Research data accumulates slowly at best, and the complications of CAM research have slowed the process considerably. Meanwhile, patients are availing themselves of the array of techniques available outside mainstream medicine. Either for fear of alienating their physicians or because they understandably do not trust their doctors' knowledge in this area or for lack of time, many patients do not discuss their extra-medical activities with their physicians. Although there may be legitimate concern for certain drug-herb interactions, CAM interventions are generally low risk. Empirical understanding of CAM mechanisms may lie in the distant future; nonetheless, we can investigate the impact of CAMs on patients' subjective markers such as anxiety, depression and pain. There is already adequate evidence that subjective states can precipitate physiological changes that can influence medical outcomes.

The goals of CAM treatment are primarily to return the system to balance, strengthen immune functioning and support continued well-being. Measures to destroy pathogens may be used as part of a comprehensive care program. Rather than being passively done to the patient, CAM treatment generally involves the patient, empowering him or her to tap inner resources for healing.

Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States-Prevalence, costs, and patterns of use. NEJM 328(4): 246-252 1993.

Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States-Prevalence, costs, and patterns of use. NEJM 328(4): 246-252 1993.

Reiki Research
No large randomized controlled trials (RCTs) focused on the clinical effects of Reiki treatment have been published at this time, and the appropriateness of linear model of RCTs to measure the multifaceted effects of therapies such as Reiki is being debated (Block 2004). Nonetheless, an increasing number of small studies have reported interesting data, and NCCAM currently has five research projects on Reiki.

Studies looking at various biological markers have yielded preliminary evidence that Reiki treatment influences the body toward relaxation and enhanced immune response (Wardell and Engebretson 2001; MacKay, Hansen, McFarlane 2004). Two studies have shown that Reiki can be blinded, which opens the door for more rigorous investigations. One feasibility study demonstrated the possibility of single blinding (Mansour 1999). For the NIH-funded study of Reiki and stroke, I designed the training so that Reiki treatments were double blinded (Shiflett 2002). A program evaluation of a hospital-based HIV First degree Reiki classes showed significant reduction in anxiety and pain after 20 minutes of Reiki treatment. Self-treatment was as effective as treatment received from another student (Miles 2003). Other studies support the usefulness of Reiki to reduce pain, anxiety, and fatigue and improve quality of life (Olson and Hanson 1997; Olson, Hanson, Michaud 2003; Vitale and O’Connor 2006; Tsang and Carlson 2007). Reiki can be used successfully by people with depression to help improve their symptoms and maintain the improvement over time (Shore 2004). Clearly more research is needed.

Professionals and patients who have seen Reiki successfully used to support conventional medical treatment are encouraged to write case reports. Well documented accounts are instructive to those who want to include Reiki treatment in a comprehensive health care regime aimed at either maintaining well-being or managing disease. (Guidelines for writing a medically credible case report are given in "The Bridge to Conventional Medicine: A Call for Reiki Case Reports," originally published in Reiki Magazine International and available at www.ReikiInmedicine.org under References and Resources/Articles)