Research Standards: CAM vs. Western
I have written numerous time about CAM (complementary and alternative medicines) and the value that some treatments seem to bring to many women. The caveat is always that those treatments or medications have not been rigorously tested per our usual research standards, and there are many questions/concerns about their efficacy. Perhaps, more worrisome, there are questions about possible negative interactions between some herbs or "natural" medicines and chemotherapy drugs. This is a fine editorial from the Journal of Clinical Oncology by Mark Levine, MD. Here is a quote and then a link to read more. If you use or are considering the use of any CAM medications, I strongly urge you to read the whole thing.
For many years, surgery, radiation therapy, chemotherapy, and endocrine therapy have been the mainstays of cancer treatment. These were the modalities available when I ?rst started clinical practice in 1981. In the early 1990s, I began to notice that some patients were choosing alternatives to the mainstream or conventional treatments. These so-called alternative therapies included a range of interventions, such as dietary and behavioral interventions, vitamin supplements and herbs, and traditional systems such as Chinese and homeopathic medicines.
- Most of these were not supported by sound scientific methods. Alternative therapies appealed to certain patients who were exasperated with the conventional treatments they had received, terrified of the adverse effects, or desperate for miracles because they had been told their cancers were incurable. It was not long before the term complementary medicine appeared. This referred to therapies or practices used alongside conventional medicine, whereas alternative medicine was used in place of conventional medicine.
- The goal of this discussion is not to debate the merits of conventional medicine versus CAM. Rather, the objectives are to consider whether these two paths of medicine should be held to the same standards of evidence in terms of clinical and policy decision making and to determine whether a model that historically has been based on weak evidence can be reconciled with the new paradigm of the requirement for high-quality evidence.
Complementary and alternative medicines are often bundled together under the acronym CAM, the goals of which are to increase the efficacy of conventional cancer treatment programs, reduce symptoms, and improve quality of life for patients with cancer. CAM is grouped into four domains to account for the wide diversity in therapies: mind-body medicine, biologically based practices, manipulative and body-based practices, and energy therapies.
- Cutting across all four domains is the category of whole medical systems. These represent comprehensive systems of theory and practice developed before — or parallel to — biomedicine. These systems usually have his- tories of effectiveness ascertained through many years of observation within specific cultural contexts (eg, traditional Chinese medicine).