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Integrative medicine: What’s that?

Posted on behalf of Roberta Kwok

The US National Academies is hosting a meeting on “integrative medicine” this week, and some scientists are not happy about it.

The meeting, a “Summit on Integrative Medicine and the Health of the Public” held in Washington DC, bills itself as a discussion of “health care that addresses together the mental, emotional, and physical aspects of the healing process”. The academies’ Institute of Medicine organized the summit in partnership with the Bravewell Collaborative, a private philanthropic organization based in Minneapolis, Minnesota.

On the agenda are topics such as social determinants of health, mind-body medicine, and continuous care for chronic disease. “The purpose of the meeting is to discuss alternatives to the current health care system, which anybody would agree is facing a tremendous crisis,” says Ralph Snyderman, a rheumatologist and chancellor emeritus of Duke University in Durham, North Carolina, who chaired the summit planning committee.


But Wallace Sampson, a retired oncologist and professor emeritus at Stanford University in Palo Alto, California, argues that integrative medicine is an “intentional neologism” that has replaced terms like alternative or holistic medicine while still encompassing pseudo-scientific techniques. “They don’t have a basis in science,” he says.

IOM president Harvey Fineberg describes integrative medicine as an approach that brings together physical and mental health, coordinates care across specialties, covers the spectrum from prevention to rehabilitation, and uses a patient-centered philosophy. “The term is almost like a projective psychological test,” he says. “You apply to it the things that you bring to it.” Snyderman gives the example of a cancer patient who might need additional programs such as meditation, acupuncture, and nutritional guidance to cope with the trauma of disease diagnosis and treatment. “If one calls this alternative therapy, so be it, but that’s not the way we look at it,” he says.

Bravewell, which proposed the summit to IOM, also includes treatments such as homeopathy, energy medicine, touch therapy, and prayer on its Web site’s list of “Evidence-Based Therapies Used in Integrative Medicine“.

“I don’t think that Bravewell is passing judgment on what kinds of therapies or modalities might or might not be valid,” said Diane Neimann, executive director of Bravewell, when asked about the list. “We’re interested in consideration of all the evidence-based therapies that would be therapeutic in any situation.” Christy Mack, Bravewell’s president, says the goal of integrative medicine is prevention and behaviour change, incorporating “the interconnection of the mind and the body and the spirit.”

Treatments like homeopathy and touch therapy will not be discussed at the summit, says Snyderman. But Norm Sleep, a National Academy of Sciences member and geophysicist at Stanford, says the IOM’s partnership with Bravewell is an implicit endorsement of Bravewell’s agenda.

The summit does not imply an endorsement, says Fineberg. Homeopathy, energy field, and touch therapies “don’t sound valid on the face of it to me”, he says. Integrative medicine may take a more “open-minded” approach, he says, but it should still be subjected to the same effectiveness and safety standards as other treatments. “The lesson in this is not that one is either blindly accepting or immediately dismissive, but rather that one applies the same standards of logic and evidence across the board,” he says.

Bravewell is a group of philanthropists that supports programs related to integrative medicine. It provides technical assistance to a clinical network of eight medical centers, including centers at Duke University, the University of Maryland, and the University of California, San Francisco. Bravewell was the principal funder for the summit, says Fineberg.

Comments

  1. Report this comment

    Peter Gold said:

    Ah – the endless bashing of homeopathy. All while ignoring the fact that there are hundreds of high quality, peer reviewed basic science, pre-clinical and clinical studies showing the system works – not to mention the 10s of million of patients who use the system around the world because it works.

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    Dana Ullman, MPH said:

    As someone who is attending this Summit, I can tell you that the agenda has included a wide variety of conventional and non-conventional therapeutic modalities. Speakers and participants honestly acknowledge that conventional medicine is very often not evidence-based, while there is a growing body of basic science and clinical evidence that many non-conventional methods have biological effects and cllinical relevance.

    As for homeopathy, there is a much greater body of clinical evidence than most ill-informed and uinformed people realize.

    It is time to put aside “medical partisianship” just as President Obama is trying to move beyond political partisanship. It is time for us to take the BEST of conventional medicine and the BEST of the old and emerging presently non-conventional disciplines to create a comprehensive system of health.

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    James Pannozzi said:

    Both Peter Gold and Dana Ullman are quite correct – there has been unceasing attacks against Homeopathy for over a decade, probably indicative of growing desperation by its enemies as it quietly becomes more and more established. Dana says it best:

    “It is time to put aside “medical partisianship” just as President Obama is trying to move beyond political partisanship. It is time for us to take the BEST of conventional medicine and the BEST of the old and emerging presently non-conventional disciplines to create a comprehensive system of health."

    I will add that the solution to our present broken health care system, which has left 45 million Americans with no health care coverage at all, may very well involve the necessity of making the integration of which he speaks.

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    David Colquhoun said:

    What on earth is this doing on a Nature site?

    Nature (I believe) is about science.

    “Integrative medicine” is a not-very-subtle euphemism which is designed to promote the profitable business of mystical quackery.

    From the European pont of view, the US health system does indeed look rather broken. Allowing the anti-scientific and profiteering alternative medicine business into it can only break it further.

    You can hear some of it straight from the horse’s mouth in Integrative Baloney @ Yale http://www.youtube.com/watch?v=X2WF8ovmyfg

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