MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

What motivates a doctor to work as an integrative medical practitioner? This is a question I asked myself often. Despite trying to find answers through several methods, I was not very successful. The question does not seem well-researched at all. Here is what I found so far:

Our own 1996 survey of GPs participating in a course at Exeter that was aimed at familiarizing them with so-called alternative medicine (SCAM) found that the main perceived advantage of SCAM, apart from the potential intrinsic value of the techniques themselves, was the time available for establishing a good therapeutic relationship with the patient.

A UK survey from 2001 suggested that doctors are motivated by issues ranging from feeling a responsibility to respond to their patients’ interests and needs to developing “another string to their bow.” Some are attracted to its study in its own right, others by a wish to focus some of their energy away from conventional medical practice, which they may find stressful and unfulfilling. Doctors studying complementary and alternative medicine often call on different personality traits and report a variety of positive benefits from training, including welcoming the opportunity to engage their feelings, trust their intuition, and enjoy therapeutic touch. Comments from attendees at one homoeopathic course were “I started to enjoy seeing patients again,” “Training had improved my conventional history taking,” and “Having another approach made treating heart-sink patients easier.”

A German focus group in 2008 with 17 GP suggested that scientific evidence and patient preference were the main criteria used by these doctors in deciding whether to apply a SCAM or not.

An interview study published in 2011 with Australian doctors provided some details. The researchers invited 43 doctors to participate. Twenty-three agreed to take part in either a face-to-face (n = 7) or telephone (n = 16) interviews. Here is the passage entitled “Motivations to work as an integrative medical practitioner” from their paper:

‘Family of origin health beliefs and practices’ were an important influence on the doctors’ philosophical approach and their decisions to work as an integrative medical practitioner.

…When I grew up it was not uncommon that I would see my aunties and uncles preparing all sorts of things. My auntie laying me on her lap and putting breast milk in my ear and drinking chamomile tea for a sore belly…there was lots of things that influenced me. (Female, 23 years in practice)

…There is a long tradition in [country of origin] of using a herbalist. I heard things from my mum and my grandma and those ideas were there. (Male, 16 years in practice)

The ‘personal or close family illness experiences’ reported by doctors were also influential in motivating them to practice integrative medicine. These experiences included non-conventional approaches to health and illness and the use of CAM as treatment modalities.

…I had my own illness – depression and a very bad back. I’d been on medication for years and I got sick of taking medications and I was given a prognosis of chronic illness with relapses and I really didn’t like it. So I started to look elsewhere and that took me in to the world of mind-body medicine. (Female, 24 years in practice)

Other doctors cited ‘professional experiences’, often early in their careers, of different theoretical approaches to medicine as being a powerful stimulus to practice integrative medicine. These included being inspired by a medical lecturer, an interesting, usually non-conventional experience during a placement as a medical student, and professional experiences of CAM modalities during their residency or early medical career.

…We had this subject Medical Studies 3, where there was a discussion of the French fur trapper in the Yukon who had shot himself in the stomach and the local doctor who was experimenting with various emotional states. There was just that sort of moment, of thinking, that’s the sort of area that I want to work in. (Male, 26 years in practice)

…I found myself doing a clinical attachment at a hospital in Switzerland that used integrated medicine, they had a course and I thought I’ll just do this for interest. I came in contact with an Indian person who did homeopathy and I found his stories quite interesting. (Male, 22 years in practice)

‘Dissatisfaction with the conventional approach to medicine’, which was perceived to be too illness focused or commercialized, was also cited by some doctors as a precursor to adopting an integrative approach to medical practice.

…More and more I’m realising that medicine is a personalised thing. We need to learn the art of treating people individually rather than en masse as a sick lung or a sick toe or a sick whatever because it doesn’t work like that. (Male, 22 years in practice)

…Medicine was hijacked by the market; i.e.: big pharmaceutical companies. And they have seduced the government, the colleges, the universities, general practice, everybody. GPs, in my opinion, have been deskilled. (Female, 19 years in practice).

An Australian survey from 2021 suggested that GPs were attracted to SCAM because they thought it to be relatively safe and effective, offering additional, holistic benefits to patients.

___________________________

Collectively these investigations suggest that doctors’ motivation to work as integrated medical practitioners vary greatly. They seem to include:

  • positive evidence for SCAM’s safety and efficacy,
  • having the time to establish a good therapeutic relationship,
  • wanting to use all therapeutic options,
  • dissatisfaction with conventional medicine,
  • patient preferences,
  • wanting to practice in a more human and holistic way,
  • personal and professional experiences.

But surely, there are other factors as well (from my personal experience in dealing with doctors of integrative medicine, I could list a few that are less than flattering). In any case, I would be most interested to hear your thought and read more published evidence that you might know about.

48 Responses to What motivates a doctor to work as an integrative medical practitioner?

  • … the main perceived advantage of SCAM … was the time available for establishing a good therapeutic relationship with the patient.

    Why is SCAM necessary for that?

  • I am a magician, as a hobby (and a surgeon as a profession).
    I am motivated by the intrigue and ego boost of fooling people, but have to devise ways of doing so in a style that does not embarass them and which gives them a frisson of pleasure and moment of enlightened entertainment.

    Jillette Penn (of Penn & Teller) has said “The greatest secret in magic is that magicians lie!”

    James Randi: “Magicians are very honest people!
    Magic is a very honest art form. We say we are gonna fool you and we do!
    We say we are going to entertain and delight you, and we do.
    Magicians remind us there is no such thing as impossible, just a way around it.”

    “Nothing is impossible, it’s right there in the name im possible” – Audrey Hepburn.

    Jean Robert Houdin (from whom Eric Weitz adapted the name Houdini) said:
    “A magician is an actor playing the part of a magician.”

    And when taken up professionally of course, we do it for money, fame, celebrity and fortune.

    Surely the same goes for IM practitioners?

    Just as magicians tell their audiences they are using supranatural powers, reading body language, trained non-verbal means of communication, have second sight, apply highly developed intuition, an outstanding memory, dowsing and ideomotor sensitivities etc, so IMPs will claim they can connect with ‘meridians’, ‘innate intellegence’, ‘lines of energy’, and have apparently miraculous healing powers based on thousands of years of human endeavour.

    But given there is no plausible reproducible evidence for these claims of IMPs (any more than there is for those of magicians), the default position, the null hypothesis, has to be that IMPs want to fool people – and very often, for financial reasons.

    They succeed of course because the placebo effect/response can be very powerful in satisfying patients (who are suffering) – just as a good magical performance will initiate pleasure and satisfy an engaged audience.

    No? That is a false premise?
    Then provide the evidence otherwise!
    That is why the Enlightenment introduced tools to expose and debunk false claims – no matter how they are dressed up.
    No matter if the magician’s black cloak has been swapped for a white coat.
    Simple.

    If only we still had an academic department investigating the phenomena of SCAM.
    Sigh.
    We do have departments being developed to in ‘placebo studies’, so there is some progress – but human nature is fickle, and relies on humans!

  • I think there are more factors:
    No emergency patients.
    No patients that are seriously ill and need medical or complex help right away.
    No calls an no patients to be seen at night and in the weekends, just 9.00 to 17.00 hour office based work.
    No Heath Inspection breathing down your neck, no protocol commissions, no meetings. Just you as an admired healer in your own office who can do what he/she likes.
    The money is good because you can charge what you like.
    Need I say more?

    • And of course no responsibility or accountability.
      Most alternative treatments don’t actually do anything, so they don’t come with significant risks either. And if something goes wrong after all, it is easy to deflect any blame away from the practitioner towards the patient: the patient could have known that SCAM is not real medicine, or the patient did not adhere to the treatment plan, or the practitioner acted to the best of their knowledge and training and thus is not to blame …

      • Please note that his thread discusses “What motivates a doctor to take up IM practice?”
        Many doctors do so as an adjunct to their ‘regular’ medical practice, and do remain accountable to the GMC – and might well have on-call and emergency duties.

        But still, a number of GPs provide SCAM services, or are happy to uncritically refer patients to IMPs. (If they do refer, the GMC says they remain responsible for the patient’s care).

        HM The Queen had a registered medical practitioner as a physician. He was also a proponent of homeopathy.
        I know not whether his role has been taken over following his untimely death in a road accident, nor what HRH PC does about his bizarre interests in IM.

        The GMC is consulting on a new Code of Conduct (‘Good Medical Practice’) and that offers a glimmer of hope that the GMC will curtail the activities of charlatans, quacks and scamists.
        I will report on this shortly!

  • One reason many practitioners gravitate to scam is that it is easier to practice scam than EBM. Practicing medicine is hard technically and emotionally with many a disappointment and the reality that you might have to tell a patient there is nothing more that can be done or an intervention failed.

    Ebm takes on the tough cases where many a treatment may be the lesser of two bad choices, the treatments can be painful or debilitating and outcomes unsure of.

    Scam goes for the low hanging fruit of vague maladies that defy diagnosis. The application of generally benign and relatively comfortable , easily applied treatments allows the scammer to forgo the stress , and tension of applying a real therapeutic and allows practitioner to garner the same esteem and trust as that of an ebm practitioner without the risk, or stress.

    Shining a colored light on someone , prescribing them a homeopathic remedy, or pricking them with a needle is a whole lot easier than surgery, chemo, or radiation therapy.

    So simply put , practicing scam is a lucrative cop out for those who would want to make money practicing medicine without having to actually practice medicine

    • From a list of 20 clinical conditions, respondents chose the top 5 for which they perceive integrative medicine to be most successful at their centers. These are, in descending order:

      Chronic pain

      Gastrointestinal conditions

      Depression

      Stress

      Cancer

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833660/

    • Whilst I totally agree that these treatments are without value or scientific basis I wouldn’t necessarily agree that all practitioners are scammers. Some individuals are clearly well meaning and do what they do for little or no financial gain. They have their worldview which to them seems consistent and valuable and by treating others they believe they are helping. And of course it also gives them a sense of self worth. It may be delusional but the feeling is be genuine.

      What is disturbing is the naivety that often goes along with this, such as the notion that something ‘natural’ could not have harmful side effects. But still, this is different to the deliberate deception and greed of the big SCAM companies.

    • @Chris
      I agree,with your thoughts. But I like to add the factor of poor education and training in basic sciences, scientific approach and critical thinking skills. Even if most medical professionals who practice woo seem to have chosen the easy way out of a lazy, unambitious character/attitude to their profession, like you describe, I see many ambitious, hard-working, smart professionals who still do not realise the improbability of many common “complementary” gimmicks e.g. coloured kinesio-tapes or acupuncture remarketed as “western” a.k.a. “dry” needling. Many of them latch on to such pseudomedical additives due to perceived voids in the resources and options of modern EBM /SBM. Instead of realising that we need to live with gaps in our abilities and limited therapeutic options, smmart gifted professionals also latch on to lucrative alternatives but stop short of the necessary critical appraisal and reappraisal behaviour that should have been hammered into them as students while they were being trained to avoid the trapdoor of cognitive dissonance.
      If such skills were taught and trained, I think we would see much less SCAM use, at least by the normally gifted majority of certified health professionals.

  • “What motivates a doctor to work as an integrative medical practitioner?”

    THE REAL ANSWER IS:

    “….Good doctors [!!] 😉use both
    individual clinical expertise
    and
    the best available external evidence, and neither alone is enough.
    Without clinical expertise, practice risks becoming tyrannised
    by evidence, for even excellent external evidence may be
    inapplicable to or inappropriate for an individual patient [!!]
    Without current best evidence, practice risks becoming
    rapidly out of date, to the detriment of patients…. ”

    Sackett:
    Evidence based medicine: what it is and what it isn’t
    It’s about integrating individual clinical expertise and the best external evidence
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2349778/pdf/bmj00524-0009.pdf

    • I am so gal that we have someone who has the REAL answer!

    • Without clinical expertise, practice risks becoming tyrannised by evidence

      And god forbid that evidence becomes the leading principle for the choice of treatment …

      for even excellent external evidence may be inapplicable to or inappropriate for an individual patient

      What you commit here are two fallacies known as non sequitur and false dichotomy: you (correctly) claim that statistical scientific evidence alone does not say anything about efficacy in individual cases – but then you go on to say that in cases where EMB does not work, treatment based on a practitioner’s personal experience may offer a solution – even if there is no scientific evidence at all supporting the practitioner’s experiences and beliefs.

      Basically, you are saying that whenever EBM cannot help someone, literally anyone who claims to have ‘expertise’ and ‘good experiences’ could have a go at it, up to and including the gardener who saw his listless dog perk up after eating grass.

      This is not good. For any considered intervention, there should always be scientific evidence of efficacy. Please note that this still allows practitioners to base their choice of treatment on their own experience and expertise – in fact, this happens every day in regular medicine, where doctors choose whatever treatment they think works best. However, they should not be allowed to perform treatments for which there is no good evidence at all. And the latter includes most alternative modalities.

    • And where can we find the evidence to support the notion that any CAM modalities used by IMPs have any effects better than placebo?

      If there is such evidence, the modality will be taken up by ortodox practitioners.
      If not, they will drop it.
      Many ‘orthodox’ procedures have been dropped once evidence came to light of the lack of proven benefit.
      E.g. Ligation of the internal mammary artery.

      EBM emphasises the use of ‘best available external evidence from systematic research’ – says so on the tin Dr Hümmer selectively quotes – not just ‘best external evidence’.
      So, if there is no evidence (acceptable to those of a modern scientific mind set and based on systematic research) – don’t use that modality.
      Simple.

      • Richard,
        first of all, I hope you realized that the above is “only ” quoted by the article of Sackett.

        second:
        Did you know, that the evidence of Homeopathy is equal to that of orthodox medicine?
        Mapping the Cochrane evidence for decision making in health care
        https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2753.2007.00886.x

        Third:
        The illusion of evidence based medicine
        https://www.bmj.com/content/376/bmj.o702

        • @ Heinrich Hümmer

          first of all, I hope you realized that the above is “only ” quoted by the article of Sackett.

          The article strongly suggests that Sackett is talking about properly educated and medically competent doctors – which agrees with my previous comment.
          Nowhere does Sackett argue that the unproven magical beliefs of alternative practitioners should be included in this expertise and experience.

          Did you know, that the evidence of Homeopathy is equal to that of orthodox medicine?

          Oh dear … Hasn’t your mother taught you that telling lies is bad?

          • Study situation in homeopathy and conventional medicine

            By the end of 2014, 189 randomized controlled trials of homeopathy in 100 different conditions had been published in peer-reviewed journals.
            This includes 104 studies that are placebo-controlled and eligible for further detailed assessment:
            • 41% were positive (43 studies) – they found homeopathy to be effective
            •5% came back negative (5 studies) – they found homeopathy to be ineffective
            •54% were inconclusive (56 studies)

            An analysis of 1016 systematic reviews of RCTs on conventional medical treatments came to a strikingly similar conclusion:

            •44% tested positive – treatment was probably beneficial
            •7% were negative – the treatment was probably harmful
            •49% were equivocal – results showed neither benefit nor harm

            https://www.hri-research.org…
            El Dib, R.P. et al (2007). Mapping the Cochrane evidence for decision making in health care. Journal of Evaluation in Clinical Practice, 13, 689-692.

          • CONCLUSIONS OF THE MAIN METAANALYZES ON HOMEOPATHY
            Taken from INH (INFORMATION NETWORK HOMEOPATHY) website:
            https://www.homöopedia.eu/index.php/Article:Systematische_Reviews_zur_Hom%C3%B6opathie_-_%C3%9Cbersicht
            Conclusions abbreviated but reproduced without distortion, capitalization to clarify the central statement, [additional comment]

            Kleijnen (1991) Currently the EVIDENCE from clinical studies is POSITIVE,…

            Linde (1997) ….NO CONFIRMATION for the HYPOTHESIS THAT (…) was based solely on a PLACEBO EFFECT….
            Linde (1998) ….has an EFFECT BEYOND PLACEBO….

            Cucherat (2000) ….ARE MORE EFFECTIVE THAN PLACEBO;…

            Shang (2005) …. there was WEAK EVIDENCE for a SPECIFIC EFFECT OF HOMEOPATHIC MEDICINES…
            Mathie (2014) …may show a SMALL SPECIFIC EFFECT….

            NHMRC (2015) …there are NO conditions for which there is RELIABLE EVIDENCE…

            [THIS LAST STUDY HAS BEEN DEMONSTRATELY “MODIFIED” IN A SECOND EDITION BY INCORRECT STATISTICAL METHODS TO ACHIEVE THE DESIRED RESULT, THE FIRST EDITION WAS PUBLISHED BY PRESSURE OF THE COMMONWEALTH OMBUTSMAN AND HAS SURPRISES READY…..]

          • “another-attempt-to-white-wash-the-evidence-on-homeopathy/”

            by INH ???????

            I thought THEY wanted to prove that homeopathy doesn’t work?
            Edzard, I no longer understand the world (of thoughts in which you live)!

          • Study situation in homeopathy and conventional medicine

            By the end of 2014, 189 randomized controlled trials of homeopathy in 100 different conditions had been published in peer-reviewed journals.
            This includes 104 studies that are placebo-controlled and eligible for further detailed assessment:
            • 41% were positive (43 studies) – they found homeopathy to be effective
            •5% came back negative (5 studies) – they found homeopathy to be ineffective
            •54% were inconclusive (56 studies)

            Not so: the studies described as “inconclusive” were those in which there was no significant difference between homeopathy and placebo, i.e. they found homeopathy to be ineffective. So that’s 59% negative. And this doesn’t take study quality, a known issue, into account.

            You then go on to compare these individual trials with systematic reviews of conventional treatments. This is not comparing like with like. A systematic review which is unable to come to a definite conclusion as to efficacy is not comparable to a RCT that fails to demonstrate a difference between treatment and placebo.

          • Conclusions abbreviated but reproduced without distortion…

            Nope, I know what the sources actually say, and you are blatantly quote-mining.

          • This BS about “54% inconclusive” has been addressed previously.

            “… Original studies are never inconclusive, metastudies can be (i.e. in the case when two equally good studies are one positive and one negative).”
            — Thomas Mohr

            The BHA findings in pictorial format:
            https://edzardernst.com/2017/02/the-growing-body-of-positive-evidence-for-homeopathy-in-your-dreams/#comment-86387

          • yes, but if you only have BS to say, you say it again and again and again and …….

          • Let’s put it like this:

            Orthodox medical research:
            https://upload.wikimedia.org/wikipedia/commons/a/a7/Monet.012.sonnenschirm.jpg

            Homeopathic research:
            https://empoweredparents.co/wp-content/uploads/2019/09/child-development-drawing-stages-6.jpg

            And oh boy, aren’t those homeopaths proud of what they do!

          • Mapping the Cochrane evidence for decision making in health care [OF CONVENTIONAL MEDICINE!]

            Regina P. El Dib PhD, Álvaro N. Atallah MD PhD, Regis B. Andriolo
            First published: 04 August 2007
            https://doi.org/10.1111/j.1365-2753.2007.00886.x
            Citations: 59

            “Results We analysed 1016 completed systematic reviews. Of these, 44% concluded that the interventions studied were likely to be beneficial, of which 1% recommended no further research and 43% recommended additional research. Also, 7% of the reviews concluded that the interventions were likely to be harmful, of which 2% did not recommend further studies and 5% recommended additional studies. In total, 49% of the reviews reported that the evidence did not support either benefit or harm [*], of which 1% did not recommend further studies and 48% recommended additional studies. Overall, 96% of the reviews recommended further research.”
            https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2753.2007.00886.x

            For Edzard for understanding:
            [*] “49% of the reviews reported that the evidence did not support either benefit or harm” = INCONCLUSIVE

          • for the ones who are a bit slow on the uptake:
            properly conducted trials can only confirm or reject the hypothesis; they are thus positive or negative.
            systematic reviews can be, and often are, inconclusive (for instance if there is no good evidence either way or when the results are 50:50).
            homeopaths have INVENTED the inconclusive trial where there is no difference between placebo and homeopathy.
            SUCH A TRIAL IS A NEGATIVE TRIAL!!!

  • This journal and article exemplifies pseudoscience and scam promotion in veterinary medicine:

    From: The Integrative Veterinary Journal:

    https://ivcjournal.com/pediatric-veterinary-homeopathy/

    “Conventional drugs offer limited options for treating the young animal, and often only suppress symptoms, worsening the overall condition or resulting in “side effects.”

    “Young animals are challenged in many ways, as they develop their innate immunity to various pathogens and develop a healthy gut microflora. Various homeopathic remedies have special import in helping this process, stimulating the animal’s vital force to perform in the best way possible.”

    “Major anti-miasmatic remedies can strengthen the constitution of young animals, and address a variety of common signs of illness. Among the most useful are Calcarea carbonica and Sulphur, each covering almost every pediatric symptom imaginable. Often, a single dose of 30c or 200c will stimulate a rapid, sustained healing response in a young animal, if similar to the symptom totality. Belladonna, Mercurius, Silicea, and Arsenicum album are very helpful as well, and may be needed in higher potency in some situations.”…..

    1. Saying conventiional drugs offer limited options , worsen conditions and produce side effects seems to be a direct attack on conventiional medicine, looking to disparage and diminish the importantance of its recommendation and use.

    2. Homeopathics can somehow DISTINGUISH themselves as effective and superior to conventional medicine is another attempt to disparage convential medicine and dissuade those who might opt for its use.

    3. Anti-miasmic….. enough said , have we moved back to the dark ageses where miasma’s were the working paradigm? I mean get with the times people , don’t fear the fog, fear the scammer.

  • Conventional medicine looks at a patient as a biological machine.
    Alternative medicine looks at a patient as a person.
    Who wouldn’t rather work with a person than a machine?

    • I have never met a doctor who looked at a patient as a biological machine.
      You might want to look up ‘STRAWMAN FALLACY’ and then stop claiming BS

    • Conventional medicine looks at a patient as a biological machine.
      Alternative medicine looks at a patient as a person.

      Shouldn’t that be in the “Golden rules of SCAM” thread?

    • Fixed that for you :

      ”Conventional medicine looks at a patient as a person, which some have compared to a complex biological machine.

      Alternative medicine looks at a patient as holistic/woodoo/spirit/transcendent energy per$$$on.

      Who wouldn’t rather work with a per$$$on than a person?”

  • HRI
    “Randomised controlled trials data update 2021
    4 May 2022

    We are pleased to announce the findings from Dr Robert Mathie’s latest clinical evidence update:

    Total number of randomised controlled trials (RCTs):
    2020: 233 RCTs of homeopathic treatment for 129 medical conditions
    2021: 255 RCTs of homeopathic treatments for 136 medical conditions

    It is promising to see an increase in the volume of trials published, focusing on fewer medical conditions, compared to the previous year i.e.

    2020: 11 new RCTs including 10 new medical conditions
    2021: 22 new RCTs including 7 new medical conditions

    Double-blind placebo-controlled trials (DB-RCTs):
    Considering DB-RCTs only, the analysis found:

    2020: 140 trials on 86 different medical conditions
    2021: 148 trials on 88 different medical conditions”

    https://www.hri-research.org/2022/05/randomised-controlled-trials-data-update-2021/

  • Bad news for you, Double H.

    “The #Ärztetag in #Bremen has just decided with a “large majority” (BÄK President Reinhardt) to remove the additional title of #Homeopathy from the from the model further training regulations for doctors.”

    https://twitter.com/aerztezeitung/status/1529762681250627589

    Your so-called profession of “homeopathy” will no longer play a role in the future.

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