Key Issues in Clinical and Epidemiological Research in Complementary and Alternative Medicine – a Systematic Literature Review

Abstract

Background: In the last 2 decades there has been a large increase in publications on complementary and alternative medicine (CAM). However, CAM research methodology was heterogeneous and often of low quality. The aim of this systematic review was to investigate scientific publications with regards to general issues, concepts and strategies. We also looked at research priorities and methods employed to evaluate the clinical and epidemiological research of CAM in the past to identify the basis for consensus-based research strategies. Methods: We performed a systematic literature search for papers published between 1990 and 2010 in 7 electronic databases (Medline, Web of Science, PsychArticles, PsycInfo, CINAHL, EMBASE and Cochrane Library) on December 16 and 17, 2010. In addition, experts were asked to nominate relevant papers. Inclusion criteria were publications dealing with research methodology, priorities or complexities in the scientific evaluation of CAM. All references were assessed in a multistage process to identify relevant papers. Results: From the 3,279 references derived from the search and 98 references contributed by CAM experts, 170 papers fulfilled the criteria and were included in the analysis. The following key issues were identified: difficulties in past CAM research (e.g., randomisation, blinding), utility of quantitative and qualitative research methods in CAM, priority setting in CAM research and specific issues regarding various CAM modalities. Conclusions: Most authors vote for the use of commonly accepted research methods to evaluate CAM. There was broad consensus that a mixed methods approach is the most suitable for gathering conclusive knowledge about CAM.

Whole Medical Systems versus the System of Conventional Biomedicine: A Critical, Narrative Review of Similarities, Differences, and Factors That Promote the Integration Process

“…The main similarities between WMSs and some developments in conventional medicine are as follows:The development of a personalized medicine/individualization approach in addition to the current mainstream protocolled approach [44, 45]The use and role of professional judgment in some domains of clinical practice (e.g., interpretation of radiographs) [45, 46]The increasing use of complex interventions [47–49]System approaches in diagnostics and therapy (e.g., systems biology, epigenetics, emergentism, metabolomics, “network medicine,” “polypharmacology,” and “polytarget treatment”) [5, 50–52]Shared decision-making [45, 53]A holistic dynamic health concept [5, 54]The use of pattern recognition methodologies [55, 56]The notion that RCTs are not applicable everywhere [57, 58] with a shift towards more pragmatic trials [45, 48, 58, 59] and other study types [48, 60]The notion that conducting clinical studies for multiple clinical conditions and their respective diverse therapy options has its limitations, due to excessive complexity and prohibitive costsThe increasing role of patient preferences and patient autonomyThe real-world situation that, in many medical fields (e.g., paediatric surgery, emergency medicine, and vaccination), RCT-based practice is only marginal and often critically questionedThe main differences between the WMSs and the conventional medicine system are summarized in Table 2 [61]. …”

A Research Roadmap for Complementary and Alternative Medicine - What We Need to Know by 2020

“…The review [6] concludes that in the scientific community there seems to be a consensus that the research methods used in conventional medicine are applicable to CAM. Randomised controlled trials are useful and applicable methods to evaluate CAM although in some circumstances it might be necessary to adapt these methods pragmatically.…”

“…CAM use was often measured as a group of therapies rather than individually specified CAM modalities. Finally, because of the heterogeneity of the methods and definitions it was not possible to pool the data in a meta-analysis, and we cannot make a definitive statement of the CAM use in detail in Europe [6].…”

CAMbrella – a Pan-European Research Network for Complementary and Alternative Medicine: From the Beginnings up to First Results

“…The first step in this WP was to collect and critically analyse CAM research methods used in the WPs 3-5 and to evaluate the clinical and epidemiological relevance of CAM in a systematic literature review. The results are included in this supplement [8], and served as a starting point for the development of proposals and recommendations regarding future CAM research. This second step was taken in order to develop a proposal for a roadmap of future CAM research.…”