MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

We used to call it ‘alternative medicine’ (on this blog, I still do so, because I believe it is a term as good or bad as any other and it is the one that is easily recognised); later some opted for ‘complementary medicine’; since about 15 years a new term is en vogue: INTEGRATED MEDICINE (IM).

Supporters of IM are adamant that IM is not synonymous with the other terms. But how is IM actually defined?

One of IM’s most prominent defenders is, of course Prince Charles. In his 2006 address to the WHO, he explained: “We need to harness the best of modern science and technology, but not at the expense of losing the best of what complementary approaches have to offer. That is integrated health – it really is that simple.”

Perhaps a bit too simple?

There are several more academic definitions, and it seems that, over the years, IM-fans have been busy moving the goal post quite a bit. The original principle of ‘THE BEST OF BOTH WORLDS’ has been modified considerably.

  • IM is a “comprehensive, primary care system that emphasizes wellness and healing of the whole person…” [Arch Intern Med. 2002;162:133-140]
  • IM “views patients as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment.” [BMJ. 2001; 322:119-120]

During my preparations for my lecture at the 16th European Sceptics Congress in London last week (which was on the subject of IM), I came across a brand-new (September 2015) definition. It can be found on the website of the COLLEGE OF MEDICINE  This Michael Dixon-led organisation can be seen as the successor of Charles’ ill-fated FOUNDATION FOR INTEGRATED HEALTH; it was originally to be called COLLEGE FOR INTEGRATED MEDICINE. We can therefore assume that they know best what IM truly is or aspires to be. The definition goes as follows:

IM is a holistic, evidence-based approach which makes intelligent use of all available therapeutic choices to achieve optimal health and resilience for our patients.

This may sound good to many who are not bothered or unable to think critically. It oozes political correctness and might therefore even impress some politicians. But, on closer scrutiny, it turns out to be little more than offensive nonsense. I feel compelled to publish a short analysis of it. I will do this by highlighting and criticising the important implications of this definition one by one.

1) IM is holistic

Holism has always been at the core of any type of good health care. To state that IM is holistic misleads people into believing that conventional medicine is not holistic. It also pretends that medicine might become more holistic through the addition of some alternative modalities. Yet I cannot imagine anything less holistic than diagnosing patients by merely looking at their iris (iridology) or assuming all disease stems from subluxations of the spine (chiropractic), for example. This argument is a straw-man, if there ever was one.

2) IM is evidence-based

This assumption is simply not true. If we look what is being used under the banner of IM, we find no end of treatments that are not supported by good evidence, as well as several for which the evidence is squarely negative.

3) IM is intelligent

If it were not such a serious matter, one could laugh out loud about this claim. Is the implication here that conventional medicine is not intelligent?

4) IM uses all available therapeutic choices

This is the crucial element of this definition which allows IM-proponents to employ anything they like. Do they seriously believe that patients should have ALL AVAILABLE treatments? I had thought that responsible health care is about applying the most effective therapies for the condition at hand.

5) IM aims at achieving optimal health

Another straw-man; it implies that conventional health care professionals do not want to restore their patients to optimal health.

In my lecture, which was not about this definition but about IM in general, I drew the following six conclusions:

  1. Proponents of IM mislead us with their very own, nonsensical terminology and definitions.
  2. They promote two main principles: use of quackery + holism.
  3. Holism is at the heart of all good medicine; IM is at best an unnecessary distraction.
  4. Using holism to promote quackery is dishonest and counter-productive.
  5. The integration of quackery will render healthcare not better but worse.
  6. IM flies in the face of common sense and medical ethics; it is a disservice to patients.

29 Responses to INTEGRATED MEDICINE: a disservice to patients?

  • Perhaps a bit too simple?

    The definition of IM or Prince Charles?

  • The US National Center for Complementary and Alternative Medicine (NCCAM) started as the Office of Unconventional Medicine in 1991 with $2M of discretionary US Government funding. Its current budget is about $125M a year with about thirty per cent of the total research budget focussed on pain management. Its Director, Dr Josephine Briggs, started a blog in 2012 and in the first she set out the Center’s objectives:

    ‘To bring rigorous science to the broad array of health practices that have arisen from outside of mainstream medicine’. A hard task, as most of the modalities studied are highly implausible and would break well established laws of physics if proven to be effective.

    Dr Briggs’ second post considered: ‘Integrative – What is in a Word?’
    She suggests that: ‘From one end, “integrative medicine” offers a holistic, gentle, patient-centered approach that will solve many of our Nation’s most pressing health care problems. At the other end, “integrated care” represents an invasive rebranding of modern equivalents of “snake oil” by practitioners who raise unrealistic hopes and promote approaches that are not sensible, supported by evidence, or proven safe’.

    Nevertheless, in 2015 the Center changed its name to National Center for Complementary and Integrative Health, moving further down the path of denial and obscuring its real objectives – which now seem to be the encouragement of the insurgency of irrational ideas into conventional medicine. Does this represent a failure to face reality? Denial? An attempt to deceive and mislead the public?

    You must be the judge.

    • NCCAMs to NCCIMs.. I love the ring of it… Have they got a scientific result yet? You have to justify funding one day.

    • Nevertheless, in 2015 the Center changed its name

      Sometimes a change of names can help one’s publicity and self-image. The Cheka became the NKGB, then the MGB and then the KGB. Did wonders for their recruiting 🙂

  • If ‘IM uses ALL available therapeutic choices’ then, surely, every patient benefitting from IM should be given chiropractic adjustments and acupuncture, whilst swallowing homeopathic pills, having reiki people and faith healers wave their hands around them, with burning candles in the patients’ ears and a mass of crystals and aroma sources doing their stuff as well?

  • Judging from my experience with representatives of integrative (or whatever) medicine they regard as treatment onlt things that restore to the perfect state before disease, so operation is not a treatment and neither are most of the drugs, especially used for chronic conditions. Including hormones, even in hormone replacement therapies, because, according to them, they make you dependant on drugs! And the real treatment, according to them, is the one, that makes body produce those hormones.
    So for these people all diseases are either curable or incurable, so don’t be surprised if they do not offer you simple drug since long ago known to conventional medicine – they just do not regard it as treatment.

  • You know, I disagree that medicine is ‘holistic,’ in that it does NOT routinely include ‘care’ for people’s “minds and spirit.” Thank god! Nobody with any sanity wants physicians to ‘care’ for their spirits and minds (in the absence of any overt mental illness, that is).

    My point is that I think there should be objections to the fact that one of the main ways that integrative medicine practitioners are ‘holistic’ is by intruding into domains that they have no business intruding in–the mental/psychological and spiritual* domains (and they do so without patients’ consent, by claiming that mental and spiritual health is integral to bodily health and that ‘care’ for the body therefore entails ‘care’ for the mind and the spirit).

    * Yes, yes, these camsters constantly claim that ‘spirituality’ isn’t religion, but that’s BS. What many of them mean by ‘spirituality’ is spirituality a la the New Age, and the New Age is nothing if not a religion (albeit an extremely wacky and deeply disturbing religion).

    • I think you make an important point. I would also say that physicians almost always show at least superficial respect for people’s religious and spiritual beliefs, even if they do not share them (which is superhuman in my view because I would just laugh out loud).

      I make a point of putting ATHEIST on all my forms at clinics and hospitals and tell the staff that I want no praying or clergy under any circumstances. I avoid medical institutions that are sponsored by a Church–this is mostly Catholic where I live, but due to insurance coverage, it isn’t always possible. These days, I have to add, NO “alternative” medicine.

  • I just wanted to add this quote from the Holistic Medicine Association to what I wrote above (check out the last sentence, below):

    [In holistic medicine:] Disease is understood to be the result of physical, emotional, spiritual, social and environmental imbalance. Healing, therefore, takes place naturally when these aspects of life are brought into proper balance. The role of the practitioner is as guide, mentor and role model; the patient must do the work – changing lifestyle, beliefs and old habits in order to facilitate healing. All appropriate methods may be used, from medication to meditation…..

    Holistic medicine is a term which is inclusive of the connection between the mind, body and spirit in healing. The belief system, lifestyle, social, cultural and environmental milieu, as well as the relationship between patient and practitioner, are considered to be important components in the genesis and in the healing of illness. Correction of imbalances in any of these areas will bring relief of symptoms. Illness in this model is viewed as an opportunity for personal spiritual growth.

    (American Holistic Medical Association. Excerpts from the website, c. 2014 http://www.holisticmedicine.org/)

    • Oh good grief! According to this, you can “visualize” your tumor shrinking and all that sort of positive thinking nonsense. All that “balance” blather is nothing but vitalism.

  • It doesn’t help that Prof Ernst’s views have been bizarrely misrepresented in the Telegraph yesterday.

    http://www.telegraph.co.uk/wellbeing/doctors-diary/doctor-s-diary–doctors-should-embrace-herbal-medicine/

    “Her Majesty would no doubt concur with the opinion of Professor Edzard Ernst of Exeter University that it is time doctors changed their usually negative attitude towards herbal medicines.”

    Really?

    • Nicely cherry picked line or maybe utter journalistic failure.

      • Read the whole piece – it’s only short so I can copy it below. And no I don’t do ‘cherry-picking’ thank you very much. I don’t need to in this instance!

        “The Queen’s record-breaking reign at 23,260 days might be expected to have taken its toll but there is little sign of it. This is attributable no doubt to her healthy lifestyle, regular habits (including, apparently, perusing the Racing Post and Daily Telegraph every morning over breakfast) and perhaps even the well known Royal approval of natural remedies and herbal medicine.

        The fortunes of these “alternatives” have fluctuated during her 63 years on the throne. Though initially eclipsed by the rise of modern pharmaceuticals, they are increasingly back in favour due mainly to two recent developments much emphasised at the recent 50th anniversary celebrations of the British Herbal Medicine Association.

        First, the introduction just over a decade ago of the Traditional Herbal Medicinal Products Directive now ensures that herbal medicines conform to internationally agreed standards of safety and quality control. Next their efficacy has been confirmed, to the dismay of sceptics, by the findings of numerous clinical trials investigating variously the merits of hypericum in combatting lower mood, saw palmetto in improving urinary flow and the blood thinning gingko biloba in delaying cognitive decline. It has, for technical reasons, been more difficult to demonstrate with the same degree of certainty, the merits of the popular echinacea for flu or feverfew as an antidote to migraine – but Her Majesty would no doubt concur with the opinion of Professor Edzard Ernst of Exeter University that it is time doctors changed their usually negative attitude towards herbal medicines.”

  • Holistic, evidence-based, intelligent, all available therapeutic choices, aims at achieving optimal health – sounds like my quackery-free treatment for prostate cancer. Treatment including referral to a supportive website ; pre and post surgery physiotherapy, psychologist, sex therapist. We’ve intelligently and in an evidence based way excluded some therapeutic choices until they are needed, because evidence shows no benefit in too early intervention, and excluded lots of other because they probably don’t work.
    As you said “responsible health care is about applying the most effective therapies for the condition at hand.”

  • Your colleagues in Australia – Friends of Science in Medicine – suggest that the term “CAM” should be replaced, and that conventional medicine is already integrative.

    Check out the rational here:
    http://www.scienceinmedicine.org.au/images/pdf/bp_june15.pdf

  • I presume that the ‘opposite’ of this IM medicine is ‘conventional medicine?’

    It could be argued that so-called conventional medicine is equally misguided/spun/destructive as the misguided/spun/destructive ideas that you are criticizing. I do agree with your criticisms, but I do not think that the alternative(s) are much better.

    I would argue that we do not know how to optimize health because we do not ask the right questions. We chase surrogate markers that do not have merit, we do not critically assess diet in its effects on health outcomes because we are riddled with ‘dietary knowns’ that are simply untrue: e.g. for decades we obsessed over dietary fats. We radically altered our intake of types of fats from lard/butter/olive oil to corn/vegetable/safflower/soy/margarines/etc oils. We hydrogenated these novel oils which created trans fatty acids, supposedly soon to be banned except for rare exemptions.

    Examples of how ‘conventional medicine’ misguides/damages/fails to improve health are:

    * widespread use and promotion of statins for ‘good heart health’ when there are data to show that they do NOT do what we are told. They impair endogenous processes such as biosynthesis of CoQ10 and MK-4, which appears to be destructive to heart health and they harm other aspects of health, too. The statistical spin used to promote these drugs has used relative risk reduction when discussing benefits whereas they resort to absolute risk reduction when discussing side effects. Newer data show a large increase in risk of T2D when these drugs are given, and there are publications that support this effect with mechanistic understanding of statins. These mechanisms show the downsides of statins, but this information does not seem to garner publicity.
    * widespread usage of antidepressants, in spite of data that show they are no better than placebo and they, too, do damage.
    * bisphosphonates, which make bad bone and cause femurs to snap – and the widespread promotion of DXA scans when the evidence does not support this practice
    * mammograms that have done a number on BC statistics, increasing seeming incidence and ‘showing’ how we ‘successfully treat’ it with ‘more’ survivors. We now have so much overdiagnosis and therefore overtreatment, when the mortality from BC has remained flat, even as mammography increased so much. In short, they don’t save lives.
    * water fluoridation, which does not reduce cavities in a statistically relevant amount and does damage to thyroids, teeth (ironic, but true), bones and the pineal gland. Those who do not fluoridate have the same caries incidence as those who do, and now that 41% of adolescents have dental fluorosis (and which has altered guidelines to lower amounts for ‘optimal fluoridation levels’ than previously), one might wonder whether their fluorosis is indicative of damage to their bones, pineal gland, thyroids.
    * PSA test…well, at least there is some recognition that we got way out there, damaging many, before someone pointed out that mortality was not particularly affected, whereas many had a much lower quality of life after they started down the road of ‘conventional medicine’ and its approach to this biomarker

    I could go on. So yes, these ideas are ridculous and dangerous, but so are most of the other ideas and alternatives.

    • If you do ‘go on’ could you at least reference your claims to reviews of evidence or national consensus statements? I don’t recognise what you claim about water fluoridation & damage to ‘thyroids, teeth, bones and the pineal gland’.

      The NHS policy is that:

      “Overall, the reviews have found that water fluoridation contributes to reduced decay levels in populations, although the amount of reduction varies depending on the measures used.”

      and

      “There have been some concerns that fluoride may be linked to a variety of health conditions. Reviews of the risks have found no evidence to support these concerns and the general consensus is that water containing the correct amount of fluoride and fluoride toothpaste have a significant benefit in reducing tooth decay.”

      Are you saying this is wrong, and that the NHS Choices experts are misinformed? http://www.nhs.uk/Conditions/Fluoride/Pages/Introduction.aspx

      • of course!
        didn’t you know, it’s all a very very big conspiracy !!!

        • Read The Fluoride Deception.
          I will share some references shortly.

        • Of course. How stupid of me NOT to know this:

          “Water fluoridation as a commie plot started among the wingnut paranoids during the Cold War, most notably the John Birch Society. The conspiracy theory gained currency among far-left moonbats after it mutated in the early 1990s into a plot by the aluminium industry to dispose of their fluoride wastes by dumping them into the water supply for profit. The implication that Big Pharma is out to poison you and that the scientific consensus is proof of a massive world-wide conspiracy of scientists/dentists makes reasoning with conspiracy theorists particularly difficult.”

          I’m not totally OK with the language used, but I see what they are getting at. http://rationalwiki.org/wiki/Water_fluoridation

    • None of your “examples” reflects scientific consensus, but rather cherry picked studies that often get grossly over-interpreted by the popular media.

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