CAM, eCAM, Bioprospecting: The 21st Century Pyramid

Pyramids touch us in many ways. According to a popular definition which most of us will understand, a pyramid is a stone structure with a flat (usually) square base and with sloping sides that meet at the top, especially built by the ancient Egyptians as a tomb or by the Aztecs and Mayas as a platform for a temple, raised for edification. Then there are food pyramids that propose to solve the obesity epidemic. How does such a definition fit within the confines of complementary and alternative medicine (CAM), eCAM and bioprospecting? What is more, how do we move the ancient and familiar definition to signify the 21st century pyramid and one that is relevant to CAM? At the moment, I do not yet have data on the ancient practices of the Egyptians nor the Aztecs and Mayas as their approaches relate to CAM or to eCAM. We do know about historical practices of similar ages in history from Japan and Taiwan, just to cite two recent examples of rigorous presentations (1,2). The relevant CAM pyramid that I will detail could continue to be a hard impenetrable structure unless we are willing to in effect dismantle it, to deconstruct it from bottom up from those points that gird it to unfavorable approaches that are less acceptable in the evidence-based approach to CAM. A pyramid has recently been published in Nature Immunology entitled: ‘Complementary and alternative medicine: assessing the evidence for immunological benefits’ (3). In this pyramid, there is a hierarchy of evidence. Information regarding the efficacy and safety of any clinical approach, including those of CAM, spans a continuum that ranges at the base all the way to the peak or the pyramid’s point, from anecdotes and retrospective studies to small randomized, controlled trials (phase II clinical trials) and large randomized, controlled trials (phase III clinical trials). In my opinion, this paper and its contents, and the pyramid represent a seminal tribute to the role of the immune system in CAM.