Comments of Integrative medicine

What innovative strategies could fill the gaps?


A future in which we understand the intrinsic value of integrative approaches, focusing on the whole person and prescribing effective combinations of TCAM and conventional interventions to treat and prevent illness, alleviate pain and improve quality of life for people with complex chronic diseases, will require unprecedented levels of collaboration between regulators, industry, health care practitioners, researchers and patients/consumers.

There are some encouraging examples of this type of collaboration (80). For example, the WHO has issued Guidelines for the Assessment of Herbal Medicines. Based on the classical paradigm, they follow the traditional approach to validating quality, safety and efficacy which is used for conventional pharmaceutical products, but with one major difference. The starting point is to look at the effects of interventions in human instead of animal models. By taking into account traditional experience with herbal medicine and viewing commercially based datasets, the apparently uneventful use of a substance for long periods is taken as evidence of its safety. Manufacturers are then encouraged to support research which seeks to develop a drug or a derivative, following good development practices and standard operating procedures based on the initial identification, collection and processing of plant or natural product materials. However, major challenges remain, particularly in relation to the marked variations in source material, the lack of understanding of the synergistic effects of multiple chemical ingredients and the absence of information on the potency of various formulations.

Given its reach and global role as an overseer and de facto coordinating body for issues related to human health, the WHO may need to be more aggressive in promoting better chronic disease management. Indeed, it has already encouraged the publication of reports proposing several detailed options to facilitate the implementation of Integrative Medicine services as part of programmed national health care system reforms (22). This work, which already involves substantial international collaboration, includes valuable information for those who are interested in harmonizing science and traditional medicines in diagnostics and health education, and who employ complementary treatment methods, so that they can ensure the optimal quality of CAM products in their own countries. Joint efforts with other global bodies, such as the World Trade Organization, will be needed to achieve these goals, with industry and health professional organizations playing a more prominent role.

The documentation of the safety and efficacy of TCAM practices and interventions, as well as innovative methods to develop cheaper, faster and effective medicines, should be encouraged (74). Nowadays, this is being facilitated by powerful information and communication technologies that permit the easy tracking of individuals and societies, tendencies and styles in real time. These technologies could also strengthen our efforts to gain a much better understanding of the basic sciences, chemistry, physics and mathematics, underlying the effects of TCAM, enabling us to shed light onto sorcerers’ wisdom and mystical forces and to improve our comprehension of the incredible complexity of the processes involved in healing.

Other initiatives, such as Integrative Health Coaching at the Duke Integrative Medicine Center, are currently being implemented at Integrative Medicine Centers (81). This personalized health planning and coaching program expands conventional behavioral change models by linking behaviours to personal values in the context of life as a whole and focuses on the relationship and partnership dynamics between patients and a team of providers (82). This team includes physicians, TCAM providers and health coaches, amongst others.

The importance of Integrative Medicine as a means of addressing the mental, emotional and physical aspects of the healing process and the need for greater patient involvement in health care was considered in a report by the Institute of Medicine in the US as a spin off from a Congress on Integrative Medicine in Public Health held in February 2009. The congress included reviews of the state of the science, assessed its potential and priorities and began to identify the elements of an agenda to improve our understanding, training, practice and other actions that might help improve prospects for the contributions of integrative medicine to better health and health care (83). More gatherings like this should not only be encouraged but should also be linked to large-scale projects designed to fill existing gaps.

The gap between knowledge and practice, conventional and traditional, and alternative and integrative is still wide, despite the fact that health professional associations are starting to concede value to TCAM interventions, health care professionals are enrolling in TCAM-related continuing medical education courses and consumers are seeking information about interventions they believe to be good for them, while at the same time advocating for more freedom, fewer regulations and better access. Studies on the delivery, organization and financing of different integrative healthcare models and medical and public education, which is geared to expanding the reductionist disease oriented model and understanding the changing dynamics of TCAM, should be regarded as a priority by funders of research and health services.

As populations throughout the world continue to age, the concomitant increase in the prevalence of poly-pathology will make TCAM an inevitable component of a modern health system. Now it is our turn to ensure that TCAM is properly integrated with conventional biomedical options, as part of a relationship with the public that is built on trust, respect and commitment to achieving optimal levels of well-being. A healing environment should be the ultimate goal for all.

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