From the Substance Abuse Center, Yale University School of Medicine, New Haven, Conn (Drs Margolin and Avants); and Center on Addiction and Substance Abuse at Columbia University, New York, NY (Dr Kleber).
BECAUSE ALTERNATIVE medicine therapies are used by a significant number
of Americans1,2 and people worldwide,3 there is an urgent need for their efficacy to be evaluated
formally. The most stringent evaluation would take place within the "gold
standard" for clinical research: the randomized controlled clinical trial
(RCT). However, alternative medicine comprises a large and heterogeneous group
of treatments,4 many of which are procedures
that are not readily testable under blinded conditions and for which the choice
of appropriate control conditions is by no means straightforward. Furthermore,
alternative medicine therapies may also possess a theoretical basis, may stem
from a cultural tradition that is seemingly antithetical to a quantitative,
or may possess little foundational research on which to base a controlled
evaluation. In this article, we discuss a number of key methodological issues
that arise in the controlled evaluation of one widely used alternative medicine
procedure—acupuncture for the treatment of cocaine addiction, and we
offer some suggestions for how these issues may be addressed.
Margolin A, Avants SK, Kleber HD. Investigating Alternative Medicine Therapies in Randomized Controlled Trials. JAMA. 1998;280(18):1626–1628. doi:10.1001/jama.280.18.1626
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