There are numerous issues and challenges surrounding Comparative (also often referred to as Alternative, Integrative, Traditional, etc.) medicine in mainstream medicine. Ayurveda, homeopathy, naturopathy, acupuncture, herbal medicine, yoga, etc. The main issues revolve around regulation, efficacy, safety, and reimbursement/insurance coverage.
Regulation and licensing are major aspects when it comes to “evaluating” practitioners as well as assessing evidence-based research regarding comparative medicine. Countries have different standards for regulating these therapies and practitioners compared to those practicing conventional medicine. Arguments often revolve around the lack of scientific evidence showing the efficacy of comparative medicine. Also, not all comparative medicine can be evaluated one way – for example, yoga intervention research is designed differently from evaluating the effectiveness of herbal medicine, which is different from protocols that evaluate the efficacy of acupuncture. Also, yoga is often grouped under a wellness activity and not a medical intervention and therefore does not often fare well in terms of insurance coverage. Though the government and research industries are active in funding research related to comparative medicine, a regulatory framework with standardized scientific standards does not exist for each of the comparative modalities.
Safety is another concern and contention when it comes to comparative medicine. While many of these therapies have long, traditional histories of use, there is a real and perceived lack of scientific evidence to support not just the efficacy but the safety of these modalities. Critical arguments are often based on putting comparative medicine through rigorous scientific testing and research-based scrutiny. Relatedly, these therapies should not be referred to as ‘medicine’ as they do not fall under conventional, Western medicine. Supporters on the other hand argue that since traditional knowledge has been practiced for thousands of years qualitative assessments such as patient testimonials serve as sufficient proof for the efficacy and safety of these modalities. Insurance coverage and reimbursement for non-Western modalities are limited and a political issue. Currently, comparative therapies aren’t usually covered by insurance companies. This is the case around the world, though some therapies occasionally receive health insurance coverage. Chiropractic care is covered by some health insurance plans and conditions such as neck and back pain or specific types of injuries might be covered, though coverage varies. Naturopathic medicine is also covered in some cases where patients could get consultations and nutrition-dietary advice from practitioners. Herbal supplements might also be covered by some plans but more often not. Homeopathy and Ayurveda have limited coverage through private insurance plans which might offer plans to cover treatments prescribed by qualified and certified practitioners for specific conditions.
Some countries do provide coverage for non-biomedical therapies but usually, patients end up paying out of pocket for these therapies. For example, coverage for yoga is less common as compared to other therapies. If employee benefit plans do offer coverage for yoga, it is essential to be aware of the limitations on the number of sessions or other specific conditions such as pre-existing conditions that play a factor in qualifying for coverage or reimbursement. In case yoga therapy is covered, it usually requires a doctor’s recommendation and a patient has to choose a yoga therapist within the network provider to be accepted by the insurance plan. Some Health Savings Accounts and Flexible Spending Accounts do cover the cost of yoga therapy as these accounts set aside pre-taxed funds for qualified medical expenses. There is little argument that a comprehensive approach to health care is need of the hour. However, the ‘how to’ or the implementation part is still being crafted. There is no consensus on what constitutes comparative medicine, and therefore the issue has not been properly defined yet. Though advocacy and lobbying are ongoing for shaping the politics of comparative medicine, interest groups, and stakeholders exist on both sides of the issue. Other than economics and marketplace demands including insurance companies and health care infrastructure, cultural practices and ground-up patient demands will probably keep driving this issue forward where we might see a viable framework for the true integration of traditional medicine with Western medicine.
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