What is Holistic-Complementary and Alternative Medicine/Integrative Medicine?

Defining Holistic or Complementary and Alternative Medicine (CAM), also know as Integrative Medicine (a term that highlights the school of thought that CAM can be successfully integrated in the physicians medical school taught armentarium) helps in understanding what it offers, why older patients are attracted to and find effectiveness in these therapies, and how conventional practitioners can deal with their increasing use. The most common definition in United States medical literature is "those practices neither taught widely in United States medical schools nor generally available in United States hospitals." Patient interviews must include inquiry into CAM use; providers need to know about potentially risky therapies. Integration of CAM into our health care system, although burdensome in the short term, will benefit patients in the long run, where benefit is due. Integration of CAM into treatment does not mean acknowledging its effectiveness, but taking advantage of any benefits it has to offer now while they are under scrutiny. Other descriptive terms found include "unconventional" and "traditional." There continues to be a shift in attitude toward acceptance of these therapies as complementary rather than alterative and Andrew Weil, MD has coined the phrase, "Integrative Medicine" to highlight his views on integrating complimentary and alternative medicine practices where they look safe and promising now. To highlight the distinction between Integrative Medicine and CAM (Complementary and Alternative Medicine) from Traditional American Conventional Medicine, it is necessary to define conventional medicine. Conventional therapies are those taught at allopathic medical schools. Allopathy is a system of medical practices that traditionally has fighting diseases as its goal. It is organ- and disease-based. Although many in the area of Integrative Medicine criticize this type of medicine as separating the body from the mind, which distracts from holistic concepts of health, editors of the very first edition of Harrison's Principles of Internal Medicine would disagree. They detail the expectations of a physician as not only an obligation to gain technical skills and scientific knowledge but to gain an understanding of the patient, "for the patient is no mere collection of symptoms, signs, disordered functions, damaged organs, and disturbed emotions. He is human, fearful, and hopeful." Although it would be convenient to draw dividing lines between Integrative Medicine, which emphasizes prevention and wellness, and conventional medicine, which focuses on treatment of illness, both are trying to do to some extent what the other claims to be its strength. Several brave Integrative Medicine therapies have undergone the standard double-blind randomized controlled trials; some have proven successful, some have not. For conventional medicine, the increase in chronic diseases and near-epidemic rates of obesity and diabetes have generated the subspecialty of preventive medicine and an interest in this area, even by practitioners in geriatrics.

Older persons in the United States are not going to wait for Integrative Medicine therapies to be proven effective or ineffective. In this country, this process is in its infancy. In 1991, Congress, not the medical community, was the driving force that resulted in the Office of Alternative Medicine (OAM) at the National Institutes of Health (NIH) in 1992. Finally, in 1998, the NIH realized that this type of medicine is not only alternative, but supplemental or complementary, thus creating the National Center for Complementary and Alternative Medicine (NCCAM). Thus, instead of a review of Integrative Medicine therapies that have failed or passed the evidence based medicine (EBM) litmus test; we need to increase our knowledge and awareness of different Integrative Medicine therapies from around the world. However true (or nearly true) it may be when Western physicians respond to certain patients who ask about a certain therapy that, "there is no evidence that this works," we should feel obligated to understand this field better, based on the following facts from good Western-style studies:

1. The use of Integrative Medicine/Complementary and Alternative Medicine is increasing more and more every day and is becoming recognized as good preventive medicine in America.
2. The majority of patients who use Integrative Medical therapies believe that they are effective and are very happy with their use despite opposing opinions.
3. The majority of patients do not tell their physicians that they use Integrative Medical therapies.
4. The majority of physicians do not ask about these therapies.
5. Over half of Americans surveyed believe their health plans should cover alternative therapies.
6. Approximately 80% of medical students and 70% of family physicians want training in Integrative Medicine.
7. The world is becoming a smaller place and access to worldwide information has never been easier.
8. Economies, and eventually health care systems, will continue to become more similar instead of more diverse. Given this, disease patterns and aging patterns will start to look similar.
9. As infectious causes of mortality around the world decline, chronic illnesses will increase, which will make Integrative Medicine even more popular.
10. Most Integrative Medical therapies have originated outside the United States.

There are additional reasons for studying Integrative Medicine around the world. The most obvious are the knowledge of new potential treatments that are unknown to the West and the need to identify the biochemical composition of the active agents in some herbs. Examples include the herb trichosanthin, which has undergone trials by the FDA, and an herb called qinghaosu used for treating fever in China for over 2000 years. In 1971, it was found to have antimalarial activity, the active ingredient being artemesin. Another benefit to this endeavor is to learn how other countries with high rates of Integrative Medicine use and deal with what seems in the West to be the conflict between Conventional Medicine and Integrative Medicine. As East and West continue to meet, it is important to know how different countries integrate, separate, or mediate between the two.

China is perhaps the best example in the world of an environment in which Integrative Medicine and conventional therapies are colleagues. According to Hesketh and Zhu, "China is the only country in the world where Western medicine and traditional medicine work alongside each other at every level of the health care system." In the Western medicine hospitals in China, approximately 40% of the medicines are traditional, and in the traditional Chinese hospitals, about 40% of the medicines prescribed are Western. A survey done in two village health clinics in Zhejiang Province showed that practitioners always prescribed a combination of Western and Chinese medicine. Communication among disciplines about all aspects of the patient in the care of older persons is the backbone of successful systems, for the hospital, for innovative care of frail older persons, and for home care programs. Included in this, of course, is communication to and from the patient and the health-care team. An additional reason to open up lines of communication about use of Integrative Medicine is to improve patient satisfaction. For some unscientific reasons, perceived effectiveness of Integrative Medicine by patients is very high. Awareness of patients' use of Integrative Medicine and understanding why they do so is not acknowledgment of effectiveness. Obtaining trust from patients can improve the health–care relationship, as indicated by the patient who tells others, "My doctor understands me." This is how many systems now track patient satisfaction.