Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany.
Explore (NY). 2011 May-Jun;7(3):175-87. doi: 10.1016/j.explore.2011.02.001.
Complementary and alternative medicine (CAM) is becoming an integral part of modern medicine. Complementary and alternative medicine therapy systems include natural medicinal products, nonpharmacological treatments, and counselling on health and lifestyle issues. Complementary and alternative medicine concepts are often elaborate, transcending biophysical models and employing the principles of salutogenesis. Evaluations of CAM therapy systems need to be integrative and cover the dimensions of: (1) therapeutic professionalism; (2) patient perspective and public demand; (3) conceptuality; (4) safety, effectiveness, and costs. Complex research strategies are required, which reverse the phases of conventional drug assessment. The predominant use of randomized trials would introduce structural bias and create an artificial picture. Important are evaluations of the whole system in real-world conditions, and surveys on component evaluations. Systemic CAM assessments should consist of a broad array of high-quality research methods: well-conducted randomized and nonrandomized studies, cohort studies, qualitative research, high-quality case reports and case series, studies on patient perspective, safety analyses, economic analyses, etc. Good clinical judgement, a core epistemic element of medicine based on nonstochastic principles, should also be integrated and could reflect routine patient care.
补充和替代医学（CAM）正成为现代医学的一个组成部分。补充和替代医学疗法系统包括天然药物产品、非药物治疗以及有关健康和生活方式问题的咨询。补充和替代医学的概念通常很复杂，超越了生物物理模型，并采用了健康促进原则。CAM 疗法系统的评估需要综合考虑以下几个方面：（1）治疗专业性；（2）患者视角和公众需求；（3）概念性；（4）安全性、有效性和成本。需要采用复杂的研究策略，反转传统药物评估的阶段。主要使用随机试验会引入结构偏差，并产生人为的结果。重要的是在实际情况下对整个系统进行评估，并对各个组件进行评估。系统的 CAM 评估应包括广泛的高质量研究方法：精心设计的随机和非随机研究、队列研究、定性研究、高质量病例报告和病例系列、患者视角研究、安全性分析、经济分析等。良好的临床判断，即基于非随机原则的医学的核心认知要素，也应得到整合，并能够反映常规的患者护理。
