LIABILITY DISCLAIMER

This site is educational in nature and does not purport to give legal advice or render a legal opinion; although the research herein may help inform legal counsel, it does not substitute for legal advice or compliance.

The Division for Research and Education in Complementary and Integrative Medicine at Harvard Medical School is committed to navigating based on evidence and sound legal/ethical principles so as not to appear to be taking an advocacy posture for one or more specific CAM therapies or for CAM therapies in general. On the other hand, study of health care policy, at the juncture of law, medicine, and ethics (focusing on the domain of CAM therapies), raises novel and important questions about access to and use of health care services historically outside conventional care.

Issues involving CAM therapies ultimately are multidisciplinary and affect not only clinicians, but also various national and international communities invested in scientific research, in legal and regulatory affairs, in commercial health care endeavors, and in resolution of ethical and bioethical issues in health care. Thus, we balance the caution against “advocacy” against the need to protect intellectual freedom and nurture creativity by enriching scientific assessment of therapies with scholarly contribution to relationships between CAM therapies and studies in the humanities. Among other things, we have observed that:

Legislative recognition trumps medical recognition: state legislatures can license providers, and thereby grant citizens access to certain therapies, even if scientific debate has not concluded in favor of those modalities…. This observation, that legal recognition trumps medical recognition, also suggests other interactions between medical/scientific and legal processes. First, legislative (and judicial) processes may override medical opinions regarding the relative efficacy and value of CAM therapies. This will occur in spite of the fact that even credentialed providers can deliver ineffective therapy. Second, in the eyes of clinicians sworn to do no harm, safety trumps efficacy and must be paramount; yet, in the eyes of many health care consumers and their elected representatives, freedom of choice not uncommonly trumps scientific or medical acceptance and/or evidence of safety. Third, while evidence-based conclusions guide medical advice and practice, the perspectives and practices of many CAM providers are based on vitalistic, spiritual and cultural understandings of health and disease, which may thereby influence legislative decisions. Fourth, when a physician refers a patient to (or co-manages the patient with) a licensed CAM provider, increased communication with both the patient and the CAM provider regarding the CAM provider’s qualifications and treatment plan may improve the physician-patient relationship and also decrease the prospect of adverse events and malpractice litigation.

Finally, larger social forces temper and mediate the entire debate. Thus, particular issues -- such as turf battles between professions over scope of practice, reflect larger cultural and political collisions over evolving definitions of mainstream medical care. Such issues also reflect fundamental philosophic questions as to who determines which providers and therapies will be accepted as safe, effective, appropriate and/or reimbursable. Legislative recognition may trump medical recognition; however, scientific evidence ultimately informs both legislative and medical behavior (as well as third-party reimbursement). These "checks and balances" are essential to the ongoing refinement of our medical delivery system.