1. Fact sheets
The fact sheets in NAFKAM's net lexicon on complementary and alternative medicine (CAM) are based on evidence from recognized, international and independent research databases.
To ensure that research results are referred both correctly as well as understandable, an interdisciplinary team consisting of at least one senior researcher and information specialist at NAFKAM analyzes the evidence before it is reported on the website. Also, the fact sheets are written according to a common template.
The template provides guidelines for which topics shall be covered in the fact sheet, and which sources shall be consulted. Thus, answers to relevant clinical questions are ensured, presented from a common and solid basis.
1.1 Section: Introduction
The introduction of the fact sheet presents the modality by name and a short summary of its main points, aiming to give a quick answer to the question What is it?
1.2 Section: Does it work?
The "Does it work"-section of the fact sheet aims what we can say from science on a summarized level, says about the modality's health-related efficacy.
1.2.1 Databases used
Evidence for efficacy is referred from summarized research published in the following international and independent research databases:
- CAM Cancer (open access worldwide, for cancer-related outcomes)
- The Cochrane Library (subscription required)
- EMBASE (subscription required)
- PubMed (open access in Norway)
- Web of Science (subscription required)
Introductory, the "Does it work"-section also aims to present the provider's explanation of how the modality works (mechanism of action); compared to generally accepted knowledge about the human body, illness and health.
1.2.2 Criteria for inclusion/exclusion of research
When considering evidence for efficacy for a given modality, a fixed procedure is followed:
Evidence must come from systematic reviews (SRs) of randomized controlled trials (RCTs). Also, an SR must comply with evidence level 1a according to the Oxford criteria: This means that the SR must be based on minimum two individual RCTs. In line with the Oxford 1a criteria, the SR does not have to pool/combine the included studies' data into a meta-analysis .
NAFKAMs threshold of SR's guarantee that the research already has been assessed; both their findings of efficacy, their methodological quality (how the research was done) as well as their clinical relevance (if the treatment given in the study, complies with how it is usually given in "real life"). These factors are thus not further evaluated by NAFKAM..
Note: The evidence included, is therapy-oriented, ie. local conditions and the regulation of CAM and official medical treatment ("school medicine") are not taken into account. Thus, an SR may therefore include studies where a treatment was provided by other practitioners than those expected in Norway:
- An example of this could be a study of classical/Swedish massage, where the treatment is performed by a physiotherapist (licensed/ authorized healthcare professional) - not by a massage therapist (non-authorised, CAM practitioner).
- Another example, could be a study of homeopathic treatment, where the remedy given is not approved for sale in Norway.
- The SRs where these studies are featured, would on the basis of the above still be eligible for inclusion into NAFKAMs fact sheets.
Other criteria that the SR must meet for inclusion, is that the SR must be written in English; and the SR must also have a clear conclusion about the therapy's effect; set against - for example - a waiting list, placebo control or the official health care system's standard practise for treating the specific problem.
If the team finds multiple SRs of the research on the same modality for the same outcome, only the latest published (most recent) is included and referred in the fact sheet. This relies on the premise that new SRs build upon the knowledge from older ones.
If no SRs are available or meet these criteria, NAFKAM is unable to refer the research status due to insufficient evidence for whether the modality works or not. Yet, there may be other research available, but none that meet our criteria.
In cases of doubt, the final decision about inclusion/ exclusion of an SR and what NAFKAM can state about efficacy is taken by the senior researcher.
1.3 Section: Is it safe?
The "Is it safe"-section of the fact sheet aims to covers what we can say from science about the safety, risk and adverse effects associated with the modalities. E.g, if it is proven or suspected that a modality causes new symptoms, or alters a medicine's effect.
The information presented in this section is based on information from several levels of evidence, with a wider range of sources; featuring PubMed, Natural Medicines, RELIS (Norway's network of Regional Medicines' Information and Pharmacovigilance Centres), FDA, and the Drugs and Lactation Database (LactMed) as the main sources.
This section also informs of any warnings, advice on usage and the like issued from official authorities about the modality.
A brief description of general advice on safe usage of CAM is also referred in this chapter, with links to further reading on this topic.
1.4 Section: Background
Further information about a modality's origin, historical development, its theory and understanding of illness, health and mechanism of action, and provider's guidelines for administration of the modality is presented in the Background sections.
Areas of outcomes for which the modality is known used from research are referred (though this should not be understood as statements supporting claims of efficacy). Other known names and terms for the modality are also referred.
1.5 Section: Sources & References
In this section, all sources for the fact sheet's information are listed and linked (if possible). The references also indicate when the information was searched for/obtained; as some sources may change its content over time due to updating andrevision.
Thus, this section may contain names of and hyperlinks to CAM entities (providers' associations or individual providers) when such are used as a source for information. This is not be confused with recommendation and/or marketing.
When possible, a subsection "Read more" is added. This aims to suggest further information relevant to the fact sheet's content.
2. Requests (Q&A)
NAFKAM provides answers to questions from patients, health care professionals, CAM providers, media, researchers etc. Answers to questions about the research status for effectiveness and safety regarding CAM modalities are based on searches and systematic reviews found in at least one of the above-mentioned research databases. All answers are quality-checked before it is sent.
All questions received and answers given are anonymised and stored internally; for possible later educational purposes and/ or the website's Q&A-section.
We strongly advise not to email us specific health information, as this is considered highly sensitive information; which in e-mail format can easily go astray. Also, remember that NAFKAM does not offer personal examination nor treatment of patients' health, advice on treatment or help in finding CAM providers.
NB
NAFKAMs procedures as well as the threshold for evidence at systematic reviews, were originally drawn up and decided after discussions with UiT, the Directorate of Health, the Ministry of Health and Care, the (former) Knowledge Center for the Health Service and the Health Library, as well as on input and advice from patient's associations such as the Norwegian Asthma and Allergy Association (NAAF) and the Norwegian Cancer Society.
We are currently restructuring and revising all fact sheets, to make it easier for the public to find relevant content on the website, based on specific outcomes and symptoms. Until this is finished, the fact sheets will vary somewhat in form and content.
The fact sheets are regularly revised, at least every third year for new evidence on efficacy and safety.
