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CAMbrella work package 7

The Roadmap for CAM research in Europe

The main objectives of this work package were to:
• analyse the research methods already applied to CAM in the EU
• develop research methods and strategies for CAM that take into
account the needs and attitudes of EU citizens and providers
• develop research strategies and a research roadmap to enable
future clinical and epidemiological research in the field of CAM regarding prevalence of use, effectiveness, efficacy, cost effectiveness and safety.

Findings

There is too little knowledge about the current state of CAM in Europe:
• about the prevalence of use of CAM in most European countries
• about the needs and attitudes of EU citizens, patients and
providers regarding CAM
• about the types and modi of CAM provision

In the past, the majority of clinical trials have assessed the efficacy rather than the effectiveness of CAM, meaning:
• there is a lack of data on the clinical outcomes of CAM treatments in comparison with conventional treatments in real-world settings
• unspecific effects seem to have significant value in CAM treatments
• reliable data about safety and adverse effects of CAM in real-world settings are scarce.

There is considerable heterogeneity within CAM in the EU and these differences have hampered the development of combined European research efforts. The challenges now are to:
• gather comparable information about the real situation as regards provision, use and regulation of CAM in all countries of Europe
• identify and address the areas in which CAM could play a role in the improvement of health care to European citizens
• Establish a scientific knowledge base that enables all stake- holders including policy makers, researchers, health care providers and citizens to make informed decisions about CAM.

Conclusions and recommendations

In order to consider employing CAM as part of the solution to the health care challenges we face in 2020, it is vital to obtain reliable information on its prevalence of use, effectiveness, safety and cost in real world settings. This research strategy aims to provide the EU and its citizens with valuable scientific information for stakeholder decisions about CAM treatments.

1. CAM is a neglected area of research – it needs active encouragement
European research in the field of CAM is limited and our knowl- edge about CAM is very poor. There is almost no significant investment in any EU country in a CAM research structure or strategy. The CAM industry is small and there are no major financial or/and industrial interests driving research efforts in this field. Scientific bias hampers the free exchange of ideas, concepts, treatment techniques and comparison of clinical outcomes. CAM is organised mostly in private provider settings (medical and non-medical), thus the academic experience among CAM providers is scarce and there are few academic centres of research, resulting in a substantial lack of funding for research programmes. Career opportunities in an academic setting are rare.
In order to pay proper attention to the real situation of use and provision of CAM in Europe, and to understand why CAM is so popular within the EU, structural and sufficient financial support is needed at all levels: private, university bound, national and European.

2. An EU research strategy for CAM must reflect the needs of the citizens, patients, providers and other stakeholders
CAM is frequently employed in prevention, health literacy and self-management of chronic long-term conditions. Therefore it could contribute to the upcoming health care challenges in Europe.

Foremost, it is needed to:
• establish a European-wide approach to assess the prevalence of use of core CAM disciplines
• address the diversity of training, education and provision of CAM across Europe
• identify the most promising CAM treatment options for the most prevalent health conditions in Europe (obesity, chronic diseases like diabetes, cancer, musculoskeletal problems, healthy ageing and others)
• quantify the economic effects of CAM in European health care
Stakeholders might have different views on CAM; these views should be taken into account in order to achieve meaningful research and allow stakeholders to make informed decisions for future health planning:
• identify the citizens’ access to and preferences for CAM pro- vision as well as their perspectives on education, training and practice of CAM providers
• determine how best to disseminate scientifically sound infor- mation about CAM to the European public, in line with the EU objective to enhance the ability of citizens to make better and informed decisions about their health care
• give clear guidance on CAM safety issues
• research and evaluate different models of CAM health care integration into routine care programmes

3. Research methods must reflect the real-world settings of health care in Europe
CAM should be considered along the same scientific lines that apply to medical research in general.

Everyone needs to know in what situation CAM is a reasonable choice. Therefore we recommend a clear emphasis on concur- rent evaluation of CAM as an additional or alternative treatment strategy in real-world settings.

The strategy for the investigation of CAM should include a broad range of mixed-method research strategies including comparative effectiveness research, qualitative and quantitative designs. Stakeholders such as citizens, patients and providers should be closely involved to ensure real world relevance for the research.

Specifically, we recommend to:
• implement comparative effectiveness research (CER) and concurrent health economic evaluation of different treatment strategies including CAM
• put emphasis on the investigation of CAM safety in clinical contexts, e.g. by support of country-wide registers, observa- tional studies, single case studies or case histories
• address the impact of context and meaning factors (generally known as non-specific effects and may include the “placebo effect”) such as preferences and expectations in clinical research.

4. A centralised and academically supported EU CAM centre should make this EU research strategy operational
Currently there is little research on CAM in Europe and no structure through which research can be co-ordinated within the EU. There is a widely recognised need to ensure high quality research to enable scientific knowledge that is considered adequate for informed decision making by both providers and patients of CAM.
We propose that the EU actively supports an EU-wide strategic approach to facilitate the development of CAM research, through the funding of an EU centre for CAM that looks into the situation of CAM and gives research-based guidelines on how to address it. The aim of such a European centre for CAM would be to actively stimulate high quality research on CAM in the EU based on pan-European collaboration, through an independent research strategy aligned with EU health policy.

The complete work package report can be downloaded here.

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