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Antioxidant Vitamin and Mineral Supplements and Cataract Prevention and Progression Page 2

Development of Complementary Therapy Assessments

Complementary, or alternative therapies, are a growing part of health care in America.  The National Institutes of Health National Center for Complementary and Alternative Medicine has broadly defined complemen-tary and alternative medicine as those treatments and health care practices not taught widely in medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies.  Americans spend an estimated $14 billion a year on alternative treatments.  Mainstream medicine is recognizing a need to learn more about alternative therapies and to determine their true value, and most medical schools in the United States offer courses in alternative therapies.  The editors of the Journal of the American Medical Association announced that publishing research on alternative therapies will be one of its priorities.  More scrutiny and scientific objectivity is being applied to determine whether evidence supporting their effectiveness exists.
 
In the fall of 1998, the Board of Trustees appointed a Task Force on Complementary Therapy to evaluate complementary therapies in eye care and develop an opinion on their safety and effectiveness, based on available scientific evidence, in order to inform ophthalmologists and their patients.  A scientifically grounded analysis of the data will help ophthalmologists and patients evaluate the research and thus make more rational decisions on appropriate treatment choices.
 
The Academy believes that complementary therapies should be evaluated similarly to traditional medicine: evidence of safety, efficacy, and effectiveness should be demonstrated.38  Many therapies used in conventional medical practice also have not been as rigorously tested as they should be.  Given the large numbers of patients affected and the health care expenditures involved, it is important that data and scientific information be used to base all treatment recommendations.  In this way, we can encourage high-quality, rigorous research on complementary therapies.39
 
Ideally, a study of efficacy compares a treatment to a placebo or another treatment, using a double-masked controlled trial and well-defined protocol.  Reports should describe enrollment procedures, eligibility criteria, clinical characteristics of the patients, methods for diagnosis, randomi-zation method, definition of treatment, control conditions, and length of treatment.  They should also use standardized outcomes and appropriate statistical analyses.
 
The goal of these assessments is to provide objective information of complementary therapies and provide a scientific basis for physicians to advise their patients, when asked.
 
To accomplish these goals, the assessments, in general, are intended to do the following: 
  • Describe the scientific rationale or mechanism for action for the complementary therapy.
  • Describe the methods and basis for collecting evidence
  • Describe the relevant evidence.
  • Summarize the benefits and risks of the complementary therapy.
  • Pose questions for future research inquiry.
  • Summarize the evidence on safety and effectiveness.

 

References

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