Mainstream and Alternative Medicine: Converging Paths Require Common Standards

The health care practices subsumed under the title “complementary and alternative medicine” (CAM) are now a substantial and growing part of health care. In the United States, office visits to CAM providers now outnumber visits to primary care physicians (1). The U.S. population spends more than $30 billion on CAM each year (1). Despite patient interest, CAM has existed largely outside of the world of mainstream medicine until recently, and evaluative research on CAM practices has lagged behind research on conventional medicine. Now, CAM and mainstream medicine are on converging paths as research funds become available and health systems search beyond conventional medicine for ways to attract—and help—patients.

In recent years, the body of research on several widely used CAM methods has grown in size and quality, partly in response to the availability of research support from the National Center for Complementary and Integrative Medicine of the National Institutes of Health. According to this evidence, some CAM treatments are effective, as measured against conventional medical treatments or against placebo, and others are not. A series of articles in Annals included systematic reviews of the very substantial body of evidence for some CAM practices (2-4), and that body of evidence continues to grow (the 21 December 2004 issue of Annals contained reports of 3 randomized trials of CAM interventions).

Reflecting this growing body of evidence of effectiveness, but also stimulated by market forces, many clinical practices are offering CAM treatments or are facilitating referral to community CAM practices. Most medical schools offer CAM coursework. Insurance carriers and health maintenance organizations are increasingly covering some CAM practices. Despite these signs, CAM's emergence into …