A landmark study by Eisenberg et al(1) of the extent of alternative or unconventional therapies, defined as therapies “neither taught widely in US medical schools nor generally available in US hospitals,” was published in 1993. It was reported that 33% of Americans were using alternative therapies, such as relaxation techniques, chiropractic, massage, and dietary supplements. Use of these therapies was highest among the most educated. These therapies were rarely prescribed by physicians, and most patients did not tell their physician that they were using these alternative therapies.
Why Do Patients Seek Unconventional Therapies?
In the past several decades we have seen a sea change in the medical landscape from the solo practice, primary care country doctor to large urbanized health care systems, from high-touch, low-cost care to high-tech, specialized, expensive, sometimes impersonal health care. Some patients feel lost in our current health care system. They see specialist after specialist and receive prescription after prescription and test after test. They wonder whether their specialists speak to each other.
In the context of these historical and social changes, a field of unconventional medicine has evolved that has been known by a progression of names: holistic medicine, complementary and alternative medicine, and now integrative medicine. It is hoped that the perspectives offered by integrative medicine will eventually transform mainstream medicine by improving patient outcomes, reducing costs, improving safety, and increasing patient satisfaction.
Integrative medicine has been defined as “the practice of 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, healthcare professionals and disciplines to achieve optimal health and healing.”(2)
The most obvious differences between integrative and conventional medicine are its practitioners, who offer longer consultations and emphasize minimally invasive therapies, such as mind-body approaches, nutrition, prevention, and lifestyle changes, and focus on healing and wellness. In addition to conventional therapies, they may recommend alternatives, such as acupuncture, dietary supplements, and botanicals. The doctor-patient relationship emphasizes joint decision-making by the patient and the physician.
More and more patients seek integrative medicine practitioners. By 2007, approximately 40% of adult Americans and 12% of children were using some form of alternative therapies compared with 33% in 1991.(3)
The number of US hospitals offering integrative therapies, such as acupuncture, massage therapy, therapeutic touch, and guided imagery, has increased from 8% in 1998 to 42% in 2010.(4) Many academic cancer centers offer these integrative practices as part of a full spectrum of care. Other hospitals offer programs in integrative women’s health, cardiology, and pain management.
A Shift of Alternative Therapies into Mainstream Medicine
Despite the increasing number of patients seeking alternative therapies, until recently, many of these skills were not routinely offered in medical schools or graduate medical education. Yet they are critical competencies and essential to stemming the tide of chronic diseases threatening to overwhelm both our health care and our financial systems. Further, conventional medical journals rarely contained articles about alternative therapies until 1998 when the Journal of the American Medical Association and its affiliated journals published more than 60 articles on the theme of complementary and alternative medicine.(5)
The National Institutes of Health established an office in 1994 and a National Center for Complementary and Alternative Medicine in 1998. Because many alternative therapies date back thousands of years, their efficacy has not been tested in randomized clinical trials. The National Center for Complementary and Alternative Medicine provides the funds to conduct appropriate trials of these therapies. They also have funded education research and programs in both conventional medical nursing schools and complementary and alternative medicine professional schools. Outcomes of these studies are being published in the conventional medical literature.
Integrative medicine began to have an impact on medical education when 8 medical school deans met in 1999 to discuss complementary and alternative medicine. This meeting led to the establishment of the Consortium of Academic Health Centers for Integrative Medicine, composed initially of 11 academic centers. By 2012, this group had grown to 54 medical and health profession schools in the United States, Canada, and Mexico that have established integrative medicine programs.
To read this article in its entirety, please visit our website.
– Victor S. Sierpina, MD, ABFM, ABIHM, James E. Dalen, MD, MPH
This article originally appeared in the August 2013 issue of The American Journal of Medicine.
