After more than two decades in emergency medicine and having published hundreds of academic papers, I’ve seen firsthand how the medical establishment evaluates scientific evidence.
Now, as I transition into delivering care as an integrative medicine physician (our practice is in Tyson’s Corner, Virginia), I am faced with a fundamental tension: the most effective treatment for an individual patient may also be one that has yet to meet the double-blind, randomized control trial “gold standard” that we might expect in conventional medicine.
However, what’s clear is that more and more patients are embracing integrative therapies, especially for weight loss and chronic conditions like Hashimoto’s disease or SIBO. Today, nearly one in three Americans use some kind of integrative therapy, often combining conventional medicine with evidence-based approaches like acupuncture, herbal supplements, yoga, and mindfulness.
Yet some in the scientific and medical communities remain skeptical about whether integrative treatments are effective. The most common concern is that the research supporting integrative medicine is not as rigorous as that behind conventional treatments.
Why is that the case?
Here are six reasons why studies in integrative medicine often appear less rigorous, and how to think about that as a patient being treated by an integrative medicine physician.
1. There Is Limited Funding and Infrastructure For Integrative Medicine Research
Research in conventional medicine is largely funded by pharmaceutical companies, major health systems, or large federal grants. Many of these funders have a financial stake in showing a specific drug or device is effective, and they have the resources to fund gold-standard randomized controlled trials (RCTs).
Integrative medicine research, by contrast, lacks the same financial backing. Nor does it have the same infrastructure, including research centers with health systems. Many integrative treatments—like yoga, massage, turmeric, or supplements—can’t be patented. That makes them commercially less attractive and leaves researchers reliant on government grants (such as those from the National Center for Complementary and Integrative Health), private donors, or academic institutions to back. The lack of large profits to be made if integrative treatments prove beneficial limits the size, scope, and often the design quality of studies.
2. Integrative Medicine Interventions Are Heterogeneous
One of integrative medicine’s greatest strengths—its personalized, whole-person approach—is also a challenge for researchers.
Unlike a blood pressure drug that comes in fixed doses, integrative treatments are often multi-component and tailored to individuals. A patient receiving integrative care for chronic pain might receive acupuncture, dietary changes, a mindfulness program, and supplements—all at once. For a researcher, it is difficult to study the effectiveness of multi-component interventions.
This complexity makes designing clean, controlled studies difficult to implement. Researchers wrestle with evaluating a specific component or whether it’s synergistic effect of a broader approach.
3. Integrative Medicine Has Blinding and Placebo Control Challenges
The gold standard for clinical trials is double-blind placebo-controlled design, where neither patient nor the clinician knows who is getting the active treatment.
That’s feasible when you’re comparing a potential drug treatment such as a pill to a placebo. But how do you offer a “sham” a yoga class as a control? Or blind a participant to whether they’re receiving acupuncture?
Researchers have attempted clever workarounds—like superficial needle insertion for “placebo” acupuncture—but this doesn’t fully eliminate confounding. When patients know (or suspect) they’re receiving a real treatment, it can enhance the placebo effect and complicate the interpretation of study findings.
Blinding and controlling for the placebo effect is harder—and sometimes impossible—in integrative medicine trials.
4. Publication Is Challenging, And Integrative Medicine Journals Are Lower Quality
While many excellent studies in integrative medicine exist, they’re often published in lower-impact journals. That’s not necessarily because the research is poorer—it’s because many top-tier medical journals are reluctant to publish studies on acupuncture or herbal medicine unless the findings are especially groundbreaking.
The issue is that lower-impact journals tend to have a less stringent peer review processes, sometimes allowing lower-quality studies to slip through. But even when a rigorous study is conducted, it may not be published in a place where it gains attention or credibility. This dynamic reinforces the perception that integrative medicine lacks strong evidence.
5. Integrative Medicine Research Commonly Uses Subjective Outcomes
Many studies in functional or integrative medicine focus on outcomes like pain, stress, anxiety, fatigue, or overall well-being. These are valuable to patients, but they’re subjective and sometimes inherently difficult to measure.
Self-reported outcomes are also more susceptible to bias, including the placebo effect, social desirability bias, and recall errors. In conventional drug trials, researchers often rely on objective biomarkers or clinical endpoints (like reducing cholesterol levels or whether someone had a stroke).
In contrast, in integrative studies, subjective experiences are often the main (or only) outcomes—making the results more vulnerable to skepticism by scientists. Yet, one could argue that in many chronic conditions, subjective outcomes are exactly what matter most to patients.
6. There Is Scientific and Institutional Bias Against Integrative Medicine
There is a culture of bias against complementary therapies within academic medicine. Many researchers, journal editors, and clinicians were trained in conventional biomedical paradigms and remain skeptical of integrative approaches. Some see integrative therapies as fringe, unscientific, or based on cultural traditions rather than molecular biology.
This bias can lead to publication bias (positive studies are more likely to be published than negative ones) or dismissal of promising early findings before they’re fully investigated. Early-career researchers may avoid integrative medicine topics entirely out of fear that it will harm their credibility or tenure prospects. Ironically, this skepticism reinforces the very research gaps that critics point to.
The Implications For Integrative Medicine Researchers
None of this means integrative medicine is inherently ineffective—or that it can’t be studied rigorously. But it does mean we need to evolve how we evaluate these therapies.
Promising developments are already underway. Pragmatic trials, which assess real-world effectiveness rather than idealized efficacy, are increasingly used in integrative research. Mixed-methods studies combine quantitative outcomes with rich qualitative insights.
Still, the path forward requires both investment and open-mindedness. Patients want—and deserve—care that honors both the science and the art of healing. For that to happen, integrative medicine research must continue to grow—not just in volume, but in quality, nuance, and credibility.
What This Means For Integrative Medicine Patients
For patients, the less rigorous evidence base in integrative medicine means a greater burden of discernment. While many integrative therapies can be helpful—especially for managing chronic pain, stress, fatigue, or insomnia—patients often must make decisions without the same level of clarity or scientific consensus that exists for conventional treatments. That doesn’t mean these therapies aren’t effective; it just means that in some cases, the science may not have caught up.
Nevertheless, patients should ask their clinicians about the evidence, safety, and possible interactions of any integrative approach they’re considering, especially if they’re also taking prescription medications. It also means patients should be wary of overpromising, especially when integrative therapies are promoted as highly effective without adequate scientific backing. At the same time, a lack of perfect evidence shouldn’t automatically disqualify therapies that have strong safety profiles and anecdotal support. Ideally, patients should work with providers trained in evidence-informed integrative care, who can help balance clinical experience, patient values, and the best available research.