User:Cjrhoads/Draft Integrative Medicine

Integrative Medicine Draft - to be completed in October or November of 2022

Definition of Integrative Medicine
According to the Academic Consortium for Integrative Medicine and Health, Integrative Medicine and Integrative Health is the branch 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 and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing."

The Mayo Clinic has identified several beneficial integrative health practices including:

- Acupuncture

- Animal-assisted therapy

- Aromatherapy

- Dietary supplements

- Massage therapy

- Music therapy

- Meditation

The Mayo Clinic notes that "integrative medicine can help people with cancer, persistent pain, chronic fatigue, fibromyalgia and many other conditions better manage their symptoms and improve their quality of life by reducing fatigue, pain and anxiety."

In 2005, the American College of Cardiology founded a Task Force to investigate integrative health practices in order to provide guidance to physicians regarding the practices which either had evidence-based support in research and/or were found to be helpful and not harmful when used in conjunction with a physician-based treatment plan. The practices they reported on are: - nutrition and supplements - mind/body and placebo - acupuncture - bioenergetics (energy medicine) - spirituality/intentionality

The Cleveland Clinic defines Integrative Medicine as a combination of conventional and complementary medicine practices. They note that it "helps maximize wellness for people with chronic and complex diseases. Care may include chiropractic care, yoga and meditation."

The Osher Center at Vanderbilt Health offers integrative medicine services. They "focus on your whole health: body, mind and spirit. We offer scientifically proven complementary therapies, such as acupuncture and yoga, to work alongside your conventional medical care. More than treating symptoms, this integrative medicine empowers you to take an active part in your healing and wellness so you can enjoy a better quality of life."

In its 2020 publication, The Role of Integrative Medicine Now: Tools in the Time of COVID, Drs. Gordon and Rosenbaum noted that: "Integrative medicine looks at interventions with the best evidence and least harm, then combines these with conventional medicine. This approach allows us to take better control of our personal health and well-being. Fortunately, there are many modalities we can tap into that will improve our chances of staying healthy or help us recover."

Harvard Medical, Brigham and Women's Hospital, Cleveland Clinic, Mayo Clinic, Vanderbilt, and many other clinical centers now offer Tai Chi and Qigong classes to their patients, having found that there is enough evidence for this low-impact exercise to provide benefits to their patients, especially those with chronic illnesses such as cardiovascular and pulmonary diseases, cancer, auto-immune disorders, depression, fatigue, and many other.

Initial suppression of Integrative Medicine
While Integrative Medicine has been around for a long time, it has only been in the last two decades that medical schools in the United States have adopted Integrative Medicine as a valid branch of modern western medicine. Initially, Integrative Medicine was looked upon with suspicion because many of the therapies did not have research-based evidence and were therefore "unproven". The American College of Cardiology task force cautions against limiting potentially successful treatments due solely to terminology: "Many commonly used labels (e.g., 'alternative', 'unconventional', or 'unproven') are judgmental and may inhibit the collaborative inquiry and discourse necessary to distinguish useful from useless techniques. Without proper study, simply dismissing treatments not currently taught in medical schools would cause problems, especially since more than 62% of Americans utilize integrative health practices. It is suggested that physicians embrace all the potential options and keep an eye on new studies that might conclude additional beneficial therapies. In all cases they suggested guidelines for more effective clinical trials.

Reasons for rise of Integrative Medicine
There are many proposed reasons for the rise of Integrative Medicine. For some, the increase in specialists and the increasingly reductionistic methodology of modern medicine is causing a backlash, and a yearning to return to the days when family doctors took care of all basic medical needs for everyone without the limitations of insurance companies and health network administration policies, or the need to prescribe pills or recommend surgeries. The typical multi-layer payment structure of insurance-based financing (where the "customer" is not the "payor") introduces inefficiencies and incentives for wasteful uses of prescriptions, surgeries, and technologies.

These inefficiencies contributed to the rise of Integrative Medicine because the out-of-control healthcare costs for an increasingly older and unhealthier population paid for by government services such as Medicare, Medicaid, and other National Health Insurance Systems could not sustain the goal of healthcare for everyone when healthcare meant only prescriptions and surgeries. According to Andrew Weil, founder of the Center for Integrative Medicine at the University of Arizona College of Medicine: "The economic failure of the American health care system has made doctors receptive to Integrative Medicine. When I look around the Western world, I see the same pattern happening. In all the developed countries of the West, health care costs have increased uncontrollably. Populations are getting older, the occurrence of life style related diseases are increasing, and national health care systems are beginning to crumble." Another more accessible method for healthcare needed to be found.

Furthermore, Integrative Medicine was banished to the fringes in the early years because medical understanding of how it worked was non-existent. But that, too, has changed. Because of the pioneering work in the fields of immunology and neuroscience, the medical world has finally developed the type of understanding that explains the mind-body connection that is often so important in Integrative Medicine success stories. According to Esther Sternberg, former director of Integrative Neural Immune Program and Professor at Washington University: "Even the greatest skeptic must now admit that a wealth of evidence exists to prove in the most stringent scientific terms that the functions of the mind do influence the health of the body, and that sickness in the body can affect our moods and emotions through molecules and nerve pathways." In her book, The Balance Within, Sternberg outlines the scientific medical discoveries that have, over the years, added to that wealth of evidence.

Sternberg describes why it took so long for this adoption, but also why it was inevitable: "Only very recently has this mind-set [rejection of integrative medicine] begun to thaw – with considerable pressure from the popular culture. The overemphasis on a narrow focus, combined with a fascination with technology to the exclusion of the personal touch, has been a toxic mix for the practice of medicine. It has led the public to seek alternative treatments, which in the right circumstances can help, but in the wrong can harm. The plethora of therapies that have sprung up to fill the vacuum, where science and academic medicine have failed the public, have caused confusion for the consumer who must try, without expertise, to make a judgment on the validity of each cure. … Until the last decade we simply did not have the tools capable of demonstrating the physical and molecular underpinnings of both emotions and disease. … But medical science is now at a mosaic of the biological basis and physiological effects of sleep, relaxation, even prayer.''

Several organizations have sprung up to provide the public, and the physicians who care for their patients, the type of scientific evidence necessary to know what works and what is just a fantasy (i.e. quackery). One of the most prolific is the Osher Center for Integrative Medicine, which is a joint program operated by Harvard Medical School and the Brigham and Women's Hospital in Boston, MA. According to Matthew Kowalski, the Associate Clinical Director of the Osher Clinical Center, in the year 2000 the center had just 74 faculty, 107 publications, and 17 institutions working on the Integrative Medicine Research Network. In 2019, there were 733 faculty, 1358 publications, and 23 institutions.

One of the therapies with the most scientific evidence is movement-based healthcare practices such as Tai Chi. The number of studies for just this one type of therapy has increased drastically. At the International Medical Tai Chi & Qigong Association annual meeting in 2019, Byeongsang Oh Associate Professor, Sydney Medical School, University of Sydney and Research fellow at Dana-Farber Cancer Institute (DFCI), Harvard Medical School presented this graphic which illustrates the change in the number of studies on the topic.

Evidence of efficacy of Integrative Medicine
The scientific evidence for Integrative Medicine and Healthcare is extensive and global.

An overview of the different organizations and publications focusing on Integrative medicine can be found at the Nordic Integrative Medicine website.

They list several academic organizations involved:


 * Academic Consortium for Integrative Medicine and Health (IM Consortium) with a membership of over 75 academic medical centers, nursing schools, and health systems that includes more than 15 Integrative Medicine Fellowship Programs credentialed by the American Board of Physician Specialties&#8217; (ABOPS) American Board of Integrative Medicine (ABOIM)
 * European Society of Integrative Medicine whose work includes holding scientific events such as the annual "European Congress for Integrative Medicine" (ECIM) and conducting dialogue with professional health care and public health associations and institutions.
 * National Institute for Integrative Medicine (NIIM) in Australia.

The American College of Cardiology Task Force identified which nutrition guidelines were helpful, as well as which supplements were therapeutic (perhaps replacing standard treatment), and which supplements did not have enough support to utilize over standard treatments. They also listed all of the potential interactions in order to help doctors and their patients to recognize when an interaction might be dangerous. They reported on many of the mind/body therapies such as qigong, meditation, and healing touch and found that, as adjunctive therapies, they provided positive benefits. They also identified acupuncture and bioenergetics as adjunctive with evidence of therapeutic results. Additionally, spirituality/intentionality was determined to be a reasonable approach in certain situations, and that physicians should look to the culture and beliefs of the patient for guidance of the benefits.

The National Qigong Association published Know The Evidence originally in 2016, with an update in 2019, (and is currently working on a 2022 update as well) that outlines the hundreds of studies that have been published in medical journals on the effectiveness of tai chi and qigong.

Also in 2019 three researchers, across three continents, set out to take stock and map the state of the academic research in the field of integrative medicine field. Amit Bernstein, PhD, Professor of Psychology and Director of the Observing Minds Lab at the University of Haifa, Israel, David Vago, PhD, Research Director of the Osher Center for Integrative Medicine and director of the Contemplative Neuroscience and Integrative Medicine (CNIM) Laboratory at Vanderbilt University Medical Center, and Thorsten Barnhofer, PhD, Professor of Clinical Psychology at the University of Surrey, invited 100 scholars to write 57 papers critically reflecting on the extant data.

Growth of Integrative Medicine
Over the past two decades, popular and scientific interest in mindfulness has rapidly developed. Whereas a total of 39 scientific papers were published before the year 2000, today that number is 6000 papers. Likewise, mindfulness practices and interventions have innervated nearly every sector of society including health care, schools, corporations, corrections, government and policy making, military, social justice movements, and mobile applications with reach and access to millions of new practitioners.