Integrative medicine: more than the promotion of unproven treatments?

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.