The Integrator Blog
Share |
Contact Me, Experience, Mission, Sabbatical in Central America, plus
Editorial Advisory Board
Michael Levin
Taylor Walsh
background resources in PDF
Insurance, Integrative Clinics, Industry Summit Reports, News Files '99-'04
some organization links
Professions, Academia, Research, Policy
some CAM/IM publication links
Electronic, Peer-Reviewed, Blogs, More
Bradly Jacobs, MD, MPH, Revolution Health Blog
supported conference
Institute for Health & Productivity Management - Integrative/Complementary Healthcare
Economist Patricia Herman: The Top 9 CAM Therapies with High Quality Evidence of Cost Savings PDF Print E-mail
Written by John Weeks   

Herman's Systematic Review Yields Top 9 Therapies/21 Conditions with High Quality Evidence of Cost Savings from CAM

Summary: Preliminary results of a systematic review of approximately 6600 articles so far found 256 with CAM economic evaluations. Forty-eight were deemed "high quality," with comparisons available. These yielded 9 therapies and 21 conditions where complementary and alternative medicine has generated evidence of not merely cost-effectiveness but of cost-savings. So reports the professional who is emerging as the leading North American voice on CAM costs, economist-practitioner-researcher Patricia Herman, ND, MS, PhD. Herman co-authored the paper on the economics of integrative medicine for the recent Institute of Medicine Summit on Integrative Medicine and the Health of the Public. She reported findings from her 80% complete systematic review of over 8,000 references at the August 2009 convention of the American Association of Naturopathic Physicians. Here are Herman's top 9 therapies and 21 conditions.   
Send your comments to
for inclusion in a future Integrator.

Systematic review yields evidence of cost-savings from CAM
The most critical piece of the puzzle needed for the uptake of more complementary and integrative practices into mainstream payment and delivery is quality evidence of cost-savings. Particularly in economic downturn, evidence of efficacy and even effectiveness are not enough.

So it was particularly intriguing to see a presentation entitled "Systematic Review of Economic Evaluations: Can CAM be Cost Saving?" at the August 19-22, 2009 convention of the American Association of Naturopathic Physicians (AANP). The presentation was by a professional whose background is rare for a professional in any healthcare field. The resume could be one-of-a-kind in integrative practice. Patricia Herman, ND, MS, PhD was a resource economist working for North American utilities on early green energy projects in her first profession before entering studies to become a licensed naturopathic physician. Herman subsequently completed two research fellowships on CAM economics funded by the NIH National Center for Complementary and Alternative Medicine.

Patricia Herman, ND, MS, PhD - economist, researcher, practitioner
Herman's work has become increasingly visible, and respected, this year. With Kenneth Pelletier, PhD, MD(hc), and others Herman co-authored the paper on the economics of integrative medicine for the Institute of Medicine Summit. Attendees at the May 2009 North American Research Conference on Complementary and Integrative Medicine heard her work called out and honored from the podium of the final plenary session by economist and keynoter Dean Jamison, PhD.
She offered economic insights as a participant on three panels and posters at the conference. 

Characteristics of the search and review

Herman, who has previously reviewed evidence of CAM costs but not from this broad and inclusive a set of studies, independently took on this exhaustive review as part of a paper in preparation with Harvard Medical School's David Eisenberg, MD. Her review included 34 search terms for CAM and 16 search terms for economics. She explored all available years in 6 databases. The searches yielded roughly 8000 references, which Herman is painstakingly examining. When completed the work will be be definitive for the field. Herman plans to continue updating it.

At the AANP, Herman reported completed analysis of 6600 of these articles, a work 82% complete. From these she found 256 CAM economic evaluations, 185 of which were published in the last 10 years. Herman caveated her presentation by underscoring that the findings remain preliminary in two ways. She has not only not completed the review, she hasn't yet satisfied herself with enough of a detailed review of some studies.

Herman's Top 9 Therapies/21 Conditions
with High Quality Evidence of Cost-Savings

 9 Therapies

21 Conditions

  Low back pain, oocyte removal, migraine
and symptoms after transurethral resection
of the prostate (TURP)


Back pain, neck pain, lumbar disc
herniation, 'non-surgical' M/S

(omega 3, arginine,

  Gastrointestinal surgery

  Lymph node resection and adhesive


  "Functional disorders," e.g. irritable
bowel syndrome (IBS) and
temporomandibular disorders (TMD)

Guided imagery and
relaxation therapy

  Cardiac surgery and post myocardial
infarction patients

  Large core needle breast biopsy

Basic body awareness
therapy (*)

  Psychiatric disorders
 Moist burn ointment (^)

  Partial-thickness burns <40% of
the body

(*) Includes mindfulness, Tai chi.
(^) Beta-sitosterol, berberine, other herbs

Herman reports that in the last decade there have been 48 "high quality" studies for which comparison is possible, that meet the criteria of being prospective, randomized and also show effectiveness of the CAM therapy. Of these, 21 (44%) showed cost-savings and another 20 showed the CAM intervention to be "cost-effective." The table above shows the 9 CAM approaches which were found to be cost-saving based on these high-quality studies. 

Herman concluded her slide presentation with a word to both payers and to researchers. To the former she says, bluntly: "It's quite possible for CAM to reduce costs." To researchers, Herman suggests a shift in practices: enter directly into testing effectiveness, and when you do, "try to also capture both cost of treatment and cost offsets."

Comment:  Responding to patient interest in "CAM" may be an insurer's modus operandi in flush times when companies are feeling flush and may be competing for workers. In an economic down-turn, with cash tight, neither patient interest nor evidence of efficacy, and perhaps not even effectiveness, are likely to move the payer. Evidence of cost savings may be the only leverage for gaining inclusion.

Herman's emerging work is a major contribution to the field. I look forward to the formal paper, and to the potential of having this regularly updated database available going forward. That way we can all be loaded for bear in forging the dialogue for inclusion.

Send your comments to
for inclusion in a future Integrator.

< Prev   Next >
Integrative Practitioner
The Westreich Foundation
voluntary contributions
Support the work!
All Integrator Round-ups
Integrator Top 10 Lists 2006-2015
Issues #140-#142 Oct-Dec 2015
Issues #137-#139 July-Sept 2015
Issues #134-#136 April-June 2015
Issues #131-#133 Jan-March 2015
Issues #127-#130 Sept-Dec 2014
Issues #123-#126 May-Aug 2014
Issues#119-#122 Jan-April 2014
Issues #116-#118 - Oct-Dec 2013
Issues #113-#115 July-Sept 2013
Issues #110-#112 April-June 2013
Issues #108-#109 Jan-March 2013
Issue #105-#107 Oct-Dec 2012
Issues #102-#104 - July-Sept 2012
Issues #99-#101 - April-June 2012
Issues #96-#98-Jan-March 2012
Issues #94-#95 Nov-Dec 2011
Issues #92-#93 Sept-Oct 2011
Issues #90 and #91 - July-Aug 2011
Issues #88 and #89 - May-June 2011
Issues #86 and #87 - March-April 2011
Issues #84 and #85 - Jan-Feb 2011
Issues #82 and #83 - Nov-Dec 2010
Issues #80 & #81 - Sept Oct 2010
Issues #78 & #79 - July August 2010
Issues #76 & #77 - May June 2010
Issues #74 & #75 - March-April 2010
Issues #73 & #73 - Jan-Feb 2010
Issues #69, #70 & #71 - Nov-Dec 2009
Issues #67 and #68 - Sept-Oct 2009
Issues #65 and #66 - July-August 2009
Issues #63-#64 - May-June 2009
Issues #60-#62 - March-April 2009
Issues #57-#59 - Jan-Feb 2009
Issues #55-#56 - Nov-Dec 2008
Issues #51-#54 - Sept-Oct 2008
Issues #47-#50 - July-August 2008
Issues #46 & -#47 - May-June 2008
Issues #43-#45 Mar-April 2008
Issues #41 & #42 - Feb 2008
Issues #39 & #40 - Dec-Jan '08
Issues #37 & #38 - Nov 2007
Issues #35 & #36 - Oct 2007
Issues #33 & #34 - Sept 2007
Issues #30-#32 - July-Aug 2007
Issues #28 & #29 - June 2007
Issues #26 and #27 - May 2007
Issue #25 - April 2007
Issues # 23 & #24 - March 2007
Issues #21 and #22 - Feb 2007
Issues #19 and & 20 - Jan 2007
Issues #17 and #18 - Dec 2006
Issues #15 and #16 - Nov 2006
Issues #13 and #14 - Oct 2006
Issues #11 and #12- Sept 2006
Issues #9 and #10 - Aug 2006
Issues #7 and #8 - July 2006
Issues #5 and #6 - June 2006
Issues #3 and #4 - May 2006
Issues #1 and #2 - April 2006
All Articles by Subject: 2006
All Articles by Subject: Jan-June 2007
IAYT-Sponsored Series on the Future of Yoga Therapy