CLINICAL-PRACTICE GUIDELINES IN COMPLEMENTARY AND ALTERNATIVE MEDICINE - AN ANALYSIS OF OPPORTUNITIES AND OBSTACLES

An estimated 1 of 3 Americans uses some form of complementary and alte rnative medicine (CAM), such as acupuncture, homeopathy, or herbal med icine. In 1995, the National Institutes of Health Office of Alternativ e Medicine convened an expert panel to examine the role of clinical pr actice guidelines in CAM. The panel concluded that CAM practices curre ntly are unsuitable for the development of evidence-based practice gui delines, in part because of the lack of relevant outcomes data from we ll-designed clinical trials. Moreover, the notions of standardization and appropriateness, inherent in guideline development, face challengi ng methodologic problems when applied to CAM, which considers many dif ferent treatment practices appropriate and encourages highly individua lized care. Due to different belief systems and divergent theories abo ut the nature of health and illness, CAM disciplines have fundamental differences in how they define target conditions, causes of disease, i nterventions, and outcome measures of effectiveness. These differences are even more striking when compared with those used by Western medic ine. The panel made a series of recommendations on strategies to stren gthen the evidence base for future guideline development in CAM and to meet better the current information needs of clinicians, patients, an d guideline developers who seek information about CAM treatments.