Flores De Bach Y Fibromialgia

Quality of Efficacy Research in Complementary and
Alternative Medicine
Eugenia Chan
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current as of June 12, 2008.

JAMA. 2008;299(22):2685-2686 (doi:10.1001/jama.299.22.2685)
http://jama.ama-assn.org/cgi/content/full/299/22/2685

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Statistics and Research Methods; Complementary and Alternative Medicine;
Pediatrics; Pediatrics, Other; Psychiatry; Attention Deficit Hyperactivity Disorder
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Hypericum perforatum (St John's Wort) for Attention-Deficit/HyperactivityDisorder
in Children and Adolescents: A Randomized Controlled Trial
Wendy Weber et al. JAMA. 2008;299(22):2633.

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EDITORIAL

Editorials represent the opinions
of the authors and JAMA and
not those of the American Medical Association.

Quality of Efficacy Research in Complementary
and Alternative Medicine
Eugenia Chan, MD, MPH

C

OMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)

has received increased attention in mainstream medicine since a 1993 study demonstrated that onethird ofUS adults used some form of “unconventional medicine.”1 By 2002, the prevalence of CAM use by adults
had increased to 62% to 68%,2,3 and it has become clear that
users of CAM are not primarily dissatisfied with conventional care, but have a more holistic approach to health4 or
simply appreciate multiple treatment options.5 What was once
identified as “alternative medicine” has become“complementary,” “holistic,” and “integrative”; indeed, CAM therapies, such
as probiotics, melatonin, massage, yoga, and acupuncture, have
become part of the conventional medicine armamentarium,
and the demarcation between CAM and mainstream medicine continues to shift.
Physicians have been scrambling to catch up with the exponential increase in CAM use among their patients. Most
discussions of CAM areinitiated by patients and families,
rather than by physicians,6 and patients may not disclose
CAM use to their physicians.7 Recent surveys show that most
physicians are aware of their patients’ interest in using CAM,
believe that CAM may have beneficial effects, and are eager
to seek reliable, evidence-based information about CAM for
both personal and professional practice.6,8,9
Limiting theindiscriminate use of costly or dangerous ineffective therapies—whether based in conventional or unconventional medicine10—should be a high priority for all
clinicians. This is especially true for children, whose unique
physiology, developmental and cognitive trajectories, and
position in society render them particularly vulnerable. Although often touted as “natural” and “safe,” some CAMtherapies have the potential for adverse effects (eg, lead poisoning from some ayurvedic remedies),11 may cause interactions
with mainstream medical therapies (eg, oral contraceptives and St John’s wort),12 and involve significant time, effort, and cost burdens for families (eg, biofeedback).
In this issue of JAMA, Weber and colleagues13 report the
results of an 8-week randomized,placebo-controlled, doubleblind trial of Hypericum perforatum (St John’s wort) in 54 children aged 6 through 17 years who met criteria for the diagSee also p 2633.
©2008 American Medical Association. All rights reserved.

nosis of attention-deficit/hyperactivity disorder (ADHD) and
who were not receiving any other ADHD-related treatments,
including pharmaceuticals, during the study. Changes in
ADHD...