Challenges in Systematic Reviews of Complementary and Alternative Medicine Topics

21 June 2005 | Volume 142 Issue 12 Part 2 | Pages 1042-1047

The use of complementary and alternative medicine (CAM) continues to grow in the United States. The Agency for Healthcare Research and Quality has devoted a substantial proportion of the Evidence-based Practice Center (EPC) program to systematic reviews of CAM. Such syntheses present different challenges from those conducted on western medicine topics, and in many ways are more difficult. We discuss 3 challenges: identifying evidence about CAM, assessing the quality of individual studies, and addressing rare serious adverse events. We use illustrations from EPC evidence reports to show readers approaches to the 3 areas and then present specific recommendations for each issue.

Author and Article Information

From the Southern California Evidence-based Practice Center (RAND Corporation, Santa Monica, California; the Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California; and the University of Alberta Evidence-based Practice Center, Edmonton, Alberta, Canada).

Disclaimer: The authors of this article are responsible for its contents. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality, the National Center for Complementary and Alternative Medicine, the Office of Dietary Supplements, the National Institutes of Health, or the U.S. Department of Health and Human Services.

Acknowledgments: The authors thank Dr. Terry Klassen for feedback on the manuscript, Di Valentine and Cony Rolon for their assistance, and Marilyn Josefsson for administrative support.

Grant Support: This research was performed by the Southern California Evidence-based Practice Center based at RAND, Santa Monica, California, with assistance from the University of Alberta Evidence-based Practice Center at Edmonton, Alberta, Canada, under contract with the Agency for Healthcare Research and Quality (contract 290-02-0003) and is based on work originally supported by the National Center for Complementary and Alternative Medicine and the Office of Dietary Supplements, both at the National Institutes of Health. Dr. Shekelle was a Senior Research Associate of the Veterans Affairs Health Services Research and Development Service.

Potential Financial Conflicts of Interest: Authors of this paper have received funding for Evidence-based Practice Center reports.

Requests for Single Reprints: Paul G. Shekelle, MD, PhD, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401; e-mail, Paul_Shekelle{at}rand.org.

Current Author Addresses: Dr. Shekelle and Ms. Suttorp: RAND Corporation, 1776 Main Street, Santa Monica, CA 90401.

Dr. Morton: RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194.

Dr. Buscemi and Ms. Friesen: University of Alberta Evidence-based Practice Center, 11402 University Avenue, Room 9420, Edmonton, Alberta T6G 2J3, Canada.