Setting an agenda for strengthening the evidence-base for traditional and complementary medicines : perspectives from an expert forum in Australia

Objectives: To explore the challenges regarding evidence and complementary medicine in Australia and identify potential future directions to develop leadership, action and debate. Design: Facilitated discussion among a roundtable of experts to identify and consider the relevant issues and potential actions. Methods: Purposive sampling of 17 expert stakeholders with a variety of experience in the traditional and complementary medicine (T&CM) arena. Thematic analysis of the half-day discussion transcript resulted in a framework for a broad agenda to support the development of appropriate evidence for T&CM. Results: Five key areas (with sub-themes) were identified, forming the backbone of an agenda-setting framework: focus areas; strategies; actions and outputs; barriers; and drivers of change. ‘Focus areas’ encapsulated the main themes and informed all key areas, these were: consumer perspectives and needs; hierarchies of evidence; safety of products, practitioners and practices; modernisation of T&CM; regulation and policy; and evidence-based practice. Two recurring themes informed the framework at multiple levels: the complexity and varied understanding of what is ‘appropriate evidence’ for T&CM; and putting consumers at the centre – to ensure that their needs and safety are prioritised. Lack of resources for undertaking T&CM research necessitates the need to bring together information from multiple sources so that ‘totalities of evidence’ can be assessed to increase the T&CM evidence-base. Doing so requires reassessment of the relative value of traditional forms of evidence and challenges current linear evidence hierarchies that prioritise clinical trials as the ‘gold standard’. Conclusions: This Australian agenda-setting framework for strengthening T&CM evidence requires an interdisciplinary leadership group (including consumer, clinician, academic and industry representatives) to build consensus, foster collaboration, and generate and disseminate information. Prioritising the perspectives and needs of consumers should be a primary focus in taking the ‘strengthening evidence for T&CM’ agenda forward.