Not effective. Not cost-effective.

Health and insurance plans usually cover the cost of anti-inflammatory drugs. But what about acupuncture? Should it be an insured benefit? How about chiropractic?  Health insurance providers and medicare programs worldwide are scrutinizing health spending. Devoting dollars to one area (say, hospitals) is effectively a decision not to spend on something else, (perhaps public health programs). All systems, be they public or private, allocate funds in ways to spend money in the most efficient way possible. Thoughtful decisions require a consideration of both benefits and costs. So where does that place complementary and alternative medicine (CAM)?

One of the central tenets of a science-based approach to healthcare is that all health interventions should be evaluated based on a consistent scientific standard. From this perspective, there is no distinct or separate practice of medical care deemed “alternative”, “complementary” or more recently “integrative”. There are only treatments and interventions which have been evaluated and found to be effective, and those that have not. So why concern ourselves with unproven and disproven products and treatments? That these treatments persist is a testament to promoters of CAM who, unable to meet the scientific standard with their products and services, have argued (largely successfully) for different (i.e., lower) standards and special consideration — be it product regulation, like the Natural Health Products Directorate in Canada, or practitioner regulation. But this doesn’t mean that their services will be paid for by health insurace.  In an environment of economic restraint in health spending, promoters recognize that showing economic value of CAM is important. Consequently they use the tools of economics like they use scientific methods and research: to argue a belief, rather than answering a question. That seems to be the case with a recent paper that’s being celebrated by alternative medicine practitioners. Entitled, Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations, it attempts to summarize economic evaluations conducted on CAM treatments. The results of the paper are enlightening – but not in a way the authors intended. Continue reading