A position statement written by AETNA health insurance labels equine therapy as experimental. In further elaborating on what constitutes experimental, AETNA continues to say that equine therapy is experimental “because there is insufficient scientific data in the peer reviewed medical literature to support the effectiveness of hippotherapy for the treatment of individuals with these indication,” (referring to those with Cerebal Palsy).
So just what is the difference between experimental and standard treatment? In an article written for HealthAffairs, SJ Reiser (1) outlines two basic principles that separate standard care from experimental care.
The first guideline is that standard care must be certain, meaning that outcomes resulting from this treatment can be said to have a “known effect resulting from definitive experience.” On the other hand, experimental care would produce only “hypothetical or ambiguous” results, according to Reiser.
The second guideline deals with the treatment’s flexibility. Standardized care, Reiser states, can be “shaped to address differences among patients.” Therefore, because standard care is never really delivered in a standard way, as Riser notes, the biological, psychological, cultural, and social uniqueness of patients can be accounted for within the standardized treatment. Experimental treatment, however, typically adheres to a set protocol of delivery that cannot be deviated from in the face of patient differences.
This leads to the question: when does an experimental therapy become standard?
Reiser outlines that there are both clinical and social issues that determine whether or not a treatment can move from experimental to standard and cites the example of electronic fetal monitoring which, “has been widely used in most deliveries, despite the fact that clinical studies show that it is of no benefit in routine deliveries and of only marginal benefit in complicated ones” and explains that the use of this treatment is only to ease legal burdens that could result if the treatment were not used and things were to go awry.
In further answering the question, Reiser illuminates four criteria that help make the decision to allow a treatment to be considered standard. These are: established indications of use, specified outcomes of care, standardized requirements of application, and articulated criteria for learning and certification.
Treatments that have established efficacy in a particular area, are sometimes then applied to similar areas in what is known as “crossover.” Riser mentions that in pediatrics, “drugs are used for “off-label” purposes an estimated 70 percent of the time.” Another example the author shares is in oncology. Because of the dire nature of oncology, Reiser states that “almost 80 percent of drugs are used in this off-label manner when combination regimens are administered, and up to 50 percent with single-dose regimens.”
Given the possible consequences of a “crossover” therapy going wrong, one would wonder why this practice is so rampant. Or even further, why equine therapy, which, although not without some risk, does not carry the same risk as a possible drug allergy or reaction.
But then we must remember that equine therapy has, from the beginning, been categorized as an “alternative” treatment method, akin to chiropractic, massage, homeopathics and acupuncture. Because none of these methods were conceived in the traditional medical model, the same acceptance that may be given to a new drug treatment is not bestowed upon them.
But that reality isn’t so bad either. The National Center for Complementary Medicine, a division of the National Institutes of Health, states that as of 2007, 38% of the population use alternative medicine. And even more promising, the majority of these users are from the higher socioeconomic levels — meaning that they are more likely to be able to afford equine facilitated therapy.
For those who cannot afford to work therapeutically with a horse, many centers certified by the Professional Association of Therapeutic Horsemanship International (formerly NAHRA) offer low cost, or sliding scale fee equine therapy sessions. Even better, many centers are always on the lookout for volunteers. In this way, a person wanting to spend some therapeutic time with a horse, for whom finances are a challenge, can not only be around a horse for free, but can also help another person in need.
1. S J Reiser. Criteria for standard versus experimental therapy. Health Affairs, 13, no. 3 (1994):127-136
Horse photo available from Shutterstock.
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Last reviewed: 9 Feb 2012