Healthcare is changing as evidence-based medicine (EBM) is incorporated into education and practice. This article considers the hierarchy of evidence, the validation of evidence for decision making and the extent to which this includes aspects of cultural and social constructs of health. We review the influence and the methodology of EBM as it is applied to complementary and alternative medicine (CAM), and suggest that there is an uneasy relationship as the two approaches to health have divergent understandings of health and evidence. There are fundamental philosophical and epistemological differences between orthodox and complementary medicine and we suggest that EBM is limited in how it can be applied to CAM. We question how the two approaches to healthcare can work together to create optimal outcomes in practice.
The movement towards evidence-based practice underscores the division between biomedicine and CAM. Historically, there has been little scientific research into CAM, largely because of its place as a `fringe' profession. Most research is funded by private sector interests who might see the economic benefit of a certain procedure or product. The research culture that has developed has been one that emphasises an evidence-based approach to establishing the efficacy of single herbs and nutrients, which overlooks the way that complementary therapists use these substances. The review concludes with a concern that the relationship between EBM and complementary medicine may become unbalanced, and the proponents of one system ignore or dismiss the values of the other. This lack of cross-paradigmatic respect is the wellspring for division and suspicion that is currently permeating the arranged marriage between CAM and EBM.