Jonas W B
Department of Family Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814, USA.
Appl Psychophysiol Biofeedback. 2001 Sep;26(3):205-14. doi: 10.1023/a:1011398120476.
Complementary and alternative medicine (CAM) is an area of great public interest and activity, both nationally and worldwide. Many alternative medical practices have existed for hundreds, even thousands of years. Patients and professionals are turning to CAM for a variety of reasons. Most have tried conventional medicine for a particular (usually chronic) medical condition and have found the results inadequate. Some are concerned over the side effects of conventional therapies. Some are seeking out a more "holistic" orientation in health care where they can address body, mind, and spirit. A continuing challenge will be how to address CAM services that are based on time, practitioner-patient interactions, and self-care, using modern standards of evidence, education, licensing, and reimbursement. For most CAM therapies, there is insufficient research to say definitively that it works and CAM research is especially limited in the area of cancer. Given that situation, the questions (but not answers) facing the medical practitioner are clear-cut. Should the practitioner await the definitive results of formal Phase III randomized clinical trials, or should the practitioner rely on limited data, seeking out evidence that makes physiological sense and small trials that seem to offer some benefit to the patient? When and at what point do you discourage, permit, or recommend an available alternative therapy? The answers are not simple. There may be differences of opinion and values among the patient, the practitioner, and the organizations that pay for a therapy. CAM areas should be approached with every patient who enters the office recognizing that there are precautions to consider when patients are using, or plan to use, such therapies. This paper presents a broad survey of what complementary and alternative medicine is from the perspectives of both the public as user and the conventional medical practitioner, as well as provides examples of issues pertinent to understanding and evaluating research in CAM. The past is back and the future will involve integration of modern and ancient ways.
补充和替代医学（CAM）在国内和全球都是一个备受公众关注且十分活跃的领域。许多替代医学实践已经存在了数百年，甚至数千年。患者和专业人士出于各种原因转向补充和替代医学。大多数人针对特定的（通常是慢性的）医疗状况尝试过传统医学，但发现效果不尽人意。一些人担心传统疗法的副作用。一些人在寻求更“整体”的医疗保健方向，在这种方向下他们可以兼顾身体、心理和精神。一个持续存在的挑战将是如何依据现代的证据、教育、许可和报销标准，来处理基于时间、从业者与患者互动以及自我护理的补充和替代医学服务。对于大多数补充和替代医学疗法，没有足够的研究能确切表明其有效，而且补充和替代医学在癌症领域的研究尤其有限。鉴于这种情况，医学从业者面临的问题（但不是答案）很明确。从业者应该等待正式的III期随机临床试验的明确结果，还是应该依靠有限的数据，寻找具有生理意义的证据以及似乎对患者有一定益处的小型试验？何时以及在什么情况下应该劝阻、允许或推荐一种现有的替代疗法？答案并不简单。患者、从业者以及为治疗付费的组织之间可能存在意见和价值观的差异。对于每一位走进诊室的患者，都应该探讨补充和替代医学领域的问题，要认识到当患者正在使用或计划使用此类疗法时，有一些预防措施需要考虑。本文从公众作为使用者以及传统医学从业者的角度，对补充和替代医学进行了广泛的概述，并提供了与理解和评估补充和替代医学研究相关的问题示例。过去已然回归，未来将涉及现代与古老方法的融合。
