Integrated medicine

Abstract

Integrated (or integrative) medicine has become a popular concept, at least amongst proponents of alternative therapies. It has been defined as ‘medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence and makes use of all appropriate therapeutic approaches, health care professionals and disciplines (conventional and complementary) to achieve optimal health and healing’ [1]. This and other definitions [2] are sound promising, but they do not tell us what modalities might be included under this umbrella. To find out, we have several options. We can, for instance, search the internet, where we find any manner of unproven treatments, even outright quackery, associated with integrated medicine [3]. But it might be unfair to judge this field by its associations in a commercial environment. Perhaps, it is more objective to define integrative medicine through an analysis of the contents of recently published books on this subject. Table 1 lists the therapies which were discussed in detail in six recent books on the subject [4-9]. Based on these data, integrated medicine covers a wide range of therapies. Unanimous agreement amongst the authors of these books seems to exist that it includes the following modalities: acupuncture, herbal medicine, homeopathy, massage and osteopathy. Most of the books would furthermore include biofeedback, chiropractic, hypnotherapy, meditation and naturopathy. For all other treatments, no clear consensus emerges. With the exceptions of counselling, exercise, massage (in European countries), nutritional therapies, psychotherapy, spinal cord stimulation and vitamins, the listed therapies are all nonorthodox (Table 1). For most of them, the evidence base is less than solid [10]. Prime examples of unproven or disproven treatments include homeopathy [11], prayer [12], reflexology [13] and spiritual healing [14]. Another option to describe the nature of integrated medicine might be to evaluate the abstracts of an academic conference on this topic. The third ‘European Congress of Integrated Medicine’ took place on 3–4 December 2010 in Berlin. I categorized its 222 abstracts[15] according to subject areas, whenever possible, attributing one therapeutic technique to each abstract. There were several general abstracts, e.g., surveys (such as ‘Complementary medicine use in XY’) and abstracts with disease-specific topics (e.g. ‘Integrative medicine approach for neuropathic pain’). None of them were linked to a specific intervention. Acupuncture (n = 21), homeopathy (n = 20), anthroposophic medicine (n = 14) and herbal medicine (n = 14) stood out as the most frequent therapies. They were followed by Traditional Chinese Medicine (n = 8), mind–body therapies (n = 5), Ayurveda (n = 5), placebo (n = 5), massage (n = 4), diet (n = 3) and spiritual interventions (n = 3). Two abstracts each related to art therapy, hypnotherapy, kinesiology and nonherbal supplements. One abstract each related to aromatherapy, Bach flower remedies, the Balint approach, bioresonance, chiropractic, cupping, dance therapy, electrotherapy, fasting, honey, leeches, music therapy, naturotherapy, osteopathy, reflexology, thermotherapy, Tibetan medicine, water immersion and yoga. Both analyses confirm that integrated medicine embraces a wide range of unproven or disproven alternative therapies with little consensus amongst experts which modalities are at the core of this area. They also show that mainstream modalities are largely excluded. It is thus fair to suspect that integrated medicine is alternative medicine by another name, nothing other than a cloak of respectability disguising alternative medicine. The term ‘integrative’ seems to disclose the ‘bait and switch’ tactic of charlatans. At best, integrative medicine is well meaning but naïve[1]; at worst, it represents muddled or even fraudulent concepts [2, 3, 16] with little potential to serve the needs of patients. No conflicts of interest to declare.