CAM in Europe – Ideas and Notions

The efficacy paradox in randomized controlled trials of CAM and elsewhere: beware of the placebo trap.

The Journal of Alternative and Complementary MedicineVol. 16, No. 1 EditorialComparative Effectiveness Research and CAMMikel AickinMikel AickinSearch for more papers by this authorPublished Online:27 Jan 2010https://doi.org/10.1089/acm.2009.0718AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Comparative Effectiveness Research and CAM." , 16(1), pp. 1–2FiguresReferencesRelatedDetailsCited ByThe Role of Research in Guiding Treatment for Women’s Health: A Qualitative Study of Traditional Chinese Medicine Acupuncturists19 January 2021 | International Journal of Environmental Research and Public Health, Vol. 18, No. 2Spiritual Leadership and Self-Development Model5 May 2021Acupuncture for the treatment of trigeminal neuralgiaMedicine, Vol. 97, No. 11Effect of catgut implantation at acupoints for the treatment of allergic rhinitis: a randomized, sham-controlled trial10 November 2016 | BMC Complementary and Alternative Medicine, Vol. 16, No. 1Exploring the prospect of a complementary and integrative medicine database for use in the Australian primary care settingAdvances in Integrative Medicine, Vol. 1, No. 1Parental Perspectives on Use, Benefits, and Physician Knowledge of Complementary and Alternative Medicine in Children with Autistic Disorder and Attention-Deficit/Hyperactivity Disorder Angela Huang, Kapila Seshadri, Tara Anne Matthews, and Barbara M. Ostfeld6 September 2013 | The Journal of Alternative and Complementary Medicine, Vol. 19, No. 9A double-blind controlled clinical trial assessing the effect of topical gels on striae distensae (stretch marks): a non-invasive imaging, morphological and immunohistochemical study12 April 2013 | Archives of Dermatological Research, Vol. 305, No. 7Review of Cochrane Reviews on Acupuncture: How Chinese Resources Contribute to Cochrane Reviews Shuang Jiao, Kiichiro Tsutani, and Nobuhiko Haga2 July 2013 | The Journal of Alternative and Complementary Medicine, Vol. 19, No. 7Effectiveness guidance document (EGD) for acupuncture research - a consensus document for conducting trials6 September 2012 | BMC Complementary and Alternative Medicine, Vol. 12, No. 1The optimized acupuncture treatment for neck pain caused by cervical spondylosis: a study protocol of a multicentre randomized controlled trial9 July 2012 | Trials, Vol. 13, No. 1Development of a Chinese Medicine Pattern Severity Index for Understanding Eating Disorders Sarah Fogarty, David Harris, Chris Zaslawski, Andrew J. McAinch, and Lily Stojanovska11 July 2012 | The Journal of Alternative and Complementary Medicine, Vol. 18, No. 6Decontextualized Versus Lived Worlds: Critical Thoughts on the Intersection of Evidence, Lifeworld, and Values Jeff Flatt17 May 2012 | The Journal of Alternative and Complementary Medicine, Vol. 18, No. 5Key Issues in Clinical and Epidemiological Research in Complementary and Alternative Medicine a Systematic Literature ReviewForschende Komplementärmedizin / Research in Complementary Medicine, Vol. 19, No. s2The Intersecting Paradigms of Naturopathic Medicine and Public Health: Opportunities for Naturopathic Medicine Jon Wardle and Erica B. Oberg16 November 2011 | The Journal of Alternative and Complementary Medicine, Vol. 17, No. 11Naturopathic Medicine and Public Health: Teaming Up for a Transformative Tomorrow Elizabeth Sutherland16 November 2011 | The Journal of Alternative and Complementary Medicine, Vol. 17, No. 11Introduce the idea of comparative effectiveness research to clinical research of Chinese medicineJournal of Chinese Integrative Medicine, Vol. 9, No. 8Revised STRICTA as an Extension of the CONSORT Statement: More Items Should Be Involved in the Checklist Zhao-Xiang Bian and Yung-Hsien Chang23 February 2011 | The Journal of Alternative and Complementary Medicine, Vol. 17, No. 2Improving the prediction of response to therapy in autismNeurotherapeutics, Vol. 7, No. 3 Volume 16Issue 1Jan 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:Mikel Aickin.Comparative Effectiveness Research and CAM.The Journal of Alternative and Complementary Medicine.Jan 2010.1-2.http://doi.org/10.1089/acm.2009.0718Published in Volume: 16 Issue 1: January 27, 2010PDF download

Complementary and Alternative Medicine Use and Initiatives in Europe

I am excited to join with you for the beginning of a new era for The Journal of Alternative and Complementary Medicine (JACM). We plan to push the boundary of what a peer-reviewed ''CAM'' journal can mean for health and medicine. This column outlines some of my early, amendable thinking. Let me know your thoughts and responses.

BackgroundThe aim of this publication is to present a case study of how to locate and appraise qualitative studies for the conduct of a meta-ethnography in the field of complementary and alternative medicine (CAM). CAM is commonly associated with individualized medicine. However, one established scientific approach to the individual, qualitative research, thus far has been explicitly used very rarely. This article demonstrates a case example of how qualitative research in the field of CAM studies was identified and critically appraised.MethodsSeveral search terms and techniques were tested for the identification and appraisal of qualitative CAM research in the conduct of a meta-ethnography. Sixty-seven electronic databases were searched for the identification of qualitative CAM trials, including CAM databases, nursing, nutrition, psychological, social, medical databases, the Cochrane Library and DIMDI.Results9578 citations were screened, 223 articles met the pre-specified inclusion criteria, 63 full text publications were reviewed, 38 articles were appraised qualitatively and 30 articles were included. The search began with PubMed, yielding 87% of the included publications of all databases with few additional relevant findings in the specific databases. CINHAL and DIMDI also revealed a high number of precise hits. Although CAMbase and CAM-QUEST® focus on CAM research only, almost no hits of qualitative trials were found there. Searching with broad text terms was the most effective search strategy in all databases.ConclusionsThis publication presents a case study on how to locate and appraise qualitative studies in the field of CAM. The example shows that the literature search for qualitative studies in the field of CAM is most effective when the search is begun in PubMed followed by CINHAL or DIMDI using broad text terms. Exclusive CAM databases delivered no additional findings to locate qualitative CAM studies.

We propose 6 core areas of research that should be investigated to achieve a robust knowledge base and to allow stakeholders to make informed decisions. These are: Research into the prevalence of CAM in Europe: Reviews show that we do not know enough about the circumstances in which CAM is used by Europeans. To enable a common European strategic approach, a clear picture of current use is of the utmost importance. Research into differences regarding citizens’ attitudes and needs towards CAM: Citizens are the driver for CAM utilization. Their needs and views on CAM are a key priority, and their interests must be investigated and addressed in future CAM research. Research into safety of CAM: Safety is a key issue for European citizens. CAM is considered safe, but reliable data is scarce although urgently needed in order to assess the risk and cost-benefit ratio of CAM. Research into the comparative effectiveness of CAM: Everybody needs to know in what situation CAM is a reasonable choice. Therefore, we recommend a clear emphasis on concurrent evaluation of the overall effectiveness of CAM as an additional or alternative treatment strategy in real-world settings. Research into effects of context and meaning: The impact of effects of context and meaning on the outcome of CAM treatments must be investigated; it is likely that they are significant. Research into different models of CAM health care integration: There are different models of CAM being integrated into conventional medicine throughout Europe, each with their respective strengths and limitations. These models should be described and concurrently evaluated; innovative models of CAM provision in health care systems should be one focus for CAM research. We also propose a methodological framework for CAM research. We consider that a framework of mixed methodological approaches is likely to yield the most useful information. In this model, all available research strategies including comparative effectiveness research utilising quantitative and qualitative methods should be considered to enable us to secure the greatest density of knowledge possible. Stakeholders, such as citizens, patients and providers, should be involved in every stage of developing the specific and relevant research questions, study design and the assurance of real-world relevance for the research. Furthermore, structural and sufficient financial support for research into CAM is needed to strengthen CAM research capacity if we wish to understand why it remains so popular within the EU. In order to consider employing CAM as part of the solution to the health care, health creation and self-care challenges we face by 2020, it is vital to obtain a robust picture of CAM use and reliable information about its cost, safety and effectiveness in real-world settings. We need to consider the availability, accessibility and affordability of CAM. We need to engage in research excellence and utilise comparative effectiveness approaches and mixed methods to obtain this data. Our recommendations are both strategic and methodological. They are presented for the consideration of researchers and funders while being designed to answer the important and implicit questions posed by EU citizens currently using CAM in apparently increasing numbers. We propose that the EU actively supports an EU-wide strategic approach that facilitates the development of CAM research. This could be achieved in the first instance through funding a European CAM coordinating research office dedicated to foster systematic communication between EU governments, public, charitable and industry funders as well as researchers, citizens and other stakeholders. The aim of this office would be to coordinate research strategy developments and research funding opportunities, as well as to document and disseminate international research activities in this field. With the aim to develop sustainability as second step, a European Centre for CAM should be established that takes over the monitoring and further development of a coordinated research strategy for CAM, as well as it should have funds that can be awarded to foster high quality and robust independent research with a focus on citizens health needs and pan-European collaboration. We wish to establish a solid funding for CAM research to adequately inform health care and health creation decision-making throughout the EU. This centre would ensure that our vision of a common, strategic and scientifically rigorous approach to CAM research becomes our legacy and Europe’s reality. We are confident that our recommendations will serve these essential goals for EU citizens.

The 2018 Declaration of Astana* issued by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) represents a
\nlandmark step for all of primary health care, public health, and traditional
\ncomplementary and integrative medicine. It brings together the priorities of the
\nWHO’s 1978 Alma-Ata Declaration, the international importance of universal
\nhealth coverage, and the ongoing efforts of the global community to reach
\nUNICEF’s Sustainable Development Goals. It is the first global primary health
\ncare document to explicitly acknowledge the value and importance of traditional medicine systems in achieving successful primary health services;
\n‘success’ being underpinned by specific commitments and evaluated by key
\nsuccess measures**. The Declaration explicitly refers to the application of
\ntraditional knowledge and the appropriate inclusion of traditional medicines as
\nfactors that will drive the success of primary care. However, the Declaration
\nalso makes commitments and identifies other success drivers that, despite
\nnot being directly linked to traditional and integrative care, are equally relevant. These omissions represent potentially untapped and overlooked opportunities for meaningful engagement to improve primary care.

Analysis of the status and trends of international research in complementary and alternative medicine based on literature mining

The Journal of Alternative and Complementary MedicineVol. 6, No. 2 PerspectivesMethodological Problems of Clinical Research into Spiritual Healing: The Healer's PerspectiveCraig K. BrownCraig K. BrownSearch for more papers by this authorPublished Online:24 Sep 2007https://doi.org/10.1089/acm.2000.6.171AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byEmpathy and mental health associated with non-conventional healing practices27 August 2020 | Journal of Spirituality in Mental Health, Vol. 24, No. 1Perceived outcomes of spiritual healing and explanations - a qualitative study on the perspectives of German healers and their clients12 July 2014 | BMC Complementary and Alternative Medicine, Vol. 14, No. 1Key Issues in Clinical and Epidemiological Research in Complementary and Alternative Medicine a Systematic Literature ReviewForschende Komplementärmedizin / Research in Complementary Medicine, Vol. 19, No. s2Treating Children With Therapeutic and Healing TouchPediatric Annals, Vol. 33, No. 4Sham in CAMEvidence-Based Integrative Medicine, Vol. 1, No. 4Outcomes research: costs and quality of lifeThe Clinical Effectiveness of Healing Touch5 July 2004 | The Journal of Alternative and Complementary Medicine, Vol. 8, No. 1Introduction: therapeutic agents from ethnomedicineChronically Ill Patients Treated by Spiritual Healing Improve in Quality of Life: Results of a Randomized Waiting-List Controlled Study5 July 2004 | The Journal of Alternative and Complementary Medicine, Vol. 7, No. 1Developing Research Methodology in Spiritual Healing: Definitions, Scope, and Limitations30 June 2004 | The Journal of Alternative and Complementary Medicine, Vol. 6, No. 4The Lure of the Ghetto30 June 2004 | The Journal of Alternative and Complementary Medicine, Vol. 6, No. 4 Volume 6Issue 2Apr 2000 InformationCopyright 2000, Mary Ann Liebert, Inc.To cite this article:Craig K. Brown.Methodological Problems of Clinical Research into Spiritual Healing: The Healer's Perspective.The Journal of Alternative and Complementary Medicine.Apr 2000.171-176.http://doi.org/10.1089/acm.2000.6.171Published in Volume: 6 Issue 2: September 24, 2007PDF download

Research in complementary and alternative medicine (CAM) encounters a variety of challenges, such as potentially synergistic, multimodal, and complex interactions, aiming at behavioral changes in the patient with long-term effects. Furthermore, these interventions are often dependent on the relationship between practitioner and patient as well as on patients’ preferences, expectations, and motivations [1]. Moreover, patients seeking CAM care often suffer from chronic diseases and multiple pathologies [1]. The challenges these complex and multifactorial clinical settings impose to clinical research are even potentiated when it comes to whole medical systems, such as traditional medical systems (e.g. Ayurveda) or homeopathy, whose traditions not only include particular treatment modalities but also diagnosis and patientpractitioner interactions as well as techniques for changing the patient’s behavior [2, 3]. Moreover and almost as a general rule, research in CAM faces the challenge that treatment is not derived from a biological hypothesis as it is (ideally) the case in pharmacological trials. CAM research faces the fact that the therapies are practiced regardless of whether the biological mechanisms, comparative effectiveness, component efficacy, or even safety aspects are known [4]. All these preconditions, the complexity of the interventions and the treatment setting, the fact that many of the patients often suffer from several chronic diseases, and the fact that there is generally no clear hypothesis on the biological mechanism of action make the applicability of the gold standard in clinical research, the randomized controlled trial (RCT), questionable [1, 2, 4, 5]. In the field of CAM, there has been a growing understanding and agreement that not more RCTs but the development of appropriate methodological and statistical tools for the investigation of complex interventions is the answer to the quest [1, 2, 4]. But that also includes in part a re-discussion and re-definition of the ‘outcomes’ concept [5]. As Paterson et al. [5] consequently emphasized, outcomes which are appropriate for complex health interventions ideally are able to detect changes and dynamics. In complex health interventions we often see that a treatment, even under strictly controlled conditions, shows its effect in the way a subject adapts to a challenge. As Paterson et al. [5] pointed out, a process is something that enables the individual to adapt to varying experiences. In conclusion, the change of process, not of status, may be the indicator of improved health. However, the related outcomes are complex, they often represent time series, and there is a substantial need for new methodological and statistical approaches [2, 5]. These challenges may even be enhanced when trying to integrate biomarkers into complex interventional trials, since biomarkers are usually identified and selected on the basis of a clear, biological hypothesis investigated in a design which allows for the application of the ‘principle of isolated variation’ in experimentation. The principle of isolated variation requires that the treatment groups are varied according to only one particular variable. The classical pharmacological RCT is a typical example in that it only varies the content of the active drug against a placebo. With regard to biomarkers and the ‘principle of isolated variation’, complex trials in the CAM field struggle with two major challenges: a) The mechanism of action of the intervention is often unclear, and the explanatory models are rarely grounded in physiology/pathophysiology. b) The interventions are complex and often address several aspects of the patient and his or her symptoms, which from an understanding of a specific pathophysiology may be seen as unrelated to the disease or at least only relevant in second or third line. In the light of the complexity of the problem, can we integrate biomarkers into these multidimensional trials and is there a

There is a link between integrative medicine (IM) and prospective research on complementary and alternative medicine (CAM). IM is the future direction of CAM and research is needed to support clinical practice. Meaning of IM, proposed models of IM, and existing research on IM will be presented. Prospective research on CAM will cover methodologies presenting randomised controlled trials, harms studies of CAM in kidney disease, and a gap of CAM research. Study design and outcome measures are current challenges in CAM/IM research. Several networks of CAM research worldwide are still working on them and have proposed possible alternative approaches, such as pragmatic clinical trials and cohort multiple randomised controlled trials. These approaches would solve some limitations of randomised controlled trials in CAM research.

There is a link between integrative medicine (IM) and prospective research on complementary and alternative medicine (CAM). IM is the future direction of CAM and research is needed to support clinical practice. Meaning of IM, proposed models of IM, and existing research on IM will be presented. Prospective research on CAM will cover methodologies presenting randomised controlled trials, harms studies of CAM in kidney disease, and a gap of CAM research. Study design and outcome measures are current challenges in CAM/IM research. Several networks of CAM research worldwide are still working on them and have proposed possible alternative approaches, such as pragmatic clinical trials and cohort multiple randomised controlled trials. These approaches would solve some limitations of randomised controlled trials in CAM research.

BackgroundOver the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM.MethodsThe scoping review was undertaken using the Arksey and O’Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data.ResultsOf the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers.ConclusionsWhile the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.

Fadlon, J. Negotiating the Holistic Turn – the Domestication of Alternative Medicine . New York : State University of New York , 2005 . £34.50 (hbk) 157pp . ISBN 0-7914-6315-X Baer, H. Toward an Integrative Medicine – Merging Alternative Therapies with Biomedicine . California : Altamira Press , 2004 . $27.95 (pbk) 224pp . ISBN 0-7591-0302-X The field of the sociology of complementary and alternative medicine (CAM) can be viewed as the poor cousin of the sociology of health and illness. Whilst public and medical interest in this area continues to grow, both in the UK and in most Western societies, there is a paucity of texts that tackle this ever-increasing field of treatment and consumption. Publishers often pigeonhole anything with alternative/complementary medicine in the title as nursing or healthcare related only. Moreover, once published, such texts often find themselves (mis)placed in ‘new age’ or mind, body spirit catalogues and book shop sections – never to be found by mainstream sociologists, who may, if they did find them, be pleasantly surprised. Both these texts must be commended for making it to publication and for helping to develop this emerging area. They also contribute sparkling insight into the integration of CAM in the USA (Baer) and the methods by which CAM has become familiar and accepted in Israeli society (Fadlon). Specifically, they both address issues around CAM modalities working alongside, or in close proximity to, orthodox healthcare approaches but they do so by using different theoretical frameworks. Fadlon's text focuses upon the process through which foreign holistic practice is made familiar (a process she terms ‘domestication’). Although the work is set within the Israeli context the process she discusses can be identified in a number of Western countries. Fadlon describes her work as ethnographic and she uses both qualitative and quantitative data in her book. The scope of the work is very broad with in-depth discussion of clinics that use what she terms non-conventional medicine (NCM), case studies of patients, description of institutions of learning in NCM and excerpts from newspapers and other documents. A brief historical discussion is provided in the book's introduction, along with clarification of NCM's legal status in Israel. Chapter 1 outlines the approach and conceptual framework of the book. Fadlon notes that her main concern is with the issues of ‘acculturation and assimilation’, the former term implying that previously autonomous cultural traditions, over time and during their contact with one another, will often lead to far-reaching changes in either or both systems. Fadlon argues assimilation occurs when a minority group gradually becomes part of conventional society. Both these processes she sees as part of the more general concept of domestication, in which alien, or at least generally unknown, holistic practice is made familiar in a society. Chapter 2 provides a detailed historical, legal and cultural account of the Israeli context of this work and raises some methodological considerations. Chapter 3 ethnographically walks the reader through a practising NCM clinic, which is noted as being part of a large general (conventional) hospital and that uses a range of NCM modalities such as acupuncture and reflexology. In doing this Fadlon provides a very in-depth rich insight into both the physical and symbolic settings in which domestication occurs in Israel. The way the clinic looks, operates, interacts with the general hospital, along with a description of the staff, how they approach patients as well as their attitudes to medicine and NCM, are all scrutinised here. Chapter 4 focuses upon the patients of NCM and their attitudes. Here, the patients’ willingness to pick and mix, using either conventional or non-conventional medicine as it suits them is focused upon. However, the qualitative ethnographic findings presented indicate that NCM in Israeli society is preferably consumed under the supervision of conventional medicine. Chapter 5 outlines how NCM ideas are filtered through to the general public in Israel by the media. Using excerpts from newspaper articles, Fadlon demonstrates that domestication is occurring, as although there are stories in the media that attack NCM, there is an even balance of other stories that celebrate it. In the last chapter, Fadlon's ethnographic approach is applied to the places where NCM qualifications are attained and the content of the NCM courses that are available. Interestingly, evidence of medical orthodoxy is shown to permeate these institutions: biomedical paraphernalia adorns the rooms alongside, for example, ancient Oriental decor; and conventional science and biomedicine are important components of the curriculum as much as are alternative healing techniques. Baer's text takes a different approach from Fadlon's. Rather than focusing upon the processes that make CAM familiar in society, his work provides an overview of patterns of integration of various CAM in the USA. The subtitle, Merging Alternative Therapies with Biomedicine provides a clue as to the approach taken by the text. The work identifies and discusses the processes by which alternative forms of healing move towards being constructed by biomedicine as complementary. It also highlights the new approach of integrative medicine, in which biomedical and complementary approaches are used together, either in hospital or clinic settings, or are combined when treating individual cases of illness or disease. Whilst the text outlines the processes of change in the area of ‘other’ forms of healing it does not neglect the importance of consumption and individual charismatic personalities within this process. In this way the book provides a broad brushstroke approach to the development of CAM, but at the same time focuses in on particular insightful cases, people and events that illuminate key points. The introduction provides a comprehensive overview of healing taxonomies. It is very striking from Baer's discussion that the issue of how to define ‘other’ healing practices is still contentious and difficult to pin down. The US context, which is the main focus of this text, is a particularly complicated setting for trying to define or organise healing because of the diversity of the population and therapeutics available. Because of ethnic and religious variety, the US has a multitude of indigenous and imported folk healing practices and influences on health provision and, as a result, there is enormous choice for the user/consumer of services. In Chapter 1, Baer outlines the public growth in interest in holistic health and new-age health beliefs. Insightfully, he notes the diverse influences on the holistic health movement, including counter-cultural influences from the late 1960s and 1970s, the human potential movement and environmental social movements. This is a really interesting approach as many discussions fail to identify the diverse components and proponents of holism. One important area Baer does miss out here is the holistic movement within orthodox medicine. We are thinking here of the pioneering work of individuals within the hospice movement and palliative/terminal nursing care. But that criticism aside, Baer does broaden the debate on the development of holism and CAM in a way that no other writer has. Chapter 2 moves on to outline ‘semi-legitimation’ of chiropractic, naturopathy, oriental medicine/acupuncture and homoeopathy. Here, Baer engages the reader in the history of the push towards professionalisation in these modalities. The high level of historical and policy detail in this section is fascinating. Chapter 3 examines what Baer defines as partly professionalised groups and their struggle to find a niche in the holistic health market place. Interestingly, he identifies not only conflicts between other healing and biomedicine but those that occur within and between other healing forms themselves. In Chapter 4, Baer tackles the relatively recent move towards redefining ‘other’ forms of healing as complementary and alternative medicine (CAM). His discussion focuses upon the impact of key medical and nursing organisations, such as the American Holistic Nurses Association, along with the influence of individual conventional practitioners in establishing CAM as an acceptable area of medical interest. In doing this the chapter outlines the medical networks that began the process of mainstreaming key CAM ideas. In Chapter 5, Baer turns his attention to key spokespeople of the holistic health movement, selecting Deepak Chopra and Andrew Weil for special attention, along with the responses their approaches have drawn from orthodox biomedical colleagues and the public. This in many ways is perhaps the most innovative section of the book. Chapter 6 examines the role of governmental and corporate organisations in the proliferation of CAM integrations. Again, this is an innovative part of the book, as it outlines the way that CAM-use as a money-saving device is increasingly advocated in the US by groups such as insurance schemes. Chapter 7 examines the possibilities for CAM and outlines the obstacles that still stand in the way of integrative approaches. Such obstacles include the power and authority of biomedicine, the anger and critiques of so-called fraud busters (many of whom are medically trained) and the threat posed by the growing demand from mainstream medicine for evidence of CAM efficacy. Baer paints a picture of an uncertain future in which integrative approaches in the USA, whilst popular with the public, still have their enemies in regular medicine and beyond. Baer's work is broad in scope but manages to provide a fascinating account of the history, contemporary situation and potential future of integrative approaches in the USA. Skilfully written, he manages to include some interesting accounts of the personalities and power play that takes place around holistic forms of healing. A definite ripping read for all sociologists of health and illness, Baer's work steps beyond being solely about CAM by providing an account of change in new and emerging professional health groups. Both these pieces of work present wonderful accounts of ‘other’ forms of healing in their particular societies and both have much to offer academics interested in health and wellbeing, social change and knowledge and power. Whilst Fadlon's work is not fully successful in distinguishing her concept of domestication, it provides rich ethnographic insight into how non-conventional healing forms operate in Israel. Indeed, it is a shame she did not focus more upon the culturally specific issues raised by her settings as this aspect of the work was absorbing. Fadlon's style is somewhat bitty though and the chapters often appear to work as separate units in the text. This stylistic point aside, it is difficult to put the book down due to its compelling topic. Baer's work has more broad appeal perhaps than Fadlon's due to his focus upon professional projects and strategies in healthcare more generally. In essence though, both works are well worth the read as together, although different in many ways, they complement each other in terms of their detail and contemporary approaches.

Integrative medicine and culture: toward an anthropology of CAM.