It looks like you're using Internet Explorer 11 or older. This website works best with modern browsers such as the latest versions of Chrome, Firefox, Safari, and Edge. If you continue with this browser, you may see unexpected results.
Research Directions in Complementary, Integrative & Alternative Medicine: Modeling Clinical Research
Information on clinical evidence models and new approaches for conducting CAM research.
Awareness evolves, and practitioners have increasingly recognized the limitations of the hierarchical model, especially in relation to complementary/integrative clinical practice:
"The evidence hierarchy is too simplistic for much of medicine and for the complex interventions in many CAM practices. As every clinician knows, patients recover for complex and interacting reasons, many of which are not additive and cannot be isolated in controlled environments.”
Jonas WB. (2005). Forschende Komplementärmedizin Und Klassische Naturheilkunde = Research in Complementary Medicine; 12 (3): 163. Note: Wayne B. Jonas, MD, was the founding director of NCCAM (now National Center for Complementary & Integrative Health) at the National Institutes of Health.
This recognition prompted the development of more inclusive models, such as the Evidence Circle and the Evidence Funnel. Here are links to articles or abstracts discussing these models.
"Instead of an Evidence Hierarchy, we propose a Circular Model. This would imply a multiplicity of methods, using different designs, counterbalancing their individual strengths and weaknesses to arrive at pragmatic but equally rigorous evidence which would provide significant assistance in clinical and health systems innovation."
The Evidence Funnel represents the central position of research literacy in evidence informed practice (EIP). Research literate practitioners are best positioned to enhance treatment outcomes in their patients.
This article addresses "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. .... I suggest a framework of an 'Evidence House' for addressing many of these challenges."
Dr. Joshua Goldenberg, ND and founder of drjournalclub.com, discusses Wayne B. Jonas' concept of an Evidence House. (You can access all of Dr. Goldenberg's videos via Library>Databases>DrJournalClub; institutional login required)