Divining Integrative Medicine

Medicine, like scientific inquiry, is necessarily dynamic. As our understanding of health and disease continues to grow, medicine as we know it will change. Alternative therapies and perspectives that are coming to light will be illuminated by modern methods of inquiry applied to pre-modern healing systems. At the same time, patient demands and cultural concerns about health and healing influence the expansion of conventional medicine. The integrative medicine movement is a reflection of how these issues have tumbled together creating a medical field that is at once undefined and almost indescribable. Integrative medicine is growing in popularity among consumers and healthcare providers alike. An August 7, 2006 article in the Los Angeles Times (1) asserted under the heading Twice as Strong that ‘Western medicine team[ed] up with acupuncture, yoga and herbs to fight both disease and pain …[is] going mainstream’. Three regional clinical programs were described. Each was based in a conventional medical clinic; each identified as an integrative or multidisciplinary practice. Readers of the Twice as Strong article (Los Angles Times daily circulation is approximately 850 000 as of March 2006) (2) and viewers of The New Medicine television show broadcast March 29, 2006 (estimated audience between 4 and 9 million) (3, 4) learned that conventional biomedicine is undergoing a transformation from within. The popular message is that this movement is led by conventionally trained physicians who are opening their practices to include mind–body therapies as well as traditional techniques from other medical cultures such as acupuncture and oriental medicine (AOM). However, this is a narrow view. We hold a particular interest in the integration of AOM with conventional medicine where the breadth of this phenomenon can be readily comprehended. This emergence of integrative medicine in the public eye is full of irony, giving rise to our question: what comprises integrative medicine exactly? It is not complementary and alternative medicine (CAM). (5) It is a phenomenon that has defined itself, with requirements for membership self-determined by each practitioner who chooses to promote her practice as integrative medicine. Consider the following brief descriptions of integrative medicine providers. A physician who completed a 300 h acupuncture course for physicians prefers to refer out for needling to licensed acupuncturists. He identifies as an integrative practitioner relying on his strong research skills and belief in nutrition as medicine. He has a full practice. An acupuncturist teaches at many of the AOM colleges in Southern California. Born and trained in China she is widely recognized as an authority in orthopedic integrative medicine. She reads X-rays, tongue, pulse and inserts needles. She prescribes herbs. She treats side effects of chemotherapy. Her practice is full. A conventional physician witnessed Chinese medicine on the mainland in the early 1980s. When he became ill upon return to the United States he found a Chinese practitioner of AOM after exhausting conventional medical solutions. He is now an herbal expert in demand as a speaker. He knows herbs will be the last medicine to enter the integrative medicine circle. He fights to include the most basic herbal formulas in his multi-discipline integrative clinic. An American acupuncturist who became involved with Chinese medicine in the 1950s has been a witness to the history of AOM in the USA. He was among the first to earn an OMD degree (Oriental medicine doctorate), an early degree requiring ∼1000 h. The current master's degree requires nearly 3000 h. He believes physicians could learn enough about AOM in 1000 h, maybe less given their strong grounding in organ systems, basic anatomy and physiology. He believes traditional Chinese medicine and conventional Western medicine are very closely aligned; both allopathic with a central emphasis on the neurovascular system. He refers to his practice as One Medicine. Integrative medicine is as much a prototypical grass-roots populist movement as it is a medical approach that has sprinted ahead of any simple, fixed and lasting definition. As a descriptive term integrative medicine is multi-functional and prone to metamorphosis. It is full of nuances that correspond to various factors including the background of the author(s) attempting to describe it. Integrative medicine is bound by context and orientation, not fixed by any set of criteria at any level. It is worthwhile to ask the question how will we understand exactly what is integrative medicine?