What is it?
primary care system that emphasizes wellness and healing of the whole
person… as major goals, above and beyond suppression of specific somatic
disease” (Arch Intern Med.
2002. 162. 144-140).
- “views patients as whole people with minds and spirits
as well as bodies and includes these dimensions into diagnosis and
treatment” (BMJ. 2001. 322.
practice of medicine that reaffirms the importance of the relationship
between the practitioner and the patient, focuses on the whole person, is
informed by evidence, and makes use of all appropriate therapeutic
approaches, healthcare professionals and disciplines to achieve optimal
health and healing” (Consortium of Academic Health Centers for
Integrative Medicine Steering Committee, revised in 2006, based on input
from the Academic Consortium for Complementary and Alternative Health
part an extension of allopathic medicine, in part a philosophy of
treatment, in part integration of diverse providers rather than simply
integration of modalities by a M.D. or D.O.
Medicine - a system of therapeutics based on production of a condition
incompatible with or antagonistic to the condition being treated (i.e.
antibiotics, antihistamines, antipyretics, anti-inflammatory medications).
What are some of the basic tenets of Integrative
- It is
a philosophic approach to treatment rather than just more tools in the
toolbox. In contrast, in terms of contemporary terminology, CAM (complementary and alternative medicine) is
about specific modalities of treatment.
- It is
patient-centered rather than physician-centered, and emphasizes the
centrality of the doctor/patient relationship in the healing process.
that healing is innate - the role of the practitioner is to remove any
blocks to healing, and facilitate or stimulate one's own natural healing
that often the patient is the diagnostician and the practitioner is the
of the role of the mind and the spirit in good health. Health is a
cohesive balance of mind, body, and spirit.
of the role of nutrition and exercise in good health.
that health is more than the mere absence of disease.
of herbs and vitamins and dietary supplements in addition to or instead of
of complementary modalities of treatment such as chiropractic, massage
therapy, acupuncture, homeopathy, and others, when indicated.
to the scientific method and evidence-based practice.
Why should physicians learn about it?
demand (i.e. chiropractic was covered by Medicare in 1966 despite the
Surgeon General warning against it, based in part on 12 million letters
sent by Americans to their Congressmen).
- Popularity of complementary
modalities (functionally defined as interventions neither taught widely in
medical schools nor generally available in U.S. hospitals, and by
definition includes relaxation techniques, herbal medicines, massage,
chiropractic, spiritual healing by others, megavitamins, self-help groups,
imagery, commercial diets, folk remedies, lifestyle diets, energy healing,
homeopathy, hypnosis, biofeedback, and acupuncture, in order of decreasing
popularity of use in the past 12 months in 1997).
in 1990 (Eisenberg DM, et al. Unconventional Medicine in the United States.
J Med. 1993; 328: 246-252).
in three adults in the U.S.
used unconventional care in 1990.
use of unconventional care is distributed across all socioeconomic
of users of unconventional care also used conventional treatment.
number of visits to providers of unconventional care (425 million
visits) was greater than the number of visits to all primary care
medical doctors (388 million visits).
expenditures for unconventional care (10.3 billion dollars) were
approximately equal to out-of-pocket expenditures for all
in four adults seeing a medical doctor for a serious health problem
are also using unconventional treatment, but seven in ten do not tell
their physician about the use of unconventional care.
reassessed in 1997 using the same definitions (Eisenberg DM, et al.
Trends in Alternative Medicine Use in the United States, 1990-1997. JAMA. 1998; 280:1569-1575).
of alternative therapies increased from 33.8% in 1990 to 42.1% in 1997,
with the largest percentage increases in use seen for herbal medicine,
massage, megavitamins, self-help groups, folk remedies, energy healing,
probability of users visiting an alternative medicine provider increased
from 36.3% in 1990 to 46.3% in 1997.
therapies in both 1990 and 1997 were used most frequently for chronic
conditions, including back problems, anxiety, depression, and headaches.
was no significant change in disclosure rates to physicians regarding
the use of alternative therapies (39.8% vs. 38.5%).
percentage of users paying entirely out-of-pocket for services provided
by alternative medicine practitioners did not change significantly
(64.0% vs. 58.3%).
to the U.S.
population suggest a 47.3% increase in total visits to alternative
medicine practitioners, from 427 million visits in 1990 to 629 million
visits in 1997.
of all prescription users in 1997 took herbal remedies and/or high dose
expenditures for alternative medicine professional services
increased 45.2% to 21.2 billion dollars, with an estimated 12.2 billion
dollars paid out-of-pocket.
out-of-pocket expenditures in 1997 for alternative therapies were
approximately 27 billion dollars, exceeding out-of-pocket expenditures
for all physician services in 1997.
reassessed in 2002 using the same definitions (Tindle
HA et al. Trends in use of complementary and alternative medicine by US
adults, 1997-2002. Altern Ther Health
Med. 2005. 11. 42-49).
1990 there have been 10 national surveys looking at popularity of CAM,
but each has used a different definition of CAM,
and the demographic makeup of the study group has varied from study to
most complete and comprehensive findings on Americans' use of CAM are derived from National Health Interview
Surveys (NHIS). The questions were developed by NCCAM and the data can be
viewed at http://nccam.nih.gov/news/camsurvey.
questions included in the 2002 survey, administered to 31,044
adults. This survey showed that
74.6% of adults surveyed had ever used CAM, with 62.1% of adults using CAM in the past 12 months. If prayer for health was excluded the
statistics were 49.8% of adults had ever used CAM, with 36.0% of adults
using CAM in the past 12 months. The ten most common CAM therapies
utilized were prayer/self 43%, prayer/others 24.4%, natural products
18.9%, deep breathing 11.6%, prayer group 9.6%, meditation 7.6%,
chiropractic 7.5%, yoga 5.1%, massage 5.0%, diets 3.5%. Note that only
12% of survey respondents sought care from a licensed CAM
provider. This survey also included data on reasons for CAM use.
on data from the 2007 survey,
38% of adults reported using CAM in the previous 12 months; 83 million
US adults (40% of the adult population) spent $33.9 billion out of
pocket on visits to CAM practitioners and on purchases of CAM products,
classes, and materials (11.2% of total out of pocket expenditures on
health care in the US); out of pocket spending for supplements was $14.8
billion (1/3 the total of $47.6 billion in out of pocket expenditures
for prescription drugs); out of pocket spending for CAM practitioner
visits was $11.9 billion (1/4 of the total of $49.6 billion out of
pocket expenditures for physician visits) [Nahin
RL et al. National Health
Statistics Report; no 18, National Center for Health Statistics.
contemporary ecology of medical care in the U.S. in 2000 - it is
estimated in a typical month that 800 of 1000 persons report symptoms,
217 visit a physician's office, 113 of the 217 visit a primary care
physician's office, 65 visit a complementary or alternative medicine care
provider, and 8 are hospitalized (N
Engl J Med. 2001. 344. 2021-2025).
options to offer your patients.
Why are complementary modalities popular?
SM, et al. Pursuit and Practice of Complementary Therapies by Cancer
Patients Receiving Conventional Treatment. Br Med J. 1994; 309. 86-89.
authors surveyed all patients in a cancer registry in England -
600 surveys were sent and 415 were returned.
results showed that 16% of the 415 patients used complementary
treatments, and 80% of these patients responded that they were satisfied
with their complementary treatment (even though other results showed no
cited a more hopeful outlook on the part of the practitioner and a
more supportive relationship as reasons for satisfaction.
- Astin JA. Why Patients Use Alternative Medicine:
Results of a National Study. JAMA.
1998; 279: 1548-1553.
paper reports the results of a survey of 1035 randomly selected
rate was 69%.
of respondents used alternative therapies, but only 4.4% relied primarily
on alternative therapies.
than in the 4.4% who relied primarily on alternative therapies,
dissatisfaction with conventional medicine did not predict use of
was associated with subjective reports of poorer health status.
users were more likely to have had a self-reported transformational life
experience, and users were more likely to report that health care
alternative treatments were more congruent with their individual values
(i.e. a more holistic attitude toward health).
Other surveys fail to verify the notion of widespread fraud amongst
practitioners of complementary modalities, and find that most
practitioners are dedicated, caring individuals.
motivations for seeking out complementary modalities
effectiveness and safety
with the patients philosophy
a particular kind of practitioner/patient relationship
motivations for seeking out complementary modalities
effects of conventional medicine
of “the establishment”
of allopathic medicine:
very effective at treating viral illnesses, nutritional and metabolic
diseases, allergies, autoimmune diseases, cancer, and the mental
on a paradigm of war and external forces as a cause of disease instead
of a paradigm of balance and internal forces or the terrain as a cause
of disease (i.e. focuses on meningococcemia rather than focusing on the
individuals colonized with meningococcus who
do not get sick, focuses on strep throat rather than focusing on
individuals colonized with streptococcus who do not get sick).
can backfire (antibiotic resistance).
does not work well for chronic disease.
health only in the negative sense as the absence of disease.
of adjustment for biochemical individuality.
a precise definition of the approach to illness in a positive sense.
on dissection of dead bodies (i.e. lack of appreciation of "life
on abnormal psychology (Maslow and self-actualization is the exception).
on 19th Century physics.
on separation of the mind and the body
to take into account important social, spiritual, emotional, and
environmental factors (i.e. not holistic).
to listen and to spend enough time with each patient (distorted
to communicate effectively.
to empathize/become emotionally attached.
centered care instead of patient centered care.
of Complementary Medicine (Davidoff F. Ann
Intern Med. 1998; 129: 1069-1070).
controls his/her own destiny.
of therapeutic failure blamed on the patient, not on the complementary
viewpoint gives hope.
of unrealistic optimism that can distort reality.
medicine is constantly subject to self-scrutiny.
of conventional medicine in trouble due to self-scrutiny.
What are the myths about complementary medicine
users? [British Journal
of Clinical Psychology. 1996. 35. 37-48]
with medicine in general - national survey data do not support the view
that users of CAM are dissatisfied with
conventional medical care. Furthermore, adults who use both CAM and
conventional care are less concerned about their doctor's disapproval than
their doctor's inability to understand or incorporate CAM therapy use
within the context of their medical management (Eisenberg DM, Kessler RC,
et al. Perceptions about complementary therapies relative to conventional
therapies among adults who use both: results from a national survey. Ann Intern Med. 2001. 135.
motivated by lower cost.
it because it was the only choice available.
characteristics or attitudes when compared to non-users.
How do I practice Integrative Medicine?
on recognition of patient suffering as well as diagnosis and treatment
(three roles of the physician in caring for the sick include skilled
diagnosis, effective treatment, and human recognition of suffering).
on nutrition, exercise, lifestyle issues, prevention, and wellness.
reassurance when indicated.
vitamins, minerals, herbs, and dietary supplements when indicated.
to one of a network of complementary practitioners when indicated.
How do I decide when and where to refer?
invoke a complementarity model:
- Allopathy is the most effective modality for treating
trauma, acute medical and surgical emergencies, and acute bacterial,
fungal, and protozoa infections.
- Allopathy is less effective at treating most viral
illnesses, nutritional and metabolic diseases, allergies, auto immune
diseases, and the mental illnesses.
- I rely
on a classification of complementary treatment modalities:
which address structural imbalances in the body (osteopathy,
chiropractic, physical therapy, massage therapy, shiatsu, rolfing).
NCCAM labels this category as “MANIPULATION & BODY-BASED
PRACTICES,” with sub-categories including chiropractic, massage, Pilates,
which focus on maintaining or restoring biochemical balance (herbal
medicine, environmental medicine).
NCCAM labels this category as “BIOLOGICALLY BASED PRACTICES,” with
sub-categories including food supplements, herbals, animal products, and
that seek to restore mental and emotional balance at a physiological
level (biobehavioral methods, including
meditation, guided imagery, and biofeedback). NCCAM labels this category as
“MIND-BODY MEDICINE,” with sub-categories including hypnosis, meditation,
tai chi, and yoga.
that address the energetic levels of the body (therapeutic touch,
homeopathy, Bach flower essences).
NCCAM labels this category as “ENERGY MEDICINE,” with
sub-categories including healing touch, qi gong, and reiki.
systems (naturopathy, TCM, Ayurvedic medicine). NCCAM labels this category as “WHOLE
recognize that belief is central to healing:
often will not occur in the absence of belief.
alone may be adequate to achieve healing (this is the placebo effect).
How does one find a practitioner?
Are complementary modalities efficacious?
and more research is appearing, but much is published in peer review
scientific journals not read by physicians.
there are still relatively few controlled clinical trials of complementary
of the efficacy of complementary modalities may be due to the placebo
response rates may be as high as 60 - 70% when the patient believes in the
treatment ordered, the practitioner believes in the treatment ordered, and
the practitioner-patient relationship is characterized by trust.
are the three elements of the placebo response, as per Dr. Herbert
using the placebo effect as a therapeutic ally, as per Dr. Andrew Weil.
that the history of medicine is the history of the placebo response.
- Issues of a level playing field
Congressional Office of Technology Assessment report in 1978 which
indicated that only 10-20% of conventional medical practice was based on
controlled studies (Office of
Technology Assessment. Assessing the Efficacy and Safety of
Medical Technologies. Washington, D.C.: U.S. Govt. Printing Office;
1991, it was estimated that 15% of medical interventions were supported
by solid scientific evidence (BMJ.
1991. 303. 798-799).
2003 study concluded that only about half of medical treatments are
supported by evidence (Hardern RD et al.
How evidence based are therapeutic decisions taken on a medical
admissions unit? Emerg Med J. 2003. 20. 447-448).
2003 paper concluded that a range of 11% to 70% of decisions in various
medical specialties follow the rules of evidence-based medicine (Pelletier
K. Focus Altern
Complement Ther. 2003. 8. 3-6).
that even in "evidence-based medicine," most decision-making
takes place in areas of scientific uncertainty.
a societal standpoint, especially with regard to limited resources, we
should probably require the strictest evidence of efficacy (i.e. large
RCTs) for the treatments whether conventional or unconventional which can
do the most harm.
of a level playing field
meta-analysis of 39 prospective studies in U.S. hospitals found that in
1994, 2,216,000 hospitalized patients had an adverse drug reaction, and
106,000 had fatal adverse drug reactions (JAMA. 1998. 279. 1200-1205).
are 16,000 deaths and 100,000 hospitalizations in the U.S. each year from NSAID's
J Med. 1999. 340. 1888-1899). It is estimated that only 1 in 5
individuals who GI bleed from a NSAID have any warning symptoms.
Differences between acute and chronic disease
primarily in charge
History is short
Focus is on the
about WHAT is happening
tends to be single-focused; primarily pharmaceutical or surgical
History is long
Focus is on the
body, mind, spirit, lifestyle, and environment
about WHY it is happening
holistic; patient involvement is vital
How does the ‘trajectory’ of CAM
differ from that of conventional medicine?
- Conventional medicine: T>P>E>S.
Technical advances (basic research, clinical trials) usually precede
political factors (support of the medical establishment), which usually
precedes economic factors (determination of economic viability), which
usually precedes social factors (public acceptance).
- CAM: S>E>P>T. Social factors
(popular demand) in combination with economic factors (affordability)
usually precede political factors (political support) which usually
precedes technical factors (clinical trials).
Historical Landmarks in the history of integrative
· 1990 – Dr Dean Ornish
publication showing a lower rate of revascularization surgery in patients
randomized to a comprehensive lifestyle intervention.
· 1993 – Dr David Eisenberg publication on
popularity of unconventional medicine.
· 1997 – NIH Consensus conference report on
efficacy of acupuncture
· 1998 – JAMA
theme issue on CAM
· 2000 – White House Commission on CAM
What is the current status of integrative medicine?
(Office of Alternative Medicine) at the NIH.
in 1992 by Congressional mandate (Senator Harkin’s bill, passed by
of 2.2 million dollars in 1992/3, budget of 3.5 million dollars in 1994,
5.4 million dollars in 1995, 7.4 million dollars in 1996, 12 million
dollars in 1997, and 20 million dollars for 1998.
in 1993 funded 30 pilot proposals – response to request for proposals was
largest in the history of NIH, with over 6000 requests for applications,
800 letters of intent, and 452 applications.
research base by funding 10 exploratory centers in 1995.
changed to a Center within the NIH in 1998, entitled National Center
for Complementary and Alternative Medicine, and budget increased to
50 million dollars for 1999.
68.7 million dollars in 2000, 123 million dollars in 2005, 121.6 million
dollars in 2008, 132 million dollars in 2011
research funded in part by other Centers within the NIH. In 2008, CAM research at more than 260 institutions
supported by NCCAM funding.
1999, NCCAM continues to add Research Centers, and these are now
categorized as either Centers for Excellence for Research on CAM or Developmental Centers
for Research on CAM. The current list of centers (2/09) is:
1. Bastyr University - HIV/AIDS
2. Columbia University - Women's health issues
3. Harvard Medical School - General medical conditions
4. Kessler Institute for Rehabilitation - Stroke and neurologic
5. Palmer Center for Chiropractic Research - Chiropractic
6. Stanford University - Aging
7. University of Arizona - Pediatric conditions
8. University of California, Davis - Asthma, allergy, and immunology
9. University of Maryland - Pain/Arthritis
10. University of Michigan - Cardiovascular disease
11. University of Minnesota - Addiction
12. University of Texas - Cancer
13. University of Virginia - Pain
14. Kaiser in Portland, OR - Craniofacial disorders
15. Oregon Health Sciences University - Neurological disorders
16. Maharishi University in Fairfield, IA - CV disease and aging in African
17. Johns Hopkins University - Cancer
18. University of Pennsylvania - Cancer
of Calif, San Francisco - Mindfulness-based stress
20. Harvard -Alcohol and drug
of N Carolina, Chapel Hill - Asthma
of Minnesota - Mushroom extracts and immune response
23. Oregon Health and Science Univ - Placebo effects
of North Texas - Mechanisms of osteopathic manipulation
25. Purdue Univ
- Health effects of polyphenols
of Illinois - Botanical supplements and women’s health
27. Pennington - Botanicals and
28. Sloan-Kettering - Botanical immunomodulators
29. Wake Forest U - Botanical
of Maryland - Arthritis and Traditional Medicine
31. Mt Sinai - Chinese Herbal
32. Temple U - Mechanism
Underlying Millimeter Wave Therapy
Maryland - Functional Bowel Disorders in Chinese Medicine
Missouri - Indigenous Phytotherapy Studies
of Wisconsin - Center for the Neuroscience and Psychophysiology of Meditation
36. Montana State Univ - CAM as Countermeasures against Infectious and
of CA, San Fran - Metabolic and Immunologic Effects of Meditation
of Chicago - Center for Herbal Research on Colorectal Cancer
of Dietary Supplements (ODS)
office, which is within the NIH, was established as a result of the 1994 DSHEA
legislation on dietary supplements.
collaborates with multiple other NIH Institutes and Centers, including
- The ODS budget has increased
from $1 million in 1996 to $25 million in 2004.
- The ODS IBIDS database
currently contains over 690,000 unique scientific citations and
- The ODS exhibits at national
meetings such as the Annual Session of the ACP.
in CAM were a requirement in
approximately 90% of US medical schools in 2007-2008, compared with 30%
in 2001-2002, according to the AAMC (NCCAM 11/09 newsletter)
a study of 53 medical schools in 2000, 66% taught relaxation and
meditation, 37% taught guided imagery, and 34% taught biofeedback (Acad Med. 2002. 77. 876-881).
in 2000 offers grants of up to 1.5 million dollars per school for
innovative programs which integrate complementary and alternative
medicine into the medical school curriculum.
CME programs for practicing physicians (Center for Mind Body Medicine,
Scripps, and University of Arizona).
on Integrative Medicine in 2009 led by Dr Ralph Snyderman.
in Integrative Medicine (Sierpina VS and Dalen
JE. The Future of Integrative Medicine. Am J Med. 2013. 126. 661-662).
of Arizona two year residential fellowship started 1997 and transitioned
in 2000 to a distance-learning Fellowship, with 1000 hours required. In
2013, more than 1000 MDs, DOs, NPs, and PAs have completed this
2013, 13 medical schools offer fellowships in Integrative Medicine
– Georgetown U Masters Program – 1 year with a
focus on research.
medicine in residencies – 200 hour curriculum is in place in 2013 in 30
family practice and 2 internal medicine residencies (Sierpina
VS and Dalen JE. The Future of Integrative Medicine. Am J Med. 2013. 126. 661-662).
- A Consortium of Academic Health Centers
for Integrative Medicine (CAHCIM) was formed in 2001, following
initial meetings in 1999 and 2000.
initial 8 members were Duke University, Harvard
University, Stanford University,
University of California at San
of Arizona, University of Maryland,
University of Massachusetts, and the University of Minnesota.
consortium has grown steadily, with 42 member medical schools as of 2009
(38 in US and 4 in Canada), 54 members as of 2012.
3 working groups (clinical care, education, and research), with a fourth
working group (policy) added in 2005.
mission is to help transform medicine and healthcare through rigorous
scientific studies, new models of clinical care, and innovative
educational programs that integrate biomedicine, the complexity of human
beings, the intrinsic nature of healing and the rich diversity of
is funded primarily by the Bravewell
Collaborative, an organization of philanthropists whose goad is
transforming medicine. Philanthropists and foundations participating in
the Bravewell Collaborative must pay $50,000
annual dues. In 2003, there were 16 foundations/philanthropists
participating in Bravewell; this number
decreased to 8 foundations/philanthropists at the end of 2007.
first research conference was held in 2006, with subsequent research
conferences in 2009 and 2012.
2006, the Consortium decided to require annual dues from member medical
schools, $2500/year. www.imconsortium.org.
Academic Consortium for
Complementary and Alternative Health Care (ACCHAC) was formed in
2004, following initial meetings dating back to May, 2000 (Integrative
Medicine Leadership Summit)
- Principally represents leading
educators in disciplines such as chiropractic, massage therapy,
naturopathy, and Oriental medicine. Founding executive director is
Pamela Snider, ND.
got started based on a philanthropic grant; in 2006 decided to require
annual dues from member organizations, on a sliding scale ranging from
$1000 to $5000.
Family Medicine Residency – in 2004 the Family Medicine RRC approved an
experimental 4 year program at six institutions; several of the lead faculty
are graduates of the University
- Duke University
opened in January 2007 an Integrative
in a free standing building.
Pediatrics (Explore. 2007. 3.
1997-2007, 17 academic medical centers created pediatric integrative
Pediatrics Council formed in 2004 – consists of individuals in
leadership positions in pediatric integrative medicine in the U.S. and Canada, and offers an annual
Pediatric Integrative Medicine Conference.
Association of Pediatrics in 2005 established the Provisional Section on
Complementary, Holistic, and Integrative Medicine.
Medicine in Residency – in 2008, family medicine residencies at 8 major
medical centers have embraced a 250-hour integrative medicine training
curriculum developed at the University of Arizona Center for Integrative
Medicine, and aimed at developing core competencies in integrative
medical practice. The program makes extensive use of online learning
tools and web-based course work.
- New York Beth Israel
in 2006 became the first general services hospital in the nation to add a
formal department of integrative medicine. The first chair of the
department is Woodson Merrell,
MD. The department will
coordinate diverse services, including acupuncture, Alexander technique,
art therapy, healing touch, massage, meditation, music therapy, and
of hospitals surveyed by the American Hospital Association in a 2007
national poll offered at least one CAM
therapy (NCCAM 11/09 newsletter)
reviewed journals and newsletters:
- Alternative Medicine Review -
- Alternative Therapies in Health and
Medicine – every other month
- Alternative and Complementary
- Explore – every other month
– American Botanical Council
- Integrative Cancer Therapies
- Integrative Medicine - A Clinician's
Journal – every other month
- Journal of Orthomolecular Medicine
– quarterly (since 1970)
- Journal of the Society for Integrative
- Seminars in Integrative Medicine –
quarterly review journal
- Seminars in Preventive and Alternative
Medicine – quarterly
- The Journal of Alternative and
- The International Journal of
- Alternative Medicine Alert – every
for Mind Body Medicine at Georgetown
Body Clinic at the New
Hospital (Herbert Benson,
Based Stress Reduction Program at the University of Massachusetts.
Established in 1979 (Jon Kabat-Zinn, PhD)
- Rosenthal Center
University (Fredi Kronenberg, PhD)
- Essentials of Complementary and
Alternative Medicine edited by Wayne Jonas and Jeffrey Levin. 1999.
- Integrative Medicine edited by
David Rakel MD. 2003. 793 pages. Second edition
- Integrative Medicine: Principles for
Practice edited by Benjamin Kligler MD and
Roberta Lee MD. 2004. 184 pages.
- Integrative Oncology: Principles and
Practice by Taylor & Francis. 2006.
- Nutritional Medicine. Alan R Gaby. 2011.
- Textbook of Functional Medicine
edited by David Jones MD. 2005. 790 pages.
- Textbook of Natural Medicine
edited by Joseph Pizzorno ND and Michael Murray
ND. 1993, 1999. 1620 pages (2nd edition).
- The American College of Physicians
(ACP) Evidence-Based Guide to Complementary and Alternative Medicine. Edited
by BP Jacobs and K Gundling. 2009.
- Integrative Medicine Consortium (IMC) – a
cooperative organization formed in 2006, composed of the American
Association of Environmental Medicine (AAEM), American Association of
Naturopathic Physicians (AANP), American College for Advancement in
Medicine (ACAM), American Holistic Medical Association (AHMA), Institute
for Functional Medicine (IFM), and International College for Integrative
Oncology – the Society for Integrative Oncology (SIO), an international
organization of oncology professionals researching and integrating
effective complementary therapies in cancer care, held its first
international conference in 2004. President in 2005 is David S.
Rosenthal, Professor of Medicine at Harvard Medical
School and Medical
Director of the Center for Integrative Therapies at the Dana-Farber
- Bravewell Collaborative www.bravewell.org – includes a
clinical network which is comprised of eight
leading integrative medicine centers that are developing successful
models of integrative medicine care and delivery.
- Cochrane Collaboration CAM Field. As of issue 4,
2009, 396 reviews related to CAM
categorized at www.cochrane.org/reviews/en/topics/22_reviews.html.
- See also Appendix below.
- increasing health insurance coverage for complementary modalities of
Mutual of Omaha).
Health - natural medicine program established through the Public Health
Service in King County (Seattle,
WA and population 1.8
medical clinics in which ND’s and MD’s work side by side, and patients
get to choose who they see (if patient is uncertain, scheduler decides
whether the initial appointment is with a MD or ND).
2008 the network consists of 7 integrative medical clinics (six include
acupuncture, naturopathic medicine, and nutrition, seventh for now with
just nutrition services), 4 dental clinics, and one school based center.
program in the community health centers is administered by HealthPoint, a nonprofit entity.
Clinton in 2000 established a White House Commission on Complementary and
Alternative Medicine Policy, which issued a report on legislative and
2003 the Policy Institute for Integrative Medicine was founded by Marc Micozzi, MD, PhD, in affiliation with Thomas Jefferson University,
based on a grant from the Ira and Myrna Brind
Foundation. The mission of this Institute is the gathering, analysis,
and presentation of best practices that can help policymakers, health
professionals, and consumers re-shape the health care system.
Website for the institute is www.piimed.org
1/12/05 the IOM released a report on a study by an expert committee on
many aspects of the use of CAM in the U.S. This study had been
requested by NCCAM amongst others, to assist in developing research
methods and setting priorities for evaluating CAM
therapies. Complementary and Alternative Medicine in the United States
is available free at www.nap.edu/catalog/11182.html
or at a charge by contacting 1-888-624-8373.
Weil on the cover of Time -
symbolic of increasing coverage of this topic by the press.
2 hour special 3/29/06 – The New Medicine, focusing on initiatives at
leading academic integrative medicine centers.
What are the barriers to more widespread use and
acceptance of Integrative Medicine?
barrier - there is currently a "conspiracy of silence" between
physicians who do not ask their patients about the use of complementary
modalities of treatment and patients who are afraid to tell their
barrier - due to lack of insurance coverage, much is available only to the
of research - most practitioners are clinicians, and not researchers.
Research that does exist is often not in English, and cannot be found by a
- Lack of
licensure for some complementary practitioners, such as naturopaths.
insurance reimbursement schedules for physicians which financially reward
that practitioners are uneducated or physicians with "weak
minds" who are simply out to "make a fortune."
of safety in the status quo.
in high technology which exceeds the evidence for effectiveness (COTA
study in 1978 which concluded that only 10-20% of conventional medicine
practices are based on data derived from controlled clinical trials).
Four step approach to the evaluation of complementary
- Is it
there evidence for efficacy?
- Is it
- Is there
a theoretic rationale for its use in a given situation?
Pneumonic: I ASK
(inexpensive, available, safe, knowledge)
Evaluation guidelines as per Dr.
a three part education:
the concepts thoroughly.
the data critically.
the practice openly.
- Do a
two part look:
- strength/likelihood of attribution.
- benefit/magnitude of effect.
a SEC approach:
good methods of evaluation.
the detail, do not just label the system.
under-evaluated from ineffective.
Physician responsibilities as per Dr. Wayne Jonas:
therapies (i.e. megavitamins).
therapies, especially if substituted for effective therapies.
inexpensive therapies (i.e. homeopathy).
and effective therapies (i.e. relaxation techniques for pain management).
for which the mechanism is understood (i.e. acupuncture for pain and
with the patient.
illness - provide input on the evidence.
Medicine as a river, ever changing.
consumer is awash in the ocean amidst many islands of treatment modalities
- practitioners must build bridges.
for Integrative Medicine.
Appendix - web sites:
Updated September 21, 2014] [Return
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