complementary and alternative medicines

introduction

• Diverse medical and health systems and practices not considered part

  of conventional medicine

  • Roots in ancient practices

  • Resurgence in popularity in recent decades

  • Lack of regulation

sources of evidence

RCTs - gold standard but have limitations for CAM

• Clinical audits - evaluate real world practice, track outcomes

• Observational studies - monitor use, survey patient perspectives

• Anecdotal reports - traditional basis but lack controls

• Literature searching - multiple sources needed, critical appraisal key

issues with RCT for cam

Lack of funding

• Subjective vs objective measures

• Patient reported outcomes vs clinical indicators

• Bias and limitations

• Confirmation bias, publishing bias, lack of replication

evidence based medicine

Integrating clinical expertise, patient values, and best available

evidence

• Patient preferences, practitioner expertise

CAM research problems

Lack of funding and prioritisation - limited resources, lack of

coordination

• Placebo and blinding difficulties - sham acupuncture, homeopathy

dilutions

• Lack of standardisation - variation in techniques and protocols

• Publishing bias - selective reporting of positive trials

• Other issues - small samples, lack of hypotheses, poor methodology

safety and risk

Direct - reactions to medicines, damage from procedures

• Indirect - inaccurate diagnosis, untreated serious conditions, drug

interactions

• Underreporting - lack of monitoring systems

• Need for training - stay within scope, refer as needed

• Public awareness - balance of risks vs. benefits

herbal medicine

Using plant-derived materials as medicines

• Requires knowledge of potential side effects and drug interactions

• Widely used for minor conditions and preventive health