Implications of Evidence Based Medicine for Complementary & Alternative Medicine

At the present time, there are many calls, mainly from the orthodox medical profession and regulatory authorities, for medical interventions of all types to be practised and regulated on the basis of whether they work as determined by clinical trials. Medicine of this sort is called ‘Evidence Based Medicine’ (EBM). On the surface, EBM seems eminently reasonable. However, for Complementary and Alternative Medicine (CAM), many problematic issues arise. EBM is not neutral. Many assumptions enter into designing, interpreting and disseminating the results of clinical studies, and taking action based on their results. Because the biomedical paradigm will in practice be the basis for EBM, CAM modalities risk loosing their autonomy in a system based on EBM. EBM is likely to be a means of subordinating CAM modalities to the biomedical paradigm in ways that this article will explore. Fundamental questions that can be asked about a medical intervention by EBM are: 1 Does it work? 2 How does it work? 3 Is it safe? Additional questions that should be asked are: 4 How does one determine ‘Does it work?’ and ‘How does it work?’ 5 Should a form of medicine be permitted until 1. 2. and 3. have been determined? Looking at these considerations closely, a large number of problematic issues arise for CAM modalities.