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A US National Survey

Jon C. Tilburt, MD, MPH; Farr A. Curlin, MD; Ted J. Kaptchuk; Brian Clarridge, PhD; Dragana Bolcic-Jankovic, MA; Ezekiel J. Emanuel, MD, PhD; Franklin G. Miller, PhD

Arch Intern Med. 2009;169(7):670-677.

Background  Little is known about whether federally funded complementary and alternative medicine (CAM) research is translating into clinical practice. We sought to describe the awareness of CAM clinical trials, the ability to interpret research results, the acceptance of research evidence, and the predictors of trial awareness among US clinicians.

Methods  We conducted a cross-sectional mailed survey of 2400 practicing US acupuncturists, naturopaths, internists, and rheumatologists.

Results  A total of 1561 clinicians (65%) responded. Of the respondents, 59% were aware of at least 1 major CAM clinical trial; only 23% were aware of both trials. A minority of acupuncturists (20%), naturopaths (25%), internists (17%), and rheumatologists (33%) were "very confident" in interpreting research results (P < .001). Fewer acupuncturists (17%) and naturopaths (24%) than internists (58%) and rheumatologists (74%) rated the results of randomized controlled trials as "very useful" (P < .001). Twice as many internists (53%) and rheumatologists (64%) rated patient preferences as "least important" compared with acupuncturists (27%) and naturopaths (31%) (P < .001). In multivariate analyses, for clinicians aware of at least 1 trial, male sex (odds ratio [OR], 1.30 [95% confidence interval {CI}, 1.05-1.62]), prior research experience (OR, 1.45 [95% CI, 1.13-1.86]), institutional or academic practice setting (ORs, 1.98 [95% CI, 1.01-3.91], and 1.23 [95% CI, 0.73-2.09], respectively), and rating randomized trials as "very useful" (OR, 1.46 [95% CI, 1.12-1.91]) (P < .001) for clinical decision making were positively associated with CAM trial awareness. Acupuncturists, naturopaths, and internists (ORs, 0.15 [95% CI, 0.10-0.23], 0.15 [95% CI, 0.09-0.24], and 0.18 [95% CI, 0.12-0.28], respectively) were all similarly less aware of CAM trial results compared with rheumatologists.

Conclusion  For clinical research in CAM to achieve its social value, concerted efforts must be undertaken to train clinicians and improve the dissemination of research results.

Author Affiliations: Department of Bioethics, National Institutes of Health, Bethesda, Maryland (Drs Tilburt and Miller); Division of General Internal Medicine and the Program in Professionalism and Bioethics, Mayo Clinic, Rochester, Minnesota (Dr Tilburt); Section of Internal Medicine and the McClean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois (Dr Curlin); Osher Research Center, Harvard Medical School, Boston, Massachusetts (Mr Kaptchuk); and Center for Survey Research, University of Massachusetts, Boston (Dr Clarridge and Ms Bolcic-Jankovic).

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