Complementary and alternative medicine: exploring the gap between evidence and usage.

Debates over the efficacy of complementary and alternative medicine (CAM) are highly polarized and have received much publicity of late. While 'believers' in CAM campaign for its integration into the NHS, 'sceptics' call for the withdrawal of any public funding for such services. These debates take place in the context of a steady rise in CAM usage both in the UK and abroad. Critics of CAM often point to the lack of scientific evidence demonstrating its efficacy. The lack of evidence gathered by means of randomized controlled trials is often used to make the claim that CAM is no more effective than placebo. This article examines some of the debates surrounding the use of evidence-based medicine to assess the efficacy of CAM. It also explores a number of issues pertaining to CAM and the placebo response including the moral questions surrounding the knowing use of placebo as therapy. The rest of the article presents material from a qualitative study carried out in northern England on the understandings of CAM efficacy. The material shows that CAM therapists and patients do not reflect the polarities evident in the public debate in their own understanding and usage of CAM. Rather they are pragmatic pluralists with clear ideas about when CAM treatment is appropriate and often have sophisticated insights into the placebo response. The article concludes with a brief discussion of the implications of these findings for future work in the growing field of CAM research.