Ryan Abbott, MD, JD, MTOM, is Associate Professor of Law at Southwestern Law School and Visiting Assistant Professor of Medicine at the David Geffen School of Medicine at UCLA. This speaker lectured for the UCLA summer course MED 180, "Introduction to Integrative East-West Medicine for Health and Wellness," which took place from June 23-August 1, 2014.
While randomized clinical trials have shown complementary and alternative medicine (CAM) to be more cost effective than conventional treatments – including with training of providers and with drug usage – there is still question over what CAM entails and whether it is worthy of insurance coverage. To address these issues, the National Institutes of Health (NIH) established the National Center for Complementary and Alternative Medicine (NCCAM) in 1998 with the mission of“explor[ing] CAM healing practices in the context of rigorous science, train[ing] CAM researchers, and disseminat[ing] authoritative information to the public, health care professionals, and policy makers.” Subsequently, the NIH has considered renaming this entity the National Center for Research on Complementary and Integrative Health (NCRCI). However, about 20 years later, the name is still being debated, the central concern being that the terms “complementary” and “alternative medicine” are not very definitive.
CAM is considered to be outside the scope of conventional medicine, bringing into question its effectiveness and safety. There is, however, growing support of CAM amongst patients and increasing evidence of its usefulness in medical journals. CAM proponents accordingly argue that insurance needs to cover alternative medicine, particularly under the recent Affordable Care Act (ACA). While the ACA establishes that insurers cannot discriminate against providers acting within the scope of their practice (expansion of a ’95 law), opponents such as insurance companies claim that CAM providers are not necessarily required. States, however, are individually choosing whether to allow treatments such as acupuncture. In addition, there are nuances involved in the regulation of dietary supplements. The increase in dietary supplements allows for a decrease in spending on prescription drugs, a decrease in patent use, and an increase in generic drug usage. However, supplements can contain groups of ingredients that end up correlating with traditional medicinal use; an example of such a drug is Fulyzaq, the second FDA-approved botanical drug, which is a substance derived from the sap of a South American tree. The issues that arise with such drugs are over who has the rights to the monetary rewards and if consent should be obtained from the indigenous tribes and/or countries using these in the scope of traditional medicine.
Thus, while the use of CAM is becoming more popular amongst individuals, issues about its efficacy and regulation are still arising. Incorporating CAM and allopathic medicine aspects through integrative medicine serves as a way to provide a middle ground while still providing the best of preventive care.
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1. Herman PM, Craig, BM, Caspi, O. 2005. Is complementary and alternative medicine (CAM) cost-effective? A systematic review. BMC Complement Altern Med 5: 11.
Lecture summary generated by Harini Kompella, Volunteer Writer, UCLA