The term 'integrative medicine' may elicit sceptical reactions from some, but it is something that many GPs are already practising, says Dr Karine Nohr.
Integrative medicine is a growing movement in many parts of the world, but the term seems to be an emotive one that generates a lot misunderstanding. So what is meant by the term ‘integrative medicine'?
Many people perceive it to be a term that is the same as complementary or alternative medicine, but this, too, is a misunderstanding. Neither of these latter terms encapsulate the whole notion of integrative medicine.
These terms imply that it is either a substitute for conventional medicine or an addition to it. Integrative medicine may incorporate some CAM therapies, but it is actually so much more.
Integrative medicine does not seek to reject conventional medicine nor accept alternative ones uncritically, but rather encapsulates the following ideas:
1. It is a ‘whole person' medicine - it embraces the notion that we are more than just our physical bodies and that there are psychological, spiritual and societal dimensions to our well-being. Our awareness that healing may be hindered by difficulties in ANY of these areas allows us to address the bigger picture
2. It assumes a basic tenet that we are naturally self-healing organisms - we have an innate capacity to heal and to mend. Therefore, treatment should seek to enable and support that process. As Hippocrates said, ‘Everyone has a doctor within; we just have to help it work. The natural healing force within each one of us is the greatest force in getting well'
3. It prioritises the importance of lifestyle - increasingly recognised within conventional medicine, well-being must embrace attention to diet, exercise, work, relationships, and so on and so forth. The WHO definition of health is that ‘health is not only about the absence of infirmity and disease but also a state of physical, mental and social well-being'
4. It recognises the importance of the doctor-patient relationship in the healing process - this is not simply a contractual relationship, but one that is based on care, empathy and trust, in an honest and mutual partnership that upholds the different nature of the expertise of both of its members
5. There are many paths to healing - the more we are educated in the diversity of the therapeutic toolbox, the more we can be patient-centred in our approach
Integrative medicine often does embrace ideas that are outside conventional medicine, but it recognises that these may range in spectrum from at one end the valuable and useful, to the ineffective in the middle, the silly, or even dangerous at the other end of the spectrum.
Contrary to what some critics may say, it encourages critical evaluation of all interventions.
In the words of NICE chair Sir Mike Rawlins, as he concluded his 2008 Harveian Oration: ‘hierarchies of evidence should be replaced by accepting – indeed embracing – a diversity of approaches'.
Furthermore, there needs to be a sliding scale for evidence, based on the potential for harm. The greater the potential for a therapy to do harm, the greater the evidence should be that it is effective. The Hippocratic caution ‘first do no harm' has too often been overlooked in modern medicine.
Integrative medicine has plenty to offer conventional medicine. Much in conventional medicine actually stems from other modalities - for example, 60% of antibacterials and anticancer drugs originate from natural products.
Integrative medicine should not be a subspeciality, but be assimilated into all branches of medicine. Indeed in many ways it already is, and increasingly so.
That does not mean that we all need to be well-versed in the intricacies and complexities of all the therapeutic options, but behoves that we be trained in the basic areas, such as lifestyle medicine, and that we should have some basic understanding of what other modalities may have to offer, both for patients who wish to weave supplementary remedies into their healthcare, as well as those for whom conventional medicine has not been helpful.
Dr Karine Nohr is a GP in Sheffield
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