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Evidence-based medicine and complementary medicine
  1. Andrew Vickers, DPhil
  1. Integrative Medicine Service, Memorial Sloane-Kettering Cancer Center, New York, NY, USA

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To apply evidence-based medicine (EBM) to complementary medicine (CM)—treatments such as acupuncture, chiropractic, homeopathy, or herbal medicine—seems, at first glance, a contradiction in terms. CM is often defined as techniques for which no evidence of benefit exists (or as a speaker at a recent Cochrane Colloquium put it, “medicine is either scientific or complementary”). But many of the interventions used by conventional clinicians have little scientific support; conversely, there is evidence from randomised trials in support of some interventions that are commonly described as CM. CM is an increasingly prevalent aspect of health care: about 10% of the UK population visit a practitioner each year,1 and about 40% of UK general practices offer their patients access to CM services on the national health service.2 As such, CM constitutes important area for the implementation of EBM for better patient care.

Can EBM be applied to CM?

There are two perspectives for thinking about EBM and CM. The external perspective is that of those outside CM. This might include a community mental health team deciding whether to employ an acupuncturist to treat addiction, a family physician considering whether to refer patients with anxiety disorders to a homeopath, or a patient deciding whether to buy an over the counter herbal remedy for depression. EBM can and should be used as part of such decisions. The internal perspective is that of CM practitioners themselves, finding, appraising, and acting on evidence to diagnose, treat, and prognose more effectively. This use of EBM is more problematic.

EBM and decisions about referring to or purchasing CM

Contrary to widespread belief, there is considerable …

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