Original Research Papers
Setting an agenda for strengthening the evidence-base for traditional and complementary medicines: Perspectives from an expert forum in Australia

https://doi.org/10.1016/j.aimed.2018.06.002Get rights and content

Abstract

Objectives

To explore the challenges regarding evidence and complementary medicine in Australia and identify potential future directions to develop leadership, action and debate.

Design

Facilitated discussion among a roundtable of experts to identify and consider the relevant issues and potential actions.

Methods

Purposive sampling of 17 expert stakeholders with a variety of experience in the traditional and complementary medicine (T&CM) arena. Thematic analysis of the half-day discussion transcript resulted in a framework for a broad agenda to support the development of appropriate evidence for T&CM.

Results

Five key areas (with sub-themes) were identified, forming the backbone of an agenda-setting framework: focus areas; strategies; actions and outputs; barriers; and drivers of change. ‘Focus areas’ encapsulated the main themes and informed all key areas, these were: consumer perspectives and needs; hierarchies of evidence; safety of products, practitioners and practices; modernisation of T&CM; regulation and policy; and evidence-based practice. Two recurring themes informed the framework at multiple levels: the complexity and varied understanding of what is ‘appropriate evidence’ for T&CM; and putting consumers at the centre – to ensure that their needs and safety are prioritised. Lack of resources for undertaking T&CM research necessitates the need to bring together information from multiple sources so that ‘totalities of evidence’ can be assessed to increase the T&CM evidence-base. Doing so requires reassessment of the relative value of traditional forms of evidence and challenges current linear evidence hierarchies that prioritise clinical trials as the ‘gold standard’.

Conclusions

This Australian agenda-setting framework for strengthening T&CM evidence requires an interdisciplinary leadership group (including consumer, clinician, academic and industry representatives) to build consensus, foster collaboration, and generate and disseminate information. Prioritising the perspectives and needs of consumers should be a primary focus in taking the ‘strengthening evidence for T&CM’ agenda forward.

Section snippets

Background

Many people across the world use traditional and complementary medicine (T&CM) products, practitioners and practices, and in some regions, this use is increasing [1,2]. Definitional and methodological issues related to T&CM products and practices prevent clear global comparisons of T&CM use. It is estimated that up to 70% of people in Australia use at least one T&CM modality within a given year [3,4]. Twelve-month prevalence rates reported elsewhere range from 36%–42% in the USA [1], 20%–44% in

Aims & design

A descriptive qualitative design was used to explore the themes arising from an experts’ forum toward furthering understanding of how ‘evidence’ for complementary medicine products is conceptualised, and to develop an agenda to guide how it should be conceptualised and supported going forward into the future.

Participants

A purposeful sample of academic, industry and consumer participants for the expert complementary medicine evidence forum were identified by NICM and ASMI staff through known academic and

Results

While the aim of the forum was to discuss challenges related to evidence for T&CM products, the forum discussion promptly expanded to incorporate T&CM practitioners and practice. Table 2 summarises the key areas and themes arising, organised into a linked framework that can be used to guide agenda-setting and actions towards strengthening appropriate evidence for T&CM (noting that a T&CM leadership group or other similar entity is needed to operationalise the strategies and coordinate the

Discussion

This paper presents an Australian-focused agenda for strengthening the evidence-base for T&CM. It is the outcome of a roundtable discussion of experts who collectively brought together many decades of accumulated knowledge from research, clinical practice and/or teaching experience in the fields of T&CM (Chinese medicine, naturopathy, herbal medicine and others), medicine (including general practice), nursing, pharmacology, social sciences and philosophy. The interweaving of the themes

Conclusion

The time is ripe in Australia to establish a leadership group to change the nature of debate around what is appropriate evidence for T&CM and to lead action to advance this area. Clinicians and T&CM consumers should be mobilised to lobby for greater recognition. This paper provides a framework that can be used to guide such work. The framework is broad but encapsulates: focus on consumers; the importance of evidence, regulation and policy; challenges arising from the modernisation of T&CM; and

Ethics approval and consent to participate

Formal ethics approval was not required for the roundtable discussion (the forum). All forum participants recorded their consent for their de-identified contributions to be reported, all were provided opportunity to comment on the draft manuscript, and all provided written consent to be named in the acknowledgements of this paper.

Consent for publication

The authors and forum participants have read the manuscript and provided written consent for publication.

Competing interests

Author JH, is engaged in integrative medicine clinical practice and is an academic researcher at NICM. As a medical research institute, NICM receives research grants and donations from foundations, universities, government agencies, individuals and industry. Sponsors and donors provide untied funding for work to advance the vision and mission of NICM. The project that is the subject of this article was not undertaken as part of a contractual relationship with any organisation or donor. Authors

Authors’ contributions

RC and ML undertook data analysis. RC conceptualized and drafted the paper with input from ML and JH. All authors reviewed and revised the manuscript.

Funding

This work was jointly funded by NICM, Western Sydney University, and the Australian Self-Medication Industry (ASMI).

Acknowledgements

The forum was co-convened by NICM and the Australian Self-Medication Industry (ASMI) and hosted at the ASMI Offices in Sydney and facilitated by Robert Lippiatt, Southern Pacific Consulting. Thank you to the forum participants and also Annaliese Scholz (ASMI) and Adjunct Professor Michael Smith (National Center for Natural Product Research, University of Mississippi and Adjunct Fellow NICM) for their input into this paper. In addition to the authors, forum participants were: Professor Alan

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