Building an evidence house: challenges and solutions to research in complementary and alternative medicine

Conventional biomedicine is having a revolution in scientific input from genomics to imaging to information and systems biology. Biomedicine is also struggling to find a balance between rigor and relevance such that public values and health care costs can be properly managed. At the same time complementary and alternative medicine (CAM) is becoming increasingly popular. Can rigorous research in CAM be developed? Can it be held to the same standards of evidence as conventional medicine? Should it be held to those standards? Are there additional standards and better integration strategies for CAM that are of value to all medicine, complementary or conventional? In this article, I address some of the major challenges faced by investigators when conducting research in CAM. These challenges include: quality standards of research; the evolving nature of science; accommodating pluralism; addressing underlying assumptions; and, managing controversial topics in CAM research. These challenges are formidable and will require that CAM attain a sufficient level of science to move it out of the margins of health care and a more careful approach to research integration that can keep its focus on public benefit and the public's health. I suggest a framework of an 'Evidence House' for addressing many of these challenges.