Therapeutic modalities in integrative medicine

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chapter 3 Therapeutic modalities in integrative medicine

INTRODUCTION

In general practice, time and training can limit us to using only a narrow range of modalities in order to promote wellbeing or manage a patient’s illness. This could be likened to using only one or two octaves of a keyboard. The medical and surgical options are like one octave that we are familiar with, and lifestyle factors may be another, but a range of other modalities can be made available, given time, training and some rearranging of the practice.

This chapter examines some of the language and the main modalities used in integrative medicine. Many of these are outlined in more detail in other chapters, in the context of particular conditions and systems. One important distinction in the mind of the GP will be to determine which are effective and, even more importantly, which are safe and which are not. It is vital to help patients make informed decisions that will increase their wellbeing wherever possible, or at least not to cause them harm. There are legitimate concerns if patients forgo effective medical therapies in order to use complementary therapies that might be unsafe or of lesser efficacy.

DEFINITIONS

This section explains the following terms, which are commonly used in integrative medicine and complementary therapies:

• integrative medicine
• orthodox (conventional) medicine
• unorthodox medicine
• alternative medicine
• complementary medicine
• complementary and alternative medicine
• natural medicine
• holistic medicine.

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:

• enhance outcomes—e.g. a man taking pomegranate juice as a part of his management for prostate cancer
• minimise side effects—e.g. using acupuncture to help control nausea, or meditation to control stress
• reduce costs—e.g. using the Ornish lifestyle programs to minimise progression of heart disease.

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

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