Coulter Ian D
Samueli Institute, UCLA School of Dentistry, RAND, Santa Monica, Southern California University of Health Sciences, Corona del Mar, CA 92625, USA.
Forsch Komplementmed. 2007 Apr;14(2):102-8. doi: 10.1159/000101054. Epub 2007 Apr 23.
The present paper examines the experience of establishing a center for evidence-based complementary and alternative medicine (EBCAM) practice. It examines both the difficulties and the challenges of doing research to establish EBCAM. The paper also examines the political context of the demand for evidence- based practice (EBP) for CAM.
A center for EBCAM was funded for 3 years within the Southern California Evidence-Based Practice Center by the National Center for CAM and administered by the Agency for Health Research Quality. This experience provides the basis for this paper.
While the experience of creating an EBM Center for CAM has shown that much work can be accomplished by applying standard methods of EBP medicine, it also highlights the weaknesses of such an agenda. Many standard research methods are simply not applicable to CAM, and even where they are, effectiveness is a much more important means of assessing CAM than simply efficacy. Researchers however, must be conscious of the political motivations behind much of the demand for EBCAM. Where such demands are coming from allopathic medicine, they clearly form a continuing part of medical opposition to CAM and may be intended to perpetuate the dominance of the biomedical paradigm in healthcare. The challenge for CAM is to recognize the limitations of EBP but not to throw the 'baby out with the bathwater'. There is much in EBP that clearly should be emulated by the CAM community but only where it is appropriate.
本文探讨建立循证补充与替代医学（EBCAM）实践中心的经验。研究建立EBCAM过程中遇到的困难与挑战。本文还审视了补充与替代医学循证实践（EBP）需求的政治背景。
国家补充与替代医学中心在南加州循证实践中心内资助了一个为期3年的EBCAM中心，由卫生研究质量局管理。这一经验为本文提供了依据。
虽然创建补充与替代医学循证医学中心的经验表明，应用循证医学的标准方法可以完成大量工作，但也凸显了这一议程的弱点。许多标准研究方法根本不适用于补充与替代医学，即便适用，评估补充与替代医学时，有效性比单纯的疗效是更重要的衡量手段。然而，研究人员必须意识到对EBCAM诸多需求背后的政治动机。如果这些需求来自对抗疗法医学，它们显然构成了医学对补充与替代医学持续反对的一部分，可能旨在使生物医学范式在医疗保健领域的主导地位永久化。补充与替代医学面临的挑战是认识到循证实践的局限性，但不要把“孩子和洗澡水一起倒掉”。循证实践中有许多内容显然值得补充与替代医学领域效仿，但前提是要适用。
