ABSTRACT
Complementary Therapies in Neurology: An Evidence-Based Approach Edited by Barry S.Oken ISBN 1-84214-200-3 Copyright © 2004 by The Parthenon Publishing Group, London
A number of terms have been used to describe a group of clinical activities that have traditionally been outside the scope of conventional or allopathic medical practice. The most common term is complementary and alternative medicine (CAM) and this abbreviation will be used throughout this book despite its potential shortcomings. CAM is not an ideal term, in part because the therapies are usually not alternative to conventional medicine as practiced by most of the population but are complementary, with the two approaches used at the same time. The CAM grouping is somewhat artificial, as there is no inherent link between all aspects of what is considered CAM: unconventional uses of magnets do not have much in common with dance therapy or high-dose vitamin therapy. There have been some formal attempts to define the therapies that are considered CAM. The initial definition of CAM was simply clinical practices not taught at most medical schools and not generally available at most hospitals. Given that most medical students are now taught about some dietary supplements and many medical students are at least exposed to therapies such as acupuncture this is no longer a useful definition. In an editorial in The New England Journal of Medicine, Angell and Kassirer suggested that there is no such thing as alternative medicine. ‘There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work’1. While the practice of evidence-based medicine is an excellent goal, there are always gaps in the knowledge base. Clinicians frequently have to make clinical decisions in the absence of clear evidence. Pediatricians may have to make decisions about use of drugs based on clinical trial data from adults, and geriatricians may have to make similar decisions for their centenarians based on clinical trial data with essentially no centenarians, even for Alzheimer’s disease. Clinical trials often exclude patients with multiple medical problems that may confound the focused objective of determining the efficacy of a treatment for a specific condition. Given these concerns, the above-noted editorial regarding the terminology is simplistic.
