Anyone with an interest in alternative medicine will have come across the term ‘integrated medicine’ (or ‘integrative medicine’ in the US). The word implies some novel way of amalgamating alternative and conventional treatments for the benefit of patients and consumers. But what does integrated medicine really mean? What are its main concepts, and do they make sense?
The most influential UK proponent of integrated medicine is Prince Charles. In 1993 he even established his Foundation for Integrated Health which was, however, closed down in 2010 amid allegations of money laundering and fraud.
But what is ‘integrated medicine’? A detailed description can be found on the website of the British Society of Integrated Medicine:
Integrated Medicine is an approach to health and healing that provides patients with individually tailored health and wellbeing programmes which are designed to address the barriers to healing and provide the patient with the knowledge, skills and support to take better care of their physical, emotional, psychological and spiritual health.
Rather than limiting treatments to a specific specialty, integrated medicine uses the safest and most effective combination of approaches and treatments from the world of conventional and complementary/alternative medicine. These are selected according to, but not limited to, evidence-based practice, and the expertise, experience and insight of the individuals and team members caring for the patient.
So, according to these and numerous other sources, integrated medicine is based on two main pillars. The first is that of ‘whole person care’, and the second is often summarised with Prince Charles’s slogan ‘the best of both worlds’. Attractive and laudable concepts, one might think — why, then, do I find integrated medicine utterly superfluous, deeply misguided and plainly wrong? Let me try to answer this question by discussing its two concepts in turn.
Integrated healthcare practitioners are doctors or alternative practitioners who pride themselves on not just treating the physical complaints of a patient but looking after the whole individual: body, mind and soul. At the first glance, this approach seems fine. However, a closer look reveals major problems.
The truth is that all good medicine is, was, and always will be holistic: today’s GPs, for instance, should care for their patients as whole individuals dealing the best they can with physical problems as well as social and spiritual issues. I said ‘should’ because many doctors seem to neglect the holistic aspect of care. If that is so, they are, I would argue, not good doctors. And, if the deficit is widespread, we must reform conventional healthcare.
Delegating holism to practitioners of integrated medicine would be tantamount to abandoning an essential element of good healthcare. It would be a grave disservice to today’s patients and a detriment to the healthcare of tomorrow.
It follows, I think, that the promotion of integrated medicine under the banner of holism is utter nonsense. It misleads us into believing that holism is an exclusive feature of integrated medicine, while, in fact, it is a hallmark of any good healthcare. Alternatively, if holism were indeed neglected or absent in a particular branch of conventional medicine, it detracts us from the important task to remedy this deficit. We simply must not allow a core value of medicine to be hijacked by quacks.
The best of both worlds
Proponents of integrated medicine claim to use the ‘best’ of the world of alternative medicine and combine it with the ‘best’ of conventional healthcare. Again, this concept looks commendable at first glance, but a critical analysis reveals serious flaws.
They hinge, in my view, on the use of the term ‘best’. What does ‘best’ stand for in the context of healthcare? Surely it cannot mean the most popular or fashionable — and certainly ‘best’ is not by decree of HRH, the Prince of Wales. In a healthcare context, ‘best’ can only signify ‘the most effective’ or more precisely ‘being associated with the most convincingly positive risk/benefit balance’.
If we understand ‘the best of both worlds’ in this way, the concept becomes synonymous with the concept of evidence-based medicine (EBM) which represents the currently accepted thinking in healthcare. According to the principles of EBM, treatments must be shown to be safe as well as effective. When treating their patients, doctors should, according to EBM principles, combine the best external evidence with their own experience as well as with the preferences of their patients.
If ‘the best of both worlds’ is synonymous with EBM, we clearly do not need this confusing duplicity of concepts in the first place. It would only distract from the auspicious efforts of EBM to continuously improve healthcare. In other words, the second axiom of integrated medicine is as nonsensical as the first.
The first hospital of integrated medicine
The picture below shows the ‘Rudolf Hess Krankenhaus’ in Dresden which, during the Third Reich, was arguably the first hospital of integrated medicine. Nazi leaders had united alternative and conventional medicine under the umbrella of ‘Neue Deutsche Heilkunde’, New German Medicine, a concept which resembles the one of integrated medicine in many ways.
The hospital was the first institution where this shot-gun marriage was being put into clinical practice. In the end, the attempt to amalgamate the two ‘worlds’ proved to be a failure. This outcome is hardly surprising: any attempt at improving something by adding to it a dose of charlatanry is doomed to failure. It flies not just in the face of science but also in that of common sense.
The current practice of integrated medicine
On the basis of these considerations, integrated medicine cannot be much more than a superfluous, misleading and counterproductive distraction. But the most powerful argument against integrated medicine originates from the bogus and often dangerous things that are happening every day in its name.
If we look around us, go on the internet, read the relevant literature, or walk into an integrated medicine clinic, we are sure to find that behind all these politically correct slogans of holism and ‘best of all worlds’ there lurks the face of pure quackery.
A few months ago, I Googled ‘integrative medicine clinic’ and extracted from the websites of the first five institutions that came up the treatments they offered. Here is the list that emerged (the numbers refer to the times a therapy was mentioned; no number means the therapy was only mentioned once):
The message here seems all too obvious: integrated medicine clinics offer a bizarre array of therapies, most of which are not based on anything that might remotely resemble sound evidence.
The Society for Integrative Oncology
Despite these theoretical reservations and practical concerns, integrated medicine has become widely accepted, perhaps nowhere more so than in the area of cancer care. At the forefront here is the US Society for Integrative Oncology. Among other initiatives, this group issued ‘clinical practice guidelines’ which ‘inform clinicians and patients about the evidence supporting or discouraging the use of specific complementary and integrative therapies for defined outcomes during and beyond breast cancer treatment, including symptom management’.
The guidelines issue fairly firm recommendations for the use of acupuncture to help cancer patients with fatigue, hot flushes and anxiety. Scrutinising the validity of these recommendations, I recently disclosed in a blog post that the evidence they are based on is spurious. Even the seemingly respectable end of the ‘integrated medicine’ spectrum is far from evidence-based.
Professor David Gorski, an oncologist from the US, has expressed his concerns about integrated medicine too: ‘When health fraud turned into “alternative medicine” and then evolved into “complementary and alternative medicine” and then reached its final form of “integrative medicine”, the language war was lost. That’s how quackery became mainstream.’
I believe that integrated medicine is little more than a front designed to appear attractive and convincing to consumers, healthcare professionals and policy makers. Anyone looking behind the façade will find boundless amounts of quackery being promoted by a spectrum of people ranging from naïve charlatans, unable to think critically, to irresponsible entrepreneurs, out to make a fast buck.
Edzard Ernst, emeritus professor at the University of Exeter, is the author of A Scientist in Wonderland and the awardee of the John Maddox Prize 2015 for standing up for science. He blogs at edzardernst.com.