Integrated medicine

Rees and Weil’s editorial on integrated medicine gives a rather one-
sided view of the topic. It talks about selectively incorporating
“elements” of complementary and alternative medicine into “comprehensive
treatment plans alongside solidly orthodox methods of diagnosis and
treatment”. It also identifies a need for “physicians with the biomedical
knowledge” to be able to distinguish between the multiple options of
complementary therapies. This comes across as orthodox biomedical “cherry
picking” from the complementary field, in order to supplement conventional
treatment. It also implies far greater knowledge and certainty about the
relative merits of different complementary therapies than currently
exists, or which will exist for some time to come.

It is precisely because of the limitations of biomedical knowledge
and treatment that doctors (particularly GPs) began to open the door to
complementary practitioners. During the late 1980s and early 1990s, some
GPs and complementary therapists developed pragmatic forms of
collaboration, which represents “integration” on a more equal professional
footing. In these arrangements, GPs often referred patients to
complementary therapists for their opinion and advice, rather than with
certainty that a particular therapy would help the patient. Also, they
found that complementary therapists could make an important contribution
to patient care, even in the absence of a clear-cut orthodox medical
diagnosis. The picture that emerged from these arrangements is very
different from Rees and Weil’s image of “doctors in charge”.

When such inter-professional collaboration has been developing at the
grass roots for so long and in an unsung way, why has the BMJ now
dedicated an issue to “integrated medicine”? Surely not because one of the
elite bodies of the medical profession (the Royal College of Physicians)
is finally taking complementary medicine seriously. Nor because an
organisation locked into the heart of the British establishment (the
Foundation for Integrated Medicine) has been campaigning for its own
medically dominant brand of integration.

The expansion of complementary therapies over recent decades has been
widespread, consumer driven and at the grass roots. We are now witnessing
the establishment finally waking up to the potential threat from
alternative healing practices if they continue to flourish unchecked.
Come on BMJ, get real! Despite the pious claim to be “restoring the soul
to medicine”, what your theme issue really signifies is orthodox
medicine’s attempt to shore up its monopoly by bringing the complementary
therapy professions under its wing.