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The first international case conference of ‘integrated medicine’

Is integrated care really the best of both worlds? Professor Edzard Ernst digs deep into the validity of unconventional therapies.

This sounds rather grand, doesn't it? What it really amounted to was a group of CAM-enthusiasts getting together during a CAM-conference and discussing in public how to treat one specific patient. Their objective was 'to explore the common ground between conventional and CAM treatment and the potential for integrated medicine approaches' (see below for ref).

The panel comprised of one expert in conventional medicine (an anaesthesiologist) as well as one each in naturopathy, homeopathy, acupuncture and anthroposophical medicine. All were doctors. The case they decided to discuss was a 51-year old with back pain, a history of DVT, allergies and nicotine addiction.

The anaesthesiologist advocated a multidisciplinary approach including CBT, exercise, physical therapies, muscle relaxants, antidepressants and an alpha 2 delta-calcium-channel binder.

The naturopaths recommended fasting, life-style modification, mind-body approaches, hydrotherapy, cupping, Gu Sha, leeches or cantharidin plaster, yoga, Feldenkrais and St John's wort.

The homeopath considered the following remedies: secale, lachesis, natrium muriaticum, sepia. Statphysagria, bellis perenis, arnica, rhus toxicodendron and kalium carbonicum as well as the Alexander technique.

The anthroposophical doctor recommended physical activity, hay-packs, massage, the oral remedies tabacum, arnica and bamboo as well as eurythmy, relaxation of the 'astral activity', biography work, cognitive and spiritual counselling or logo-therapy.

The acupuncturist advocated acupuncture on trigger points, myotomes and periosteal needling.

Some agreement amongst these doctors emerged about the importance of the patient-physician-relationship and appropriate consultation time. There also was a consensus that both the diagnostic process and the resulting treatment plan should be individualised and focused on the patient as a complete person, identifying the significance which the condition has for the patient.

What can we learn from all this? Many of the CAM treatments suggested may be totally unknown to British GPs. Their majority is not backed up by evidence for effectiveness. This, I think, begs the questions: What is 'integrated medicine'? Is it really the best of both worlds', as its proponents want us to believe?

Whenever I start digging a little deeper, I seem to find that integrated medicine is just a confusing term for smuggling unproven therapies into routine healthcare - not a step forward, but a big step in the wrong direction!

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