J Altern Complement Med. 2001 ; 7 Suppl 1(): S145-52.

A critique on complementary and alternative medicine.

Shine KI.

Institute of Medicine, National Academy of Sciences, Washington, DC 20418, USA. kshine@nas.edu

Modern medicine regularly uses the products of science to improve health. Until recently, however, medicine itself has not been practiced in a scientific manner. The growth of evidence-based medicine is predicated upon the concept that insofar as possible, all aspects of medical care ought to be examined with regard to the evidence. All forms of treatments and preventive strategies should be subjected to assessments of efficacy and effectiveness. Efficacy is demonstrated in the day-to-day practice of medicine. An evaluation of effectiveness may lead to one or more randomized clinical trials, where the results of these randomized clinical trials may be necessary to maximize effectiveness. From a health care perspective, safety must be assessed, not only with regard to adverse effects of the particular intervention, but also in the context of a comparison to alternative treatments. If evidence demonstrates the efficacy and/or effectiveness of a particular intervention, it may be unsafe to select a treatment for which evidence of efficacy or effectiveness is lacking. Certainly patients should be fully informed of the evidence that is available for making rational choices. Alternative and complementary modes of medicine should be subject to these principles. The history of digitalis glycosides provides an interesting example of an important treatment arising from herbal medicine, by which many of these elements can be exemplified.