A fresh look at ‘Integrative Medicine’ … and it turns out, I am all for it!

On this blog, I have often been highly critical of integrative (or integrated) medicine (IM) – see, for instance:

• Integrative medicine: a satirical perspective
• A slightly different perspective on ‘INTEGRATIVE MEDICINE’
• Memorandum ‘INTEGRATIVE MEDICINE’
• Prince Charles’ opening speech at the ‘biggest ever’, ‘history-making’ integrative medicine conference
• The European Parliament’s Pathetic Attempt to Dabble in Integrative Medicine
• Integrative Medicine or Infiltrative Pseudoscience?
• Integrative Medicine: here is my slightly altered and much improved version
• More uncomfortable thoughts on ‘integrative medicine’
• The reality of ‘integrative medicine’ consists of little more than re-discoveries from conventional medicine, platitudes and outright nonsense

Recently, I began to realize that my previously critical stance has been largely due to the fact that 1) a plethora of definitions of IM exist causing endless confusion, 2) most, if not all, of the definitions of IM are vague and insufficient. At the same time, IM is making more and more inroads which makes it imprudent to ignore it.

I therefore decided it is time to change my view on IM and think more constructively. The first step on this new journey is to define IM in such a way that all interested parties can come on board. So, please allow me to present to you a definition of IM that is constructive and in the interest of progress:

IM is defined as the form of healthcare that employs the best available research to clinical care integrating evidence on all types of interventions with clinical expertise and patient values. By best available research, I mean clinically relevant (i.e., patient oriented) research that:

• establishes the efficacy and safety of all types of therapeutic, rehabilitative, or preventive healthcare strategies and
• seeks to understand the patient experience.

Healthcare practitioners who are dedicated to IM use their clinical skills and prior experience to identify each patient’s unique clinical situation, applying the evidence tailored to the individual’s risks versus benefits of potential interventions. Ultimately, the goal of IM is to support the patient by contextualising the evidence with their preferences, concerns, and expectations. This results in a process of shared decision making, in which the patient’s values, circumstances, and setting dictate the best care.

If applied appropriately, IM has the potential to be a great equaliser – striving for equitable care for patients in disparate parts of the world. Furthermore, IM can play a role in policy making; politicians are increasingly speaking to their use of research evidence to inform their decision making as a declaration of legitimacy. IM reflects the work of countless people who have improved the process of generating clinical evidence over several decades, and that it continues to evolve.

Developing the skills to practise IM requires access to evidence, opportunities to practise, and time. IM proponents strive to find novel ways to integrate evidence into personal holistic health in the best interest of our patients.

_________________________

I feel confident that this could create a basis for a fresh start in the dabate about the merits of IM. I for one am all for it!

In case some of my readers thought that the wording of my definition sounded somewhat familiar, I should perhaps tell you that it is my adaptation of the definition of evidence-based medicine (EBM) as published in ‘BMJ Best Practice‘.

What does that mean?

The points I am trying to make are the ones that I have tried to get across many times before:

1. IM is a flawed, unethical, superflous and counter-productive concept.
2. It is flawed because it is aimed at smuggling unproven or disproven treatments into routine care which can only render healthcare less safe and less effective.
3. It is unethical because it cannot provide the best possible healthcare and thus is not in the best interest of patients.
4. It is superflous because the aspects of IM that might seem valuable to proponents of so-called alternative medicine (SCAM) are already part of EBM.
5. It is counter-productive because it distracts from the laudable efforts of EBM.