Debate among those with a vested interest in integrated medicine entering the domain of conventional medical care is intense. The stakes are high for practitioners whose opinions on this issue range from enthusiastic support for integrative or evidence-based complementary and alternative medicine (CAM) to those who view its use to treat serious medical problems as dangerous and unscientific.

The research community has only begun to systematically investigate CAM’s use in traditional medical settings, revealing mixed results. Conventional medical practitioners who are educated in the tradition of objectivism are often skeptical of complementary treatments that have not undergone peer review. CAM is nonetheless growing in popularity with patients. It would behoove practitioners to be prepared for patient questions.

Evaluating CAM’s Effectiveness

It helps when practitioners are actively aware of major medical trends and prepared to weigh in. This includes reviewing recent research and discussing it online and at conferences to provide patients curious about CAM with well-informed feedback. Overall, the evidence for the use of CAM therapies is mixed and plagued by several key issues. These challenges represent hurdles to CAM’s adoption in standard medical practices.

When evaluating the merits of CAM therapies, consider:

• Studies of CAM involve evaluating complex and highly individualized treatments. This makes the measurement and standardization of CAM protocols difficult.
• Methodological issues of these research studies include patient sampling discrepancies regarding recruitment, randomization, and patient retention.
• The conditions for successful CAM treatments may not always translate to the real world or fail to be replicated in further study.
• Studies may successfully demonstrate a cursory level of treatment effectiveness but fail to identify whether the relationship is correlative or causative, specific or non-specific, to patient outcomes. They also fail to identify what mechanism of action is responsible for any detected outcomes and effects.

Despite these issues, some practitioners are open to adding integrative medical practices in the form of both complementary and alternative medicine (also called integrative medicine) to their practice. A growing body of research is dedicated to applying evidence-based standards to medicine, including CAM practices. Continuing medical education (CME) should include this research and its practical implications to help better inform practitioners about CAM’s benefits and risks.

Definitions

It is important to understand the definitions of these concepts to evaluate them. Some key definitions are listed below.

Integrative medicine: Combining conventional and complementary medical approaches to treat patients holistically. CAM approaches to medicine can be incorporated with conventional medicine to comprise integrative medicine. Complementary medicine is typically used to augment or supplement traditional therapies, not replace them. This arrangement recognizes:

1. medical techniques outside of traditional western approaches should undergo rigorous empirical evaluation based on their own clinical merits. The success or failure of one type of CAM treatment should not affect the evaluation of others.
2. complementary approaches should be ‘medicalized,’ that is: standardized, modified, and optimized similarly to traditional approaches to maximize the benefits of each.
3. complementary treatments can comprise a wide range of clinical modalities, ranging from herbal supplementation and nutrition to acupuncture. They shouldn’t be rejected simply because of their origin in foreign or esoteric medical traditions.

Complementary medicine: Any supportive clinical approach that works with or alongside traditional therapies to alleviate side effects, increase their effectiveness, or target a malady in a way that is unique from simultaneous conventional therapy. The school of osteopathy is an example of a more widely accepted and empirically supported complementary or additive medical approach.

Note: The concept of integrated medicine is not to be confused with “integrated healthcare” the trend of providing access to a wider range of practitioners and treatments such as providing mental health care within primary care settings.

Alternative medicine: Alternative medicine can be considered any substitute for conventional western-style medicine. In practice, alternative therapies typically revolve around ‘time-honored’ perspectives such as Ayurvedic medicine but some have matured more recently, like biofeedback.

CAM and the Clinical Modalities at Hand

Mind-body: Examples include meditation, biofeedback, hypnosis, and yoga.

Biologically based: Examples include special diets, nutrition including food as medicine, dietary supplements, botanicals, and vitamins.

Body manipulations: Examples include massage, chiropractors, and osteopathic medicine treatments.

Medical systems: Examples include Chinese medicine and Ayurvedic medicine.

CAM: Potential Use Cases

Pain management: Applications for CAM are emerging in the area of pain management. The most high-profile example may be the use of cannabinoids like CBD for pain relief and inflammation. CAM is also effective in pain management clinics due to its demonstrated effectiveness treating opioid dependency.

Cancer care: Major cancer centers nationwide are offering complementary medicine services to their patients. Many of these center on reducing stress, relieving pain, and helping the patient feel more in control of treatment. Nutritional counseling to ease treatment side effects and promote healing is also common, however, there are concerns that certain healthy foods could actually hinder cancer treatment.

Lifestyle medicine: Practitioners that use lifestyle medicine are often internists, primary care providers, or family medicine specialists but any MD can become certified. These physicians focus on improving patients’ overall wellness, with disease prevention and health resiliency, using complementary approaches like nutrition to fight illness and promote healing.

Incorporating CAM into Your Medical Practice

CAM applications in conventional medicine could vary but already, many patients in western nations are trying these techniques outside their doctor’s supervision. There are efforts to integrate complementary therapies in a coordinated, evidence-based way into traditional treatment regimens.

Practitioners should consider how an open dialogue related to the potential benefits, limitations, and dangers of CAM could benefit patients. Consider the benefits of these CAM therapies in your own practice:

Personalization: CAM treatments are typically not standardized and must be applied based on an individual’s preferences, needs, and responsiveness to treatment.

Singular practitioner: You may be concerned that, as a conventional physician, your lack of experience in CAM makes you unqualified to offer it to your patients. However, you are best positioned to ensure safety and the effectiveness of supportive treatments.

Test in your own practice: Evidence-based medicine emphasizes the importance of listening to patients and real-world applications. Inform patients of the risks and benefits of CAM and where you stand on its use. Help patients use CAM responsibly, even if you decide against it in your own practice.