Comments of Integrative medicine

Why is this topic important?

The world is rapidly changing and vast amounts of information are readily and quickly available, literally at our fingertips. Yet health and disease are concepts that have evolved slowly, cautiously and incompletely. For more than 200 years, biomedicine has approached diseases by studying the processes which underlie them (pathogenesis), inferring causal connections and developing specific approaches to modify these processes by means of therapies. This pathogenic approach, which is highly successful in acute and traumatic conditions, is often ineffective in chronic disease, primarily because of the complex, multi-factorial nature of most disorders, which does not permit simple
causal, linear inference or standardized therapeutic interventions that view individuals as cases of malfunctioning organs or systems and undervalue the socio-cultural and humanistic aspects of care (
1). Unfortunately, the surge in technological development, the increased need for immediate reward and the overestimation of our capacity to deal with human suffering have driven the medical system even further toward this disease based approach to health care. The results are a diminishing public faith in the medical establishment and the rise of alternative medical philosophies and practices. The real crisis in medicine and healthcare in general today may not really be about economics, but about the loss of the fundamental human relationship between the health system and the public; between health professionals and patients (2). Ancient models of care are now re-emerging, allowing physicians and other health professionals to refocus on the unique experience of illness for the individual and the community (3, 4).

Within this context an approach known as Integrative Medicine is evolving. It focuses on health and healing through the integration of conventional and traditional complementary and alternative medicine (TCAM). Integrative Medicine emphasizes the relationship between the patient and the health practitioner, and the responsibility of the latter to enable the patient to benefit from a full array of modalities that can be shown to benefit our health. It addresses the biological, psychological, social and spiritual aspects of health and illness and has a strong focus on preventive health (5-8).

At the micro (clinical) and meso (health services) level, IM seeks to harmonize the treatment methods which characterize conventional biopharmaceutical medical approaches with the TCAM approaches various cultures have adopted for the restoration and maintenance of health (9, 10).

At the macro level, Integrative Medicine promotes health care systems that integrate self-care, lifestyle based interventions and TCAM with conventional medicine through rational, comprehensive patient evaluation and monitoring. It emphasizes respect for the human capacity for healing and our awareness of our own health. Promoting collaboration among practitioners, it also stresses the importance of the relationship between practitioner and patient, supporting individual behavioral changes focused on evidence based health care, be it conventional, alternative, or complementary (11, 12).

Given the undisputedly important role that TCAM plays in most cultures around the globe, the World Health Organization (WHO) has recognized it as a source of culturally acceptable, affordable and sustainable primary health care services (5). Such services, according to the WHO, include any health practices, approaches, knowledge or belief incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being (6, 7). Such therapies may be used alone, as an alternative to conventional therapies, or in addition to conventional, mainstream medicine to treat illnesses and promote wellbeing (5, 13, 14). Another important aspect of TCAM is that it views the patient holistically, seeking to shift from a disease treatment
approach to addressing patients as individuals with the capacity to contribute to their own well-being and choices (15, 16). This emphasis on making sure the patient’s environment, choices, emotions and spirit are considered becomes ever more relevant for people living with multiple chronic diseases, whose ill health is caused and fuelled by the complex interaction of multiple factors (17-19). Such complexity is also taken into account in relation to efforts to evaluate interventions, as advocates of integrative medicine call for whole systems research, departing from the linear and reductionist approaches that pervade the assessment of conventional health interventions (20, 21).

Not surprisingly, the broad range of healing philosophies, approaches and therapies embraced by TCAM generate resistance within mainstream Western medicine. As a result, TCAM, and, by default Integrative Medicine, is not used, accepted, studied, understood or made available within most conventional healthcare institutions around the world.

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