Integrative medicine

Integrative medicine, which is also called integrated medicine and integrative health in the United Kingdom,^[1] combines alternative medicine with evidence-based medicine. Proponents claim that it treats the "whole person," focuses on wellness and health rather than on treating disease, and emphasizes the patient-physician relationship.^[1][2][3][4]

Integrative medicine has been criticized for compromising the effectiveness of mainstream medicine through inclusion of ineffective alternative remedies,^[5] and for claiming it is distinctive in taking a rounded view of a person's health.^[6]

Definition

The Consortium of Academic Health Centers for Integrative Medicine defines it as "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing".^[7] Proponents say integrative medicine is not the same as complementary and alternative medicine^[1][8] nor is it simply the combination of conventional medicine with complementary and alternative medicine.^[2] They say instead that it "emphasizes wellness and healing of the entire person (bio-psycho-socio-spiritual dimensions) as primary goals, drawing on both conventional and CAM approaches in the context of a supportive and effective physician-patient relationship".^[2]

Critics of integrative medicine see it as being synonymous with complementary medicine, or as "woo".^[9] David Gorski has written that the term "integrative medicine" has become the currently preferred term for non-science based medicine.^[10]

History

In the 1990s, physicians in the United States became increasingly interested in integrating alternative approaches into their medical practice, as shown by a 1995 survey in which 80% of family practice physicians expressed an interest in receiving training in acupuncture, hypnotherapy, and massage therapy.^[11] In the mid-1990s hospitals in the United States began opening integrative medicine clinics, which numbered 27 by 2001.^[11] The term "integrative medicine" was increasingly popularized by, among others, Deepak Chopra, Andrew Weil, and Prince Charles.^[12] The Consortium of Academic Health Centers for Integrative Medicine was founded in 1999 and by 2015 included 60 members, such as Johns Hopkins University School of Medicine, Duke University School of Medicine, Georgetown University School of Medicine, and Mayo Clinic. The goal of the Consortium is to advance the practice of integrative medicine by bringing together medical colleges that include integrative medicine in their medical education.^[1][13][14] The American Board of Physician Specialties, which awards board certification to medical doctors in the U.S., announced in June 2013 that in 2014 it would begin accrediting doctors in integrative medicine.^[15]

Impetus

Medical professor John McLachlan has written in the BMJ that the reason for the creation of integrative medicine was as a rebranding exercise, and that the term is a replacement for the increasingly discredited one of "complementary and alternative medicine".^[6] McLachlan writes that it is an "insult" that integrative medical practitioners claim unto themselves the unique distinction of taking into account "their patients' individuality, autonomy, and views", since these are intrinsic aspects of mainstream practice.^[6]

Proponents of integrative medicine say that the impetus for the adoption of integrative medicine stems in part from the fact that an increasing percentage of the population is consulting complementary medicine practitioners. Some medical professionals feel a need to learn more about complementary medicine so they can better advise their patients which treatments may be useful and which are "ridiculous".^[8] In addition, they say that some doctors and patients are unsatisfied with what they perceive as a focus on using pharmaceuticals to treat or suppress a specific disease rather than on helping a patient to become healthy. They take the view that it is important to go beyond the specific complaint and draw upon a combination of conventional and alternative approaches to help create a state of health that is more than the absence of disease.^[2] Proponents further suggest that physicians have become so specialized that their traditional role of comprehensive caregiver who focuses on healing and wellness has been neglected.^[1] In addition, some patients may seek help from outside the medical mainstream for difficult-to-treat clinical conditions, such as fibromyalgia and irritable bowel syndrome.^[1]

Reception

Integrative medicine is sometimes lumped together with alternative medicine, which has received criticism and has been called "snake oil."^[9][16] A primary issue is whether alternative practices have been objectively tested. In a 1998 article in The New Republic, Arnold S. Relman, a former editor of The New England Journal of Medicine stated that "There are not two kinds of medicine, one conventional and the other unconventional, that can be practiced jointly in a new kind of 'integrative medicine.' Nor, as Andrew Weil and his friends also would have us believe, are there two kinds of thinking, or two ways to find out which treatments work and which do not. In the best kind of medical practice, all proposed treatments must be tested objectively. In the end, there will only be treatments that pass that test and those that do not, those that are proven worthwhile and those that are not".^[5]

In order to objectively test alternative medicine treatments, in 1991 the U.S. government established the Office of Alternative Medicine, which in 1998 was re-established as the National Center for Complementary and Alternative Medicine (NCCAM) as one of the National Institutes of Health. However, skeptic Steven Novella, a neurologist at Yale School of Medicine, said that NCCAM's activities are "used to lend an appearance of legitimacy to treatments that are not legitimate".^[9] The NCCAM website states that there is "emerging evidence that some of the perceived benefits are real or meaningful". NCCAM also says that "the scientific evidence is limited" and "In many instances, a lack of reliable data makes it difficult for people to make informed decisions about using integrative health care".^[17]

A 2001 editorial in BMJ said that integrative medicine was less recognized in the UK than in the United States.^[8] The universities of Buckingham and Westminster had offered courses in integrative medicine, for which they were criticized.^[18][19][20] In the UK organizations such as The Prince's Foundation for Integrated Health, The College of Medicine^[21] and The Sunflower Jam^[22] advocate or raise money for integrative medicine.

In 2003 Michael H. Cohen argued that integrative medicine creates a “liability paradox,” in that the greater the cross-disciplinary integration among providers, the greater the risk of shared liability among them; thus, “information sharing may expand liability but ultimately reduce risk to the patient; yet maintaining sharp boundaries between providers may decrease risk of shared liability but ultimately increase risk to the patient.”^[23]

Steven Salzberg has criticized the teaching of integrative medicine in medical schools, especially the inclusion of pseudoscientific subjects such as homeopathy.^[24] In Salzberg's view in offering an integrative medicine course, the University of Maryland Medical School was "mis-training medical students".^[24]

See also

• Disease management (health)
• Personalized medicine
• Wellness (alternative medicine)

References

Further reading

• Hall H (14 December 2010). "Integrative Medicine is the Butt of a Sokal-Type Hoax". Science-Based Medicine. Retrieved April 2014. 
• McCartney M (2011). "The scam of integrative medicine". BMJ 343: d4446. doi:10.1136/bmj.d4446. PMID 21752859.