Guidance on Designing Clinical Trials of CAM Therapies: Determining Dose Ranges.. Accessed February 3, 2006.Google Scholar
  29. 29.
    Wear A. Quack. The Lancet 2005;366(9492):1157.CrossRefGoogle Scholar
  30. 30.
    Flora K, Hahn M, Rosen H, Benner K. Milk thistle (Silybummarianum) for the therapy of liver disease. Am J Gastroenterol 1998;93(2):139–143.PubMedCrossRefGoogle Scholar
  31. 31.
    Bell IR, Caspi O, Schwartz GER, et al. Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary health care. Arch Intern Med 2002; 162(2): 133–140.PubMedCrossRefGoogle Scholar
  32. 32.
    Gordis L. From Association to Causation: Deriving Inferences from Epidemiologic Studies. In: Gordis L. Epidemiology. Philadelphia, PA: Saunders, 2004, pp. 203–223.Google Scholar
  33. 33.
    Marks HM. The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900–1990. Cambridge, England: Cambridge University Press, 1997.Google Scholar
  34. 34.
    Tunis SR, Stryer DB, Clancy CM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA 2003;290(12):1624–1632.PubMedCrossRefGoogle Scholar
  35. 35.
    Black N. Why we need observational studies to evaluate the effectiveness of health care. BMJ 1996;312(7040):1215–1218.PubMedGoogle Scholar
  36. 36.
    Vickers A. Methodological issues in complementary and alternative medicine research: a personal reflection on 10 years of debate in the United Kingdom. J Altern Complement Med 1996;2(4):515–524.PubMedGoogle Scholar
  37. 37.
    Vickers AJ. Message to complementary and alternative medicine: evidence is a better friend than power. BMC Complement Altern Med 2001;1(1):1.PubMedCrossRefGoogle Scholar
  38. 38.
    Rothman KJ, Michels KB. The Continuing Unethical Use of Placebo Controls. N Engl J Med 1994;331(6):394–398PubMedCrossRefGoogle Scholar
  39. 39.
    Hrobjartsson A, Gotzsche PC. Is the placebo powerless? Ananalysis of clinical trials comparing placebo with no treatment. N Engl J Med 2001;344(21):1594–1602.PubMedCrossRefGoogle Scholar
  40. 40.
    Benedetti, F, Pollo A, Lopiano L, Lanotte M, Vighetti S, Rainero I. (2003) Conscious expectation and unconscious conditioning in analgesic, motor, and hormonal placebo/nocebo responses, J. Neurosci 2003;23:4315–4323.Google Scholar
  41. 41.
    Miller FG, Rosenstein DL. The nature and power of the placebo effect. J Clin Epidemiol 2006;59:331–335.PubMedCrossRefGoogle Scholar
  42. 42.
    Brody H. The placebo response—Recent research and implications for family medicine. Journal of Family Practice 2000;49(7):649–654.PubMedGoogle Scholar
  43. 43.
    Walach H. The efficacy paradox in randomized controlled trials of CAM and elsewhere: beware of the placebo trap. J Altern Complement Med 2001;7(3):213–218.PubMedCrossRefGoogle Scholar
  44. 44.
    Kaptchuk TJ. The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance? Ann Intern Med 2002;136(11):817–825.PubMedGoogle Scholar
  45. 45.
    Kaptchuk TJ. Effect of interpretive bias on research evidence. BMJ 2003;326(7404):1453–1PubMedCrossRefGoogle Scholar
  46. 46.
    Adams KE, Cohen MH, Eisenberg D, Jonsen AR. Ethical considerations of complementary and alternative medical therapies in conventional medical settings. Ann Intern Med 2002;137(8):660–664.PubMedGoogle Scholar
  47. 47.
    Kligler B, Maizes V, Schachter S, et al. Core competencies in integrative medicine for medical school curricula: a proposal. Acad Med 2004;79(6):521–531.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2007

Authors and Affiliations

  1. 1.Vanderbilt UniversityUSA
  2. 2.University of MichiganUSA

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