Trials of complementary and alternative medicine may not sway many clinicians

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Comment: The National Institutes of Health have spent more than $2 billion researching complementary and alternative medicine (CAM). However, these studies may have little influence on mainstream physicians and even CAM providers, according to a survey reported in the April 13 issue of the Archives of Internal Medicine.

“In this study we wanted to know, ‘Can CAM research have social value?'” Dr. Jon C. Tilburt told Reuters Health. “We sought to answer this from the perspectives of the clinicians who might benefit from the published clinical trials of CAM.”

Dr. Tilburt, a bioethicist at the NIH in Bethesda, Maryland, and at the Mayo Clinic in Rochester, Minnesota, added, “Awareness of and willingness to recommend a therapy based on new evidence are preliminary indicators of whether or not CAM research is making its way into clinical practice.”

The research team mailed questionnaires to clinicians to assess awareness of two “landmark, high-profile CAM studies” involving randomized, controlled trials of interventions for osteoarthritis of the knee. A 2004 study of acupuncture appeared in the Annals of Internal Medicine, and a 2006 study of glucosamine and chondroitin was published in the New England Journal of Medicine.

Completed questionnaires were returned by 345 rheumatologists, 334 general internists, 440 acupuncturists, and 442 naturopaths. Results showed that 59% of all respondents were aware of at least 1 study, and 23% were aware of both.

“We thought conventional clinicians would universally be more familiar with both CAM trials, but that was not the case,” Dr. Tilburt said. “For instance, acupuncturists were much more likely (than general internists) to report being familiar with the acupuncture trial, which surprised us.”

The team also found that CAM providers believed more in the importance of patient preferences than they did in research evidence, while conventional clinicians — especially rheumatologists — put more emphasis on research evidence.

Neither perspective is sufficient, the researcher noted. “Both research evidence and patient preferences are critical to sound clinical decision making and must be integrated. CAM and conventional clinicians probably have a lot to learn from one another in figuring out how to integrate patient preferences with research evidence.”

Dr. Tilburt believes science policy must change if CAM research is to affect clinical practice.

“We need to make the evidence relevant to the practice of clinicians and recognize the real questions they face in their practice,” he explained. “It would be nice to see more uniform practical critical appraisal skill being built into the clinical training of all clinicians, but the research needs to be more relevant and digestible as well.”

To clinicians, he recommends, “Before you categorically dismiss CAM by saying there is no reliable research on it, do a quick search of PubMed or another reliable source. There are Cochrane reviews of CAM and many good systematic reviews that offer reliable information.”

Conclusion: For clinical research in CAM to achieve its social value, concerted efforts must be undertaken to train clinicians and improve the dissemination of research results.

Arch Intern Med 2009;169:670-677. View Abstract View Reuters Comment

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