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Integrative Medicine not the same as Alternative Medicine

Unless I see a consensus to the contrary I plan to create a separate page for Integrative Medicine. I believe it is a mistake to redirect Integrative Medicine to Alternative Medicine. The two practices of medicine are distinctly different. It is my understanding that Alternative Medicine can be practiced by anyone whether or not they are licensed to practice medicine and can consist be almost any wild or weird alternative way to treat someone. Whereas Integrative Medicine is practiced by licensed physicians (MD and DO) or licensed nurse practitioners, and physician assistants who are working under the supervision of licensed physicians. Here is a link to an integrative medicine fellowship at the University of Arizona run by Andrew Weil, MD. Notice the section on Eligibility: "The Fellowship admits physicians (MD and DO), nurse practitioners, and physician assistants. http://integrativemedicine.arizona.edu/education/fellowship/tuition.html Citizen-of-wiki (talk) 15:29, 10 October 2009 (UTC)

It used to exist, but was merged into this article. Currently it is mentioned in at least two places in this article, the first one is here. The statements by Weil are definitely controversial, but have so far remained in the article, even though they are considered deceptive marketing by many skeptics. Two aspects to this subject are (1) how methods are used (in conjunction with conventional medicines) and (2) who is administering it. It appears you are concerned with the second aspect. Please propose your suggested improvements here on the talk page and let's hammer out a consensus version that will be acceptable. Improvements (that are consensus versions) are always welcome. If you have several V & RS to back up your position, please provide them. -- Brangifer (talk) 20:55, 10 October 2009 (UTC)

I must say that I don't see anything controversial about Dr. Weil's statement's in this article. Perhaps you could help me understand how these statements are controversial. I really don't follow your comments about deceptive marketing. Maybe I am missing something. I agree that an important focus on Integrative Medicine is that it is being performed either by a licensed physician or by licensed nurse practitioner or physician assistant working under the supervision of a licensed physician. My proposed improvement is to create an different article on Integrative Medicine. Grouping Integrative Medicine with Alternative Medicine, in my opinion, is like saying apples are the same fruit as oranges. And when people go to a Misplaced Pages page on apples they are redirected to page on oranges. See my arguments above for why Alternative Medicine is different from Integrative Medicine. I don't believe there is enough room on this talk page for an Article on Integrative Medicine. I suggest that the prior merged integrative medicine article be copied to my user space or your user space. We can work on developing a consensus on the article while it is in user space. When it is ready we can move the Integration Medicine article to the main Misplaced Pages. How does this sound to you? Citizen-of-wiki (talk) 19:18, 11 October 2009 (UTC)

The last legitimate version before the merge (which was discussed in the archives of this article) was a three-sentence stub located here. My comment about "deceptive marketing" is regarding the undisputed statement (IOW, he does say it) by Weil about "for which there is some high-quality scientific evidence of their safety and effectiveness." The truth of that statement is disputed by scientific skeptics, who find it to be rather dubious. I'm just pointing out that there is a difference of opinion on that point, but the statement has been allowed to be included without much debate. Without it there wouldn't be much to say about the subject. Scientific skeptics contend that if there really was such evidence (that is disputed), then it would be called "medicine", not "integrative". I'm referring to the old joke: "What do you call alternative medicine that works? Medicine!" . This all gets back to the definitional issues discussed in the whole Definitions and categorizations section. In the end, the difference doesn't justify a whole article. Even the previous article was just a three-sentence stub.

Your concern is an angle that could be developed by adding a sentence and some refs to back it up. I don't see any reason why that might not work, and it would be an improvement in the coverage of that matter. That's why I encourage you to give a proposal a try here on the talk page. It might very well fly and get support from most editors.

You may wish to consider if there is any significant difference between what you are proposing and the definition of "complementary medicine", which is also merged into this article. If so, go for it. Note that they all (alt med, complem. med, integr med) use exactly the same methods, but it is the setting that makes the definitional difference. In practice, even "integrative" medicine uses exactly the same unproven and disproven methods, but it's often a licensed physician who's prescribing it (which is why Quackwatch mostly subjects licensed professionals to criticism). That's where actual practice and Weil's definition conflict with each other. (That's where I'm hoping your proposal can sort this out.) When Weil's best proposals (what methods he considers have "some high-quality" evidence) are examined, skeptics consider the word "some" to truly be a very little "some"thing-or-other, and "high-quality" to be "low-quality", IOW Weil's interpretation of standards of quality is suspect and varies considerably from the authorities quoted as sources in the "Definitions and categorizations" section. It appears to be an attempt to fly "under the radar", sneaking unproven and disproven methods into mainstream medicine. (It's a huge industry that needs more customers.) There has been some success in this endeavor, but it is backfiring and universities are now dropping their programs in alternative/integrative medicine. (See User:BullRangifer/Alternative_medicine_critics.) The difference of opinion exists in the real world and can be sourced to V & RS, so that is being done in this article. All sides of the subject must be covered per NPOV, and we try to do it here. I hope you can flesh out this particular point about "who does it". Good luck. -- Brangifer (talk) 20:29, 11 October 2009 (UTC)

BullRangifer, you act as if Weil is the only one to use the term "complementary medicine". There are some quite reputable medical universities that have complementary medicine as a branch of their setup, with papers published in the standard medical journals. Duke Integrative Medicine is one, being a part of Duke University and Duke Medicine. Here is a page with papers published by their staff . The for Integrative Medicine at George Washington Medical Center is another. stmrlbs|talk 20:46, 11 October 2009 (UTC)

I suspect you meant "complementary", when I was only referring to "integrative". I believe Weil was one of the originators of the term, hence my reference to him. I'm well aware of the use of the term in various ways, including academic circles. This link to the modalities used at GWMC is interesting. It's a mixture of modalities, ranging from those that sometimes include pseudoscience, to some that are purely pseudoscientific/metaphysical. Note that even the worst may provide some benefits in the form of relaxation. Since relaxation can be achieved without resorting to woo woo, and since "It's a very dangerous thing to believe in nonsense," (James Randi), scientific skeptics retain their skepticism and attempt to debunk such practices for the protection of vulnerable individuals who are suffering and easy marks for those who would rob them of their last hope in their utmost time of need. -- Brangifer (talk) 22:22, 11 October 2009 (UTC)

BullRangifer, thanks for your detailed response. When I get a chance I will work on a version of an Integrative Medicine article in my user space. When it is developed enough I will post some or all of the article on this talk page to get feedback. It sounds like you and I disagree agree about whether or not Integrative Medicine should have a separate article. As Stmrlbs points out above, there are many physicians and medical schools that are including/expanding integrative medicine. It seems to me that this trend is growing. We can wait and see how the Integrative Medicine article comes together in my user space. Let me know if you have any other guidance, references, suggestions, etc. Citizen-of-wiki (talk) 21:06, 11 October 2009 (UTC)

Whether we agree or disagree is really immaterial. If you have a notable idea that can be sourced properly, then by all means work on it and you'll get my support and comments. I suspect you can contribute to improve coverage of this subject, and that would be great. If you were to examine my history here, you will discover that I edit and protect many articles about subjects which I consider dubious and even totally nonsensical. As an editor here, my personal POV is irrelevant to whether an article should be here. If it qualifies to be here, then I work to keep it in line with our policies, including to the point of protecting the inclusion of patent nonsense, as long as it's sourced properly. Your proposal doesn't even come close to nonsense, and I think it should be developed better. Good luck. -- Brangifer (talk) 22:22, 11 October 2009 (UTC)

Please do not create separate articles for each of the several terms used to refer to the same set of practices and ideas (with minor quibbles). There is only one movement, albeit loosely connected. - 2/0 (cont.) 22:46, 11 October 2009 (UTC)

Integrative Medicine and what's controversial about Andrew Weil, M.D.

As an old hand in a “medical care game” who has seen it both from the side of being a patient and doctor, perhaps I can explain what’s controversial about Weil’s statement and his attitude. Briefly, it is this: if you define “integrative medicine” in the way he wants to, it ends up “integrating” all honorable professions and caring activities, something like The Blob or The Borg. Pretty much anything which makes the patient better or feel better, in this view, now becomes “health care.” And anybody who provides such a good or service, becomes a “health care provider.” Never mind tradition. If a toenail trim or flowers or a sympathetic ear make for better health (which they do), then the pedicurist, florist, aromatherapist, astrologer, spiritual adviser and shaman all become health care provider/workers, too. The borders now go far past the podiatrist, physiatrist, and psychologist. Health care providers now include the guy who sets up your computer and net connection if THAT improves your mental health. And your car mechanic to get you a functional automobile, if THAT impacts your health (which it does).

So Weil’s message, while long-recognized and perfectly true (Voltaire reminds us that much of medicine is entertaining the patient while nature cures the disease), at the same time it isn’t very USEFUL. We know that all honorable professions and relationships are necessary for health. None of this helps us decide what a physician or coordinating “Health Care Provider” should do in pursuit of “healing.” Ricardo’s law of economic comparative advantage suggests that it’s not such a great idea to train an M.D. for 10 years in arcane fields of biochem, anatomy, and pathophysiology, and then have him or her spend much time wearing a rubber clown nose and floppy shoes. People go to clown school for that, and they’re funnier. If a clown is needed for mental health, there are a lot of clowns out of work (so sad!). Hire one, if you have the dough. Similarly, leave social work to social workers, and so on. Calling all this stuff “health care” encourages an ultimately pernicious view that any practice which prevents or ameliorates disease should be coordinated and by a doctor with a thumb in the pie, and either provided free, or else paid for by donors or by the government (see taxpayer). Needless to say, neither “Patch” Adams nor Weil actually make a living doing “integrative medicine.” Weil lives on grants and telling OTHERS how they should be doing it. There aren’t too many economic niches like the one he occupies, though, and it’s a pyramid game, if not. Dr. Weil has a degree from Harvard and is fun (I’ve read all his books). I just wish he practiced medicine. :( SBHarris 21:53, 11 October 2009 (UTC)

He also makes a living by selling dietary supplements, and if you take his online Vitamin Advisor, you will no doubt get sold some product, no matter whether you need it or not.....;-) Dr. Relman has written an interesting article about him: "A Trip to Stonesville: Some Notes on Andrew Weil (1998), by Arnold S. Relman, M.D.. It is currently housed at Quackwatch: "This article was published in the December 14, 1998, issue of The New Republic and is reproduced here with the kind permission of the author. At the time it was published, Dr. Relman was editor-in-chief emeritus of The New England Journal of Medicine and professor emeritus of medicine and social medicine at Harvard Medical School." -- Brangifer (talk) 22:50, 11 October 2009 (UTC)

The Title: Alternative Medicine

People in the field of Complementary Therapies do not normally use the term Alternative Medicine. People from mainstream medicine or Allopathic medicine use the term. It makes it seem as if you have to choose either one or the other, which is an incorrect assumption. It is seldom that a person goes to see someone from a Complementary Therapy without it also seeing their MD.

Additionally, the term Alternative Medicine has developed unpleasant connotations due to the fact that any unfriendly article written about Complementary Therapies uses the term Alternative Medicine. This is pronounced enough that if you see the term Alternative Medicine in the title it is almost always critical towards it. Feel free to keep this in mind and discover the truth of this. I would suggest ditching the less friendly term, re-title it Complementary Medicine and redirect any searches for Alternative Medicine to the better title.

24.36.87.239 (talk) 04:30, 16 October 2009 (UTC)Nacken24.36.87.239 (talk) 04:30, 16 October 2009 (UTC)

I think "Complementary Medicine" is a wonderful name. It brings up visions of hospitals where there is turn-down service, a Kron chocolate on your pillow, and in the bathroom, actual quality hotel toilet-paper folding so you can guess that if you get multiply drug resistant Staph, it won't be from there. Comp'ed! Don't you feel better, already? Check-out is any time you like, and as a courtesy, we don't let you see your list of room charges till you're long gone. Or else you might have a relapse. SBHarris 04:52, 16 October 2009 (UTC)

(Good one SBH!) Since AM always refers to the basic methods used, no matter if one is referring to AM, CM, or IM, this article title has been chosen because it refers to the root term, a term invented by alternative therapists and used by them, and the most commonly used term. Look at practically every directory and list on alternative medicine websites. They use the term, and it is still the most commonly used term. The other terms (CM and IM) only refer to the setting in which the exact same methods are being used, IOW with or without the cooperation of an MD or other medical professional. That is dealt with in a few sentences, because there simply isn't that much more to say about it. -- Brangifer (talk) 05:04, 16 October 2009 (UTC)

Blood electrification

Blood electrification is term coined as a method of inducing a small current of around 26 volts in micro-ampere strength to the blood by way of a electronic device by what is generally known as alternative medicine. It is not a officially scientifically studied medical process, and is therefore not considered medical science. The method though has been spread through the alternative media, the internet and alternative gatherings in the US.

The above is the content I have written to a wiki article on the subject.

Misplaced Pages has removed this article several times, mostly it seems through not bothering to protect the serious edits of the article and later giving the reason that it is not serious. please vote if this should be kept or not, as many are using blood electrification devices with relatively great success. Nunamiut (talk) 00:15, 18 October 2009 (UTC)

Your admission statement that "It is not a officially scientifically studied medical process, and is therefore not considered medical science" obviously begs the question "How do you know that it has "relatively great success"?" Without such studies one cannot know for certain. One only has anecdotes, and they aren't reliable.

On another note, noting your username I looked up the Nunamiut article and figure you might be interested in this article I wrote (Reindeer hunting in Greenland) and why I have the username I have chosen (a bull rangifer tarandus = a bull caribou/reindeer). The best tasting red meat on earth ;-) -- Brangifer (talk) 02:48, 18 October 2009 (UTC)

I'm not "admitting" anything , I am stating it openly. It's my statement, not yours. And I'm not interested in promoting or documenting blood electrifications effectiveness. I'm only interested in informing the public about what it is. Electro shock therapy to the head has been going on for almost a century too with no definitive conclusions, should we delete all references to that as well? But As most of us know by now, anything and everything that isn't patented or commercially sold by the pharmaceutical industry will only receive detrimental comments and be called anecdotal everywhere no matter how many success cases you have, basically because it is forbidden by law with penalty of jail and loosing your license as a doctor for life to say that you have cured anyone with anything that is not regulated as a drug. So basically we can never document or tell you anything about such cases, nor give you links to documented cases. However if wiki admins bothered to do any research except googling (as if google was the end all be all of all knowledge on the planet) and reading more than the first page of google result, they would encounter a huge audience that in a few years will put some wiki admins to great shame. It's a pity but there you go. Go figure.Nunamiut (talk) 05:08, 18 October 2009 (UTC)

I have changed my wording to make sure no one misunderstands the figure of speech which you haven't understood. If you really want to write an article about it, then it needs to be done properly by using proper Misplaced Pages formatting, style, and policies. You can make a start by doing it in your own userspace here: User:Nunamiut/Blood electrification. Place these {{NOINDEX|visible = yes}} {{User sandbox}} at the top of the page to avoid problems. When you start, contact me on my talk page and I'll try to give you some help and advice. BTW, your statement about what will happen to a physician, starting with these words - "it is forbidden by law..." - isn't true. Only if someone gets hurt badly AND complains might something happen, and even then not nearly as bad as you write. It's pretty rare for physicians to be punished so severely. Maybe a fine and temporary loss of license for a year or so. They get put on probation. If the injury is severe, the patient has a good lawyer, and there is proof of criminal intent, then the punishment might be more severe. -- Brangifer (talk) 05:43, 18 October 2009 (UTC)

Website survey

I found the following content that was hidden in the text and needs to find a proper "home" in the article:

• A survey of websites providing information about breast cancer found that about one in twenty such sites contained inaccurate information, and that CAM websites were 15 times more likely to contain inaccuracies.

-- Brangifer (talk) 13:52, 21 October 2009 (UTC)

References

Please keep this section at the bottom. TO ADD A NEW SECTION, just click the EDIT link at the right and add the new section ABOVE this one. Then copy the heading into the edit summary box.

1. $2.5 billion spent, no alternative cures found. Big, government-funded studies show most work no better than placebos. Associated Press, June 10, 2009
2. Predictors of inaccurate online breast cancer information
3. Elmer V. Bernstam, Muhammad F. Walji, Smitha Sagaram, Deepak Sagaram, Craig W. Johnson, Funda Meric-Bernstam (2008). "Commonly cited website quality criteria are not effective at identifying inaccurate online information about breast cancer". Cancer. In press: 1206. doi:10.1002/cncr.23308. Retrieved 2008-02-12.{{cite journal}}: CS1 maint: multiple names: authors list (link)

"Variouis bodies of evidence" & Other Issues

from the first paragraph: "Alternative medicine is often based on the belief that a particular health regimen has efficacious effects even while there exists various bodies of evidence to contradict such a belief under the rigorous standards of evidence based medicine."

It is unlikely that there exist large or substantial bodies of evidence to CONTRADICT such beliefs. There may be no published evidence to SUPPORT such beliefs, but generally there is little in the way of evidence to "contradict" or disprove.

Also: "the rigorous standards of evidence based medicine" is a boast, which implies that those standards are superior to one's own personal experience with any health or medical practice. In truth, those rigorous standards ARE superior, but not for individuals and their personal practices. They are superior for representing what happens on average across a population; on that score they win, hands down. But they are of limited use in predicting what will happen with a given individual, and they are of even more limited use in composing a personal plan of health care. Unless this distinction is made clear, then the passage as it stands in the opening paragraph is misleading.

Further, in the section "Relation to Evidence-Based Medicine", we find this: "The IOM found that in a study of 160 Cochrane systematic reviews of mainstream techniques, 20% were ineffective and 21% had insufficient evidence."

Reference #16 is to this book: http://www.nap.edu/catalog.php?record_id=11182#toc Complementary and Alternative Medicine in the United States

I'm trying to find a correspondence between the assertion above, from the article, and what I am reading in that book.

For example, here's a snippet from pages 135-6, describing the Cochrane and other reviews:

http://books.nap.edu/openbook.php?record_id=11182&page=135 "The largest number of treatments described in the reviews were classified as insufficient evidence of an effect (n = 82; 56.6 percent), followed by positive effect (n = 36; 24.8 percent) and possibly positive effect (n = 18; 12.4 percent). Only one review described a treatment that was classified as harmful (Caraballoso et al., 2003) (see Table 5-2). The reviews describing treatments classified as having positive effects are listed in Table 5-3. Although this exercise suggests that there is strong evidence for the effectiveness of some CAM therapies, much more research is required, as demonstrated by the large proportion of reviews of treatments classified as insufficient evidence of an effect. The fact that only one of the treatments in the Cochrane reviews fell into the harmful effect category suggests that clinical trials of CAM therapies have posed little risk to the participants. Some interesting findings emerge when the results of the evaluation of Cochrane reviews of CAM therapies are compared with the results of the earlier study (Ezzo et al., 2001) evaluating Cochrane reviews of conventional therapies: insufficient evidence of an effect was determined for a larger proportion of CAM therapies (56.6 percent for CAM versus 21.3 percent for conventional medicine), CAM therapies were less likely to be classified as harmful (8.1 percent for conventional medicine versus 0.69 percent for CAM) or as having no effect (20.0 percent for conventional medicine versus 4.8 percent for CAM), and classification of the therapies as having positive or a possibly positive effect was approximately equal for CAM and conventional medicine therapies (41.3 percent for conventional medicine versus 38.4 percent for CAM)." END OF QUOTE

Perhaps the article could reflect in more detail, and more accurately, what the Institute of Medicine said. —Preceding unsigned comment added by Alan2012 (talk • contribs) 15:28, 30 October 2009 (UTC)

Definition of "Integrative" (vs. Complementary/Alt)

It might be helpful to read some of the literature on the subject.

......................

http://www.amazon.com/Integrative-Medicine-David-Rakel/dp/0721692885

Integrative Medicine (Hardcover) ~ David Rakel (Editor)

Product Description

This groundbreaking text provides the first definitive clinical reference for the rapidly growing field of integrative medicine. Using a clinical, disease-oriented approach, Integrative Medicine offers practical guidance for safely and effectively integrating complementary and alternative therapies into regular primary care practice. Drawing on available scientific evidence and the author’s first-hand experience, it covers therapies such as botanicals, supplements, mind-body, lifestyle choices, nutrition, exercise, spirituality, and more.

From the Publisher

A discussion of the philosophy of integrative medicine is followed by sections that specifically define the pharmaceutical treatments as well as the nutritional, mind-body, supplemental, and botanical treatments for common disease states. An emphasis on disease prevention helps the reader direct patients toward health maintenance and wellness. An invaluable Tools for Your Practice section offers advice on topics such as Exercises for Back Pain, Recommending Meditation, and The Elimination Diet.

About the Author

David Rakel, MD, Assistant Professor, Department of Family Medicine; Medical Director, Integrative Medicine Program, University of Wisconsin Medical School, Madison, WI

Product Details

• Hardcover: 800 pages
• Publisher: Saunders (June 15, 2002)
• Language: English
• ISBN-10: 0721692885
• ISBN-13: 978-0721692883

http://www.amazon.com/Integrative-Medicine-Benjamin-Kligler/dp/007140239X

Integrative Medicine (Hardcover) ~ Benjamin Kligler (Author), Roberta Lee (Author)

The number of individuals turning to unconventional medical therapies continues to increase each year. Now, more than ever, today's medical and health care professionals require the knowledge and skills to successfully bridge the gap between conventional therapies and complementary/alternative medicine (CAM).

McGraw-Hill now introduces the latest compilation of integrative approaches to many conditions and syndromes. This work reflects the authors' synthesis of many years of clinical experience and the theories underlying the many alternative modalities and traditional medical practices. Clinicians will find this text a highly effective resource.

Built on the evidence-based expertise developed at New York City's Beth Israel Center for Health & Healing -- the largest integrative medicine practice in the United States -- INTEGRATIVE MEDICINE uniquely combines a body systems approach with practical case studies, to clearly illustrate how clinicians can successfully incorporate conventional and CAM therapies into their daily practice.

Earn CME credits! Also available: Kligler/Lee: Integrative Medicine CME Study Guide (ISBN 0-07-140238-1) Features 1000 multiple-choice Q&As keyed to the Integrative Medicine text AND includes a bonus 100-question test for CME credit from Innovisions!

Product Details

• Hardcover: 700 pages
• Publisher: McGraw-Hill Professional; 1 edition (April 2, 2004)
• Language: English
• ISBN-10: 007140239X
• ISBN-13: 978-0071402392

http://www.amazon.com/Textbook-Integrative-Mental-Health-Care/dp/1588902994

Textbook of Integrative Mental Health Care (Hardcover) ~ James Lake (Author)

Complete coverage of the conceptual foundations of integrative mental health care allows the practitioner to gain a firm understanding of the philosophy and clinical methodology of integrative medicine. The textbook also describes evidence-based paradigms that enable the practitioner to develop assessment techniques and individualized treatment plans that address the unique needs of each patient.

This textbook will help psychiatrists, psychologists, and mental health care professionals develop safe and effective integrative approaches for the evaluation and treatment of emotional and mental problems.

About the Author

James H. Lake , M.D. Clinical Assistant Professor, Dept. of Psychiatry and Behavioral Sciences, Stanford University Hospital; Chairperson, American Psychiatric Association Caucus on Complementary, Alternative and Integrative Approaches in Mental Healthcare; Board-certified Psychiatrist in Private Practice, Monterey, CA, USA (Author)

Product Details

• Hardcover: 400 pages
• Publisher: Thieme New York; 1 edition (October 2, 2006)
• Language: English
• ISBN-10: 1588902994
• ISBN-13: 978-1588902993

SNIPPETS ONLY (full text is at the URL):

http://ecam.oxfordjournals.org/cgi/content/full/nem104

eCAM Advance Access originally published online on September 26, 2007

eCAM 2008 5(4):409-413; doi:10.1093/ecam/nem104

Commentary

Divining integrative medicine

Steven H. Stumpf1, Simon J. Shapiro2 and Mary L. Hardy3

1Stumpf Consulting, Calabasas, 2BWell Clinic, Santa Monica and 3Simms-Mann Health and Wellness Program, Venice Family Clinic, Los Angeles, CA, USA

Keywords: Complementary medicine – Integrative Medicine – Traditional Chinese Medicine

Introduction

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.

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.

Integrative medicine has gone through several generations of ‘definitional’ changes. The greatest change is from CAM to integrative. One of the major—and earliest (1999)—CAM textbooks was Essentials of CAM, edited by Wayne Jonas and Jeffery Levin (6). Although the title still reflected the model of CAM, the introduction of evidence-based medicine was prominent. One of the introductory chapters is ‘How to Practice Evidence-Based CAM.’ Two more recent textbooks, Integrative Medicine by Benjamin Kligler and Roberta Lee (7), and Integrative Medicine by David Rakel (8) both prefer the term integrative to CAM. The preface in Kligler asserts this new medicine is ‘renewing the soul of medicine’. The foreword to Rakel, authored by Andrew Weil, draws a clear distinction between CAM and integrative medicine. Weil distinguishes CAM as modality-focused, especially regarding treatments not taught in conventional schools of medicine. He also distinguishes integrative medicine as evidence-based. Rakel's integrative approach puts a ‘holistic understanding of the patient’ at the center of the interaction (8). This emphasis on the patient continues in the Kligler and Lee textbook both in the forward, also written by Andrew Weil, and in the preface. These similarities are not surprising as all three authors trained with Andrew Weil.

The most important textbook written from a ‘CAM’ perspective is the Textbook of Natural Medicine edited by Pizzorno and Murray (9), both naturopathic physicians. They do not present the materials as an integrative medicine textbook even though many naturopaths consider themselves the prototype integrative physician. It is presented as a science-based textbook of natural medicine, in effect, an evidence-based practice model. Interestingly, the first chapter is ‘Eastern Origins of Integrative Medicine and Modern Applications’. The first edition was written in 1993 (currently in 3rd edition).

One of the earliest physician-edited textbooks on integrative medicine is the Micozzi series. The first edition was published in 1996 prior to Jonas. One can easily track the nuances driving definitional change with each new Micozzi text. The 2006 third edition of Fundamentals of Complementary and Integrative Medicine (10) was titled Fundamentals of Complementary and Alternative Medicine (italics added) in the first two editions. The prefaces in each edition illustrate the context-laden drivers for arriving at a suitable definition. In the brief half-page preface to the 1996 first edition, CAM is ‘a classic consumer movement and a current social phenomenon of significant dimensions.’ (11) CAM is also metaphysical as the reader is assured his views will expand regarding how ‘light, time, touch, sensation, energy and mind enter into health and medicine.’

For the consumer and many providers the term CAM has already been supplanted by the term integrative medicine. Integrative medicine may hold more relevance for a widening range of providers that self-identify with the new medicine. For example, the American Medical Students Association's Humanistic Medicine Action Committee simply combines the two terms, publishing an ‘ICAM’ newsletter and hosting an online ‘ICAM’ resource center—Integrative, Complementary and Alternative Medicine (13).

Defining the concept of integrative medicine is one first step towards understanding the phenomenon. However, a definition is more likely to emerge from key issues that are shaping the future of integrative medicine. These issues inevitably come to the fore when practice races ahead of regulation. They are clinical care, research, education standards, as well as economic opportunities. We allude to these topics here with intention to address them more substantially in subsequent reports. Identification among integrative medicine providers could progress from our current state of self-determination to bilateral peer approval and finally bilateral certification (Fig. 1).

There is no unifying conceptual framework (14) of integrative medicine just as there are no unifying training standards or scope of practice. Attempts at one unifying definition are limited by context, often seeming speaker-dependent. In terms of collaborative medical practice in which the patient and doctor are partners, integrative medicine has been described as ‘a comprehensive, primary care system that emphasizes wellness and healing of the whole person (bio-psycho-socio-spiritual dimensions) as major goals, above and beyond suppression of a specific somatic disease.’ (15) From the perspective of scientific research, for example NCCAM (the National Center for Complementary and Alternative Medicine under the National Institutes of Health), complementary and alternative medicine includes ‘healthcare practices outside the realm of conventional medicine, which are yet to be validated using scientific methods.’ (16) According to NCCAM, integrative medicine ‘combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.’ (17) A more transcendent view defines integrative medicine as ‘healing-oriented medicine that re-emphasizes the relationship between patient and physician, and integrates the best of complementary and alternative medicine with the best of conventional medicine.’ (18)

We do not challenge the sincerity of the previous efforts to define integrative medicine. We have tried to show that the definition is malleable and, like CAM before it, depends on the perspective of the definer (22). The markers of definitional change have moved from observing the power of consumer economic choice, to spiritual regeneration of a mechanistic medicine, to the expansion of choice based on scientific evidence. In addition to a multitude of new treatment options, CAM offers conventional medicine a philosophy of holism (23), ‘new’ ways of looking at the complex phenomena of health and disease (24), and the concept of inherent healing capacity (vis medicatrix naturae), while conventional medicine offers CAM rigorous means to scientifically examine these practices and ideas (25). Integrative medicine, at its current stage of development, incorporates the best practices of CAM and conventional medicine into a unified treatment plan, a goal that requires both camps to step into the integrative circle and examine themselves and each other with an open mind. Integration of medical disciplines will first require movement from isolation to collaboration before real integration occurs (Fig. 3).

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