Comparative Bibliometric Analysis of Herbal Medicine Research in Chinese and Iranian Complementary and Alternative Medicine (CAM) Clinical Trials

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

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.

Increasingly, complementary and alternative medicine (CAM) research is being conducted by clinical nurses; this is partly evidenced by the evolution of CAM special issues and sections in JCN and previous editorials on the subject (Smith 2008a,b,c). There is a growing awareness amongst CAM researchers and practitioners of the importance of employing appropriate and rigorous research methods when studying an intervention (Broom & Adams 2007). Presently, CAM research faces unique challenges in relation to the design and execution of studies, with specific respect to generalisability and internal validity. Furthermore, research on CAM interventions is usually only considered once the therapy is widely used, by which time personal experiences and expectation biases may well be established. As such, many published CAM studies are methodologically flawed; they suffer from poor design and inappropriate analysis (O’Mathuna 1998). Watson (2008) identified the need for more scientific rigour in CAM research. CAM research design is further complicated when a clinical nurse is delivering the intervention, where characteristic and incidental components of the study may be intertwined and often difficult to define. This very issue was highlighted by Paterson and Dieppe (2005) in their examination of placebo effects in acupuncture. What is clear in CAM research is that interventions are often very complex in nature and that evaluation can be problematic. Saks (2005) has identified large gaps in CAM research, in relation to the mechanisms of action, safety issues and the synergies between conventional medicine and CAM in clinical practice. The most fundamental – and perhaps most pertinent – question for clinical nurses in CAM research is related to the efficacy of an intervention and it is this question that requires the most attention. How can nurse researchers show that CAM therapies work in their clinical practice? It is important that efficacy of CAM is evaluated as rigorously as conventional medicine to protect our patients from unsafe and unethical practices. With increasing focus on evidence-based practice, a rigorously designed randomised controlled trial would be considered the most robust way to obtain evidence about the effectiveness of any health care intervention. This approach is well respected as the ‘gold standard’ in medical research. For interventions with one component, like clinical drug trials, standardisation is straightforward by measuring optimal dose of a drug against placebo or standard treatment. However, standardisation is more complicated when we deal with the evaluation of nurse-led CAM interventions. Such interventions are complex as they consist of many interdependent and inter-related components. The delivery of a nurse-led hypnotherapy service for irritable bowel syndrome patients highlights complex intervention highlights this point (Smith 2006). Complex interventions (CIs) in health care comprise several separate elements which seem essential for the proper function of the intervention, although the ‘active ingredient’ or ‘X factor’ of the intervention that is effective is difficult to specify. They have been defined as ‘built up from several components, which may act both independently and interdependently’ (MRC 2000, p. 2). Much nursing and CAM research fulfils these criteria. Campbell et al. (2000) viewed complex interventions as often difficult to measure using conventional RCT’s as by there very nature they have multiple variants that can affect the outcomes. There have been a variety of approaches that have been developed to evaluate complex treatment, including Medical Research Council (MRC) guidance from the UK. The MRC originally produced a framework for the development and evaluation of RCT’s for complex interventions to improve health. They proposed an approach to evaluation which was similar to that adopted for evaluating new drugs. Their five-phase sequential and step-wise model framework for the evaluation of complex interventions, from preclinical theoretical work through to long-term implementation, concluded that the RCT was the optimal study design for CIs. Hawe et al. (2004) raised concerns about the standardisation in CI research. Despite recommending the use of RCT’s, they proposed that researchers should be lees concerned about the actual content of a CI and more about its function. Blackwood (2006) also supported the use of the MRC framework in clinical nursing research; however, she argued that each component of a CI should have a separate evaluation and highlighted the potential role of qualitative research methods in CI evaluation. This use of qualitative methods alongside randomised controlled trials has been further elaborated by Lewin et al. (2009). The MRC original report has now been updated (MRC 2008, http://www.mrc.ac.uk/complexinterventions, retrieved 27/09/10) to reflect developments since its original publication. To deal with criticism of the original report, the new guidance has a broader scope, and it covers observational methods as well as RCT’s and includes a broader definition of complex interventions beyond the core of having several components. In their summary of the new framework, Craig et al. (2008) identified a less linear model than the original guidance. The need for both quantitative and qualitative approaches in CAM research has been identified (Saks 2005). It may be that some modification to research methodology is appropriate in CAM research to ensure that what is being examined under experimental conditions is consistent with everyday practice CAM. Nursing research in clinical practice can often have several components. In this special section, there are several papers which highlight the complex nature of evaluating CAM interventions. Music therapy is one form of intervention which receives attention and the use of three different research designs highlights the methodological challenges that nurse researcher faces evaluating music therapy. Lin et al. (2010a,b) used a quasi-experimental design to evaluate the effects of music therapy on anxiety and postoperative pain in patients undergoing spine surgery. They concluded that music therapy had a positive impact on these patients. In a Turkish study, Korhan et al. (2010) examined the effect of music on patients receiving mechanical ventilatory support using a study case control experimental repeated measures design. They demonstrated that music therapy was effective in reducing anxiety levels in this patient group. Finally, a randomised control trial design was employed to determine the effect of music therapy on state anxiety and anxiety-induced physiological manifestations in cancer patients following chemotherapy (Lin et al. 2010). In this Taiwanese study, music therapy was found to be effective in reducing chemotherapy-induced anxiety. These studies demonstrate the positive impact that music therapy can play in health care and suggest that, when used appropriately, it can have a positive impact on quality of nursing care. In summary, the real challenge for CAM researchers is to derive a research methodology to address philosophical concerns and maintain high standards of methodological rigour. The updated MRC framework highlights several key issues that help nurse researchers develop and evaluate their CAM study. First, ensuring relevant research evidence is used systematically to develop all components of the intervention. Second, improve definition and measurement of potentially complex interventions. Finally, adapt the most relevant research design/evaluation for their study. This may involve the use of both quantitative and qualitative or a mixed method approach. There exists many ways of collecting CAM research data, and nurse researchers should make best use of the MRC guidance to identify the most appropriate and feasible approach to research in this area.

Complementary and Alternative Medicine Use and Initiatives in Europe

Editorial: Consensus on CAM methods for nursing research?

Marcus and Grollman miss the mark in their critique of the National Center for Complementary and Alternative Medicine (NCCAM) (“Review for NCCAM is overdue,” D. M. Marcus and A. P. Grollman, Policy Forum, 21 July, p. 301). We believe that NCCAM, under the leadership of Stephen Straus and Margaret Chesney, has made remarkable progress in laying the groundwork and advancing rigorous research in complementary and alternative medicine (CAM). They have brought definition, a conceptual framework, strategic plans and goals, and scientific standards to the field of CAM research. The processes through which proposals are submitted, reviewed, funded, and managed are all consistent with standard NIH practice. The disciplinary diversity of the NCCAM study section members and NCCAM councils is in keeping with the breadth of CAM research. The broad representation is also consistent with current practice in other centers and institutes. NIH advisory bodies regularly include members who are grantees, and well-tested procedures are in place for managing conflicts of interest. The same procedures are used for the study sections and advisory councils for NCCAM. Marcus and Grollman's comment that the NCCAM research agenda is shaped more by politics than by science is gratuitous, as is their suggestion that the Institute of Medicine (IOM) report, Complementary and Alternative Medicine in the United States ([1][1]), was flawed because some of the members of the panel were NCCAM grantees. In fact, like NIH, the IOM has procedures for recognizing and managing conflicts of interest. Those of us who participated in it were very mindful of any potential conflicts of interest and guarded against them in our deliberations. Further, the report was carefully reviewed by external, independent reviewers before publication. Because CAM is already in the public domain, used by millions of people at a cost of billions of dollars each year and with health effects that largely have not yet been scientifically evaluated, it is appropriate that a significant focus be on clinical research. As is true in clinical trials with new conventional drugs, we should expect that many trials of CAM treatments will not show definitive efficacy, and as with most research on understudied agents, multiple studies are often needed to develop a research base adequate for mature judgment concerning efficacy or the lack thereof. We need to be patient and use our best tool, that is, science, to understand and evaluate these widely used health practices. We believe that NCCAM has established a standard not for advocacy, but rather for rigorous objectivity. 1. 1.[↵][2]Committee on the Use of Complementary and Alternative Medicine by the American Public, Complementary and Alternative Medicine in the United States (Institute of Medicine, National Academy Press, Washington, DC, 2005). # Response {#article-title-3} The main point of the letter from Folkman et al. and the response to our Policy Forum by S. E. Straus and M. A. Chesney (“In defense of NCCAM,” Policy Forum, 21 July, p. [303][3]) is that NCCAM uses standard NIH procedures for review of proposals, appointments to advisory and review groups, and management of conflict of interest. That is formally true but misleading. Because of its charter, NCCAM advisory and review groups include many individuals whose scientific credentials would not qualify them for appointment to other NIH institutes. Of greater importance, the continued funding of poor-quality proposals refutes Straus and Chesney's claim that NCCAM applies the same review standards as other NIH institutes. Except for Bondurant, the signatories of the Folkman et al. letter all hold leadership positions in CAM or integrative medicine centers supported by NCCAM. Bondurant is a senior academic officer at Georgetown University Medical Center, which has a CAM center, and he was chairman of the IOM Committee that issued the report on CAM. Berman, Eisenberg, and Folkman also served on the IOM committee. The NCCAM appropriation for 2005, $123 million, understates NIH expenditures on CAM research. In 2004, the NCCAM budget was $117.8 million, and the total NIH expenditure on CAM research was estimated at $305 million, much of which represented projects that were co-funded by NCCAM and other institutes. NCCAM recently announced the creation of five new centers that will conduct research on multicomponent traditional African and Chinese herbal medicines. Each center will receive approximately $1 million per year, which is the equivalent of 20 RO-1 research grants. Some of this research is meritorious, but much of it is not. An independent review is urgently needed to bring the evaluation of proposals by NCCAM into line with the rest of NIH and to ensure that the limited funds available for biomedical research support the best science. [1]: #ref-1 [2]: #xref-ref-1-1 View reference 1. in text [3]: /lookup/doi/10.1126/science.1131608

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

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.

Disorders of gut-brain interaction (DGBI) are common in children and often persist despite conventional treatments, leading families to seek complementary and alternative medicine (CAM). However, evidence for CAM in pediatric DGBI is scarce. This multicenter survey study assessed parents’ and pediatricians’ experiences with and attitudes toward CAM for children with gastrointestinal symptoms. Parents and pediatricians of children (0–18 years) with gastroesophageal reflux disease (GERD) and DGBI (infant colic (IC), functional abdominal pain, and functional constipation) from six Dutch hospitals were included. GERD diagnosis was based on international guidelines, DGBI on Rome IV criteria. Parental surveys addressed child health, medication, (reasons for) CAM use, and attitudes toward CAM research. Pediatricians’ surveys covered experiences and attitudes toward CAM for pediatric DGBI. A total of 677 parents (71%) and 76 pediatricians (79%) responded. Most patients had functional constipation (45%) or abdominal pain (41%), with 8% IC and 6% GERD. Seventy-one percent had symptoms for over a year; 58% used medication, and 49% reported side effects. Overall, 42% of patients used CAM, mainly manual therapies, homeopathy, and natural remedies. Predictors of CAM use included IC, longer symptom duration, higher household income, and positive parental CAM experience. Among pediatricians, 53% recommended CAM. Pediatricians with over 15 years’ experience were less likely to recommend CAM. Sixty-five percent of parents were willing to participate in CAM research. Conclusion: CAM use is common among children with DGBI or GERD, and over half of pediatricians have recommended CAM, underscoring the need for efficacy studies of frequently used CAM.What is Known:• Complementary and alternative medicine (CAM) is commonly used among pediatric patients with gastrointestinal symptoms but often excluded in evidence-based guidelines due to insufficient evidence.• Previous research has examined perspectives of patients and families, with limited insight into pediatricians’ recommendations.What is New:• In Dutch hospitals, 42% of children with infant colic, reflux, abdominal pain, or constipation used CAM. Most pediatricians (52.6%) recommended some CAM to these patients.• Predictors for CAM use include infant colic, longer symptom duration, positive parental CAM experience, and higher income; pediatricians with > 15 years’ experience were less likely to recommend CAM. Parental interest in CAM research is high (65%).Graphical Supplementary InformationThe online version contains supplementary material available at 10.1007/s00431-026-07058-3.

Integrative medicine and culture: toward an anthropology of CAM.

PurposeAs part of a nationwide research about knowledge, attitude, experiences and educational needs towards complementary and alternative medicine (CAM) among Indonesian clinical psychologists (CPs), the purpose of this paper is to explore CPs’ perceptions of CAM research and their interest in learning CAM.Design/methodology/approachA link to an online survey was e-mailed to all 1,045 CPs across Indonesia. At the end of the survey, two open-ended questions were asked: “What do you think about CAM research in Indonesia?” and “Why are you interested in learning about CAM?”, which were responded to by 127 participants (87 per cent of females; Mage=36.67, SD=9.02). Participants’ responses were analysed using inductive qualitative content analysis.FindingsIt was found that two global themes for CPs’ perceptions of CAM were to improve participants’ professionalism and as part of continuing education and development for mental health professionals. The favourable responses in this study may reflect participants’ willingness to be involved in collaborative CAM research and education. Moreover, CAM was perceived as part of Indonesian culture and participants viewed CAM research and knowledge as a chance to promote Indonesian local wisdom to complement conventional psychotherapy.Research limitations/implicationsThese findings might call for stakeholders to integrate CAM knowledge into psychology education, facilitate CAM research in psychology settings and encourage collaborative CAM research. However, self-selection bias may limit the findings of this study.Originality/valueThis study explored perceptions of CAM research and interest in learning CAM that have rarely been investigated among mental health professionals and particularly, until now, have not been investigated in Indonesia.

Background: In the last 2 decades there has been a large increase in publications on complementary and alternative medicine (CAM). However, CAM research methodology was heterogeneous and often of low quality. The aim of this systematic review was to investigate scientific publications with regards to general issues, concepts and strategies. We also looked at research priorities and methods employed to evaluate the clinical and epidemiological research of CAM in the past to identify the basis for consensus-based research strategies. Methods: We performed a systematic literature search for papers published between 1990 and 2010 in 7 electronic databases (Medline, Web of Science, PsychArticles, PsycInfo, CINAHL, EMBASE and Cochrane Library) on December 16 and 17, 2010. In addition, experts were asked to nominate relevant papers. Inclusion criteria were publications dealing with research methodology, priorities or complexities in the scientific evaluation of CAM. All references were assessed in a multistage process to identify relevant papers. Results: From the 3,279 references derived from the search and 98 references contributed by CAM experts, 170 papers fulfilled the criteria and were included in the analysis. The following key issues were identified: difficulties in past CAM research (e.g., randomisation, blinding), utility of quantitative and qualitative research methods in CAM, priority setting in CAM research and specific issues regarding various CAM modalities. Conclusions: Most authors vote for the use of commonly accepted research methods to evaluate CAM. There was broad consensus that a mixed methods approach is the most suitable for gathering conclusive knowledge about CAM.

In recent years, there has been a substantial increase in the amount and quality of research on complementary and alternative medicine (CAM) and according to a survey, German medical universities have an interest CAM research [1]. Nevertheless, compared to other fields of study, the number of researchers in Europe specialising in CAM has remained very small, whereas the number of physicians practicing CAM is still growing. This discrepancy may have several causes. It is conceivable, for example, that many physicians who practice CAM trust more in experience and expert knowledge than in the results of clinical trials. In addition, research methodology has become increasingly sophisticated, and the formal hurdles related to ethical approval and quality assurance are high. Research is conducted primarily by universities or industry, leaving individual physicians with little opportunity to gather experience or apply for funding. To further improve the quality of CAM research and to increase its practical relevance, it is crucial that ambitious young professionals be equipped with both practical and methodological skills. Treating patients and conducting research are not mutually exclusive, and for some CAM practitioners the combination of both may be an interesting option. However, barriers are high for young physicians who want to get a first taste of research, and outside of a university career they do not have the opportunity to receive proper training in research methodology. To date, courses on evidence-based medicine have focused on the critical appraisal of clinical studies, but have not taught students how to conduct them. Other summer schools on epidemiology focus almost exclusively on epidemiological studies and spend very little time on clinical research. Therefore, to meet the special challenges in CAM research [2] and to motivate more CAM practitioners to pursue research, specially tailored training is needed. With this in mind, and after some years of discussion, we have attempted to take a first step in this direction by offering an introductory summer school on CAM research methods. Upon completing the programme, participants will have a basic knowledge of a range of study designs (e.g. randomised trials, observational studies, single-case research, economic studies, meta-analyses) and specific methodological issues related to selecting participants, randomising patients, choosing controls, ensuring proper blinding, and measuring outcomes, etc. A pilot course was offered during the summer of 2007 and was made possible thanks to encouragement and funding from the Robert Bosch Foundation. In a 4-day seminar, the 18 participants learned which study types are best suited to answer which research questions. The participants were also trained to appraise clinical research studies criti cally, to understand the statistical findings of clinical studies, to perform simple sample-size calculations and basic statistical analyses, and to design their own study while taking into account specific problems related to CAM. The summer school will be distinguished by its practically oriented training, an e-learning platform, a congenial atmosphere, and very low costs for participants. The two main course instructors (Claudia Witt and Klaus Linde) participated in all lectures so as to provide a range of experience and to include questions raised in the lectures in subsequent lessons. In addition, the classes in statistics were taught by a statistician with experience in CAM (Rainer Ludtke). The participants in the first summer school, which was conducted in German, were from Germany (14), Austria (2), and Switzerland (2). The mean age was 43 years (range 26–60 years) and 56% of the participants were women. Nearly all of the participants had conducted previous research or planned their first clinical studies. Some participants were educators, themselves, and were thus in a position to disseminate the knowledge they acquired in the summer school. The programme was evaluated by participants using a validated questionnaire, and its overall quality was rated as very high. 069_070_editorial_witt:069_070_editorial_witt 23.04.2008 13:36 Uhr Seite 69

Although complementary and alternative medicine (CAM) is widely used in the pediatric population, research on the use of these therapies in the pediatric oncology population is of mixed quality. In this multicenter survey, we investigated the prevalence of CAM use, possible determinants of use, and parental attitude towards communication and research on CAM therapies. The prevalence of CAM use in the past 12 months was assessed by using a questionnaire based on the European guidelines on CAM research, filled out by parents of children visiting pediatric oncology outpatient clinics of six academic hospitals in the Netherlands. The questionnaire consisted of 26 questions on the child's clinical status, CAM use, and attitude towards communication and research on CAM therapies. One hundred and twenty-two of 288 respondents (42.4 %) reported CAM use. The most frequently used categories were homeopathy (18.8 %) and dietary supplements (11.5 %). Female gender and parental CAM use were significant predictors for the use of CAM (p < 0.001). Only one third of the parents had discussed CAM use with their pediatric oncologist. More than 80 % of the respondents identified a need for information about CAM from their pediatrician and 85.7 % was positive towards research on CAM. Half of the parents were interested in participating in future CAM trials. Conclusion, with more than 40 % of parents of Dutch pediatric oncology patients providing complementary and alternative medicine to their child and with lacking evidence on efficacy and safety of most CAM modalities, there is a clear need for high-quality research in this field. This study shows that most parents have an open attitude towards CAM research and that almost half of the parents would consider participating in future CAM trials, paving the way for research on CAM and aiming for its evidence-based use in pediatric oncology.

The present editorial wants to draw your attention, once again, to the current European CAM research situation which has been stirred and – for some people maybe even – shaken by the start of CAMbrella, the pan-European research network for complementary and alternative medicine (CAM), in Munich, in January 2010 [1]. Dieter Melchart already dedicated his editorial of the last issue of Forschende Komplementarmedizin / research in complementary medicine [2] to some of the controversial questions that seem to mushroom in the CAM field as soon as anything gets the go: envy-driven and so-called skeptical positions (as if, by definition, a CAM researcher was not a skeptic, i.e. a rational and scrutiny-driven person ...) say that first, you should not have started the thing at all, and second, it would have been better if the money had been granted to the skeptics. But this is of no big interest, or: as Karlsson-on-the-Roof, the famous little flying man in Astrid Lindgren’s children’s story used to say, when he was caught with a prank: ‘This does not make odds to a great mind!’ The much more interesting question is: What is going on in CAMbrella? For a general overview, you can consult the CAMbrella website (www.cambrella.eu) which gives detailed information on the entire working process and the different questions that will have to be answered by the end of 2012, when the final CAMbrella conference will be held in Brussels. In order to be informed on a regular basis, just subscribe to the quarterly newsletter; the first two issues are already available (www.cambrella.eu/newsletter). A major goal of the project is to deliver an informed proposal to the European public of how a definition of the various medicines could work that encompasses the whole of Europe (in its difference to North America or Asia) and at the same time does not eliminate the oddities and peculiarities of different regional traditions. Given the 27 member states and the 3 candidate countries (Croatia, Macedonia, Turkey), this is not a small task. For instance, is the term ‘Integrative Medicine’ suitable for the European patchwork situation? This notion is heavily doubted by the editor in chief of this journal, Harald Walach [3], for instance. Should we use a term that takes into account the European aspect, e.g. ‘Traditional European Medicine,’ a term which was coined to counterbalance the traditional Asiatic medicines like TCM or TTM, or should we stick to the NCCAM definition, for the sake of interrelatedness? How about the classical term of ‘Naturheilkunde’ in the German context or ‘Non-Conventional Medicine’ which seems to be more prevalent in the northern countries? One of CAMbrella’s tasks – in fact a fairly fundamental one – is the establishment of a glossary of CAM in Europe that includes a comprehensive definition of what CAM means in the European context. As one of the journals in the field – and the most relevant European one in that matter – Forschende Komplementarmedizin / research in complementary medicine wishes to offer particular input to that debate that was opened at the ISCMR [4] workshop ‘Complementary or Integrated? – Clarifying the Concepts’ at the ECIM congress in Berlin, in November 2009. At that workshop, Claudia Witt, Associate Editor, and Harald Walach, Editor in Chief of the present journal both gave topical statements regarding the definitional issues, and the ensuing discussion with the audience was a friendly and open, yet conceptionally sharp debate. ‘The targeted outcome’ of the Berlin workshop was to start ‘a series of, hopefully, clarifying discourses around the notion of integrative versus complementary medicine’ [5]. To continue this process for its own sake and the whole field as well as to give an informed input to the discussions that have to take place within the CAMbrella group, the Associate Editors of Forschende Komplementarmedizin / research in complementary medicine will share their ideas about that subject in one of the following issues of this journal.