Walach H, Guthlin C, Lewith G, Jonas W; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2000; 16: 297.
*University Hospital Freiburg, Department of Environmental Medicine and Hospital Epidemiology, Hugstetterstr. 55, D - 79106 Freiburg, Germany
Introduction: It is usually assumed that randomized controlled trials (RCTs) are the only valid method to evaluate health technologies, and that this is also true for complementary and alternative medicine (CAM). We challenge this view. We argue that often several explicit or implicit presuppositions for the application of RCTs are not met within CAM research, some of them inherent in the subject matter, some of them germane to RCTs in general. Argument: Among the problems are that RCTs test for specific efficacy, while CAM possibly works via non-specific mechanisms. In CAM we often find the efficacy paradox: CAM interventions are not specifically superior to placebos, but altogether quite effective in everyday practice. RCTs presuppose indifference on the part of practitioners and patients, while most of CAM consumers and providers have clear preferences. RCTs create internally valid evidence of questionable external validity. Taking psychotherapy research as an example, we argue that a staged research program is necessary to provide the evidence needed. Such a program must seek to have as its primary strategy the acquisition of information using various methods and not be primarily limited to the development of RCTs. Within such a staged effort, outcomes research has a clear place. It can provide data on general effectiveness in everyday practice in large numbers of patients with long-standing chronic diseases and a well-known disease history - the typical conditions for which CAM is used. We give practical examples of several ongoing studies. Conclusion: In conclusion we call for a multimethod approach in which both RCTs and outcomes studies mutually complement each other.
Publication Types:
Keywords:
- Biomedical Research
- Complementary Therapies
- Health Services Needs and Demand
- Humans
- Research Design
- methods
- hsrmtgs
Other ID:
UI: 102272067
From Meeting Abstracts