The use of complementary and alternative medicine (CAM) by patients with inflammatory bowel disease (IBD) is common. Physicians and scientists believe that the randomized controlled trial (RCT) provides the best evidence of an intervention's efficacy. However, thcre are only a few controlled trials that have assessed these lherapies in IBD and all contain methodological problems. The RCT does not always fit well with the underlying principles of disease causation and treatment of CAM. Many forms of CAM take a holistic approach to the diagnosis and treatment of disease, where the patient plays an active and key role in healing and treatments are often highly individualired. Thercfore, the use of placebos, blinding. and random allocation to structured trcatnient protocols in an RCT setting is often contradictory to the principles of CAM. We still know relatively little about the use of CAM in IBD. Prior to embarking upon a program of clinical trials to evaluate these therapies, a better understanding of the specific therapies being used, reasons for thcir use, and their potential side effects is required. We also need to understand how the CAM practitioners use their therapies, what they view as the appropriate indications, and how treatments are best adininistered. Key Words: Complcmcntary and alternative medicine-Intlammatory bowel disease-Randomized controlled trials.
Complementary and alternative medicine (CAM) use among the general population is widespread in North America ( I ,2). CAM is difficult to define and the definition tends to be somewhat situational, and distinctions between conventional medicine and CAM are not always clear (3). CAM encompasses a broad spectrum of practices and approaches. Table provides a classification of CAM (4) and some examples of specific therapies, including those used for inflammatory bowel disease (IBD). They are often defined as medical practices that are not in conformity with the standards of the medical community, which are not widely taught in North American medical schools and which are generally not available in North American hospitals ( I ) . However. a1 prcsent this situation is changing rapidly.