Integrative medicine

DEFINITION: A relationship-centered care system that combines mainstream medical and alternative therapeutic methods to potentiate the body’s innate capacity to heal.

• PRINCIPAL PROPOSED USES: Allergies, anxiety, cardiovascular disorders, depression, endocrine dysfunction, infections, metabolic dysfunction, pain management, respiratory diseases, skin and joint diseases
• OTHER PROPOSED USES: Cancer, diabetes, hypertension, osteoporosis, pregnancy-related conditions, menopause-related conditions, stroke, substance abuse

Overview

According to Andrew Weil, a prominent physician and a proponent of this system, integrative medicine (IM) works with the body’s natural potential for healing. In the human body, many pathways and mechanisms serve to maintain health and promote healing. The IM perspective recognizes that treatment, often a combination of allopathic and alternative medicine, should unblock and enhance these mechanisms.

In practice, the therapeutic process addresses the whole person and relies on the main pillars of a person’s well-being: mind, body, spirit, and community. This paradigm emphasizes the importance of a sound physician-patient relationship for a successful healing process. Developing rapport and empathy greatly facilitates the efficacy of lifestyle changes and the use of therapies such as pharmaceuticals, homeopathy, dietary supplements, traditional Chinese medicine, Ayurveda, manual methods, mind/body techniques, and movement therapy.

Until the 1970s, little was done to connect traditional, ancient healing modalities to biomedicine. At that time, the holistic health movement in the United States and in Western Europe started a “dynamic alliance” of therapists, including American Indian healers, yoga teachers, and homeopaths. Modern medicine began taking steps to reduce the use of technology and the disconnect from the patient while rediscovering more natural, less invasive avenues of healing.

The Consortium of Academic Health Centers for Integrative Medicine (later renamed the Academic Consortium for Integrative Medicine and Health), founded in 2000, brings together many highly esteemed academic medical centers dedicated to promoting IM through educational opportunities, health policies, research, and collaborative initiatives.

Mechanism of Action

Integrative medicine combines conventional medical treatments with carefully selected alternative therapies that are proven to be safe and effective. The goal of the integrative movement is to bring back the art of healing and to address the root of the pathological process, not just the symptoms. In addition to acquiring the foundations of medical knowledge, physicians should be able to release, explore, and exploit the intrinsic healing responses of the body. Practitioners are therefore encouraged to become familiar with, and critically assess, the modalities of complementary and alternative medicine (CAM).

Core areas of education include the philosophy of science, cross-cultural medicine, principles of mind/body medicine, self-healing, and spirituality. The practitioner’s ability to self-explore and maintain their own health balance is considered essential for the therapeutic act. The physician strives to become a partner and a mentor who understands the important coordinates of their patient’s life events, culture, beliefs, and relationships. By acknowledging a person’s uniqueness, the processes of health maintenance and healing are tailored to best address a person’s background and conditions. Matching the patient’s belief system can, especially in chronic illness, lead to the activation of an internal healing response, often known as the placebo effect. This response can ultimately result in enhanced health.

Uses and Applications

Overall, IM is a combination of art and science that seeks health maintenance and disease prevention and treatment using the most natural, least invasive interventions available. Virtually all categories of disorders, and especially chronic diseases, can benefit from an integrated approach.

Cardiovascular disorders. Cardiovascular disorders such as congestive heart failure, coronary artery disease, hypertension, and peripheral vascular disease can be treated with conventional methods and with lifestyle modifications, nutrition, dietary supplements (omega-3 fatty acids, coenzyme Q₁₀, carnitine, arginine, hawthorn, and garlic), relaxation, meditation, and hydrotherapy. This combination of traditional and complementary medicine is sometimes called integrative cardiology. Primary prevention is critical in coronary artery disease, stroke, and hypertension. These may be addressed with stress management techniques, lifestyle changes, mind-body medicine, or acupuncture.

Cancer. Cancer can be treated with the synergistic reduction of the sequellae by limiting the toxicity or trauma of conventional therapies and by alleviating psychological distress. Nutritional changes, dietary supplements (vitamins, immunomodulators, ginger, marijuana, and St. John’s wort), acupuncture, mind/body techniques, and group support are often recommended. Preventive approaches (for breast cancer, for example) involve lifestyle changes (exercise, nutrition, limiting toxins, and breastfeeding), botanicals (seaweed, rosemary, and green tea), and mind/body methods.

Endocrine and metabolic disorders. Endocrine and metabolic disorders are also amenable to integrated therapies. Insulin resistance is often treated with metformin hydrochloride, lifestyle changes, and a low-carbohydrate diet. Supplements such as chromium, vanadium, alpha-lipoic acid, American ginseng, and fenugreek can provide benefits too. In persons with diabetes mellitus, essential care includes diet, exercise, and pharmaceuticals. Dietary supplements, such as vitamins, bilberry, and Ginkgo biloba, and mind/body techniques (for example, relaxation and yoga) may mitigate vascular disease and even lower glucose levels. Alternative therapies to consider in persons with hypothyroidism include dietary supplements such as vitamins, zinc, selenium, and traditional Chinese botanicals and practices such as yoga. Pharmaceuticals are available for the treatment of osteoporosis, and vitamin D, ipriflavone, and exercise constitute useful adjuvants.

Gastrointestinal disorders. Gastroesophageal reflux, peptic ulcer disease, and irritable bowel syndrome can be treated with lifestyle changes and with botanicals (licorice, chamomile, and marshmallow root), homeopathy, and mind-body therapies (including stress management and guided imagery). Sometimes, by introducing stress relief mechanisms, lifestyle changes, and certain supplements, individuals can take less medication and feel better. Some methods include aromatherapy, diaphragmatic breathing, yoga, and Reiki.

Neurological disorders. Stroke, multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, seizures, and migraine have been linked to oxidative stress, neurotoxic factors, and inflammatory processes. Thus, they can greatly benefit from integrative methods. The complementary therapies include, but are not limited to, dietary and nutritional supplementation (omega-3 fatty acids, glutathione, coenzyme Q₁₀, alpha-lipoic acid, N-acetylcysteine, niacin, vitamins, melatonin, and magnesium), herbal supplementation (Ginkgo biloba, milk thistle, turmeric, vinpocetine, and skullcap), meditation, yoga, and exercise.

Asthma and allergies. Asthma and allergies respond well to alternative methods that include nutritional and environmental changes, exercise, botanicals (ginkgo, coleus, licorice, kampo, bioflavonoids, and stinging nettle), vitamins and minerals, homeopathy, massage, inhalation, breathing techniques, and mind/body therapy.

Upper respiratory infections and sinusitis. Upper respiratory infections and sinusitis can be treated with pharmaceuticals, dietary changes, hydration, steam inhalation, supplements (vitamins, antioxidants, zinc, magnesium, garlic, and echinacea), and homeopathic remedies.

Depression and anxiety. Depression and anxiety represent a spectrum of disorders ideally suited for IM. In addition to pharmaceuticals, persons can benefit from lifestyle changes, physical activity, nutritional remedies (omega-3 fatty acids, B vitamins, folic acid, and hydroxytryptophan), botanical remedies (St. John’s wort, kava kava, and ginkgo), psychotherapy, relaxation training, yoga, acupuncture, and transcranial stimulation.

Pain. Pain management represents a challenge for both the physician and the person in pain. Truly integrating allopathic and alternative medicines can offer relief and reduce frustration. Reassurance and lifestyle changes are often the first step of the therapeutic plan. A vast array of useful approaches includes pharmacotherapy, exercise, supplements (arnica and omega-3 fatty acids), homeopathy, manual methods, acupuncture, transcutaneous nerve stimulation, and mind/body therapy. Surgery is considered after conservative therapies have failed. The issue of chronic pain and opioid addiction had grown especially concerning by the end of the second decade of the twenty-first century, and health experts were consistently seeking complementary and integrative methods for treating this pain to minimize reliance upon such drugs, particularly for military veterans. In 2017, the US Department of Veterans Affairs, the US Department of Health and Human Services, and the US Department of Defense announced that they had formed a partnership to fund at least twelve research projects valued at millions of dollars dedicated to researching the efficacy of nondrug pain management treatments such as mindfulness and massage.

Pregnancy and menopause. The integrative approach to pregnancy and menopause reaches beyond the use of combined mainstream and alternative therapies. These conditions require a careful initial encounter and subsequent consideration of the mind, body, spirit, and community context. The patient-practitioner interaction is oriented toward health rather than disease, and listening to the person seeking care is essential. In pregnancy especially, the need for noninvasive, natural approaches becomes crucial. Nausea and vomiting, for example, are treated with supplements (vitamin B₆, red raspberry leaf, ginger root, and chamomile), homeopathy, acupuncture, and mind/body therapies.

Alcoholism and substance abuse. Therapeutic options for alcoholism and substance abuse include botanicals (valerian, kudzu, kava kava), acupuncture, mind/body therapies, and spirituality. The options also include twelve-step programs. Acupuncture and CAM psychotherapies like mindfulness meditation gained considerable global attention for treating substance use disorders beginning in the late 2010s.

Scientific Evidence

Integrative practice is committed to the scientific method and is rooted in evidence. At the same time, the integrative practitioner aims to transcend the confines of “scientific truth” and connect with the people they serve on multiple levels.

A number of CAM therapies have proved effective as complements to conventional medical treatments. These CAM therapies include dietary and herbal supplements, acupuncture, manual therapy, biofeedback, relaxation training, and movement therapy. When a strong evidence base is developed for a particular complementary method, it can become part of the integrative armamentarium. After it reviewed the evidence base, for example, the Society for Integrative Oncology supported the use of acupuncture in cases in which cancer-related pain is poorly controlled.

According to the American Academy of Pediatrics, a review conducted in 2002 found more than fourteen hundred randomized-control trials of pediatric CAM; the quality of these trials was determined to be as good as those focusing on conventional therapies. It is important to note that different levels of evidence are required to prove the safety and efficacy of complementary therapies, depending on the goals of the treatment. Lower levels of evidence (that is, nonrandomized and observational studies) are acceptable for preventive or supportive goals and for noninvasive approaches. Furthermore, integrating represents more than combining; it involves holistic treatment and the synergistic application of an array of treatments. Thus, the extent of the combination or integration varies. This leads to unique challenges for the scientific validation of integrative methods. Traditional research models often appear inadequate. More studies are needed that examine the appropriateness and manner of integration for specific diseases and conditions. In acknowledgment of the increased recognition and implementation of the interdisciplinary approach of integrative medicine, the National Institutes of Health's National Center for Complementary and Alternative Medicine, long responsible for spearheading and funding major research projects on the subject, was renamed as the National Center for Complementary and Integrative Health in 2014.

Choosing a Practitioner

A large number of medical schools in the United States have courses in CAM. Integrative medicine centers and fellowship programs exist at many prominent universities and hospitals in the United States, including the University of Arizona, Duke University, Harvard University, the University of Michigan, and the Mayo Clinic. These centers tend to be directed by conventional physicians (doctors of medicine and doctors of osteopathy) and staffed by various practitioners.

The American Board of Physician Specialties (ABPS) offers a certificate in integrative medicine. However, qualified IM practitioners are often difficult to find, and the demand greatly exceeds the supply. Oftentimes, the collaboration between conventional physicians of various specialties and certified CAM practitioners provides the foundation and benefits of integrative care. The American Holistic Medical Association maintains a directory of integrative and holistic practitioners holding relevant degrees.

Safety Issues

When implemented by physicians and CAM practitioners who are well-versed in the integrative method, IM is safe and beneficial. Because there is a lack of herbal supplement regulation in the United States and little standardization for practitioner certification in many CAM subspecialties, individuals should carefully research practitioners before receiving treatment. Before beginning a supplement regimen, it is important to ensure they will not interact with any other medications.

Bibliography

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