With publication of the consensus paper on complementary and alternative medicine (CAM) practices in cardiovascular care, the American College of Cardiology (ACC) has pointed cardiologists to a unique dimension of health care concepts, research, and practice.1 As the trend among patients to use CAM therapies has risen exponentially,2 growing professional interest in CAM therapies as adjuncts to the high-tech world of cardiovascular care has been paralleled by concerns about exaggerated claims of efficacy, as well as by quackery and frank toxicity across the largely unregulated pantheon of CAM practices. The combination of relatively unrestricted access to Internet information and widespread cultural interest in self-empowerment and holistic paradigms of health care in the lay public constitute a mandate for cardiologists to become better informed about CAM therapeutics. At the very least such education will support more thoughtful, less defensive dialogue between physicians and patients. At best, cardiologists knowledgeable about CAM therapies will be better positioned to encourage and envision both the many necessary research directions and more integrated clinical strategies necessary for the advance of optimal data-driven practice in modern cardiovascular care.3
Although many CAM therapies have been practiced for thousands of years, the scientific literature is still immature by modern standards in most of these areas. The introduction to the ACC consensus document observes that "Topics chosen for coverage by Expert Consensus Documents are so designed because the evidence base and experience with technology or clinical practice are not considered sufficiently well developed to be evaluated by the formal ACC/AHA [American Heart Association] Practice Guidelines process."1 Ambiguous nomenclature, lack of practice certification standards, and absence of quantitative profiles of active agents in consumables such as herbal remedies confound evaluation of safety and efficacy in specific heart disease populations. As with other areas of immature literature in medical practices, investigator bias, reporting bias, and publisher bias also confound the interpretation of available data.
Even more essential to the actual integration of modern medical technology and practice with CAM therapies is the challenge to engage whole new paradigms, both of healing and of how research defining optimal healing might be conducted. The modern scientific tendency to articulate biochemical mechanisms and translate them into clinical practice therapeutics tested by clinical protocols is potentially fatally reductionist with regard to holistic systems that view interaction with the body as approximately 20% of the mind–body–spirit process that actually accomplishes the transformation of suffering called healing.4,5 Research in CAM therapies in cardiovascular care must balance standards for clinical trial designs or mechanistic studies with sensitivity to the cultural assumptions of how these therapies actually work.6–9
With the growth of the National Center for Complementary and Alterative Medicine (NCCAM) at the National Institutes of Health, more comprehensive attention and research resources have been directed to sort through some of these issues and to develop the requisite infrastructure. With even the terms alternative, complementary, integrative, and others still in ...