EDITORIAL Evidence-based Complementary Medicine—Challenges and Future Directions

There is considerable interest in complementary medicine (CM) and the usage of various alternative therapies is reportedly at an all-time high in the West. Bensoussan1 stated that each year, 57 % of Australians were using CM with an estimated expenditure of A$621 million spent on complementary medicines (products) and A$309 million on CM practitioners. In the USA, a similar trend was reported by Eisenberg and his colleagues.2 A survey from 1990 to 1997 showed that 42 % of Americans visited CM practitioners each year and the costs of CM professional services were conservatively estimated at US$21.2 billion in 1997, with at least US$12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditure for all US hospitalisations. These figures are indeed astounding. Despite this increased public demand and usage of CM, which has incidentally aroused a lot of disquiet amongst those steeped in orthodox medicine, there is still a general lack of acceptance of CM within the mainstream of medicine. The reasons for this are multi-fold and Bodeker,3 in the second editorial for this issue, will cover some of the broad issues confronting CM at the present time. I wish to concentrate on two related issues, firstly, on the entrenched attitudes towards CM and secondly, on the evidence for CM or the lack of it. The severest critics and antagonists of all forms of CM liken CM proponents to “Cuckoos in a Warbler’s nest”. In a theoretical argument and scathing attack against CM, Leibovici4 stated that “The deep model of alternative medicine i