Complementary and Alternative Medicine: Challenge to eCAM

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eCAM 2006;3(1)1–2
doi:10.1093/ecam/nek019
Editorial
Complementary and Alternative Medicine: Challenge to eCAM
Edwin L. Cooper
Laboratory of Comparative Neuroimmunology, Department of Neurobiology, David Geffen School of
Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095-1763, USA
Our new journal eCAM, Evidenced-based Complementary and
Alternative Medicine has just celebrated a major milestone
since its birth in 2004. Conceived and incubated in Kanazawa,
Japan and born at UCLA, Los Angeles with assistance from
Oxford University Press. With this editorial, we enter our third
volume; eCAM is 2 years old, i.e. two volumes that are hard
copy. Electronic submission and peer reviewing hasten
publication by advance access before the appearance of a
hard copy issue. Although these points may be old news to
some, our international travels have taught us that many
of our potential authors and readers are unaware of these
publication policies and mechanisms. Moreover, it seems not
universally understood that because we are young we are still
waiting for an impact factor. Happily and with relief, we are
on the positive path, having been monitored by PubMed since
volume 1 and recently listed in ISI retroactive to volume 1.
To follow the infant analogy, rather than being the usual asser-
tive 2-year-old whose response is the emphatic ‘no’, eCAM
adopted the more broad yet cautious view and published
what we considered the best of available papers that were
scientific and evidence based; among those, some were
distinctly clinical.
An equally positive and early direction toward scientific
rigor is due to a preponderance of editorial board mem-
bers who are biologists of various specializations, e.g. immu-
nologists, neuroscientists, endocrinologists along with others
who are considered more bona fide classical members of
the community of complementary and alternative care givers.
Yet, with the turn of the New Year and the appearance
of volume 3, we are still grappling with a dearth of
classical CAM papers that are solidly evidenced based. From
conception, I have pondered a solution to this rather unfocused
me
´lange that would not compromise our mission to publish
strong papers that are evidence based. I initiated this quest
in my very first editorial (1) and in several others—
emphasizing the need for rigor, strong science. Like all
growing creatures, we learn, we advance, we learn more and
we advance further ad infinitum. Of course the level and
extent of our growth in any direction will depend upon our
contacts, interested readers, potential authors and a coopera-
tive editorial board and many diligent referees who unselfishly
contribute their valuable time to the review process in order
to publish high quality papers.
We set about in several directions across the wide field
of complementary and alternative medicine. One of our most
enthusiastic forays opened up the untapped resource of natural
products, especially those derived from animals (e.g. sponges,
mollusks and earthworms). This area gained such considerable
attention that we have adopted the term bioprospecting. This
area may seem far from the clinical work implied by the
title of our journal, yet as a biologist I see this as laying the
foundation for new and exciting products that will eventually
make their way into the clinical arena. At the same time,
though, we have kept our commitment to the orientation
of medicine and have included some true clinical papers that
are theoretical (2–5), practical and even some that are based
upon readily applicable and easily recognized animal models
(6,7). Now our journal deems it essential to embark on a
more rigorous and concerted tact broadening our 2 year
attempts to recruit, review and publish high quality papers
that are clinical. This is what was urged in the last editorial
of 2005 (8).
Will our strategy for volume 3 and 2006 be different from
that which generated clinical papers for volumes 1 and 2?
How shall we define acceptable papers that are high quality?
We focused on this concern most recently while in Daegu,
Korea at the International Congress of Oriental Medicine
in October 2005—after administrative and editorial meetings
in Tokyo and later lectures and Editorial Board meeting
For reprints and all correspondence: Edwin L. Cooper, Distinguished
Professor, Laboratory of Comparative Neuroimmunology, Department of
Neurobiology, David Geffen School of Medicine at UCLA, University of
California at Los Angeles, Los Angeles, CA 90095-1763, USA. Tel: þ1-310-
825-9567; Fax: þ1-310-825-2224; E-mail: ecam@mednet.ucla.edu
ÓThe Author (2006). Published by Oxford University Press. All rights reserved.
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in Beijing. Our International Administrator, Patty Willis,
called attention in a report sent to our Editorial Board shortly
thereafter in early November. In this note she mentioned:
‘Our ground-breaking meeting in Korea was a time to reflect
on what we have accomplished as well as look to the years
ahead’. As already mentioned, there has always been a concern
for how to broaden our search to find a way to open eCAM
to more clinical work. During our gathering in Korea with
Korean and Japanese Editorial Board members, we all agreed
that this was an important new direction for the future. We
decided to actively encourage the submission of clinical
work in four different forms: (i) brief case reports; (ii) devel-
oped case reports with detailed, illustrative documentation;
(iii) case reports expanded into hypotheses; and (iv) clinical
studies that have as strong an evidence base as possible are
absolutely essential. As a clinician, you will need to choose
which of these four categories best suits the data you deem
worthy to present.
As clinicians dealing each day with patients, your first con-
cern is naturally ‘if’ something works, not ‘why’ something
works. As I expressed in my last editorial, we are asking you
to be brave, to take the data as far as you can, to ask difficult
questions and even develop hypotheses (Option iii). As has
always been true in the world of knowledge, there are clini-
cians and scientists at this very moment in other parts of the
world who are grappling with the same questions. Perhaps
your experience contains that vital piece of a puzzle needed
halfway across the world or in a hospital across town.
Just as paintings that show as much from the brush strokes
as from what the artist has left blank, be clear in your writing
about what you feel to be missing, about the questions that
remain unanswered. Once you submit your paper, it will go
through a rigorous review before publication. Do not be
discouraged by this process, for the duty of the referees is to
guide you even farther along a more rigorous path. If you are
not in accord with their comments, expand on the reasons
why you disagree. Your paper will be strengthened by the
inclusion of their concerns and your rebuttal.
In 1998, the National Center for Complementary and
Alternative Medicine (NCCAM) was established by the US
Congress at the National Institutes of Health (Bethesda, MD,
USA) to rigorously investigate CAM modalities in order to
determine which are beneficial and worthy of further consid-
eration for mainstream practice. Introduced in my other
editorials because of its clear delineation of what comprises
the evidence base of clinical work, the CAM pyramid of
Goldrosen and Strauss (9) gives order to the array of clinical
articles. Beginning at the base with the least desirable of
approaches such as anecdotes and case studies it reaches up
to the sky with large-scale Phase III trials.
How will we implement this new thrust? We are at work
now with our offices in Tokyo and Oxford to define eCAM’s
rules for publishing clinical papers in the four categories
described earlier. The rules can be quite varied from numbers
of words, figures, etc. Infusing the concept of basic biology,
we could move from a brief observation to a full-fledged study.
Let us see what happens in 2006—our New Year’s challenge.
Let us strive for more relevant and high quality papers that
are clearly clinical. To succeed, we will need the strong
support of our editorial board. Clearly eCAM is our journal
and to achieve this singular and important goal requires the
active collaboration of the editorial board to help us attract
the most exciting clinical work to eCAM from their areas of
influence all over the world.
References
1. Cooper EL. Complementary and alternative medicine, when rigorous, can
be science. Evid Based Complement Alternat Med 2004;1:1–5.
2. Olalde Rangel JA. The systemic medicine theory of living systems and
relevance to CAM: Part I: The theory. Evid Based Complement Alternat
Med 2005;2:13–8.
3. Olalde Rangel JA. The systemic medicine theory of living systems and
relevance to CAM: The theory (Part II). Evid Based Complement Alternat
Med 2005;2:129–37.
4. Olalde Rangel JA. The systemic theory of living systems and relevance to
CAM: the theory (Part III). Evid Based Complement Alternat Med
2005;2:267–75.
5. Olalde Rangel JA, Magarici M, Amendola F, del Castillo O. The systemic
theory of living systems. Part IV: Systemic medicine—The Praxis.
Evid Based Complement Alternat Med 2005;2:429–39.
6. Kiyohara H, Matusumoto T, Yamada H. Combination effects of herbs in
a multi-herbal formula: expression of Juzen-taiho-to’s immuno-modulatory
activity on the intestinal immune system. Evid Based Complement Alternat
Med 2004;1:83–91.
7. Wang XQ, Takahashi T, Zhu SJ, Moriya J, Saegusa S, Yamakawa J, et al.
Effect of Hochu-ekki-to (TJ-41), a Japanese herbal medicine, on daily
activity in a Murine Model of chronic fatigue syndrome. Evid Based
Complement Alternat Med 2004;1:203–6.
8. Cooper EL. eCAM is waiting for eCAM. Evid Based Complement Alternat
Med 2005;2:427–8.
9. Goldrosen MH, Strauss SE. Complementary and alternative medicine:
assessing the evidence for immunological benefits. Nat Rev Immunol
2004;4:912–21.
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