Complementary and Alternative Medicine in the United States

Institute of Medicine

Public Briefing
Jan. 12, 2005

Opening Statement
by

Stuart Bondurant, M.D.

Interim Executive Vice President and Executive Dean
Georgetown University Medical Center
and
Chair, Committee on Use of Complementary and Alternative Medicine (CAM)
by the American Public

Good morning. Thank you for your interest in the conclusions and recommendations of this report, which was developed by the Institute of Medicine's Committee on the Use of Complementary and Alternative Medicine by the American Public.

As Bill has just said, CAM is here to stay. More than one-third of American adults routinely use CAM, spending more than $30 billion a year of their own money. There has been rapid progress in our understanding of CAM as evidenced by the fact that more than 7,000 controlled trials on CAM have been published in the medical literature.

This committee reviewed an extensive collection of relevant literature and heard a series of expert presentations, discussions, and public comments in open meetings.
To ensure adequate input from CAM providers, the committee established a working liaison group composed of 32 leaders of CAM and conventional medical disciplines and held a number of formal and informal interchanges with these groups.

The committee concluded that the goal of health care should be to provide comprehensive care that is based on the best available scientific evidence about benefits and risks of harm and costs of care; that recognizes the importance of compassion and caring; that encourages patients to share in decision-making about their therapeutic options; and that promotes choices in care that include both CAM and conventional medical therapies when appropriate.

To enable health care providers to provide comprehensive care and to competently advise patients about CAM, the committee recommended that conventional health professional schools incorporate information about CAM treatments into their curricula.

Of primary importance to the committee, and underlying all its deliberations, was the question, What do patients and health professionals need to know in order to make good decisions about use of health care interventions, including CAM? One answer to that question concerns whether treatments are safe and effective. We recognize that there are extremes of belief about how to judge effectiveness. For some individuals, evidence limited to their own experience or knowledge is all that is necessary to prove that a CAM therapy is effective. For others, no amount of evidence is sufficient. This report will please neither of those extremes.

The committee recommends that the same principles and standards for demonstrating treatment effectiveness apply to all treatments. We say this with the understanding that certain characteristics of some CAM and some conventional medical interventions make it difficult or impossible to conduct standardized randomized controlled trials. For these therapies, innovative methods of evaluation are needed.

The report also discusses the importance of having CAM practitioners involved in research in order to ensure that research reflects as much as possible the actual ways in which CAM therapies are administered and used. We call for more CAM practitioners to be trained in research. Furthermore, practice guidelines for CAM therapies should be developed by CAM practitioners in order to foster research and quality.

The intent of the report is not to medicalize or co-opt CAM but to sustain the existing forms of validated CAM therapies, whether integrated into conventional practices or continued as freestanding approaches. The committee urged that great care be taken to test CAM therapies in the ways that they are used.

Because dietary supplements are an important component of several CAM approaches and because their use by Americans is growing, the committee addressed the issue of what is needed to facilitate research on supplements. Reliable and standardized products are needed if studies to determine the safety and efficacy of dietary supplements are to be conducted. In order to improve product consistency and reliability, the committee recommended that Congress and relevant stakeholders -- including industry representatives, researchers, and consumers -- work to amend the Dietary Supplement Health and Education Act in ways that strengthen product quality control and provide incentives for privately funded research on the efficacy of products and brands.

Complementary and alternative therapies are frequently used in conjunction with conventional medical therapies. To enable health care providers to competently advise patients about CAM, the committee recommends that conventional health professional schools incorporate information about these treatments into their curricula.

The committee believes that health care is in the middle of an exciting time of discovery, a time when an evidence-based approach brings opportunities for the incorporation of the best options from all sources of care -- both conventional medicine and CAM. The challenge is to avoid parochial bias and to approach each possibility with an appropriate degree of both skepticism and open-mindedness. Only then will it be possible to ensure that informed, reasoned, and knowledge-based decisions are made.

That concludes my statement. My colleagues and I will now take your questions. As a reminder, we ask those of you in the room to use one of the floor microphones so that all can hear the questions. Those listening to the webcast may e-mail in questions using the form on the National Academies Web site. We ask everyone to please identify yourself by name and affiliation before asking your questions. We'll start with a question from the room.