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Integrative
Medicine: An innovative approach to Michael
J. González1, Jorge R. Miranda-Massari2, Edna
Mora3, School
of Public Health, Dept. of Human Development, Nutrition
Program1, School of Pharmacy, Department Pharmacy Practice2, School
of Medicine, Department of Surgery and Pathology and Puerto Rico
Cancer Center3, Department
of Pediatrics4, Department of Medicine5,
Deparment of Obstetrics and Gynecology6, PO Box 365067, San
Juan, PR 00936, University of Puerto Rico, Central Administration,
Office of Student Affairs PO Box 364984, San Juan PR, 009367.
Center for Advanced Studies, Dept. Clinical Psychology, PO Box
9023, 711 Old San Juan Station 009028, Colegio de Medicos
Cirujanos de Puerto Rico9,
ATA Pharm, La Rambla Shopping Center, Suite 210, Ave. Tito
Castro 360, Ponce, PR 0073110, Pontificial Catholic
University of Puerto Rico, Biology Dept. Ave. Las Américas, Ponce, PR
0073211 Introduction The
use of alternative/complementary medicine has been increasing in the
last 15 years. This
increase was first accounted by Cassileth in 1990 (1). This study showed
that approximately one third of American adults used unconventional
medical treatments. Interestingly
the most frequent users of this approach were educated, upper income
white Americans in the 25 to 49 year age group (2). It has
also been reported that 72% of the people using both conventional and
unconventional (alternative/complementary) medicine did not informed
their conventional physician of their use of unconventional therapies (2).
In addition, an increased use of unconventional therapies has
been accounted for cancer patients (1).
The study by Cassileth concluded that conventional and
unconventional treatments for cancer produced similar results in life
expectancy. In terms of
this significant trend, unconventional
therapy use has reached the legislative, educational and corporate
areas. The Office of
Alternative Medicine (OAM) at the National Institutes of Health was
mandated by Congress in 1991 and launched in 1992 with an annual
budget of $2 million. This
has subsequently evolved to the Center of Complementary and
Alternative Medicine with a budget of $50 million (3,4). In
1995 the National Library of Medicine (NLM) expanded both its key
words and journal listings to include alternative medicine. Also
increasing numbers of articles related to alternative medicine are
appearing in the mainstream, peer reviewed medical literature (See
table I). In a survey in
JAMA alternative medicine was ranked the 7th most important
topic out of 73 for publication in the journal by physician readers (5).
The demand for alternative/complementary medicine is also
affecting the business of health care.
Changes have begun in reimbursement policies by managed care
organizations, insurance carriers, hospital providers.
New companies are being formed to address the market’s
formidable demand (3). Conventional
(allopathic, modern, western, orthodox, contemporary) medicine is
realizing that it must begin to address issues related to the use of alternative/complementary medicine by their patients, issues or research, safety, regulation and education. A recent study in the journal of the American Medical Association (JAMA) revealed that the majority of patients choosing alternative medicine do so mainly because they perceive that these approaches are more aligned with their own values, beliefs and philosophical orientations toward health and life (5). A
challenge lies to create a new approach to medicine, one based on a
model of health rather than disease, one that trains practitioners to
take time to listen, to value life style and nutritional influences on
health and illness. To be
able to offer treatments in addition to drugs and surgery, to understand
the innate potential of the human organism for self repair and healing.
This approach operates from the premise that prevention is a
primary responsibility of practitioners and that whenever possible,
simple, safe, cost effective treatments should be offered before
invasive, expensive ones. This
principle is very well in accordance with current models of health care
addressing cost effectiveness (6). In
this article we present the flaws of the current definitions of unconventional
medicine (alternative and complementary) and discuss the term
integrative medicine as a more appropriate term.
In addition we give a perspective on the influence of Integrative
Medicine in the education of the physician facing the new millenium. Integrative Medicine: The Melting Pot for a
Preventive Healing Based Care We
will first establish important differences in relation to the terms of
Alternative Complementary and Integrative Medicine and then explain the
Integrative Medicine Philosophy. The
term Alternative Medicine has
been used to cover all non-conventional healing practices and therapies,
but the term alternative has a segregative
nature. If something is
alternative you have to choose between one or another.
Most of the time, optimal care requires more than one approach(a
combination of approaches) that
often produces better results. The
term Complementary Medicine
is of a more conciliatory nature. Nevertheless,
it entails that Complementary Medicine has only a mere supportive (accessory) role to Conventional Medicine.
However, it must be realized that in treating certain conditions,
as for example, arthritis and mild depression, Unconventional
“Alternative/Complementary” Medicine may have a primary role.
A broader term that combines the best available approaches is
therefore needed. The
term Integrative Medicine
fulfills the need of a more accurate term.
It involves the understanding
of the interaction of the mind,
body and spirit and how to interpret this
relationship in the dynamics of health and disease.
It distinguishes healing
from curing, understanding that healing is always possible even when
curing is not. The term cure, from the Latin “curare”
means to take care. The
term “cure” emphasizes what can be done to help the patient from the
outside to eliminate disease.
When trying to cure, the practitioner has the active role whereas
the patient has a passive role. In
comparison, the term healing from the old English haelan
and old German heilen
which means to make whole and restore health.
In Spanish, the word for heal is “sanar”
that comes from the Latin “sanare”
which means to find or restore health.
The term “healing”
emphasizes what the patient can do to restore
his inner balance in order to improve his quality of life and
well-being status. When
trying to heal the patient has an active and protagonic role, while the
practitioner has a supportive and guidance role. Integrative Medicine
shifts the orientation of the medical practice from a disease based
approach to the healing based approach.
The disease based approach tries to antagonize the manifestations
of the disease process in an attempt to cure.
This approach while proven very effective in acute diseases and
trauma, has been of limited benefit in treating chronic degenerative
diseases. In contrast, the
healing approach tries to understand the disease state from a broader
holistic perspective. The
integrative approach does not necessarily antagonizes the manifestations
of disease, but rather aspires to direct the healing forces within the
body to restore health. This
approach involves the whole human being (mind, body and spirit), his
environment and community in the health restoring process (3). The
integrative approach is based
in a partnership between the patient and the practitioner within which
the best therapies available for his condition, will be used to
stimulate the body’s intrinsic healing abilities.
The Integrative Medicine approach is committed to the practice of
good medicine irrespective of its origin, either conventional or
unconventional, it is based on good science and open to new paradigms.
Integrative medicine does
not reject conventional medicine nor uncritically accepts unconventional
practices. Re-steering Medical Education for the next
Millennium The
study of dead bodies, dead tissue cells, components and chemicals to
understand life processes, in addition to the quest for magic bullets to
combat diseases are based upon a reductionist, materialist view of
health and healing (7).
We have made tremendous advances over the past hundred years by
applying these concepts to medicine.
However, the resulting biomedical system is not always able to
account for and use many
observations in the realms of clinical and personal experience, natural
law and human spirituality. Conventional medicine is a scientific paradigm with a
particular history, as much influences by social history as it is by
scientific laws (7). Conventional
medicine conceptually uses Newtonian physics and pre-Darwinian biology,
Newtonian physics explains and can reproduce many observations on the
mechanisms of every day experience.
Contemporary quantum physics (quantum mechanisms) recognizes
aspects of reality beyond Newtonian mechanics, such as matter-energy
duality, verified fields of energy and matter and wave functions (7).
Quantum physics and contemporary biology-ecology principles may
be needed to understand alternatives.
Nuclear medicine uses the technology of modern physics but does
not yet incorporate the concepts of quantum physics in its fundamental
approach to patient health.
Conventional medicine does measure the body’s energy using
electrocardiography, electroencephalography and electromyography for
diagnostic purpose, but does not use the body’s energy for the purpose
of healing. The biological
science of conventional medicine is essentially pre-Darwinian in
that it emphasizes topology rather than individuality and variation.
Modern biology-ecology explores the phenomenon of how living
systems interact at the level of the whole. One
way of studying and understanding alternative medicine is to view it in
light of contemporary physics and biology-ecology and to focus on the
physiologic response of the body. When
homeopathy or acupuncture is observed to result in a physiologic or
clinical response that cannot be explained by the biomedical model, it
is not the role of the scientist or physicians to deny this reality, but
rather to modify the explanatory model(s) that account for it.
Science must account for all that is observed, not just part of
it, this is why physics has proved beyond Newtonian mechanics and
biology beyond topology. In
this way, science itself progresses.
While
conventional medicine utilizes new technologies in the service of
relatively old ideas about health and healing, alternative methods
employ old technologies whose fundamental character reflects new
scientific ideas on physical and biological nature (7). A
large percentage of our population is utilizing
alternative/complementary modalities in which their physicians are not
educated. Moreover, the
majority of these patients are not informing their physicians about their choices (2).
Given that the practice of good medicine is based in the
physicians working knowledge of the treatments in which patients are
engaged and their potential effects, this might turn out to be a
dangerous circumstance (3). Physicians
need to have a working knowledge of the treatments used in
alternative/complementary medicine.
They need to know which practices are potentially harmful or are
unlikely to be of benefit in order to avoid risk to the patient from an
unsafe modality, dangerous interaction or by delay of effective
treatment. The knowledge is
also necessary to help patients avoid spending financial resources on
ineffective treatments. Physicians
also need to know what practices are
complementary to the conventional approach, which
alternative/complementary practice can be of value in addition to or
instead of what is available today.
Physicians need to
know what alternative/complementary modality they can provide or to what
professional they may refer their patients in the continuous search of
the practice of good medicine in benefit of their patients. Having
the goal of practicing the best medicine possible, physicians should be
aware of which alternative/complementary methods, when critically and
intelligently integrated into health care could be of benefit to
patients. Despite this need
there is no formalized academic training nor a certification process
covering these areas (3).
Here lies an opportunity to create a richer, more fulfilling,
more effective and human approach to medicine based in the benefit of
the patients following good medicine practices in a scientific manner,
the Integrative Medicine approach. References 1.
Cassileth BR, Lusk EJ, Guerry D, Blake AD, Walsh WP, Kascius L,
Shultz DJ. Survival and
quality of life among patients receiving unproven as compared with
conventional cancer therapy. N
Engl J Med 1991, 324:1180-1185. 2.
Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR and
Delano TL. Unconventional
medicine in the United States: prevalence, costs and patterns of use.
N Engl J Med 1993, 328:246-252. 3.
Gadded TX. Integrative Medicine: The evolution of a new approach to
medicine and to medical education.
Int Med 1998, 1:67-73. 4.
Kuhn MA. Complementary therapies for Health Care providers, 1999.
Lippincott, Williams and Wilkins, Philadelphia. 5.
Astin JA. Why patients use alternative medicine: results of a national
study. JAMA 1998,
279:1548-1643. 6.
Jons WB and Levin JS. Essentials
of Complementary and Alternative Medicine, 1999.
Lippincott, Williams and Wilkins, Philadelphia. 7.
Micozzi MS (ed). Fundamentals
of Complementary and Alternative Medicine, 1996.
Churchill Livingstone, New York. Table
I Number
of Published Articles in Medical Journals retrieved using the
terms Alternative and Complementary Medicine
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