The Research and Development Agenda
The lack of product quality and consistency and the absence of compelling data on the safety and efficacy of most CAM and TM approaches present major challenges to any effort to optimize the distribution of precious health resources. These difficulties also pose opportunities for research. Other formidable challenges include the variability in training, credentialing, and licensing CAM and TM practitioners. Increasingly, efforts are being made in several countries to regulate both products and practitioners. Ultimately, stringent controls on training, practices, and products must be complemented by rigorous research to ascertain which approaches are safe and effective—and for which indications.
The global use and potential effect of CAM and TM practices, the lack of adequate data validating their safety and efficacy, and the existence of highly effective conventional alternatives for many of them dictate that resources should be devoted to fuller characterization and standardization of CAM and TM approaches. Investing precious resources in integrating such approaches further into health care infrastructures can be justified only on the basis of compelling data. This point leads to the question of what constitutes a rational agenda for this work.
For resource-rich industrial nations, one model for CAM and TM research is that being implemented by the National Center for Complementary and Alternative Medicine (NCCAM) of the U.S. National Institutes of Health (http://nccam.nih.gov). In 2004, NCCAM planned to invest US$117 million in research and research training. It is supporting some 800 individual projects at present, including studies of the composition of natural products and their pharmacological effects, studies of the neurobiological mechanisms of acupuncture and the placebo effect, and clinical trials with 30 to 30,000 participants. NCCAM now has a strategic plan for its international programs that emphasizes research, training, and efforts to learn about the rich, indigenous TM heritage. Australia, through a government agency similar to NCCAM, is conducting research and training programs in collaboration with its indigenous people. Although the scope of NCCAM's research agenda is larger than what most other nations could accommodate, its underlying philosophy should be universal. That is, the standards for research into CAM and TM approaches should be no different from those used in conventional biomedical research.
Both CAM and TM and biomedical practitioners need to understand the strengths, limitations, and contributions of their particular approaches so that they can work together in ways that ensure the best possible care for their patients and the achievement of their shared goals of improved individual and public health. Once these issues have been addressed, countries could devote additional resources to studying those CAM and TM approaches that appear to be the most promising in relation to their most pressing public health problems. Some priority areas for CAM and TM research are widely applicable, including studies of approaches to palliate chronic pain and suffering, relieve depression, help release the grip of addictive substances, and slow the progression of degenerative disorders such as arthritis and dementia.
Notes
1. Because some individuals had gone to more than one provider during the four-week period, the total comes to more than 10,033.
2. The median duration of current treatment at the Royal London Homeopathic Hospital was three years.
3. This study did not take into account the costs of physician time, the costs of laboratory tests, or patients' costs.
