Why Integrative Medicine will be The medicine of the future!

Integrative medicine got a boost of greater public awareness -- and funding -- after a landmark 1993 study. That study showed that one in three Americans had used an alte
ative therapy, often under the medical radar.
Proponents prefer the term Integrative Medicine or complementary to emphasize that such treatments are used with mainstream medicine, not as replacements or alte
atives.
What makes integrative medicine appealing? Advocates point to deep dissatisfaction with a health care system that often leaves doctors feeling rushed and overwhelmed and patients feeling as if they're nothing more than diseased livers or damaged joints. Integrative medicine seems to promise more time, more attention, and a broader approach to healing -- one that is not based solely on the Western biomedical model, but also draws from other cultures.
Integrative medicine is a neologism coined by practitioners to describe the combination of practices and methods of alte
ative medicine with conventional medicine. Some universities and hospitals have integrative-medicine departments. The term has been popularised by, among others, Dr. Deepak Chopra, and Dr. Andrew Weil . Dr.Weil says that patients should take the Western medicine prescribed by the doctor, and then incorporate alte
ative therapies such as Natural Vitamins, minerals, essential fatty acids, antioxidands, herbs and other “spiritual” strategies.
There is no doubt that modern medicine as it is now practiced needs to improve its relations with patients, and that some of the criticisms leveled against it by people such as Weil -- and by many more within the medical establishment itself -- are valid. There also can be no doubt that a few of the "natural" medicines and healing methods now being used by practitioners of alte
ative medicine will prove, after testing, to be safe and effective. This, after all, has been the way in which many important therapeutic agents and treatments have found their way into standard medical practice in the past. Mainstream medicine should continue to be open to the testing of selected unconventional treatments. In keeping an open mind, however, the medical establishment in this country must not lose its scientific compass or weaken its commitment to rational thought and the rule of evidence.

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. Can there be any reasonable "alte
ative"?

Many people have never heard of integrative medicine, but this holistic movement has left its imprint on many of the nation's hospitals, universities, health care budgets and medical schools worldwide.

Treating the Whole Person

Both doctors and patients alike are bonding with the philosophy of integrative medicine and its whole-person approach -- designed to treat the person, not just the disease.

IM, as it's often called, depends on a partnership between the patient and the doctor, where the goal is to treat the mind, body, and spirit, all at the same time.

While some of the therapies used may be nonconventional, a guiding principle within integrative medicine is to use therapies that have some high-quality evidence to support them.

Conventional and Alte
ative Approaches

The Duke Center for Integrative Medicine is a classic model of integrative care. It combines conventional Western medicine with alte
ative or complementary treatments, such as herbal medicine, acupuncture, massage, biofeedback, yoga, and stress reduction techniques -- all in the effort to treat the whole person. Proponents prefer the term "complementary" to emphasize that such treatments are used with mainstream medicine, not as replacements or alte
atives.

Integrative medicine got a boost of greater public awareness -- and funding -- after a landmark 1993 study. That study showed that one in three Americans had used an alte
ative therapy, often under the medical radar.

In the past decade, integrative medicine centers have opened across the country. According to the American Hospital Association, the percentage of U.S. hospitals that offer complementary therapies has more than doubled in less than a decade, from 8.6% in 1998 to almost 20% in 2004. Another 24% of hospitals said they planned to add complementary therapies in the future. Patients usually pay out of pocket, although some services -- such as nutritional counseling, chiropractic treatments, and biofeedback -- are more likely to be reimbursed by insurance.

The Appeal of Integrative Medicine

What makes integrative medicine appealing? Advocates point to deep dissatisfaction with a health care system that often leaves doctors feeling rushed and overwhelmed and patients feeling as if they're nothing more than diseased livers or damaged joints. Integrative medicine seems to promise more time, more attention, and a broader approach to healing -- one that is not based solely on the Western biomedical model, but also draws from other cultures.

"Patients want to be considered whole human beings in the context of their world," says Esther Ste
berg, MD, a National Institutes of Health senior scientist and author of The Balance Within: The Science Connecting Health and Emotions.

"Physicians and academic researchers finally have the science to understand the connection between the brain and the immune system, emotions and disease," she says. "All of that we can now finally understand in terms of sophisticated biology."

That newfound knowledge may help doctors to see why an integrative approach is important, she says.

"It's no longer considered fringe," Ste
berg says. "Medical students are being taught to think in an integrated way about the patient, and ultimately, that will improve the management of illness at all levels."

The Osher Center for Integrative Medicine at the University of Califo
ia, San Francisco, takes a similarly broad view of health and disease. The center, which includes a patient clinic, says on its web site: "Integrative medicine seeks to incorporate treatment options from conventional and alte
ative approaches, taking into account not only physical symptoms, but also psychological, social and spiritual aspects of health and illness."

To promote integrative medicine at the national level, the Osher Center and Duke have joined with 42 other academic medical centers -- including those at Harvard,Columbia, Georgetown, and the University of Pennsylvania -- to form the Consortium of Academic Health Centers for Integrative Medicine.

Medical Schools and Integrative Medicine

Even medical schools have added courses on nontraditional therapies, although doing so can sometimes be a point of contention among faculty.

At the University of Califo
ia, San Francisco, medical students can augment their coursework in infectious disease and immunology with electives, such as "Herbs and Dietary Supplements" or "Massage and Meditation." They can even opt to study as exchange students at the American College of Traditional Chinese Medicine. In the world of integrative medicine, it's not unusual to see a Western-trained MD who also has credentials in acupuncture or hypnosis, or a registered nurse who is also a yoga teacher and massage therapist.

Many proponents of integrative care say that it's crucial to hold alte
ative therapies up to scientific scrutiny, rather than dismissing them outright, because doctors and patients alike need answers. For example, a patient may be taking an herb that is harmful or may interfere with prescription drugs.

As a result, researchers across the country are studying complementary and alte
ative therapies for safety and effectiveness. Duke is studying whether stress-reduction techniques, such as meditation and writing in a journal, can help prevent preterm labor, which can be precipitated by stress-related hormones. In other clinical trials, researchers are trying to determine, among other things, how acupuncture affects brain activity, how biofeedback can better treat incontinence, and whether the medicinal herb valerian improves sleep in patients with Parkinson's disease.

With the large numbers of people using nontraditional therapies, even finding out what doesn't work can be valuable. For example, researchers affiliated with the Osher Center at the University of Califo
ia, San Francisco, completed a study that showed that saw palmetto did not improve benign prostate hyperplasia, a noncancerous enlargement of the prostate gland. More than 2 million men in the U.S. take saw palmetto as an alte
ative to drugs. The results were published inThe New England journal of Medicine.

Tracy Gaudet, MD, director of the Duke Center for Integrative Medicine, says she encounters little resistance once fellow doctors understand that integrative medicine doesn't entail "blindly advocating for alte
ative approaches and rejecting conventional ones."

I believe that Integrative Medicine is the medicine of the future. It is an idea whose time has come!

Prof. Dr. George Grant, Ph.D., I.M.D.