摘要：Scientific research is particularly important as a guide to health care policy regarding the “integration” of complementary and alternative medicine (CAM) into conventional medical practices. A spectrum of possibilities has emerged around the question of balancing integration toward complementary vs alternative usages. Although scientific research can guide policies and practices, it has become subject to greater scrutiny and linked to differences on policy issues. Using CAM cancer therapies as a case study, this commentary explores relationships between methodology and policy regarding the integration of CAM therapies. UNDER AN EVIDENCE-BASED medicine model, policies for the integration of complementary and alternative medicine (CAM) into mainstream public health and medical practice are, ideally, guided by scientific research. Scientific research holds out the promise of depoliticizing and rationalizing a policymaking process in which interest group politics could overwhelm concerns with safety and efficacy. However, the emphasis on research-guided policy also increasingly politicizes scientific methods and research funding decisions. This essay explores some of the linkages between research design and CAM policy. The terms “alternative” and “complementary” are understood here to refer to how a therapy is used, that is, either as a replacement for conventional therapies or as an adjuvant to them. In other words, the same therapy may be alternative or complementary depending on its use and position in a therapeutic protocol (e.g., a nutritional protocol that is either complementary to cancer chemotherapy or an alternative to it). Increasingly, complementary and alternative therapies are being “integrated” into mainstream practices, and the integration process involves a spectrum of options. At one end, which I call “strong integration,” patients are given greater choices to replace conventional therapies, under the care of a physician or another qualified health care professional (e.g., the option to pursue complex nutritional programs instead of one or more conventional, drug-based regimens for a chronic disease). At the “weak” end of the integration spectrum, choices are mostly adjuvant to conventional therapeutic packages, as occurs in cancer hospitals that offer adjuvant nutritional counseling. The difference corresponds roughly to the trade-off in medical ethics between autonomy and paternalism. The design decisions of research protocols can become linked to the spectrum of stronger to weaker integration. To understand the linkages, this commentary focuses on research on CAM cancer therapies in the United States. In this field, about which there is a substantial literature, 1– 4 the politics of research methods have been heavily scrutinized in controversies over substances such as laetrile, vitamin C, and antineoplastons. In addition, the politics of research bias have been well explored in this field for conventional therapy research. 5
