Editorial Comment
| doi: 10.1111/j.1365-2796.2011.02417.x
Integrated medicine Integrated (or integrative) medicine has become a popular concept, at least amongst proponents of alternative therapies. It has been defined as ‘medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence and makes use of all appropriate therapeutic approaches, health care professionals and disciplines (conventional and complementary) to achieve optimal health and healing’ [1]. This and other definitions [2] are sound promising, but they do not tell us what modalities might be included under this umbrella. To find out, we have several options. We can, for instance, search the internet, where we find any manner of unproven treatments, even outright quackery, associated with integrated medicine [3]. But it might be unfair to judge this field by its associations in a commercial environment. Perhaps, it is more objective to define integrative medicine through an analysis of the contents of recently published books on this subject. Table 1 lists the therapies which were discussed in detail in six recent books on the subject [4–9]. Based on these data, integrated medicine covers a wide range of therapies. Unanimous agreement amongst the authors of these books seems to exist that it includes the following modalities: acupuncture, herbal medicine, homeopathy, massage and osteopathy. Most of the books would furthermore include biofeedback, chiropractic, hypnotherapy, meditation and naturopathy. For all other treatments, no clear consensus emerges. With the exceptions of counselling, exercise, massage (in European countries), nutritional therapies, psychotherapy, spinal cord stimulation and vitamins, the listed therapies are all nonorthodox (Table 1). For most of them, the evidence base is less than solid [10]. Prime examples of unproven or disproven treatments include homeopathy [11], prayer [12], reflexology [13] and spiritual healing [14].
academic conference on this topic. The third ‘European Congress of Integrated Medicine’ took place on 3–4 December 2010 in Berlin. I categorized its 222 abstracts[15] according to subject areas, whenever possible, attributing one therapeutic technique to each abstract. There were several general abstracts, e.g., surveys (such as ‘Complementary medicine use in XY’) and abstracts with disease-specific topics (e.g. ‘Integrative medicine approach for neuropathic pain’). None of them were linked to a specific intervention. Acupuncture (n = 21), homeopathy (n = 20), anthroposophic medicine (n = 14) and herbal medicine (n = 14) stood out as the most frequent therapies. They were followed by Traditional Chinese Medicine (n = 8), mind–body therapies (n = 5), Ayurveda (n = 5), placebo (n = 5), massage (n = 4), diet (n = 3) and spiritual interventions (n = 3). Two abstracts each related to art therapy, hypnotherapy, kinesiology and nonherbal supplements. One abstract each related to aromatherapy, Bach flower remedies, the Balint approach, bioresonance, chiropractic, cupping, dance therapy, electrotherapy, fasting, honey, leeches, music therapy, naturotherapy, osteopathy, reflexology, thermotherapy, Tibetan medicine, water immersion and yoga. Both analyses confirm that integrated medicine embraces a wide range of unproven or disproven alternative therapies with little consensus amongst experts which modalities are at the core of this area. They also show that mainstream modalities are largely excluded. It is thus fair to suspect that integrated medicine is alternative medicine by another name, nothing other than a cloak of respectability disguising alternative medicine. The term ‘integrative’ seems to disclose the ‘bait and switch’ tactic of charlatans. At best, integrative medicine is well meaning but naı¨ve[1]; at worst, it represents muddled or even fraudulent concepts [2, 3, 16] with little potential to serve the needs of patients.
Another option to describe the nature of integrated medicine might be to evaluate the abstracts of an
ª 2011 The Association for the Publication of the Journal of Internal Medicine
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Cardiovascular Disease.
Ed: WH Frishman,
MI Weintraub, MS Micozzi. [5]
Acupuncture
Medicine. Ed: D Peters,
A Woodham (Dorling
Kindersley) [4]
Acupuncture
ª 2011 The Association for the Publication of the Journal of Internal Medicine Journal of Internal Medicine 271; 25–28
Homeopathy
Homeopathy
Homeopathy
Homeopathy
Homeopathy
Herbal medicine
Herbal medicine
Herbal medicine
Herbal medicine
Exercise
Chiropractic
Breathwork
Biofeedback
Aromatherapy
Acupuncture
K Olness. [8]
Ed: TP Culbert,
Pediatrics. OUP.
2010, Integrative
Exercise
medicine
Chiropractic
medicines
Chinese herbal
Biofeedback
Aromatherapy
Acupuncture
Ed: May Loo [7]
for Children.
Medicine
2009, Integrative
Homeopathy
Herbal medicine
reprocessing
desensitization and
Eye movement
Electrotherapy
Craniosacral therapy
Counselling
Chiropractic
Bioresonance
Biofeedback
Autogenic training
Art therapy
Applied kinesiology
Acupuncture
L Anderson. [9]
LA Wisnescki,
Medicine, 2nd Ed.,
Basis of Integrative
2009, The Scientific
|
Environmental
Herbal medicine
Chiropractic
Counselling
Chiropractic
Chinese herbal medicines
Chelation
Ayurveda
Auriculotherapy
Aromatherapy
Aquatic therapy
Acupuncture
Therapeutic T. [6]
A Bailey. Part II,
Ed: JF0 Audette,
Pain Medicine.
2008, Integrative
medicines
Chinese herbal
Biofeedback
Autogenic training
Art therapy
Aromatherapy
Animal-assisted therapy
Integrative Therapies for
Guide to Integrated
Alexander technique
2005, Complementary and
2000, The Complete
Table 1 Therapies discussed in five books of integrated medicine
E. Ernst Editorial: Integrated medicine
Cardiovascular Disease.
Ed: WH Frishman,
MI Weintraub, MS Micozzi. [5]
Medicine. Ed: D Peters,
A Woodham (Dorling
Kindersley) [4]
Reflexology
Reflexology
Qigong Reiki
Qigong
Psychotherapy
Reiki
relaxation
Progressive
Osteopathy
Nutritional therapies
Naturopathy
Meditation
Massage
Hypnotherapy
K Olness. [8]
Ed: TP Culbert,
Pediatrics. OUP.
2010, Integrative
Rolfing
Reiki
Qigong
Polarity therapy
Osteopathy
programming
Neuro-linguistic
Naturopathy
Music therapy
Mora therapy
Meditation
Massage
Light therapy
Laughter therapy
Laser therapy
Imagery
Hypnotherapy
L Anderson. [9]
LA Wisnescki,
Medicine, 2nd Ed.,
Basis of Integrative
2009, The Scientific
|
Psychotherapy
Probiotics
Osteopathy
Osteopathy
Osteopathy
Prayer
Nutritionaltherapies
Nutritional therapies
approaches
Mind ⁄ body
Massage
Nutritional therapies Osteopathy
Meditation
Massage
Magnet Therapy
Laser therapy
Hypnotherapy
Ed: May Loo [7]
for Children.
Medicine
2009, Integrative
Naturopathy
Native American healing
Music therapy
Mind-body approaches
Massage
Hypnotherapy
Therapeutic T. [6]
A Bailey. Part II,
Ed: JF0 Audette,
Pain Medicine.
2008, Integrative
Naturopathy
Music therapy
Meditation
Massage
Imagery
Magnet Therapy
Integrative Therapies for
Guide to Integrated
Hypnotherapy
2005, Complementary and
2000, The Complete
Table 1 (Continued)
E. Ernst Editorial: Integrated medicine
ª 2011 The Association for the Publication of the Journal of Internal Medicine Journal of Internal Medicine 271; 25–28
27
Thought field therapy
Trager method
Conflicts of interest No conflicts of interest to declare.
E. Ernst From the Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK
Therapeutic touch
Thermotherapy
Therapeutic touch
Spiritual healing
L Anderson. [9]
References 1 MacPherson H, Peters D, Zollman C. Closing the evidence gap in integrative medicine. BMJ 2009; 399: b3335, (http:// www.bmj.com/cgi/content/full/399/sep01_2/b3335). 2 Ernst E. Integrated medicine revisited. FACT 2010; 13: 73–4. 3 Ernst E. Integrated medicine? In: Ernst E, ed. Healing, Hype or Harm? A Critical Analysis of Complementary or Alternative Medicine. Exeter: Imprint Academic, 2010; 123–9. 4 Peter D, Woodham A. Complete Guide to Integrative Medicine: Combining the Best of Natural and Conventional Care. New York: Dorling Kindersley, 2000. 5 Frishman WH, Weintraub MI, Micozzi MS. Complementary and Integrative Therapies for Cardiovascular Disease. St. Louis, MO: Elsevier Mosby, 2005. 6 Audette JF, Bailey A. Integrative Pain Medicine. Totwana: Humana Press, 2008. 7 Loo M. Integrative Medicine for Children. St. Louis: Elsevier Health Sciences, 2009. 8 Culbert TP, Olness K. Integrative Pediatrics. Oxford: Oxford University Press, 2009. 9 Wisneski LA, Anderson L. The Scientific Basis of Integrative Medicine, 2nd edn. Florida: CRC Press, 2010. 10 Ernst E, Pittler MH, Wider B, Boddy K. The Desktop Guide to Complementary and Alternative Medicine, 2nd edn. Edinburgh: Elsevier Mosby, 2006. 11 Shang A, Huwiler-Muntener K, Nartey L et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005; 366: 726–32. 12 Astin JA, Harkness EF, Ernst E. The efficacy of ‘‘Distant Healing’’ a systematic review of randomized trials. Ann Intern Med 2000; 132: 903–10. 13 Ernst E. Is reflexology an effective intervention? A systematic review of randomised controlled trials. MJA 2009; 191: 263–6. 14 Ernst E. Distant healing – an ‘‘update’’ of a systematic review. Wien Klin Wochenschr 2003; 115: 241–5. 15 Willich SN. Invited Lectures [European Congress of Integrated Medicine. December 3–4, 2010]. Eur J Integr Med 2010; 2: 155–265. 16 McLachlan JC. Integrative medicine and the point of credulity. BMJ 2010; 341: c6979.
Yoga
Correspondence: E. Ernst, Complementary Medicine, Peninsula Medical School, UnUniversity of Exeter, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, UK. (e-mail:
[email protected]).
Vitamins
Spiritual healing
Tai chi
Yoga
Therapeutic touch
Supplements
Tai chi
Spiritual healing
K Olness. [8] MI Weintraub, MS Micozzi. [5]
Ed: May Loo [7] Therapeutic T. [6]
Ed: WH Frishman, A Woodham (Dorling
Kindersley) [4]
A Bailey. Part II,
Cardiovascular Disease. Medicine. Ed: D Peters,
Spinal Cord Stimulation
Medicine, 2nd Ed.,
LA Wisnescki, Ed: TP Culbert,
Pain Medicine.
Ed: JF0 Audette,
2008, Integrative
Integrative Therapies for
for Children.
Pediatrics. OUP.
Editorial: Integrated medicine
2005, Complementary and
Medicine
Basis of Integrative
|
Guide to Integrated
2000, The Complete
Table 1 (Continued)
2009, Integrative
2010, Integrative
2009, The Scientific
E. Ernst
