The Cochrane CAM Field is an international group of individuals dedicated to facilitating the production of systematic reviews of randomized clinical trials in areas such as acupuncture, massage, chiropractic, herbal medicine, homeopathy and mind-body therapy. It is a member entity of the Cochrane Collaboration, a worldwide organization that prepares systematic reviews of all kinds of healthcare therapies, and publishes these reviews in The Cochrane Library .
Founded in 1996 and coordinated by the University of Maryland Center for Integrative Medicine, the Cochrane CAM Field has worked steadily to meet the growing demand for information about CAM therapies among both practitioners and the general public by identifying published clinical trials of alternative therapies, preparing systematic reviews, training systematic reviewers, disseminating systematic reviews to the general public and healthcare providers, and conducting research to improve systematic review methodology. In May 2007, the Cochrane CAM Field was awarded a five-year 2.1 million dollar research grant from the National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM) to support and extend the work of the Field (Grant Number R24 AT001293). Some of the specific projects undertaken are described below.
Systematic Review Preparation
Systematic reviews provide summaries of the best evidence for a medical intervention. Through the use of explicit, systematic methods, reviews limit bias (systematic errors) and reduce random errors (simple mistakes), thus providing reliable results on which to draw conclusions and make decisions. In today's world we are inundated with a constant flow of new information. This is no less so in medicine and practitioners, patients, insurers, and policy makers all need dependable sources that select the best evidence and synthesize the information. As summaries of the best evidence for a medical intervention, systematic reviews serve as guides for medical decision-making.
In addition, the scientific community is increasingly valuing comprehensive systematic reviews as invaluable tools in the planning stages of a clinical trial. Literature reviews can point out where knowldege gaps exist, generate hypotheses and prevent duplication of work already completed. Traditional literature reviews, commonly called narrative reviews, usually precede project planning. However, as they lack explicit methodology, these reviews frequently have been neither comprehensive, nor systematic, and are thus prone to bias.
The staff of the CAM Field editorial base are actively involved in the preparation of systematic reviews. Over the last five years, staff have published more than ten systematic reviews, for both The Cochrane Library and for print journals. These reviews have largely focused on the use of herbal therapies and acupuncture for treating rheumatologic conditions. In addition, the CAM Field base has contributed to Cochrane Reviews by providing administrative support, including distributing copies of original reports and conducting database searches, on a per request or as needed basis. The CAM Field's NIH funding also supports the Thomas Chalmers Center in their review collaboration and review assistance work as well.
A list of all Cochrane Collaboration's systematic reviews related to CAM can be found here.
Systematic Reviewer Training
The CAM Field staff have contributed to establishing the infrastructure that supports preparation and maintenance of reviews of CAM therapies and supports CAM-reviewer training. For example, in May 2001 the Field staff organized a symposium on the systematic review and meta-analytic processes, presented at the First International Scientific Conference on Complementary and Alternative Medicine held in San Francisco. At the March 2002 meeting of the American Pain Society in Baltimore, a second symposium was organized surrounding design issues in CAM research. In October 2002, Brian Berman and Lixing Lao traveled to Hong Kong to help present a workshop on research methodology, study design, and systematic reviews in Traditional Chinese Medicine. In April 2007, Eric Manheimer, Brian Berman, and Aviad Haramati hosted a systematic review workshop at the Israeli Medical Association’s annual international meeting. Eric Manheimer also presented this workshop at the Galilee Society, an organization in the Galilee region of Israel that studies traditional Arab medicine.
All of these symposia and workshops have focused on or highlighted the work of the Cochrane Collaboration. In addition, at the Barcelona (2003), Ottawa (2004), Melbourne (2005), and Dublin (2006) annual Cochrane Colloquia, Eric Manheimer led workshops on the methodological challenges of preparing systematic reviews of CAM therapies.
Dissemination of Systematic Reviews and Other Research
Much of the effort within the CAM Field is dedicated to further disseminating CAM-related systematic reviews and related research to the CAM research and practice communities, as well as to the general public. The Field staff have actively worked with leading CAM journals to promote the work of the Cochrane CAM Field. For example, Field staff have published a paper in the January 2004 issue of Complementary Therapies in Medicine, that outlines the many projects the CAM Field is undertaking on behalf of the Cochrane Collaboration. In the journal Explore, a regular column called "Cochrane for CAM Providers", has been launched by the CAM Field to promote the awareness of the Cochrane Collaboration and to improve the understanding of RCT and systematic review methodology among the CAM community. Future installments of this column will be prepared for the journal Explore. Finally, in the Journal of Alternative and Complementary Medicine, a new series has been launched to provide an overview of the Cochrane CAM-related reviews. The first in the series has focused on Cochrane Reviews of botanicals; the second on Cochrane Reviews of vitamins. Both of these columns have been prepared by Jeanette Ezzo.
In addition, a chapter on the "State of the Emerging Evidence for CAM" has been prepared for the US Institute of Medicine report Complementary and Alternative Medicine in the United States, published in January 2005. The chief focus of this chapter is the work of the Cochrane Collaboration and the CAM-related Cochrane reviews.
Finally, a book entitled Complementary Therapies on the Internet (published by Churchill Livingstone), co-authored by Brian Berman, has been written to facilitate both professionals and consumers' acquisition of reliable information on CAM therapies and research.
Trials Register
Another core function of the CAM Field is maintaining the register of CAM trials. The entire contents of the CAM Field register is submitted regularly to the US Cochrane Center for publication in The Cochrane Library's CENTRAL Register of Controlled Trials, the most comprehensive register of trials in the world. All of the CAM Field records in CENTRAL are assigned the SR-COMPMED specialized register code in the 'CC:' field of CENTRAL. Individuals can identify the CAM Field records within CENTRAL by carrying out a search of CENTRAL and entering the CAM Field Specialized Register code SR-COMPMED as an extra search term. Systematic reviewers who search the Cochrane CAM Field register should list this National Center for Complementary and Alternative Medicine-supported resource as a data source in the search strategy section of their published review.
In addition, CAM Field staff and staff of the US Cochrane Center have collaborated on multiple projects related to register development. For example, training workshops have been held at both the Barcelona (2003) and Ottawa (2004) Cochrane Colloquia, to provide guidance for contributors from around the world in handsearching journals to identify relevant trials. As well as maintaining the register of CAM trials, the CAM Field has compiled a register of CAM-related systematic reviews, which currently numbers 340 non-Cochrane CAM-related systematic reviews and over 150 Cochrane systematic reviews. Hard copies of nearly all of these systematic reviews have been obtained.
Methodological Research
Several CAM Field research projects will contribute to improvements in the methodology of conducting trials and preparing systematic reviews in CAM. For example, at a platform presentation at the Barcelona Cochrane Colloquium, Eric Manheimer described the collaborative, international, and evidence-based approach the Center for Integrative Medicine takes towards the evaluation of Traditional Chinese Medicine (TCM). The presentation included a discussion of the many challenges and some possible solutions to the development of an evidence-based TCM. In addition, a research study conducted by the Field staff has evaluated whether RCT reports in acupuncture provide an accurate and complete description of the procedure and conduct of acupuncture trials. For this study, we undertook a survey of acupuncture trial investigators to determine whether key quality scale dimensions, based on the written report, would change if this report data were supplemented by additional information supplied directly through contact with investigators.
External Links
The principal external institution with which the Field has established affiliation is the National Center for Complementary and Alternative Medicine (NCCAM). NCCAM supports the CAM Field's efforts by providing funding, creating scientific forums by which research issues in complementary medicine can be discussed and by occupying positions on the CAM Field advisory board. Other external links at the international level include persons and /or organizations that offer their skills and time to assist with systematic reviews or related research in their areas of expertise. The CAM Field Leaflet is a concise overview of the Cochrane CAM Field's aims and activities. If you are interested in participating in reviews or in finding out more about the CAM Field, contact emanheimer@compmed.umm.edu.