MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The Americans call it ‘INTEGRATIVE MEDICINE’; in the UK, we speak of ‘INTEGRATED MEDICINE’ – and we speak about it a lot: these terms are, since several years, the new buzz-words in the alternative medicine scene. They sound so convincing, authoritative and politically correct that I am not surprised their use spread like wild-fire.

But what is INTEGRATED MEDICINE?

Let’s find out.

If the BRITISH SOCIETY OF INTEGRATED MEDICINE (BSIM) cannot answer this question, who can? So let’s have a look and find out (all the passages in bold are direct quotes from the BSIM):

Integrated Medicine is an approach to health and healing that provides patients with individually tailored health and wellbeing programmes which are designed to address the barriers to healing and provide the patient with the knowledge, skills and support to take better care of their physical, emotional, psychological and spiritual health. Rather than limiting treatments to a specific specialty, integrated medicine uses the safest and most effective combination of approaches and treatments from the world of conventional and complementary/alternative medicine. These are selected according to, but not limited to, evidence-based practice, and the expertise, experience and insight of the individuals and team members caring for the patient.

That’s odd! If the selected treatments are not limited to evidence, expertise, experience or insight, what ARE they based on?

Fascinated I read on and discover that there are ‘beliefs’. To be precise, a total of 7 beliefs that healthcare 

  1. Is individualised to the person – in that it takes into account their needs, insights, beliefs, past experiences, preferences, and life circumstances
  2. Empowers the individual to take an active role in their own healing by providing them with the knowledge and skills to meet their physical and emotional needs and actively manage their own health.
  3. Attempts to identify and address the main barriers or blockages to a person experiencing their health and life goals. This includes physical, emotional, psychological, environmental, social and spiritual factors.
  4. Uses the safest, most effective and least invasive procedures wherever possible.
  5. Harnesses the power of compassion, respect and the therapeutic relationship
  6. Focuses predominantly on health promotion, disease prevention and patient empowerment
  7. Encourages healthcare practitioners to become the model of healthy living that they teach to others.

I cannot say that, after reading this, I am less confused. Here is why:

  1. All good medicine has always been ‘individualised to the person’, etc.
  2. Patient empowerment is a key to conventional medicine.
  3. Holism is at the heart of any good health care.
  4. I do not know a form of medicine that focusses on unsafe, ineffective, unnecessarily invasive procedures.
  5. Neither am I aware of one that deliberately neglects compassion or disrespects the therapeutic relationship.
  6. I was under the impression that disease prevention is a thing conventional medicine takes very seriously.
  7. Teaching by example is something that we all know is important (but some of us find it harder than others; see below).

Could it be that these ‘beliefs’ have been ‘borrowed’ from the mainstream? Surely not! That would mean that ‘integrated medicine’ is not only not very original but possibly even bogus. I need to find out more!

One of the first things I discover is that the ‘Founder President’ of the BSIM is doctor Julian Kenyon. Now, that name rings a bell – wasn’t he mentioned in a previous post not so long ago? Yes, he was!

Here is the post in question; Kenyon was said to have misdiagnosed/mistreated a patient, exposed on TV, and eventually he ended up in front of the General Medical Council’s conduct tribunal. The panel heard that, after a 20-minute consultation, which cost £300, Dr Kenyon told one terminally-ill cancer patient: “I am not claiming we can cure you, but there is a strong possibility that we would be able to increase your median survival time with the relatively low-risk approaches described here.” He also made bold statements about the treatment’s supposed benefits to an undercover reporter who posed as the husband of a woman with breast cancer. After considering the full details of the case, Ben Fitzgerald, for the General Medical Council, called for Dr Kenyon to be suspended, but the panel’s chairman argued that Dr Kenyon’s misconduct was not serious enough for this. The panel eventually imposed restrictions on Kenyon’s licence lasting for 12 months.

Teaching by example, hey???

This finally makes things a bit clearer for me. There is only one question left to my mind: DOES BSIM PERHAPS STAND FOR ‘BULL SHIT IN MEDICINE’?

15 Responses to Integrated/integrative medicine: a paradise for charlatans?

  • “DOES BSIM PERHAPS STAND FOR ‘BULL SHIT IN MEDICINE’?” Nice one!
    “Integrative medicine” is an anagram of “I medicate teen virgin” — more scope for malpractice?

  • “DOES BSIM PERHAPS STAND FOR ‘BULL SHIT IN MEDICINE’?”

    Can it stand for anything else?

  • Yeah, what a sweet deal for them. They get grandfathered in to real medicine, without having to actually learn it.

    Bad deal for us patients, though.

  • A serious problem is that many UK institutions including the government and the BMA use the term ‘integrated medicine’ or ‘integrated healthcare’ to mean the integration of primary, secondary and social care. Surely most of us support that principle?

    But IM is used by many others (including HRH Prince Charles and the ‘College of Medicine’) to mean the integration of CAM with orthodox medicine (which of course changes in the light of evidence-based experience). Mixing pseudo-science with science. Apple pie mixed with cow pie. As discussed in this thread.

    I have drawn the attention of the BMA and BMJ to this problem, (including with a motion at BMA Annual Conference) but little general interest has been shown.

    It is essential (IMHO) that when the term ‘IM’ is used, the sense in which it being used is made clear – or patients, politicians and the public will be misled. Which is precisely what the practitioners of camistry based ‘IM’ want.

    May the Wu be with you all.

    • @Richard Rawlins
      So we need to differentiate integrated medicine. Hmmm… If i vaguely remember my calculus that takes us back, essentially, to ‘medicine’.
      Seriously, why doesn’t the combination of primary and secondary medicine with social services retitle itself ‘holistic health care’. Poaching a favourite snakeoil adjective should sow even better confusion.

      • @FrankO: You’re right if you talk about medicine as a scientific category. Medical practice is somewhat different inasmuch as there are many aspects well known in science that simply aren’t practiced – mostly due to lack of time and funds, and after a while, due to routine. Also, only few doctors take into account the findings of what one might call the sister sciences of medicine, i.e. psychology, sociology and a few others. One very common example is that doctor-patient-communication is still a widely known problem and is only starting to be addressed in medical training.
        So, there actually is a future for something one could refer to as “integrated medicine” – if and hopefully when the scientific community and dedicated patients manage to purge it of all alt-med elements and to open up medicine for knowledge and methods from other scientific disciplines.

        • As emphasised elsewhere on this thread – ‘integrative’ or ‘integrated’ can mean either of two dimensions:
          The integration of primary, secondary, tertiary, social and psychological care systems (good – we can all probably agree on that) and the insurgency by which some folks (including HRH) intend having CAM ‘integrated’ with conventional orthodox medicine (COM). Bad – because of the harm done by pseudo-science to evidence based modern medicine.

          It is essential the sense in which the term ‘IM’ is being used is clearly stated, or we can but assume the user or protagonist is intending that the reader is misled.

  • IM = Imaginative Medicine? (Just like imaginative fairies and goblins; doesn’t exist.)

  • There are many charlatans within the CAM Industry but you have to separate the C & A to get even a glimpse of the truth.

    Complementary refers to Energy Therapies and Alternative refers to those in competition with the pharmaceutical Industry.

    I don’t argue with those who claim to be Spiritual Healers, I am aware of numerous persons who work within that realm but when it comes to discuss Energy Therapies such as a system called Reiki then I find that there are very few that really know how to explain or practice it.

    Integrated/integrative medicine is not really hard to understand as all that is attempted to receive is an integration between conventional medicine and energy therapy.

    Maybe one of these days we will get our heads out of the sand and make progress as to understanding that our enotional body and the physical are really different and appart.

    • and what about EVIDENCE???

    • @len,
      “Maybe one of these days we will get our heads out of the sand and make progress as to understanding that our enotional body and the physical are really different and appart.”

      If by “we”, you mean you then yes, you do have to get your head out of the sand. You talk about “energy” as if it is some ethereal force only alt-meds understand and use. Engineers manipulate energy every day in the normal course of their work. The difference is they understand it, understand the formulae, and can calculate what will happen in the circumstances in which they use it.

      Energy is real and to those people who study science, physics, engineering and other real disciplines, it is no mystery.

    • Sorry Len,

      Unless clearly stated, we do not know what ‘complementary’ or ‘alternative’ mean. I have not found the distinction you make anywhere else.

      I go with Edzard’s definition in Trick or Treatment?:

      “Any therapy that is not accepted by the majority of mainstream doctors…
      Which are biologically implausible…
      Untested, unproven, disproven, unsafe, only marginally beneficial, or are placebos.”

      That’s broadly the sense in which HRH PC uses the terms, though he tends to avoid ‘alternative’ as it is clearly embarassing. He likes ‘ancient wisdom’, but declines to state what that means.
      I have written and asked him. His secretary replied that he does not enter into discussion on these matters.
      So we do not know what his understanding is.
      His ‘Foundation for Integrated Health’ folded some time ago.

      ‘IM’ is used as a magician uses smoke and mirrors or a scam artist uses shills when doing the three card monte.
      To deceive.

    • @Len,
       
      “Complementary refers to Energy Therapies and Alternative refers to those in competition with the pharmaceutical Industry.”
       
      Boy, you sure have difficulty with the English language! It’s not just your ignorant abuse of the meaning of the word ‘energy’, which Frank Collins has already addressed. “Complementary” means “Combining in such a way as to enhance or emphasize the qualities of each other or another” (Oxford English dictionary). In other words complementary medicine is something additional to a medical approach recognized as orthodox. Standing on one leg in a bucket of horse dung while reciting Wordsworth could be a complementary therapy if your psychology had been primed to imagine the action had a beneficial therapeutic effect. You’d do it in addition to something a doctor or surgeon was using to treat you.
       
      “Alternative” means: “(Of one or more things) available as another possibility or choice” or “(Of two things) mutually exclusive”. So alternative medicine means something you do (e.g. the one-leg-dung-Wordsworth therapy) to treat yourself while rejecting a medical approach regarded as orthodox. I have seen Edzard Ernst spell this out clearly in other threads elsewhere on this blog, but you are so out of your depth with the world of reality you pass everything anyone writes to you through a mental shredder so it doesn’t interfere with your ridiculous mysticism.
       
      And — pretty please! — stop equating medicine and the pharmaceutical industry. The NHS spend on pharmaceuticals is ~10% of total expenditure. If you visit a doctor or hospital you may be treated with dressings, appliances, prostheses, surgery, physiotherapy and counselling, among other non-pharmaceutical modalities. The idea that all medicine consists of is giving people pills is a certain sign of clinical ignorance.

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