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Complementary and Alternative Medicines [CAM] are
interventions that are not widely taught in medical schools
and are not part of the usual arsenal of treatments and medi-
cations recommended and prescribed by physicians and
available in hospitals.1 CAM is big business ($30 billion in
the US) with aggressive marketing. Their use in Europe and
North America is increasing significantly.2 For example, a
1998 phone survey of 1539 adults found that 42.1% in the
United States had used at least one CAM within a twelve
month period and that use had increased since 1990; the
most used treatments were herbal medicine, massage, mega-
vitamins, self-help groups, folk remedies, energy healing
and homeopathy.3 In 2003, 20% of all Canadians visited a
CAM practitioner, up from 15% in 1994/5.4
Users of CAM are more likely to have higher education lev-
els and report lower health status.' Common health prob-
lems treated with CAM are anxiety, back problems, chronic
pain, and urinary tract problems. Use of CAM is dependent,
not on dissatisfaction with conventional medicine as it is
most commonly used in association with conventional med-
icine, but on philosophical orientations towards health and
life, such as feminism, spirituality, and personal growth.'
Other studies suggest that CAM use allows patients and con-
sumers greater control over their health and a level of
self-empowerment.' For these reasons, it has become
increasingly important to understand the nature and impact
of popular representations of CAM in this context.
The combination of educated and self-empowered users of
CAM suggests a high degree of reliance on information
sources outside of mainstream medical practitioners. Not
surprisingly, coverage in sources including newspapers,
television, magazines, other media, and the internet has
increased to meet the demand for information. A vast quan-
tity of information of varying quality exists in the media and
on the internet.' There are concerns, however, that the media
and internet provide too rosy a picture of CAM9 and down-
play adverse reactions to CAM, which can be dangerous and
potentially fatal.10 Such coverage augments the common
misperception that CAM is natural and therefore, less harm-
ful than conventional medical treatments. Indeed, Barnes
et al. (1998) found that users of CAM were less likely to
report adverse effects than users of over-the-counter medi-
cines. These factors suggest that significant improvements
need to be made to knowledge translation mechanisms for
the public, healthcare professionals, and policy makers.
The response of the medical and scientific community has
been an increasing interest in CAM issues. There has been
an increase in the number and proportion of clinical trials of
CAM, which suggests a trend toward an evidence-based
approach. The cumulative number of clinical trial articles
indexed on MEDLINE, however, remains small (0.4%), and
more high-quality original research is needed. 13 Further, the
proportion of those articles on CAM indexed as clinical
trial-type studies is 2.1%, but rising.
The lack of clinical trials may be due to a number of factors.
There may be little incentive for commercial manufacturers
of CAM products to run expensive clinical trials. However,
the recent move to evidence-based health claims for CAM
labeling and advertising in Canada15 may drive an increase
in CAM clinical trials in that country.
Volume 15, Number 1
Trends in Evidence Based Medicine
for Herbal Remedies and Media
Coverage
Tania Bubela, Timothy Caulfield and Heather Boon
3](ViewImageLocal?handle=hein.journals/hthlr15&div=1&collection=&method=preview&ext=.png&size=3)
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