The regulatory status of CAM has been the subject of extensive debate (Saks 2002; Stone and Matthews 1996). Seen by many as an indicator of CAM’s lack of recognition by the state, CAM’s inability over the last twenty years to secure statutory regulation has been accompanied by failures to make inroads into state-funded health provision, despite usage and popularity of CAM remaining high, and successive governments’ stated commitment to promoting patient choice.1 This chapter will explore why the debate remains contested, how the broader regulatory environment has changed and how, despite signs of greater professionalism within parts of the CAM sector, the UK’s National Health Service is unlikely to embrace CAM in the current climate. A key difficultly has been the failure of the disparate bodies and organisations within CAM to come together with a common purpose or sense of collegiality either across the sector, or even, necessarily, within single therapies. Comparing the far-reaching aspirations of CAM’s more professionally organised and vocal groups with the modest inroads achieved, this chapter will argue that, in the last twenty years, CAM as a collective phenomenon has missed strategic opportunities, both politically and therapeutically, leaving little scope for creating a role for itself in a rapidly changing regulatory environment. As statutory regulation is now realistically beyond CAM’s reach, the chapter will explore alternative forms of regulation open to CAM and question whether external validation is central to, or necessary for, CAM’s longer term viability.