Integrated medicine: orthodox meets alternative

Abstract

Editor—Vickers's review is another example of how complementary and alternative medicine (CAM) is being brought into the mainstream rather than integrated.1 Times are indeed changing, but what to? The dictionary defines integration as “the incorporation of equals into society.”2 Let's be honest: there is no equality in medicine; there never was and probably never will be. The recent approval of acupuncture by the BMA is by no means an overarching endorsement of Chinese medicine as a legitimate alternative system.3 It is simply an acknowledgement of the accumulation over time of good enough evidence that shows the effectiveness of acupuncture in some conditions. This is, to borrow a metaphor from the word processing world, a cut and paste approach. It results in the assimilation, and not creation, of a new emergent property. Combination medicine is not integrated medicine. Two other important aspects related to the future of CAM deserve discussion. Health services research—Currently, much of the research effort in CAM is in the form of treatment x for disease y. Almost no systematic research is taking place on the delivery, organisation, and financing of different integrative healthcare models or on the appropriateness, quality, availability, and cost of CAM modalities in the current healthcare system. At a time when there is much interest in marketing, to ignore this line of research would undoubtedly be counterproductive in the long run simply because money is easier to measure and relate to than healing. Only by combining both types of research—biomedical that looks mainly at mechanisms of effect, and health services that looks mainly at modes of delivery—will true integration beyond the mere expansion of therapeutic tools be possible. Medical education—Tallying the number of CAM courses given in medical schools is probably the most misleading indicator of integration. It may create an illusion that CAM has already made inroads into the temples of the medical establishment. The truth is that CAM education is currently an optional dessert rather than a main course. True integration will not be feasible without shifting the medical education paradigm from disease to humanism, from cure to healing, from knowing to not knowing. Education is the key to change.4 By their nature, review articles deal with the past. People, however, ought to look at the future: what will follow the current trend of mainstreaming? Integrative medicine, in its true sense, has the potential to expand the horizons of medicine beyond therapeutics.