Laboratory of Comparative Neuroimmunology Department of Neurobiology and David Geffen School of Medicineat UCLA University of California Los Angeles Los Angeles CA USA
When eCAM was first born in 2004 we recognized ourrole in the world of integrative medicine which is tobecome the model publication devoted to evidence-basedapproaches thus the name lsquoevidence basedrsquo Recognitionwas given to the fact that eCAM is a part of a largercompendium of information technologies and ideas thatincreasingly overlap and intertwine in a tangled web ofbiological processes There are sometimes interfacingand even colliding influences that include the forces ofculture habits and attitudes that can often snuff outsmother or mask the urgencies of viewing phenomena asbiological or biomedical Yet a crucial view prevails weseek to fine-tune approaches that could yield analyses ofevidence and ultimately to define mechanisms Certainchronic ailments but perhaps not acute problems are theripest for this modern excursion into integrative medicineIn my first editorial I proposed that eCAM when
rigorous can be science (1) Happily this created a stirand the beginnings of a barrage of invitations to some-what exotic nations that are the cradles of integrativeapproaches Ayurveda (2ndash4) Traditional ChineseMedicine (TCM) (5ndash7) Kampo (8ndash10) and TraditionalArabic and Islamic Medicine (11 12) These travels wereboth inspiring enlightening and a source for viewingintegrative medicine in the larger human and multi-cultural context With a constant vision of eCAM as aspin-off from biology I assumed that the publication ofrigorously reviewed papers could be mixed ie thosedealing strictly with animal models (basic science) andhuman trials (clinical analyses) both of which ofteninvolve in vitro approaches I held this view throughvolumes 1ndash3 However in volume 4 I decided to perhapschange the focus of readerrsquos attention and to accomplishthis I chose to group the basic science papers togetherand the clinical analyses together maintaining thesubjects but as distinct and separate categoriesmdashnothingwrong with that We classify all the time art music
animals plants cultures etc In addition Irsquove publishedour first supplement (13)However I did have another vision and that was to
determine if this separation might draw readersrsquo attentionto the need for and the active recruiting of clinicalpapers After all eCAMrsquos title says it all lsquoevidence basedrsquocomplementary and alternative medicine So the instruc-tions to authors were rewritten to include quite detailedways to present clinical data (brief case reports todevelop case reports with detailed illustrative documen-tation case reports expanded into hypotheses clinicalstudies with as strong an evidence base as possible etc)(14) Moreover there were other efforts I was invited topresent Writerrsquos Workshops at several national meet-ings of the American College for Advancement inMedicine (15ndash18) opening the doors for the works ofclinicians Instructions in eCAM and Writersrsquo Workshopswere international national and local Moreover therewere policy-structured international efforts in conjunctionwith the World Health Organization (19) These weremeetings designed exclusively for veterinarians recogniz-ing the utility of animal models in the quest to under-stand human disease (20ndash22)Now here are the results of this five-year strategy
mixing and separating basic science and clinical analysesin volumes 1ndash5 From a cursory examination thereseemed to be no significant differences in the numbers ofbasic science papers vis-a-vis the clinical analyses involumes 1ndash3 In volume 4 however there was twice-higher the number of basic science papers compared withclinical analyses It was with volume 4 that the firstseparation began and that situation has prevailed involume 5 Thus despite efforts to raise the number andquality of clinical submissions it seems that basic sciencepapers outnumber the clinical papers in the two mostrecent volumes 4 and 5 of eCAM where there was theseparation and presumably greater visibility This raises
2009 The Author(s)This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (httpcreativecommonsorglicensesby-nc20uk) which permits unrestricted non-commercial use distribution and reproduction in any medium provided the original work isproperly cited
the questionmdashdo authors view eCAM as devoted more tobasic science and to do credible work is easier in thatsphere to accomplish than clinical approachesNow with volume 6 I question whether this seeming
trend (ie toward more basic science papers) in eCAM isa reflection of a national and international trend WaseCAMrsquos vision to recognize itself as a scientific journalthat lays a foundation for clinical analyses the appro-priate and meaningful way to visualize itself Despite thiscovert attempt in comparison with the more direct onesdo the rigors and flavors of science dominate andembellish eCAMrsquos strength and existence (23)Fortunately the magazine Science may have a partial
answer and present clues to questions surroundingclinical papers (Science 322 5899 149ndash328 October10 2008) Biomedical funding is in trouble and that isa cause for alarm in preparing our worldrsquos scientistsHowever I have been struck by a strong publicationdevoted to the subject of clinical applications in a specialissue lsquoClinical Trials and Tribulationsrsquo This opens withan introduction by Eliot Marshall entitled lsquoLemonsOranges and Complexityrsquo A provocative cover showsa white-coated investigator pushing a gargantuan whitepill up a mountain Upon first seeing it one is not clear ifthe mountain is made of blue rocks or piles of bluepapermdashin either case in my opinion piles of papers (quabureaucracy) are as difficult to surmount or conquer aspiles of rocks According to the description of the coverlsquoSteep terrainrsquo to move a therapy from the research labto the doctorrsquos office requires a huge investment inclinical trials which are growing more costly and morecomplex every year Five pertinent topics are treated andonline material can be viewed at wwwsciencemagorgclinicaltrials So for eCAM it seems that a clear messagemay be emerging There is a continuing place for basicscience and for clinical analyses Basic science under girdsthe successful attempt at translation from the bench tothe clinic We need it all animal models in vitro assaysand carefully monitored clinical applications At the sametime there should be an ever reminder of the paper ofGoldrosen and Strauss (24) that presented the pyramidthe base or foundation case reports and the pinnaclerandomized controlled double-blinded trials This is anessential hierarchy in approaching biomedical research
References1 Cooper EL Complementary and alternative medicine when rigorous
can be science Evid Based Complement Alternat Med 200411ndash42 Mashelkar RA Second World Ayurveda Congress (Theme
Ayurveda for the Future)mdashInaugural Address Part I Evid BasedComplement Alternat Med 20085129ndash31
3 Mashelkar RA Second World Ayurveda Congress (ThemeAyurveda for the Future)mdashInaugural Address Part II Evid BasedComplement Alternat Med 20085243ndash5
4 Mashelkar RA Second World Ayurveda Congress (ThemeAyurveda for the Future)mdashInaugural Address Part III EvidBased Complement Alternat Med 20085367ndash9
5 Liao H Banbury LK Leach DN Antioxidant activity of 45Chinese herbs and the relationship with their TCM characteristicsEvid Based Complement Alternat Med 20085429ndash34
6 Wang L Muxin G Nishida H Shirakawa C Sato S Konishi TPsychological stress-induced oxidative stress as a model of sub-healthy condition and the effect of TCM Evid Based ComplementAlternat Med 20074195ndash202
7 Xia R Huang P Shao G Nourishing Yin and promoting bloodcirculation of TCM to treat hemorheologic disorder induced bydiabetes mellitus in rats Evid Based Complement Alternat Med20074203ndash7
8 Hijikata Y Miyamae Y Takatsu H Sentoh S Two KampoMedicines Jidabokuippo and Hachimijiogan Alleviate SprainsBruises and Arthritis Evid Based Complement Alternat Med20074463ndash7
9 Murayama T Yamaguchi N Matsuno H Eizuru Y In vitro anti-cytomegalovirus activity of kampo (Japanese Herbal) medicine EvidBased Complement Alternat Med 20041285ndash9
10 Kiyohara H Nagai T Munakata K Nonaka K Hanawa TKim SJ et al Stimulating effect of Japanese Herbal (Kampo)medicine hochuekkito on upper respiratory mucosal immunesystem Evid Based Complement Alternat Med 20063459ndash67
11 Azaizeh H Saad B Cooper EL Said O Traditional Arabic andIslamic medicine a re-emerging health aid Evid Based ComplementAlternat Med (Advance Access published 13 June 2008)doi101093ecamnen039
12 Said O Saad B Fulder S Khalil K Kassis E Weight loss inanimals and humans treated with lsquoweighlevelrsquo a combination offour medicinal plants used in traditional Arabic and Islamicmedicine Evid Based Complement Alternat Med (Advance Accesspublished 24 October 2008) doi101093ecamnen067
13 Cooper EL Editor-in-chief Evid Based Complement Alternat Med20074(Suppl)1ndash70
14 Evidence-based Complementary and Alternative Medicine Instruc-tions for authors httpwwwoxfordjournalsorgour_journalsecamfor_authorsinstauth1html
15 Feig SA Speight N Hynote E Magaziner A Summary of theAmerican College for Advancement in Medicine November 2004Conference on Emerging Concepts in Immunology Evid BasedComplement Alternat Med 20052121ndash4
16 Feig SA Hynote E Speight N Magaziner A Miranda RASchachter MB Summary of the American College for Advancementin Medicine May 2005 Conference Menopause Andropause Powerin Transition Evid Based Complement Alternat Med 20052413ndash9
17 Feig SA Biddle J Hynote E Speight N Bock K Magaziner ARich JE Summary of the American College for Advancement inMedicine November 2005 Conference on Scientific IntegrativeMedicine Advancing Health Horizons Evid Based ComplementAlternat Med 20063385ndash91
18 Speight N Hynote ED Summary of the American College forAdvancement in Medicine November 2007 Conference onIntegrative Medicine Advancing Science and Clinical PracticeEvid Based Complement Alternat Med (Advance Access published20 March 2008) doi101093ecamnen020
19 Cooper EL Meeting Report 12th International Congress ofOriental Medicine Evid Based Complement Alternat Med20041103ndash6
20 Rastogi S Kaphle K Sustainable traditional medicine taking theinspirations from ancient veterinary science Evid Based ComplementAlternat Med (Advance Access published 2 November 2008)doi101093ecamnen071
21 Kaphle K Wu Y Lin J Thirtieth Annual Congress on VeterinaryAcupuncture IVAS Report Evid Based Complement Alternat Med20052239ndash42
22 Lin J Shih C Kaphle K Wu L Tseng W Chiu J et alAcupuncture effects on cardiac functions measured by cardiacmagnetic resonance imaging in a feline model Evid BasedComplement Alternat Med (Advance Access published 23 January2008) doi101093ecamnem187
23 Paul PG E-letter for bioprospecting a CAM frontier httpecamoxfordjournalsorgcgieletters211
24 Goldrosen MH Strauss SE Complementary and alternativemedicine assessing the evidence for immunological benefits NatRev Immunol 20044912ndash21
2 Editorial
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