INTEGRATIVE MEDICINE

As has been discussed previously, integrative medicine (IM) refers to the practice of medicine that incorporates evidence-based and safe therapies, whatever their origin. There is particular emphasis on safety, holism and complementarities. IM uses conventional medical care, but lifestyle interventions and evidence-based complementary medicine are also given a significant level of attention and may be used as a range of possible alternatives or as adjuncts. Used properly, IM is not ‘alternative practice’ but ‘best practice’.

ORTHODOX (CONVENTIONAL) MEDICINE

The term orthodox medicine (OM) (also called conventional medicine) is used to denote what is widely taught in medical schools, and is accepted clinical practice by most practitioners. Definitions of OM generally link it with being ‘scientific’ or ‘evidence-based’ but this is not always a good distinguishing factor between orthodox and unorthodox therapies. One would not have to search too far to find instances of widely used and promoted orthodox therapies not being based on science or evidence, or examples of therapies that have been shown by long-term follow-up studies to have caused more harm than anticipated.

UNORTHODOX MEDICINE

The term unorthodox medicine is sometimes used to denote those therapies that are not generally taught in medical schools or widely accepted in clinical practice. They are also sometimes referred to as unconventional medicine. By definition, unorthodox therapies are ‘non-scientific’ or not based on credible science or evidence, because if they were then they would be orthodox. However, this is not always the case, as there are an increasing number of examples of treatments that are not widely accepted or practised but are well supported by evidence. The boundary between orthodox and unorthodox therapies is shifting and often indistinct. For example, acupuncture would have been outside the boundary 30 years ago, but today, with a significant evidence base and approximately 90% of Australian GPs referring patients for acupuncture, it could no longer be considered an unorthodox therapy.

ALTERNATIVE MEDICINE

Alternative can have a number of meanings. It can mean that there are a number of potentially useful approaches to treatment which could be employed, such as whether to use a benzodiazepine, meditation or melatonin for insomnia, or taking glucosamine instead of NSAIDs for osteoarthritis. It can also denote that a patient wishes to reject conventional healthcare and prefers instead to use an alternative approach to therapy. This latter situation may or may not be a problem. It is certainly a problem when the conventional treatment being offered is clearly efficacious and the preferred alternative treatment is not, such as wishing to reject primary surgery for malignant melanoma and preferring ozone therapy instead. In such a case, patient autonomy is going beyond the bounds of safety and reason—after having fully and respectfully listened to the patient’s point of view, the doctor needs to clearly inform the patient about the evidence, costs, benefits, risks and safety issues.

COMPLEMENTARY MEDICINE

The term complementary medicine (CM) is in far more common usage than ‘alternative medicine’ because it better reflects the attitude of most patients wishing to seek out such therapies. Most patients do not wish to reject conventional medical care but simply feel that it is incomplete and needs to be enhanced or broadened by other approaches. CM therefore denotes therapies that are used to complement, or be adjuncts to, conventional treatments so as to:

COMPLEMENTARY AND ALTERNATIVE MEDICINE

Complementary and alternative medicine (CAM) is a less specific but widely used term, particularly in the United States. It encompasses both alternative medicine and CM.

NATURAL MEDICINE

Natural medicine generally relies on the use of naturally derived products such as herbs, diet or vitamins but can also encompass lifestyle and environmental issues. It can be seen as a philosophy as much as a form of medicine. These therapies are generally aimed at enhancing nature’s ability to heal (e.g. using diet to improve immunity) or boosting the body’s defences. It does not always distinguish well between conventional medicine and CM, because many therapies used in conventional medicine are ‘natural’ and some therapies used by CM practitioners may not be natural. Although most natural therapies do well in terms of safety, being ‘natural’ does not necessarily mean being safe. Some herbs or high doses of vitamins have interactions and side effects that can be problematic.

HOLISTIC MEDICINE

Holistic medicine generally denotes a philosophy that informs therapies or approaches to practice. The holistic approach encompasses body, mind, social, spiritual, lifestyle and environmental factors. It might be delivered by one therapist or a number of therapists working together. It does not necessarily distinguish between conventional medicine and CM, as many conventional therapies and practitioners are holistically oriented and some therapies used by CM practitioners may not be.

ALTERNATIVE MEDICAL SYSTEMS

Alternative medical systems are generally comprehensive healthcare systems, often embedded within a culture. They are holistic in focus and are underpinned by a philosophy of healthcare as much as by therapeutic techniques. These philosophies are naturalistic and generally metaphysical, with bioenergetic explanations for physical phenomena. Indigenous medicine, Ayurveda and traditional Chinese medicine are examples of such systems. Some would also classify naturopathy as an example of an alternative system. Embedded within them are generally a range of techniques including herbal medicine, contemplative practices, approaches to exercise, body-based therapies such as acupuncture, and even moral codes. These systems often have a long tradition with a strong emphasis on respect for the healing power of nature, including fostering the body’s defences, integration with the environment and the use of natural products. Their descriptions of the origin of and cures for diseases are often significantly at variance with conventional Western biomedicine. Regardless of whether we accept these explanations for the causes of and cures for diseases, undoubtedly these systems incorporate a wide range of effective therapies and strategies.

Ayurveda (from the Sanskrit ayur= life, veda= knowledge) is the traditional Indian healing system and incorporates lifestyle advice, herbs, meditation, body typing (doshas) and yoga. The yoga system is said to have eight ‘limbs’ or branches incorporating physical, psychological, mental, social and spiritual health, as well as disciplines such as meditation and lifestyle modification, and the more widely known postures and breathing techniques. Traditional Chinese medicine (TCM) is, again, more than just acupuncture and Chinese herbs. It also incorporates movement therapies (e.g. t’ai chi), breathing and meditation. Naturopathy can be seen by some as just the use of herbs but in its fullest sense it is underpinned by a ‘naturalistic’ philosophy. Patients will often use aspects of these alternative systems without adopting the underlying philosophy—such as using acupuncture for chronic pain—although in a purist sense, this would be seen as less congruent and less effective.

MIND–BODY THERAPIES

Many mind–body therapies are now considered largely mainstream and are used by the majority of doctors. They include stress management, relaxation therapies, meditation, imagery, biofeedback, prayer, humour, mindfulness, journal keeping and hypnosis. Support groups, family therapy and cognitive behaviour therapy can also be used to facilitate healing or for coping with physical illnesses and so these are also classified as mind–body therapies. Of all the modalities, mind–body probably has the most sound evidence base. A review of mind–body therapies found that:

This is not reflective of the limitations of mind–body therapies, but an indication of how far the research has progressed.

BIOLOGICALLY BASED THERAPIES

Biologically based therapies include those that use biologically active compounds, most of which are naturally occurring. These would most often include food, herbs, vitamins and supplements, but could also include things such as homeopathic remedies and essential oils used in aromatherapy. Much of the rationale for herbal therapies comes from the philosophy that whole-plant compounds include a range of co-factors, vitamins and nutrients that would not be available if one biologically active ingredient were isolated, measured and administered. Such an approach is said to improve efficacy and minimise side effects. Many pharmaceuticals, of course, are derived from plants, including aspirin, digoxin, penicillin, quinine and metformin, to name a few. Although most biologically based therapies are safer than their pharmacological counterparts, they are biologically active and can interact with drugs, and so it is important to know what patients are taking and to check potential interactions.

MANIPULATIVE AND BODY-BASED THERAPIES

These physical therapies are, like other categories, diverse and widely used. They include:

ENERGY-BASED THERAPIES

There are two main types of energy therapies:

Energy therapies are probably the least researched and hardest to validate, although some positive outcomes have been found, mostly in controlling symptoms. The mechanisms of action are difficult to explain. Other philosophical systems that have ‘bioenergetic’ explanations include qi gong, acupuncture, TCM and yoga.