BMJ 2001;322:119-120 ( 20 January )

Editorials

Integrated medicine

Imbues orthodox medicine with the values of complementary medicine

Integrated medicine (or integrative medicine as it is referred to in the United States) is practising medicine in a way that selectively incorporates elements of complementary and alternative medicine into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and treatment. The concept is better recognised in the US than in the United Kingdom, but a conference in London next week, organised by the Royal College of Physicians and the US National Center for Complementary and Alternative Medicine, may help to raise its profile in the UK.

Integrated medicine is not simply a synonym for complementary medicine. Complementary medicine refers to treatments that may be used as adjuncts to conventional treatment and are not usually taught in medical schools. Integrated medicine has a larger meaning and mission, its focus being on health and healing rather than disease and treatment. It views patients as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment. It also involves patients and doctors working to maintain health by paying attention to lifestyle factors such as diet, exercise, quality of rest and sleep, and the nature of relationships.

Conventional medicine has become dependent on expensive technological solutions to health problems, even when they are not particularly effective. In its enthusiasm for technology, it has turned its back on holism and simple methods of intervention, such as dietary adjustment and relaxation training, which are prominent in many alternative systems of medicine and are often effective.¹ Patients want guides to help them navigate the confusing maze of therapeutic options, particularly when conventional approaches are relatively ineffective and harmful.²

Most patients turn to complementary medicine out of frustration. Research shows that the consultation process and holistic approach adopted by practitioners of complementary medicine make patients feel in more control of their illness. ^{3 4} Unfortunately, this option is not often available because physicians with the desired attitudes, knowledge, and training are few and far between. Yet the multiple options of complementary therapies range from the sensible and worth while to the ridiculous and even dangerous, and patients need physicians with the biomedical knowledge to distinguish between them.

Conventional medicine can no longer ignore complementary medicine. US expenditure on complementary medicine rose in 1990-7 from $13bn to $38bn a year, and twice as many consultations were with complementary medicine practitioners as with mainstream family doctors. ^{5 6} This trend is also apparent in Australia,⁷ while in the UK a recent survey in Southampton (population 200 000) showed that around £4m a year was spent on complementary medicine outside the NHS.⁸

In Britain a recent report from the House of Lords select committee on science and technology⁹ acknowledged that the use of complementary therapy is widespread and increasing. At least 40% of general practices in the UK provide some complementary medicine services,¹⁰ although the evidence base for their use is patchy at best and non-existent at worse. The select committee divided therapies into three groups and concluded that the most organised and regulated (acupuncture, chiropractice, herbal medicine, homeopathy, and osteopathy) have a research base as well as being available in parts of the NHS. Most therapies in group 2 (such as aromotherapy and hypnotherapy) are used to complement conventional medicine and exist in some parts of the NHS, but it is this group that needs proper regulation and a research base. Group 3 contains therapies that are long established and rational in certain cultures, as well as many (such as crystal therapy and dowsing) for which there is no research evidence at all.

However, with no specific funding for research into complementary medicine, evidence will not be forthcoming. The NHS research and development directorate and the Medical Research Council need to support research into complementary therapies. The National Center for Complementary and Alternative Medicine, which has been set up as a centre within the National Institutes of Health in the US, offers a model. Writing recently in the Times, HRH the Prince of Wales pointed out that the Medical Research Council spent no money researching complementary therapies in 1998-9 and in 1999 UK medical research charities spent only 0.05% of their total research budget.¹¹ However, even when research funds are available there may be few high quality applications. We need to foster research excellence in complementary medicine.

In addition, there are no clear guidelines for the regulation of, and training in, complementary medicine for licensed health professionals who want to use a complementary therapy in their practice. Familiarisation with complementary therapies needs to start in medical schools and other institutes of higher education. In Britain, such provision is uneven, though awareness is growing and some schools already have some teaching. In the US many practitioners are being trained with a distance learning, internet based module, and medical education is also being restructured.¹² The Consortium of Academic Health Centers for Integrative Medicine aims to have programmes of integrated medicine in a fifth's of the county's 125 medical schools within the next few years.

Such programmes will produce fundamental changes in the way physicians are trained because integrated medicine is not just about teaching doctors to use herbs instead of drugs. It is about restoring core values which have been eroded by social and economic forces. Integrated medicine is good medicine, and its success will be signalled by dropping the adjective. The integrated medicine of today should be the medicine of the new millennium.

Lesley Rees, director of education. 

Royal College of Physicians, London NW1 4LE (Lesley.Rees{at}rcplondon.ac.uk)

Andrew Weil, director and professor of medicine. 

Program in Integrative Medicine, University of Arizona, Tucson, AZ 85724-5018, USA (Mnhardin{at}ix.netcom.com)

Footnotes

   LR is a trustee of the Foundation for Integrated Medicine.

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1.	Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280: 2001-2007[Abstract/Free Full Text].
2.	Maizes V, Caspio O. The principles and challenges of alternative medicine; more than a combination of traditional and alternative therapies. West J Med 1999; 171: 148-149[Medline].
3.	Austin JA. Why patients use alternative medicine. JAMA 1998; 279: 1548-1553[Abstract/Free Full Text].
4.	Lewith GT. Reflections on the nature of consultation. J Altern Complement Med 1998; 4: 321-323[Medline].
5.	Eisenberg DM, Davies RB, Ettner SL, Appel S, Wilkey S, Van Rompany M, et al. Trends in alternative medicine use in the United States 1990-1997. JAMA 1998; 280: 1569-1575[Abstract/Free Full Text].
6.	The landmark report on public perceptions of alternative care. Sacramento, California: Landmark Healthcare Inc, 1998.
7.	MacLennan AH, Wilson DH, Taylor AW. Prevalence and cost of alternative medicines in Australia. Lancet 1996; 347: 569-573[CrossRef][Medline].
8.	Dolan G, Lewith GT. The practice of complementary medicine outside the NHS. J Altern Complement Med 1999; 5: 297-300[Medline].
9.	House of Lords. Complementary and alternative medicine. London: Stationery Office, 2000.
10.	Thomas K, Fall M, Parry G, Nichol J. National survey of access to complementary health care via general practice. Sheffield: University of Sheffield, 1995.
11.	HRH Prince of Wales. When our health is at risk, why be mean? Alternative medicine needs and deserves more research funding. Times 2000;29 Dec:p28.
12.	Weil A. The significance of integrative medicine for the future of medical education. Am J Med 2000; 108: 441-443[CrossRef][Medline].

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