eCAM: A Closer Look at Clinical Analyses

eCAM continues as it began in its quest for providing linkages and revealing the interdependence of basic science and clinical analyses. If one examines the 50 most cited papers for the month of June 2009, it is difficult to determine what is purely clinical and what is basic science; there is significant overlap and blurring. To clarify, one way is to define as clinical any investigations that use exclusively humans in trials. However, using human cells in culture could be classified as an overlap between basic science and clinical investigations. One would not argue that animal models constitute basic science, or that this category would include products from animals or plants and their role in modulating disease. Taking this stance has provided me, the biologist/ immunologist, with a chance to explore those areas that (i) overlap, (ii) are biological, (iii) are immunological, and (iv) have a certain ‘‘orientation’’ or trajectory that renders them intimately pertinent to complementary and alternative medicine (CAM). Clinical evidence-based approaches present unique problems primarily due to human nature and are often difficult to structure, support, plan and complete. We must also examine ethical implications and what may emerge as reputable. It is not always easy to move past single-case reports, which is the base of the hierarchical evidence-based pyramid suggested by Goldrosen and Strauss (1), a paper that has been emphasized as a model as it relates to CAM and immunology and evidence-based analyses (2). For the following analysis exemplifying the benefit of sufficiently supported CAM approaches to clinical problems, please permit me to focus on clinical analyses published by members of the Editorial Board. These are not meant to be exclusive, nor do I intend to neglect others, but with limited space I am compelled to be brief. In fact, I hope that this discussion will inspire and stimulate us, despite our busy schedules, to take a look every month at what papers are cited. As my recollection goes, those that are mentioned in the top-50 cited papers on this current list of June 1, 2009 have already regularly appeared earlier. One can easily scroll down after accessing any one of the 50 to determine which journals have cited the paper. Even more interesting, OUP provides another service, the possibility to send e-letters that reveal all sorts of opinions from readers. As an example of what is of interest, readers are invited to view and to see what has been published and that remains on the list of 50. Of that, a total of 16 listed papers are by members of the Editorial Board and they cover a number of subjects: those that clearly constitute basic science and those that represent clinical analyses. In the following, I have chosen to focus on the clinical area of pain and how authors have analyzed it, to illustrate such a wide array of topics of highly-cited studies, both basic and clinical, in one subject area. According to Ma (3), it has long been accepted that acupuncture; that is, puncturing and scraping needles at certain points on the body, can have analgesic, anesthetic, as well as therapeutic use in treating various diseases. Ma underscores the international importance of this therapy that involves the nervous system, neurotransmitters, endogenous substances and Jingluo (meridians), all of which may respond to needling stimulation and electrical acupuncture. There is now an abundance of information related to the neurobiological mechanisms of acupuncture, with respect to both neural pathways and neurotransmitters/hormonal factors that mediate autonomic regulation, pain relief and other therapeutics. From early works we understand that the analgesic effects of For reprints and all correspondence: Edwin L. Cooper, Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA 90095-1763, USA. eCAM 2009;6(3)279–281 doi:10.1093/ecam/nep099