The BMJ (20th January) defined 'integrated medicine' as incorporating
complementary or alternative medicine into orthodox health care1. While we
applaud the movement towards a more integrated approach to healthcare and
welcome a scientific examination of 'complementary therapies' there is an
important alternative to simply accepting the use of complementary
techniques. Many researchers and clinicians have already adopted an
alternative understanding of health best characterized as a 'bio-psycho-
social model'2 and there is a wealth of research evidence demonstrating
that a combination of biological, psychological and social mechanisms
affect health outcomes in major diseases such as heart disease and
cancer3. Ironically, although integrated medicine is said to be holistic,
focusing on both minds and bodies, there is little evidence of holism in
many complimentary and alternative approaches, which actively seek to
accentuate the distinction between 'spirit' and mind. This is the same
cartesian dualism that is responsible for many of the problems associated
with conventional medicine4.
It is true that patients are increasingly abandoning a medicine that
ignores the wider view of their health but to say, in the manner of Marie
Antoinette, 'if they are dissatisfied and we have nothing better to offer,
then let them have their alternative medicine', has several dangers.
First, it allows conventional medicine to rid itself of its 'failures'
rather than learn from them. Second, it marginalises those patients who do
not want 'colonic irrigation' for example, but who would like a doctor who
recognises that they are more than a collection of molecules. Third, it
perpetuates the myth that psycho-social features of illness and health are
too 'soft' to be researchable or too complex to be integrated into
treatment. We suggest that health professionals adopt the more pragmatic
bio-psycho social approach to health care which would result in better
health outcomes in their patients.
1. Rees L & Weil A. (2001) Integrated Medicine. British Medical
Journal. 322; 119-120.
2. Engel GL. (1977) The need for a new medical model: a challenge for
biological science. Science. 196; 129-136.
3. Baum A, Newman S, Weinman J, West R and McManus. (1997) Cambridge
Handbook of Psychology, Health and Medicine. Cambridge University Press.
4. Helman C. (1986) Culture, Health and Illness. Doctor - Patient
Interactions. Chapter 5. Wright
Chalder T, Reader.
Department of Psychological medicine, Guy's, King's and St Thomas School
of Medicine, 103 Denmark Hill, London SE5 8AZ. (sphatrc@iop.kcl.ac.uk)
White P, Senior Lecturer.
St Bartholomew's Hospital, London
Main CJ, Professor.
Salford Royal Hospitals NHS Trust and University of Manchester.
Rapid Response:
An Alternative Integrated Medicine
The BMJ (20th January) defined 'integrated medicine' as incorporating
complementary or alternative medicine into orthodox health care1. While we
applaud the movement towards a more integrated approach to healthcare and
welcome a scientific examination of 'complementary therapies' there is an
important alternative to simply accepting the use of complementary
techniques. Many researchers and clinicians have already adopted an
alternative understanding of health best characterized as a 'bio-psycho-
social model'2 and there is a wealth of research evidence demonstrating
that a combination of biological, psychological and social mechanisms
affect health outcomes in major diseases such as heart disease and
cancer3. Ironically, although integrated medicine is said to be holistic,
focusing on both minds and bodies, there is little evidence of holism in
many complimentary and alternative approaches, which actively seek to
accentuate the distinction between 'spirit' and mind. This is the same
cartesian dualism that is responsible for many of the problems associated
with conventional medicine4.
It is true that patients are increasingly abandoning a medicine that
ignores the wider view of their health but to say, in the manner of Marie
Antoinette, 'if they are dissatisfied and we have nothing better to offer,
then let them have their alternative medicine', has several dangers.
First, it allows conventional medicine to rid itself of its 'failures'
rather than learn from them. Second, it marginalises those patients who do
not want 'colonic irrigation' for example, but who would like a doctor who
recognises that they are more than a collection of molecules. Third, it
perpetuates the myth that psycho-social features of illness and health are
too 'soft' to be researchable or too complex to be integrated into
treatment. We suggest that health professionals adopt the more pragmatic
bio-psycho social approach to health care which would result in better
health outcomes in their patients.
1. Rees L & Weil A. (2001) Integrated Medicine. British Medical
Journal. 322; 119-120.
2. Engel GL. (1977) The need for a new medical model: a challenge for
biological science. Science. 196; 129-136.
3. Baum A, Newman S, Weinman J, West R and McManus. (1997) Cambridge
Handbook of Psychology, Health and Medicine. Cambridge University Press.
4. Helman C. (1986) Culture, Health and Illness. Doctor - Patient
Interactions. Chapter 5. Wright
Chalder T, Reader.
Department of Psychological medicine, Guy's, King's and St Thomas School
of Medicine, 103 Denmark Hill, London SE5 8AZ.
(sphatrc@iop.kcl.ac.uk)
White P, Senior Lecturer.
St Bartholomew's Hospital, London
Main CJ, Professor.
Salford Royal Hospitals NHS Trust and University of Manchester.
(cmain@fs1.ho.man.ac.uk)
Lewin B. Professor.
Department of Health Studies, University of York, Heslington, York, Y010
5DG
(rjpl1@york.ac.uk)
Competing interests: No competing interests