The Rise of "Integrative Medicine"

Many of us in the world of scientific medicine (which naturally includes the readers of EIM!) have been alarmed at the steady rise in popularity of the so-called "Integrative Medicine" movement. The following consists of my personal opinion and commentary on this topic.
For those unfamiliar with the term "Integrative Medicine", here's the WebMD entry: IM

The Wikipedia entry is a little more telling: Integrative Medicine. As of this writing, it redirects you to the "Alternative Medicine" entry. Interesting.

So what gives? I think IM is theoretically an attempt to combine some popular alternative methods into standard science/evidence-based care. This might be due to the desire of the patient to have some of these therapies, or a desire of the practitioner to be seen as "open-minded". In practice however, I think IM is the combination of dubious (and often ridiculous) treatments with standard medical care. Therefore I think it typically results in the addition of nothing significant at the risk of conveying some dangerous ideas regarding the nature of medicine and the role of the practitioner in healthcare. For example, the responsibility of the practitioner to be an "honest broker" about the patient's healthcare options and the science and evidence underpinning those options.

There have recently been some articles in the mainstream media about the IM movement, both on MSNBC and on Fox News.

As usual, both Quackwatch and the Science-Based Medicine blog are excellent resources on this topic.
Quackwatch on IM
SBM on IM

I think we've all seen some examples of integrative medicine in physical therapy clinics. Perhaps you've seen a colleague provide a treatment of questionable value in addition to treatments you thought made sense. I know I have.
I don't think much of IM myself, and I make sure I have a good answer when patients ask me why I'm not using this or that alternative method. I feel that's an important part of my responsibility as a healthcare practitioner.

I close with a quote from Dr John Farley PhD, found at the Quackwatch link. I think it encapsulates the issue perfectly.

"Integrative" medicine is purportedly combining alternative and mainstream approaches to medicine. The claim is that integrative medicine provides the best of both approaches. This may sound reasonable, but actually it is not. Suppose that the "integrative" approach were to spread beyond medicine, and were to be more broadly adopted by other disciplines in the sciences. The biologists would "integrate" creationism with Darwinian evolution, while the chemists would integrate alchemy into modern scientific chemistry. The geologists would integrate the belief that the world is only 6000 years old (and flat) with modern dating of rocks. Physicists would integrate perpetual motion machines with the conservation of energy and the laws of thermodynamics. And the astronomers would integrate astrology and astronomy. Of course, this is ridiculous. It's not a good idea to integrate nonsense with valid scientic knowledge."

What is the proper role of IM in physical therapy, and what are its boundaries? What do you think?

-Jason Silvernail DPT

Comments

[Rob Wainner]

Jason,

Euphemisms abound and it appears that IM is another one in what will be a long parade.

Appreciate your comments on its.

However, I think Arnold Relman, M.D. former editor of The New England Journal of Medicine, expressed the viewpoint on this issue much better and more succinctly:

There are not two kinds of medicine, one conventional and the other unconventional, that can be practiced jointly in a new kind of "integrative medicine." Nor, as Andrew Weil and his friends also would have us believe, are there two kinds of thinking, or two ways to find out which treatments work and which do not. In the best kind of medical practice, all proposed treatments must be tested objectively. In the end, there will only be treatments that pass that test and those that do not, those that are proven worthwhile and those that are not [2].

While some of the comparisons used by Dr. Farley have merit, the one comparing Creationism to Darwinism does not and is a actually embarrassing to the argument he is trying to make. Both these are theories of origin that depend on a historic/legal approach to evidence vs a scientific approach as the issue of our Origins is a single event that occurred in the past and cannot be empirically tested using the scientific method. May seem like a minor point to some, but for those familiar with the arguments related to Origins it takes away from his point.

Thanks for the post.

Rob

[Jason Silvernail DPT]

Rob-

I loved Relman's piece also, and considered including it as well. However I'm trying this new thing of keeping my blog posts shorter, I think it helps readability.

While I think Relman's quote and article are excellent (readers, recommmended!) I do think Farley's quote is great also.
Having a lot of experience in the skeptical movement and the issues and positions around the Creationism issue, I must disagree with your assessment of Farley's position. Far from embarrassing, I think he does a good job of separating the "scientific" from the "nonscientific" in his various comparisons. You mentioned a historic/legal approach vs a scientific approach and I think that's exactly where Farley was going, and exactly what we should be concerned about it when it comes to deciding these issues. The issue of prior plausibility is an important consideration in science and one that I don't think gets enough attention generally speaking both in the Alt Med movement and in Evidence Based Medicine.

Thanks for your comments-
Jason

[Adam Rufa]

I am a bit disappointed with the negative attitudes being expressed about this innovative new approach to health care. This is just another example of PTs lack foresight and pathological lack of innovation. Unless we start embracing these types of movements we are going to be left behind. It is obvious that healthcare consumers want these services and if we don’t provide them someone else will.

Think about it, we can add treatments with no reasonable scientific rational or evidence of effectives. This opens up some impressive opportunities. I have started to develop some new methods to take advantage of this IM movement. The one I have worked the most on is called “The Irish Pub Method” (alternative name may be “The Guinness Method”) I have also been working on some seasonal treatments called the “Stanley Cup Method” (recent results have been promising) and “March Madness Therapy”. I am also excited about trying “The Reverse Foot Massage Method” for some of my foot pain patients.

[Rob Wainner]

Jason,

That is the point, his analogies lack homogeneity which in my opinion simply detracts from his argument.

This isn't the place for a debate of Origins nor the purpose of your post, but some of the "hopeful monster" and "alien seeding" propositions of the neo-evolutionsist movement make some of the IM stories seem tame.

Thanks for the post.

Adam, your sarcasm in the first paragraph had me going there for a minute.

Rob

[Jon Newman]

When I learned about evolution in school and read about it in books so little of it focused on our origins per se but rather on processes such as speciation, extinction, adaptation, natural selection, etc. Our origin is a conclusion one may draw from the facts presented. Most forms of creationism also make claims about these processes. On this level of analysis the analogy is consistent with his other analogies.

That doesn't mean Farley's quote was a superior quotation to use in terms of marketing the idea that integrative medicine is a misstep for medical providers. I think Rob's comments demonstrate why.

[Selena Horner]

I believe IM exists simply because the physician gatekeepers have failed and the health care system is broken. Dissatisfaction leads to searching/striving for satisfaction.

Adam... the Stanley WILL continue to remain in Detroit! Go Wings!

[Jason Silvernail]

Adam-
You had me going there too!
Selena-
Can you be more specific as to what you mean about the failure of the gatekeepers?
Jon/Rob-
Great comments, thanks.

[Jason Silvernail DPT]

Here's some more on the NCCAM, darling of the IM movement. Steven Novella has put up a post on the Neurologica blog about a recent story on the basic failure of alt med research to produce anything useful.

Neurologica: CAM Research - Much Ado About Nothing
http://www.theness.com/neurologicablog/?p=554

Associated Press Article: $2.5 Billion Spent, No Alternative Cures Found
http://www.msnbc.msn.com/id/31190909/

[Jason Silvernail DPT]

http://www.sciencebasedhealthcare.org/index.html

Great site to direct colleagues and patients towards. Prominent mention of PTs as providers of responsible manual therapy services consistent with scientific principles. As opposed to, well, you know who. Great summary pages and other resources.

[Dentistry Mesquite]

You gave us a very good insight about integrative medicine. Maybe it's time to use this kind of medicine, because it is effective and helpful.