The “Bravewell Collaborative” (www.bravewell.org) is a US organisation that 'works to improve healthcare'. They have had a long-standing focus on integrated medicine. A document1published by them in February this year reports a survey conducted in 2011 'to determine how integrative medicine was currently being practices…'. It summarises a multitude of (mostly quite boring) details. What did catch my attention, however, were the results of one particular question to 29 US centres of integrative medicine. They were asked to rate 19 statements on core values. Here are the 'values' and the percentage of centres finding them 'very important'.
|
|
Value |
% |
|
1 |
The physical influences that affect a person’s health are addressed |
100 |
|
2 |
The emotional and mental influences that affect a person’s health are addressed |
97 |
|
3 |
Our care is patient-centered |
97 |
|
4 |
We teach the connection between lifestyles and health |
97 |
|
5 |
We emphasize CAM modalities |
93 |
|
6 |
We encourage patients to take responsibility for their own health |
93 |
|
7 |
We consider the patient’s health goals in the care plan |
93 |
|
8 |
Our center strives to maintain an optimal healing environment |
90 |
|
9 |
Our care treats the causes of disease as well as the symptoms |
83 |
|
10 |
The social influences that affect a person’s health are addressed |
79 |
|
11 |
We use all healing sciences to facilitate the body’s innate healing response |
79 |
|
12 |
We emphasize prevention and wellness |
76 |
|
13 |
The spiritual influences that affect a person’s health are addressed |
69 |
|
14 |
Our care is evidence-based |
69 |
|
15 |
We use the least invasive and most natural treatment first |
66 |
|
16 |
We use food as medicine |
66 |
|
17 |
We coordinate the care with the patient’s other providers |
66 |
|
18 |
The environmental influences that affect a person’s health are addressed |
62 |
|
19 |
We integrate the patient’s family/loved ones into the care |
41 |
I think this is revealing as it shows us what integrated medicine is really all about. Every GP in the country will recognise that most of the above statements are simply describing good medicine.
It would be hard to find a doctor (integrated or not) who does not subscribe to patient-centred care, healthy lifestyle, taking responsibility, an optimal healing environment, treating the causes of illness whenever possible, disease prevention, etc. In fact, only items five, 11, 13, 15 and 16 seem a bit odd in the context of the average general practice.
Let’s have a brief look at these items. To use food as medicine sounds very nice and attractive – but to what extent is it effective?
I am not sure there is a lot of convincing evidence here beyond the advice GPs usually (should) give to their patients. Using 'the most natural treatment first' is, in my view, just daft. A treatment is not good because it is natural but because it generates more good than harm.
The 'spiritual influences' are likely to make many doctors uncomfortable. This is considered by most of us to be the domain of priests, not physicians. Using 'all healing sciences to facilitate the body’s innate healing response' seems odd too. Maximising non-specific therapeutic effects through productive and positive therapeutic encounters is what doctors (should) do. Yet resorting to obsolete concepts of vitalism may not be everyone’s cup of tea.
Finally, item five emphasizes CAM modalities. 93% of the centres subscribe to this principle. Here, I fear, we have what integrated medicine is all about. It seems to dilute evidence-based medicine with unproven or disproven treatments such as reiki or homeopathy2. Seen in this context the claim that 'our care is evidence-based', which 69% of the respondents believe to be very important, seems like a sick joke.
Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter
Reference List
(1) Horrigan B, Lewis S, Abrams D, Pechura C. Integrative medicine in America: how integrative medicine is being practiced in clinical centers across the United States. The Bravewell Collaboration, Minneapolis. 2012.
(2) Ernst E. Integrated Medicine. J Intern Med 2012; 271(1):25-28.
