Integrative and Alternative Medicine Overview

Integrative Medicine

• Integrates conventional and complementary therapies to achieve optimal health and healing.
• Focuses on the person as a whole, considering their illness or disease.
• Employs an evidence-based approach.

Complementary Medicine

• A non-mainstream approach used alongside conventional medicine.

Alternative Medicine

• A non-mainstream approach used in place of conventional medicine.

CAM (Complementary and Alternative Medicine)

• A group of diverse medical and healthcare systems, practices, and products that are not presently considered part of conventional medicine.

Problems with CAM research

• Too few studies on some topics.
• Studies are often of poor quality.
• Small funding, small samples, and inexperienced researchers.
• Easier to fund patentable products like drugs rather than natural products.
• Research design may not reflect clinical practice as many therapies are holistically practiced, making it difficult to isolate one treatment aspect.
• Difficulties with placebos and blinding, for example, procedures like acupuncture, lifestyle interventions, and counselling.
• Challenges in choosing appropriate outcome measures, such as disease progression vs. quality of life vs. symptom relief.
• Bias, such as uncritical acceptance of CAM among CAM practitioners or rejection among doctors.

Evidence-Based Medicine

• Provides answers to efficacy, effectiveness, efficiency, safety, mechanisms.
• Addresses limitations of evidence, interpretation bias, research agenda.
• The best approach to clinical decision making combines the best available evidence with individual clinical circumstances.

The Five Domains of CAM

• Use of multivitamins.
• Diet.
• Massage.
• Mindfulness-Based Stress Reduction (MBSR).
• Qigong (pronounced Chi-Kung).

Traditional Chinese Medicine (TCM)

• Includes acupuncture and acupressure.

CAM and Cancer Survival

• Many studies have had encouraging results in terms of symptom control.
• No definitive evidence suggests CAM treatment alters disease progression in breast cancer patients.
• Several modalities seem to improve other outcomes.

Negative Findings

• "There is no evidence" can mean the study was methodologically unsound or the sample was too small to statistically demonstrate an effect.
• It can also indicate a non-significant or statistically significant negative effect.
• It can mean the topic has not been studied yet.

Clinical Points When Approaching a Patient Using CAM

• Respect and listen to the patient's views.
• Think integrative, not alternative.
• Check the evidence, even if it means asking the patient to return after conducting further research.
• Encourage the use of proven therapies.
• Discourage disproven, unsafe, or exorbitantly expensive therapies.