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Integrative medicine: more than the promotion of unproven treatments?

Edzard Ernst
Med J Aust 2016; 204 (5): 174. || doi: 10.5694/mja15.01239
Published online: 21 March 2016

It would seem not …

Any uninitiated observer could be forgiven for being confused. First, alternative medicine became complementary medicine, and now it seems to have morphed into integrative (or integrated) medicine. Proponents of this form of health care are adamant that these terms are not synonymous, but is that true?

The best of both worlds

Integrative medicine made its debut in the mid-1990s with the slogan “the best of both worlds”.1 A 2001 editorial in the British Medical Journal stated that “Integrated medicine (or integrative medicine as it is referred to in the United States) is practising medicine in a way that selectively incorporates elements of complementary and alternative medicine into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and treatment.”1 The United States Academic Consortium for Integrative Medicine and Health and others have modified such descriptions, stressing that the modalities used must be “informed by evidence”.2 But why only “informed by” and not “based on” evidence? Have the advocates of integrative medicine perhaps realised that, in the latter case, the term would be synonymous with “evidence-based medicine” and thus largely superfluous?

Holistic medicine

Integrative medicine is said to be more than just the best of both worlds; it “has a larger meaning and mission, its focus being on health and healing rather than disease and treatment. It views patients as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment. It also involves patients and doctors working to maintain health by paying attention to lifestyle factors such as diet, exercise, quality of rest and sleep, and the nature of relationships.”1 Such words sound politically correct, but do they make sense? Holism, attention to lifestyle, disease prevention, empathetic doctor–patient relationships, and whatever else we might find on the banner of integrative medicine, are important features of any type of good medicine.3 If they are neglected in conventional medicine, we should reform our current health care. Creating a new branch of medicine is no solution because it can only distract from this important task. Delegating core values, such as holism, to integrative health care professionals seems divisive and counterproductive.

The reality

It has been claimed that integrative medicine is merely a rebranding exercise for alternative medicine,4 and a critical assessment of the treatments that integrative clinics currently offer confirms this suspicion. The vast majority of such establishments advertise alternative therapies that lack a solid evidence base. Many of them offer homeopathy, for instance, about which the National Health and Medical Research Council recently concluded that: “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.”5 Promoting such questionable therapies under the guise of integrative medicine seems neither ethical nor in line with the currently accepted standards of evidence-based practice.

Conclusion

Integrative medicine is an ill-conceived concept which turns out to be largely about the promotion and use of unproven or disproven therapies. It thus is in conflict with the principles of both evidence-based medicine and medical ethics.


Provenance: Commissioned; externally peer reviewed.

  • Edzard Ernst

  • University of Exeter, Exeter, UK

Correspondence: E.Ernst@exeter.ac.uk

Competing interests:

No relevant disclosures.

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access_time 06:42, 21 March 2016
edzard ernst

There is more detail about the issues discussed here on my blog: http://edzardernst.com/2016/03/is-the-society-for-integrative-oncology-guilty-of-fraud-or-scientific-misconduct/

Competing Interests: No relevant disclosures

Prof edzard ernst
university of exeter

access_time 12:54, 22 March 2016
Paul Stevens

Prof. Ernst is correct that medicine needs a radical overhaul, however he misunderstands the nature of true integrative medicine, for it is ontology that drives Dr’s and patients to seek more than what orthodoxy offers, not pseudoscience. It is clear that conflicts of interest re. actual evidence exist in all areas of therapeutics - pharmaceuticals, complementary medicines or claims about foods, however true integrative medicine is systems based in both assessment and treatment, and should not be based on product claims or faith based rationale.

Science is revealing causative functional-systems interconnectedness in chronic disease (e.g the role of the enteric-immune-metabolic-brain axis) in conditions including Chronic pain, Depression, CVD, Diabetes and OA, yet the old pathology based mindset persists in medical training and practice, reflected in the failure of orthodox therapeutics to markedly alter morbidity statistics in many cases (e.g opioids for chronic pain).

Integrative Drs are misrepresenting progressive medicine by including modalities such as homeopathy or pseudoscientific based laboratory tests, yet orthodoxy should no longer recommend antibiotics for URTI’s but continues to do so at ground zero. Perhaps a dissertation of the failure of orthodox medicine to stem the use of early childhood broad spectrum antibiotics (now known to be a major driver of childhood obesity as a result of research into the microbiome), would have been a just as valuable discussion.

Integrative medicine practitioners are not the sole practitioners utilising nutritional and lifestyle medicine, nor should they be, however they have evolved from the almost complete disinterest and neglect that conventional medicine shows to patients in managing anthropogenic lifestyle factors as the primary focus in treatment, underpinned by an almost total lack of medical education in the nutritional sciences, including any pre-pathological functional systems based understanding of illness.

Key factors like the microbiome, subtle chronic metabolic inflammation, conditional nutritional deficiencies, the effects of chronic stress on chronic inflammation, efficiency of mitochondrial function or DNA repair including telomeres, the antiinflammatory Mediterranean or Okinawan diets, or the physiological effects of mindfulness meditation, are neither pseudoscientific or without evidence, however they are simply what orthodoxy rails against, which is progress and flexible systems based thinking.

Competing Interests: No relevant disclosures

Dr Paul Stevens
Victoria University

access_time 05:14, 29 March 2016
Kylie O'Brien

Prof Ernst has chosen a narrow definition of Integrative Medicine (IM). Agreed, attention to lifestyle, disease prevention etc should be features of conventional medicine, but largely they are not with short consultation times and a focus on pharmaceuticals contributing to this. A better definition of IM is that which combines conventional western medicine with evidence-based complementary medicine, which includes nutritional, mind-body medicine and lifestyle approaches, as well as traditional medicines, for the best outcomes in the prevention and treatment of disease. This definition is not in conflict with evidence-based medicine and medical ethics. In fact, there is a serious question of whether conventional doctors are acting ethically if they are not discussing other options with their patients, including complementary therapies.
There is enough research now to clearly indicate that factors such as poor diet, stress, lack of exercise and lack of exposure to sunlight can all negatively impact on health. Stress and poor diet affects the gut microbiome and immune systems negatively and can lead to inflammation, known to underpin a plethora of chronic diseases including diabetes, cardiovascular disease and cancer. There is ample scientific evidence that many complementary medicines are able to assist patients in lowering their stress, changing the gut microbiome, and interrupting various pathways associated with chronic illness like cancer.
The public are voting with their feet, and they are defining what health means to them. Progressive universities throughout the world especially in the USA, are embracing integrative medicine to both meet the public demands and equip medical graduates to provide a more complete form of medical care for their patients.
It has always been difficult to change the way medical care is provided however the reality is that integrative medicine with its emphasis on whole person care and healthy lifestyle, is now becoming more accepted and integrated into mainstream medicine. It will become the future for all medicine.

Competing Interests: No relevant disclosures

Assoc Prof Kylie O'Brien
National Institute of Integrative Medicine

access_time 11:23, 1 April 2016
Christopher Corcos

Edzard Ernst's criticisms of integrative medicine exactly fit mainstream medicine as it is currently practiced. Much of that practice, as the author himself acknowledges, is dangerously flawed. Much of that practice "....is an ill-conceived concept which turns out to be largely about the promotion and use of unproven or disproven therapies. It thus is in conflict with the principles of both evidence-based medicine and medical ethics". Anyone who doubts that this critique applies to the practices of most doctors in western cultures at this time, should refer to the writings of one of the world's great, mainstream medical researchers and leader of the Nordic Cochrane Centre, Peter Gotzsche. Cochrane has always been the gold standard of excellence in medical research. We all need to read what Gotzsche has to say in his book "Deadly Medicines and Organised Crime". Again, as Edzard Ernst himself is warning us, none of us can afford to be naive about the bases of our practice, especially the origins and quality of the research we believe in. Another source of reliable reporting on those bases comes from Prof. David Healy, in his book, "Pharmageddon".
People increasingly want all possible contributing factors of their disease to be considered by a well-rounded, skilled and experienced physician who knows what integrative medicine can offer and where allopathic practices are needed. Those people are increasingly bringing their health dollars to those, integrative doctors. That's going to continue until mainstream medicine puts its house in order. That will mean, as a minimum, broadening medical training, curtailing pharmaceutical industry direct and indirect marketing, stopping bullying of holistic and integrative colleagues, educating the public on simple, fundamental health practices and First Doing No Harm.
In the end, that would bring all of us together as Good Doctors in the noble and vital Practice of Medicine, a goal that I'm sure all integrative doctors share with Edzard Ernst.

Competing Interests: No relevant disclosures

Dr Christopher Corcos
Private practice

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