Comparative effectiveness research: does the emperor have clothes?

Area of Science:

• Health Services Research
• Integrative Medicine
• Evidence-Based Practice

Background:

• The American Recovery and Reinvestment Act of 2009 allocated significant funding for Comparative Effectiveness Research (CER).
• Agencies like AHRQ and NIH, along with the National Center for Complementary Alternative Medicine, are actively funding CER initiatives.
• CER addresses historical concerns for CAM researchers by focusing on effectiveness and holistic care, moving beyond traditional efficacy studies.

Purpose of the Study:

• To evaluate the implications of the increased focus on Comparative Effectiveness Research (CER) for Complementary and Alternative Medicine (CAM).
• To critically assess whether current CER funding and frameworks may inadvertently privilege certain types of evidence within CAM.

Main Methods:

• Analysis of funding allocations for CER from the American Recovery and Reinvestment Act of 2009.
• Review of research priorities and funding calls related to CER for CAM.
• Critical evaluation of the CER framework's compatibility with holistic and individualized CAM practices.

Main Results:

• CER represents a significant shift, emphasizing real-world effectiveness and allowing for holistic patient care, which aligns with CAM principles.
• The current approach to CER may risk marginalizing or devaluing forms of evidence crucial to CAM, despite its potential benefits.

Conclusions:

• The expansion of CER presents both opportunities and challenges for CAM research.
• A critical perspective is necessary to ensure that CER frameworks support, rather than undermine, the diverse evidence base of CAM.