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Many clinicians unaware of federally funded research on alternative therapies

April 14, 2009

Approximately one in four practicing clinicians appear to be aware of two major federally funded clinical trials of alternative therapies, and many do not express confidence in their ability to interpret research results, according to a report in the April 13 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Complementary and alternative (CAM) therapies are widely used, but until recently few rigorous studies of their safety and effectiveness have been conducted, according to background information in the article. The National Institutes of Health (NIH) has invested more than $2 billion into this type of scientific research in the past decade. "For this investment to achieve its anticipated social value, clinical research must be translated into improvements in clinical and public health practice-a process fraught with obstacles," the authors write.

"For evidence from clinical research to have an impact on medical practice, health care professionals must first be aware of the research. Once aware, health care professionals must be able to interpret these findings, judging both their validity and their implications. Finally, they must apply the scientific evidence to their own practices," they continue. To assess this translation process surrounding CAM research, Jon C. Tilburt, M.D., M.P.H., of the NIH, Bethesda, Md., and Mayo Clinic, Rochester, Minn., and colleagues surveyed 2,400 practicing acupuncturists, naturopaths, internists and rheumatologists about their awareness of and attitudes toward CAM research.

A total of 1,561 clinicians (65 percent) completed the survey. Of those, 59 percent were aware of at least one of two major clinical trials recently published on CAM therapies for osteoarthritis of the knee (on assessing acupuncture and the other about the supplement glucosamine); only 23 percent were aware of both trials. Acupuncturists (46 percent) and rheumatologists (49 percent) were more likely to be aware of the acupuncture study than naturopaths (30 percent) and general internists (22 percent), whereas for the glucosamine trial, internists (59 percent) and rheumatologists (88 percent) were more aware than acupuncturists (20 percent) and naturopaths (39 percent).

A minority of clinicians in all groups said they were "very confident" in their ability to critically interpret research literature (20 percent of acupuncturists, 25 percent of naturopaths, 17 percent of internists and 33 percent of rheumatologists); more described themselves as "moderately confident" (59 percent of acupuncturists, 64 percent of naturopaths, 67 percent of internists and 59 percent of rheumatologists)

"Compared with those who were not aware of CAM trials, clinicians who were aware of CAM trials were much more likely to be rheumatologists, to be practicing in an institutional or academic setting, to have some research experience, to express greater ability to interpret evidence and to report greater acceptance of evidence," the authors write.

The results suggest that the translation of CAM trial results into clinical practice may vary widely based on the training, attitudes and experiences of the clinicians who might apply them, they continue. "For clinical research in CAM (and conventional medicine) to achieve its potential social value, concerted efforts must be undertaken that more deliberately train clinicians in critical appraisal, biostatistics and use of evidence-based resources, as well as expanded research opportunities, dedicated training experiences and improved dissemination of research results," the authors conclude.

JAMA and Archives Journals