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Integrative medicine, which is also called integrated medicine and integrative health in the United Kingdom, combines alternative medicine with evidence-based medicine. Practitioners declare that it treats the "whole person," focuses on wellness and health rather than on treating disease, and emphasizes the patient-physician relationship.

Definition

The Academic Consortium for Integrative Medicine and Health has developed the following definition: "Integrative medicine and health 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 and lifestyle approaches, healthcare and disciplines to achieve optimal health and healing." Practitioners say integrative medicine is not the same as complementary and alternative medicine (CAM) nor is it simply the combination of conventional medicine with complementary and alternative medicine. They say instead that it "emphasizes wellness and healing of the entire person (bio-psycho-socio-spiritual dimensions) as primary goals, drawing on both conventional and CAM approaches in the context of a supportive and effective physician-patient relationship".

History

"Initially, in the mid 19th century, alternative systems were out to destroy and eliminate the then toxic allopathic system." Before the advancement of high-throughput screening and the post-genomic era, "more than 80% of drug substances were obtained from natural products or inspired by natural compounds".

Practitioners of alternative medicine during this time ranged from "homeopathy, naturopathy, mental healing, spiritual healing, chiropractic, herbalism, hydrotherapy, and other naturalistic approaches". It was assumed that these approaches were less of a risk and liability opposed to the medicine being use during that time. Methods of treatment started developing a more scientific basis. Antibiotics, anesthetics, safe and sterile surgical procedures and other Pharmaceuticals began developing, which led to a decrease in research for alternative practices. A wide variety of alternative practitioners remained active, but were politically, culturally, financially, and scientifically relegated to a therapeutic side stream. People began living longer and developing problems such as heart failure, cancer, arthritis, and dementia. "Our epistemic and philosophical challenges have become more obvious when the remedies of modem medicine do not work. This remains the context and content of complementary, alternative, and integrative medicine".

In the 1990s, physicians in the United States became increasingly interested in integrating alternative approaches into their medical practice, as shown by a 1995 survey in which 80% of family practice physicians expressed an interest in receiving training in acupuncture, hypnotherapy, and massage therapy. In the mid-1990s hospitals in the United States began opening integrative medicine clinics, which numbered 27 by 2001. The Consortium of Academic Health Centers for Integrative Medicine was founded in 1999 and by 2015 included 60 members, such as Johns Hopkins University School of Medicine, Duke University School of Medicine, Georgetown University School of Medicine, and Mayo Clinic. In 2015 it was renamed Academic Consortium for Integrative Medicine and Health. The goal of the Consortium is to advance the practice of integrative medicine by bringing together medical colleges that include integrative medicine in their medical education. The American Board of Physician Specialties, which awards board certification to medical doctors in the U.S., announced in June 2013 that in 2014 it would begin accrediting doctors in integrative medicine.

"History demonstrates how disease drives society to seek a remedy and industry refines this complementary medicine into a product" Researchers evaluate and modify the medicine before its acceptance by conventional medicine, often as a pharmaceutical." Innovation in medicine has tendencies to be motivated by consumers and industry acceptance by conventional medicine. "This raises the question of whether a different construct is required recognising the value of integrating conventional medicines with traditional knowledge, and greater collaboration between the research, consumer, industry, and policy sectors".

To develop a drug discovery from natural products, innovative approaches include use of genomics, techniques to mine previously untouched environments, and screening technologies, which, to a large extent, need to be explored through national and international collaboration and cooperation.

File:From ancient tradition to modern drug discovery.gif

http://www.nature.com/nrd/journal/v1/n3/full/nrd750.html

Impetus

Medical professor John McLachlan has written in the BMJ that the reason for the creation of integrative medicine was as a rebranding exercise, and that the term is a replacement for the increasingly discredited one of "complementary and alternative medicine".

Advocates of integrative medicine say that the impetus for the adoption of integrative medicine stems in part from the fact that an increasing percentage of the population is consulting complementary medicine practitioners. Some medical professionals feel a need to learn more about complementary medicine so they can better advise their patients which treatments may be useful and which stand less of a chance from an evidence standpoint. In addition, they say that some doctors and patients are unsatisfied with what they perceive as a focus on using pharmaceuticals to treat or suppress a specific disease rather than on helping a patient to become healthy. They take the view that it is important to go beyond the specific complaint and draw upon a combination of conventional and alternative approaches to help create a state of health that is more than the absence of disease. Advocates further suggest that physicians have become so specialized that their traditional role of comprehensive caregiver who focuses on healing and wellness has been neglected. In addition, some patients may seek help from outside the medical mainstream for difficult-to-treat clinical conditions, such as fibromyalgia and irritable bowel syndrome.

"With the steady growth of the NHPs, (natural health products) advanced analytical- and mechanism-based screening should be considered for their promotion and value addition in every way for the betterment of healthcare". This trend influences a need for the "development of international co-ordination to promote and develop NHPs, including their assessment, perspectives, pharmacovigilance, and potential harmonization of regulation, quality control and clinical uses".

Reception

Praise

In order to objectively test alternative medicine treatments, in 1991 the U.S. government established the Office of Alternative Medicine, which in 1998 was re-established as the National Center for Complementary and Alternative Medicine (NCCAM) as one of the National Institutes of Health. In 2015, NCCAM was re-established as the National Center for Complementary and Integrative Health (NCCIH). The mission of NCCIH is "to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative interventions and to provide the public with research-based information to guide health-care decision making."

"Complementary and alternative medicine (CAM) is becoming increasingly popular in western countries, with estimates of CAM usage as high as 40%". This direction has contributed to a change of attitude of the medical establishment. Originally, CAM was dismissed by the public, but is now growing to be more accepted in mainstream medicine due to the nature of integrated medicine. This shift of mindset could be due to the following reasons. "Firstly, integration could be motivated largely by cognitive interest in CAM. Secondly, integration could be mainly power-driven, aimed at controlling the alternative movement and exploiting its capacity to make money.

The European Journal of Integrative Medicine (EuJIM) considers a wide range of complementary and integrative health care disciplines, with a particular focus on whole systems approaches, public health, self management and traditional medical systems. Action research findings showed that "Integrative Medicine in primary care clinics showed great promise"

Doctors are beginning to recommend alternative remedies to their patients when modern drugs do not work. Herbal medicines have fewer side effects, are less toxic and habit forming, in contrast to allopathic medicine, where toxic side effects may sometimes lead to death. In contrast, there is a growing evidence to show that ingredients of medicinal plants act synergistically and that suitable combinations neutralize side effects.

Criticism

Integrative medicine has been criticized for compromising the effectiveness of mainstream medicine through inclusion of ineffective alternative remedies, and for claiming it is distinctive in taking a rounded view of a person's health. The practice of Integrative medicine is sometimes lumped together with alternative medicine, which has received criticism and has been called "snake oil." A primary issue is whether alternative practices have been objectively tested. In a 1998 article in The New Republic, Arnold S. Relman, a former editor of The New England Journal of Medicine stated that "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".

McLachlan writes that it is an "insult" that integrative medical practitioners claim unto themselves the unique distinction of taking into account "their patients' individuality, autonomy, and views", since these are intrinsic aspects of mainstream practice.

Steven Novella, a neurologist at Yale School of Medicine, said that NCCIH's activities are "used to lend an appearance of legitimacy to treatments that are not legitimate". The NCCIH website states that there is "emerging evidence that some of the perceived benefits are real or meaningful". NCCIH also says that "the scientific evidence is limited" and "In many instances, a lack of reliable data makes it difficult for people to make informed decisions about using integrative health care".

A 2001 editorial in BMJ said that integrative medicine was less recognized in the UK than in the United States. The universities of Buckingham and Westminster had offered courses in integrative medicine, for which they were criticized. In the UK organizations such as The Prince's Foundation for Integrated Health, The College of Medicine and The Sunflower Jam advocate or raise money for integrative medicine.

In 2003 Michael H. Cohen argued that integrative medicine creates a “liability paradox,” in that the greater the cross-disciplinary integration among providers, the greater the risk of shared liability among them; thus, “information sharing may expand liability but ultimately reduce risk to the patient; yet maintaining sharp boundaries between providers may decrease risk of shared liability but ultimately increase risk to the patient.” Steven Salzberg has criticized the teaching of integrative medicine in medical schools, especially the inclusion of pseudoscientific subjects such as homeopathy. In Salzberg's view in offering an integrative medicine course, the University of Maryland Medical School was "mis-training medical students". David Gorski has written that the term "integrative medicine" has become the currently preferred term for non-science based medicine.

See also

• Disease management (health)
• Personalized medicine
• Wellness (alternative medicine)

Further reading

• Hall H (14 December 2010). "Integrative Medicine is the Butt of a Sokal-Type Hoax". Science-Based Medicine. Retrieved April 2014. {{cite web}}: Check date values in: |accessdate= (help)
• McCartney M (2011). "The scam of integrative medicine". BMJ. 343: d4446. doi:10.1136/bmj.d4446. PMID 21752859.

Category:Alternative diagnoses Category:Alternative medical systems Category:Alternative medicine Category:Health care Category:Evidence-based medicine