Conventional Western biomedicine has its limits.
Health professionals and consumers are both interested in safe, effective, low-cost, high-quality approaches to promote health, prevent disease, manage symptoms and relieve suffering. In particular, conventional medicine’s limited effectiveness in managing chronic diseases has been an important factor in the exploration of alternative options by health professionals and the public. These options have been described by several terms, including alternative, complementary, holistic, integrative, humanistic, biopsychosocial, behavioral, new, mind-body and mind-body-spirit.
Complementary medicine generally refers to approaches that are used along with and complement conventional medicine. Alternative medicine generally refers to approaches that are used to replace, or used instead of, conventional medicine. The term integrative medicine has become the most widely accepted name for this combination of conventional medicine with complementary and alternative medicine (CAM).
Health professionals are increasingly interested in integrative medicine as research has demonstrated safety and effectiveness of CAM use for many conditions that are inadequately controlled by conventional approaches. When confronted with patients whose chronic conditions are poorly controlled by conventional medicine, most health professionals are more interested in helping relieve suffering than remaining committed to treatments that give only partial relief. They want options as much as their patients do.
Consumers and health professionals can both rely on the National Institutes of Health (NIH) for current, scientifically-validated advice on the integration of conventional medicine with CAM approaches. The congressionally-funded National Center for Complementary and Alternative Medicine (NCCAM) was established at NIH in 1992. NCCAM’s mission is to ‘define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care.’ NCCAM’s vision is- ‘scientific evidence informs decision-making by the public, by health care professionals, and by health policymakers regarding use and integration of complementary and alternative medicine.’
The NCCAM web site allows you to search by health topic (such as sleep disorders or sinus infections) or by treatment approaches (such as melatonin or neti pot). The information presented is based on current scientific evidence, some of which has been generated by research funded by NCCAM itself. The recommendations are free of any commercial bias and allow you to make sense of advertising claims and testimonials that you encounter in the media, online and in conversation with friends and family.
Another very helpful resource is The New Medicine, a 2 hour documentary on PBS in 2005, with an accompanying web site. The term ‘new medicine’ was chosen to describe the changes in conventional medicine as it increasingly includes CAM approaches that health professionals and consumers are finding effective, safe, affordable and congruent with their health-related values and beliefs. The irony is that many of these CAM approaches are not new at all. Some of them have been used for thousands of years and are only now being investigated by scientific research methods.
The PBS documentary interviewed physicians from major US medical centers who are leaders in this process of studying and integrating CAM approaches with conventional medicine. The emphasis is on mind-body approaches, which are generally the most well-researched, most effective and safest of the CAM modalities. Examples of mind-body approaches include massage and other body-based therapies, progressive muscle relaxation and other relaxation therapies, imagery, meditation, mindfulness, breathing-related therapies, hypnosis, acupuncture, yoga, tai chi and qi gong.
The documentary was accompanied by a website that is still available as a resource for learning more about the ‘new’ medicine. The web site contains short video excerpts from The New Medicine documentary, discussing the current state of research and clinical practice throughout the country. A useful feature of the web site is a list of health conditions that permit you to review possible integrative approaches to complement conventional approaches recommended by your primary care provider or other conventional practitioner.
A question that often arises regards the level of evidence required in order to justify recommending a particular treatment. This concern applies equally to CAM and conventional medicine.
Research seeks to explain ‘how and why’ any approach works- whether CAM or conventional. Often, however, despite a treatment approach’s safety and effectiveness, answering these ‘how and why’ questions is not possible. We simply know it works. We don’t yet know ‘how or why.’ For many CAM and conventional approaches, research demonstrates safety, effectiveness and acceptance based on affordability and congruence with values and beliefs. This is sufficient to recommend treatment approaches, while we continue to investigate the ‘how and why’ of mechanisms of action.
One potential advantage of this ‘new’ integrative medicine is the reduction in the use of prescription medication. Integrative medicine can sometimes permit the substitution of non-pharmacologic approaches for pharmacologic, prescription medication therapy. Such reductions can sometimes result when a CAM approach is carefully selected and delivered by a well-trained CAM provider with respectful, open communication between the consumer, their CAM provider and the conventional health professional that has prescribed medication.
In addition to their desire to relieve suffering, all health professionals (conventional as well as CAM) seek to avoid doing harm. Despite the life-saving potential of modern pharmacologic treatments, these same treatments can cause serious harm, side effects, drug interactions, allergic reactions and even death. Integrative medicine is providing consumers, their CAM providers and their conventional practitioners ways to individualize care that promotes health, prevents disease and relieves suffering.
National Center for Complementary and Alternative Medicine
The New Medicine
About the Author-
Dr Patterson is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty at the University of Kentucky College of Medicine and the University of Louisville School of Medicine, Saybrook University’s School of Mind Body Medicine (San Francisco) and the Center for Mind Body Medicine (Washington, DC). He operates the Mind Body Studio in Lexington, where he offers integrative medicine consultations. He can be reached through his website at www.mindbodystudio.org.