Overview
According to Andrew Weil, a prominent physician and a proponent of this
system, integrative medicine (IM) works with the body’s natural potential for
healing. In the human body, many pathways and mechanisms serve to maintain health
and promote healing. The IM perspective recognizes that treatment, often a
combination of allopathic and alternative medicine, should unblock and enhance
these mechanisms.
In practice, the therapeutic process addresses the whole person and relies on
the main pillars of a person’s well-being: mind, body, spirit, and community. This
paradigm emphasizes the importance of a sound physician-patient relationship for a
successful healing process. Developing rapport and empathy greatly facilitates the
efficacy of lifestyle changes and the use of therapies such as pharmaceuticals,
homeopathy, dietary supplements, traditional Chinese
medicine, Ayurveda, manual methods, mind/body
techniques, and movement therapy.
Until the 1970s, little was done to connect traditional, ancient healing modalities to biomedicine. At that time, the holistic health movement in the United States and in Western Europe started a “dynamic alliance” of therapists, including Native American healers, yoga teachers, and homeopaths. Modern medicine began taking steps to reduce the excessive use of technology and the inherent disconnect from the patient, while rediscovering more natural, less invasive avenues of healing.
The Consortium of Academic Health Centers for Integrative Medicine, founded in 2000, brings together many highly esteemed academic medical centers dedicated to promoting IM through educational opportunities, health policies, research, and collaborative initiatives. The term “integrative medicine” will most likely be used until the value of this balanced approach becomes widely recognized as simply good medicine.
Mechanism of Action
Integrative medicine combines conventional medical treatments with carefully selected alternative therapies that are proven to be safe and effective. The goal of the integrative movement is to bring back the art of healing and to address the root of the pathological process, not just the symptoms. In addition to acquiring the foundations of medical knowledge, physicians should be able to release, explore, and exploit the intrinsic healing responses of the body. Practitioners are therefore encouraged to become familiar with, and critically assess, the modalities of complementary and alternative medicine (CAM).
Core areas of education include the philosophy of science, cross-cultural
medicine, principles of mind/body medicine, self-healing, and
spirituality. The practitioner’s ability to self-explore and maintain his or her
own health balance are considered essential for the therapeutic act. The physician
strives to become a partner and a mentor, who understands the important
coordinates of his or her patient’s life events, culture, beliefs, and
relationships. By acknowledging a person’s uniqueness, the processes of health
maintenance and healing are tailored to best address a person’s background and
conditions. Matching the patient’s belief system can, especially in chronic
illness, lead to the activation of an internal healing response, often known as
the placebo
effect. Far from being a useless phenomenon based on
deception, this response ultimately results in enhanced health.
Uses and Applications
Overall, IM is a combination of art and science that seeks health maintenance and disease prevention and treatment using the most natural, least invasive interventions available. Virtually all categories of disorders, and especially chronic diseases, can benefit from an integrated approach.
Cardiovascular disorders. Cardiovascular disorders such as
congestive heart failure, coronary artery disease, hypertension, and peripheral
vascular disease can be treated with conventional methods and with lifestyle
modifications, nutrition, dietary supplements (omega-3 fatty acids, coenzyme
Q10, carnitine, arginine, hawthorn, and garlic), relaxation,
meditation, and hydrotherapy. Primary prevention is critical in coronary
artery disease and hypertension.
Cancer. Cancer can be treated with the synergistic reduction of the sequellae and by limiting the toxicity or trauma of conventional therapies and by alleviating psychological distress. Nutritional changes, dietary supplements (vitamins, immunomodulators, ginger, marijuana, and St. John’s wort), acupuncture, mind/body techniques, and group support are often recommended. Preventive approaches (for breast cancer, for example) involve lifestyle changes (exercise, nutrition, limiting toxins, and breast-feeding), botanicals (seaweed, rosemary, and green tea), and mind/body methods.
Endocrine and metabolic disorders. Endocrine and metabolic disorders are also amenable to integrated therapies. Insulin resistance is often treated with metformin hydrochloride, lifestyle changes, and a low-carbohydrate diet. Supplements such as chromium, vanadium, alpha-lipoic acid, American ginseng, and fenugreek can provide benefits too. In persons with diabetes mellitus, essential care includes diet, exercise, and pharmaceuticals. Dietary supplements, such as vitamins, bilberry, and Ginkgo biloba, and mind/body techniques (for example, relaxation and yoga) may mitigate vascular disease and even lower glucose levels. Alternative therapies to consider in persons with hypothyroidism include dietary supplements such as vitamins, zinc, selenium, and traditional Chinese botanicals, and practices such as yoga. Pharmaceuticals are available for the treatment of osteoporosis, and vitamin D, ipriflavone, and exercise constitute useful adjuvants.
Gastrointestinal disorders. Gastroesophageal reflux, peptic ulcer
disease, and irritable bowel syndrome can be treated with lifestyle changes and
with botanicals (licorice, chamomile, and marshmallow root), homeopathics, and
mind/body therapies (including stress management and guided
imagery).
Neurological disorders. Stroke, multiple sclerosis, Alzheimer’s
disease, Parkinson’s disease, seizures, and migraine have been linked to oxidative
stress, neurotoxic factors, and inflammatory processes. Thus, they can greatly
benefit from integrative methods. The complementary therapies include, but are not
limited to, dietary and nutritional supplementation (omega-3 fatty acids,
glutathione, coenzyme Q10, alpha-lipoic acid, N-acetylcysteine, niacin,
vitamins, melatonin, and magnesium), herbal supplementation (Ginkgo
biloba, milk thistle, turmeric, vinpocetine, and skullcap),
meditation, yoga, and exercise.
Asthma and allergies. Asthma and allergies respond well to alternative methods that include nutritional and environmental changes, exercise, botanicals (ginkgo, coleus, licorice, kanpo, bioflavonoids, and stinging nettle), vitamins and minerals, homeopathics, massage, inhalation, breathing techniques, and mind/body therapy.
Upper respiratory infections and sinusitis. Upper respiratory infections and sinusitis can be treated with pharmaceuticals, dietary changes, hydration, steam inhalation, supplements (vitamins, antioxidants, zinc, magnesium, garlic, and echinacea), and homeopathic remedies.
Depression and anxiety. Depression and anxiety represent a
spectrum of disorders ideally suited for IM. In addition to pharmaceuticals,
persons can benefit from lifestyle changes, physical activity, nutritional
remedies (omega-3 fatty acids, B vitamins, folic acid, and hydroxytryptophan),
botanical remedies (St. John’s wort, kava kava, and ginkgo), psychotherapy, relaxation training, yoga, acupuncture, and
transcranial stimulation.
Pain. Pain management represents a challenge for both the
physician and the person in pain. Truly integrating allopathic and alternative
medicines can offer relief and reduce frustration. Reassurance and lifestyle
changes are often the first step of the therapeutic plan. A vast array of useful
approaches includes pharmacotherapy, exercise, supplements (arnica and omega-3
fatty acids), homeopathy, manual methods, acupuncture,
transcutaneous nerve stimulation, and mind/body therapy. Surgery is considered
after conservative therapies have failed.
Pregnancy and menopause. The integrative approach to pregnancy and menopause reaches beyond the use of combined mainstream and alternative therapies. These conditions require a careful initial encounter and subsequent consideration of the mind, body, spirit, and community context. The patient-practitioner interaction is oriented toward health rather than disease, and listening to the person seeking care is essential. In pregnancy especially, the need for noninvasive, natural approaches becomes crucial. Nausea and vomiting, for example, are treated with supplements (vitamin B6, red raspberry leaf, ginger root, and chamomile), homeopathics, acupuncture, and mind/body therapies.
Alcoholism and substance abuse. Therapeutic options for alcoholism and substance abuse include botanicals (valerian, kudzu, kava kava), acupuncture, mind/body therapies, and spirituality. The options also include twelve-step programs.
Scientific Evidence
Integrative practice is committed to the scientific method and is rooted in evidence. At the same time, the integrative practitioner aims to transcend the confines of “scientific truth” and connect with the people he or she serves on multiple levels.
A number of CAM therapies have proved effective as complements to conventional medical treatments. These CAM therapies include dietary and herbal supplements, acupuncture, manual therapy, biofeedback, relaxation training, and movement therapy. When a strong evidence base is developed for a particular complementary method, it can become part of the integrative armamentarium. After it reviewed the evidence base, for example, the Society for Integrative Oncology supported the use of acupuncture in cases in which cancer-related pain is poorly controlled.
According to the American Academy of Pediatrics, a review conducted in 2002
found more than fourteen hundred randomized-control trials of pediatric CAM; the
quality of these trials was determined to be as good as those focusing on
conventional therapies. It is important to note that different levels of evidence
are required to prove the safety and efficacy of complementary therapies,
depending on the goals of the treatment. Lower levels of evidence (that is,
nonrandomized and observational studies) are acceptable for preventive or
supportive goals and for noninvasive approaches. Furthermore, integrating
represents more than combining; it involves holistic
treatment and the synergistic application of an array of
treatments. Thus, the extent of the combination or integration varies. This leads
to unique challenges for the scientific validation of integrative methods.
Traditional research models often appear inadequate. More studies are needed that
examine the appropriateness and manner of integration for specific diseases and
conditions.
Choosing a Practitioner
Approximately 70 percent of medical schools in the United States have courses in CAM. Integrative medicine centers and fellowship programs exist at many prominent universities and hospitals in the United States, including the University of Arizona, Duke University, Harvard University, the University of Michigan, and the Mayo Clinic. These centers tend to be directed by conventional physicians (doctors of medicine and doctors of osteopathy) and staffed by various practitioners.
The American Board of Integrative Holistic Medicine establishes standards for the application of IM principles and offers certification. The American Association of Integrative Medicine provides an accreditation program. Even so, qualified IM practitioners are still difficult to find, and the demand greatly exceeds the supply. Oftentimes, the collaboration between conventional physicians of various specialties and certified CAM practitioners provides the foundation and benefits of integrative care. The American Holistic Medical Association maintains a directory of integrative and holistic practitioners holding relevant degrees.
Safety Issues
When implemented by physicians and CAM practitioners who are well versed in the integrative method, IM is safe and beneficial.
Bibliography
American Association of Integrative Medicine. http://www.aaimedicine.com. Promotes the development of IM.
American Board of Integrative Holistic Medicine. http://integrativeholisticdoctors.org. Establishes and maintains standards of care.
American Holistic Medical Association. http://www.holisticmedicine.org. Promotes holistic and integrative principles.
Consortium of Academic Health Centers for Integrative Medicine. http://www.imconsortium.org. Advances the principles and practice of integrative health care within academic institutions.
Baer, Hans. Toward an Integrative Medicine: Merging Alternative Therapies with Biomedicine. Walnut Creek, Calif.: Altamira Press, 2004. A comprehensive overview of the holistic movement and its journey into mainstream medicine.
Kurn, Sidney, and Sheryl Shook. Integrated Medicine for Neurologic Disorders. Albuquerque, N.Mex.: Health Press, 2008. Review of nutritional and herbal therapies for practitioners who treat persons with neurological disorders.
Leis, A. M., L. C. Weeks, and M. J. Verhoef. “Principles to Guide Integrative Oncology and the Development of an Evidence Base.” Current Oncology 15, suppl. 2 (2008): S83-S87. Discusses the need for evidence to support the overall practice of integration and the challenges posed by the validation process.
Rakel, David, ed. Integrative Medicine. 2d ed. Philadelphia: Saunders/Elsevier, 2007. An authoritative textbook that discusses the philosophy and method of integrative medicine and details therapeutic modalities for numerous diseases and conditions.
Rees, L., and A. Weil. “Integrated Medicine [Editorial].” British Medical Journal 322 (2001): 119-120. Defines the basic tenets of IM.
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