What is integrative medicine?

Integrative medicine (IM) is a medical approach that describes the fusion of the best of conventional medical practices with lifestyle modification to optimize health. Included in this approach are indigenous practices and alternative therapies that have a scientific rationale for use. At the core of the practice is the belief that the body has an innate capacity to heal and that the individual has the power to manage disease and maintain the highest level of wellness.

In many ways what IM aspires to achieve is not new. Doctors and other healthcare practitioners have been talking about diet, exercise, and emotional wellness for years. In today’s healthcare system, however, which generally allows physicians less time for patients, many of these important topics are not being addressed.

What’s novel about IM is the breadth and the depth of the knowledge that forms the foundation of practitioners’ approach. These healthcare professionals provide a wealth of valuable information to patients by researching both lifestyle management topics—including nutrition, exercise, and stress reduction, which become powerful preventive tools—as well as indigenous practices and other nonmedical alternative modalities that can be used alongside conventional care to maximize wellness or manage complicated chronic diseases.

The IM approach1 includes these featured hallmarks:

  • A partnership between patient and practitioner in the healing process
  • Appropriate use of conventional and alternative methods to facilitate the body’s innate healing response
  • Consideration of all factors that influence health, wellness, and disease, including mind, spirit, body, and community
  • A philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically
  • Recognition that good medicine should be based in good science, be inquiry driven, and be open to new paradigms
  • Use of natural, effective, less-invasive interventions whenever possible
  • Use of the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease

A typical IM doctor/patient visit covers a wide variety of topics. It generally opens with the question, “What brings you here today?” Seemingly simple, this approach focuses on the patient’s needs right away. The practitioner spends time listening to the patient describe the issue and how it is affecting her life, thereby learning the full impact of the illness. For the patient, speaking about the issue provides new insights about her own experience.

This dialogue is followed by standard questions regarding screening and preventive testing (mammograms, prostate screenings, colonoscopies, and routine blood work, for example). If these tests have not been conducted, discussion will focus on why there has been a delay and the associated risks of not completing the tests.

Then the assessment broadens, with further questions addressing sleep, degree of stress, quality of social relationships, environmental exposure to toxins, and even community relationships. In essence, the aim of an IM practitioner is to learn who the patient is—in a broad sense—before addressing the disease or making a wellness plan.?Ultimately, proponents of IM assert that their job in this transformative movement will be finished when IM is synonymous with good medicine and the term vanishes altogether.

resources

1. Kligler B and Lee R. Integrative Medicine: Principles for Practice. New York: McGraw-Hill; 2004.

2. What Is Integrative Medicine? WebMD Web site. Available at: http://www.webmd.com/a-to-z-guides/features/alternative-medicine-integrative-medicine?page=3. Accessed June 19, 2010.

Roberta Lee, MD, is author of the book The SuperStress Solution (New York: Random House, 2010) and vice chair of the Department of Integrative Medicine at Beth Israel Medical Center in New York City.

Complementary? Alternative? Integrative? What Do They All Mean?

The National Cancer Institute offers the following definitions for complementary, alternative, and integrative medicine. More information about these topics is available atwww.cancer.gov/cancertopics/thinking-about-CAM.

Complementary medicine is used along with standard medical treatments. For example, acupuncture might be used alongside standard therapy to help with side effects of cancer treatment.

Alternative medicine is used in place of standard medical treatments. For example, a special diet might be used to treat cancer in place of treatment that an oncologist suggests.

Integrative medicine is a total approach to care that involves the patient’s mind, body, and spirit. It combines standard medicine with complementary and alternative practices that have shown the most promise. For example, some people learn to use relaxation as a way to reduce stress during chemotherapy.

Complementary and alternative medicine is any medical system, practice, or product that is not thought of as standard care. Standard medical care is care that is based on scientific evidence. For cancer it includes chemotherapy, radiation, biological therapy, and surgery.

Integrative Medicine

Fills a Growing Need

Initially introduced by Andrew Weil, MD, a Harvard Medical School graduate and expert in indigenous medical systems, formalized training in integrative medicine began in 1997 with the first postdoctoral program in integrative medicine at University of Arizona, where Dr. Weil is executive director. The program has now trained more than 300 physicians and other allied healthcare practitioners and has inspired many other IM programs.

Public demand has been the catalyst for the recent expansion of IM in conventional settings. In 1993 a groundbreaking study from Harvard Medical School documented that one out of three patients was using alternative therapies and 70 percent were not telling their doctors about it. The findings awakened the medical community to the growing gap in knowledge about IM between healthcare providers and the patient population.

Physicians and other healthcare practitioners realized that to be true advocates of health and wellness and to address concerns about the scientific value of complementary therapies, more research into these modalities was needed. The result of this research has been the further development of integrative medicine, combining the best of conventional and complementary medicine in an academic, science-based model.

An ever-growing body of research indicates that many of these alternative and indigenous practices have the potential to improve medical outcomes. Tracy Gaudet, MD, director of the Duke Center for Integrative Medicine and an IM educator, says that she encounters little resistance once fellow doctors understand that integrative medicine doesn’t entail “blindly advocating for alternative approaches and rejecting conventional ones.” Dr. Gaudet says, “That’s not what we’re about. There’s a lot of quackery out there and a lot of dangerous therapies. Our first priority is to guide people away from them. We all want the same thing: the best care for patients.”2

On the national level, medical schools are now incorporating more information in medical school training on nutrition, physical activity, and stress reduction as well as training in self-care and burnout prevention for physicians. In 1999, Dr. Weil helped form a national organization of healthcare institutions for IM known as the Consortium of Academic Health Centers for Integrative Medicine. From its list of 11 founding institutions, the consortium has grown to include 44 member institutions, whose deans have committed to implementing IM training into basic medical school curricula.