September 14, 2010
Integrative medicine vs. alternative medicine: Why it's important to know the difference
BY Lorenzo Cohen, Ph.D.
People often do not make a distinction between the terms integrative medicine and alternative medicine. Below is the mission statement of the Society for Integrative Oncology:
The Society for Integrative Oncology (SIO) is a non-profit, multi-disciplinary organization of professionals dedicated to studying and facilitating cancer treatment and the recovery process through the use of integrated complementary therapeutic options. Such options include natural and botanical products, nutrition, acupuncture, massage, mind-body therapies, and other complementary modalities. Our mission is to educate oncology professionals, patients, caregivers, and relevant others about the scientific validity, clinical benefits, toxicities, and limitations of state-of-the-art integrative therapies. SIO provides a forum for presentation, discussion, and peer review of evidence-based research in the discipline. We advocate for responsible public policy and the highest standards of practice in integrative medicine through appropriate training and the certification of health care professionals.
You will note that the word "alternative" is not contained in the mission statement because the SIO is not a proponent of alternative therapies in lieu of conventional evidenced-based medicine. This is also true of most academic cancer centers, including MD Anderson.
Supporters of integrative medicine never advocate withholding proven interventions. As a matter of course, they embrace only the utilization of viable evidence-based treatments. We are wholly committed to quality research in the area of integrative cancer therapies.
While additional research is needed in the area of integrative oncology, there is nonetheless a sizeable and growing body of well-designed, high-quality science that clearly supports specific interventions as evidence-based. Locating well-conducted randomized trials of integrative therapies in oncology is not a difficult matter.
As funding for this area of research is relatively new and not supported by big pharma, many of the trials are small Phase II studies and lack appropriate control groups (often just usual care). As more positive Phase I and II trials are completed, we will start to see the larger, necessary, better-controlled Phase II and III trials to know the true benefits of some of these treatments.
One of the other challenges of research in this area is that with the exception of the natural product clinical trials, it is difficult to develop studies using the gold standard double-blind, placebo-controlled design. However, even using single-blind designs, it is possible to at least determine if the patients remained blinded to group assignment and assess patients' baseline treatment expectations. This can help to account for placebo effects.
It is uncommon to find scientists or practitioners who support evidence-based medicine unsupportive of well-designed clinical trials. However, this can sometimes still happen in designing, conducting and publishing integrative oncology clinical trials. Scientific observation should never be trumped by a personal belief. In fact, substituting one's own belief instead of supporting rigorous research and scientific observation is similar to what alternative medicine practitioners advocate -- deliver or withhold treatments without evidence to support that action.
If we simply followed people's predictions and beliefs then the field of medicine would not be where it is today, as many medical discoveries went against what was commonly believed and/or predicted. A good historical example of this is the story of Dr. Ignaz Semmelweis who documented that washing hands with chlorinated lime solution prior to delivering a baby dramatically decreased the rate of puerperal fever. The germ theory of disease had not been developed at the time and Dr. Semmelweis was largely ignored, rejected or ridiculed.
Another good example in oncology is the late Dr. Judah Folkman, who discovered angiogenesis and pioneered anti-angiogenic treatments. He also was initially dismissed and ridiculed by the medical community due to his ideas, which are now, of course, widely accepted.
As the majority of cancer patients use some form of complementary and even alternative medicine, it is the medical establishment's responsibility to provide proper medical advice in this area. Good research is what is needed to determine what is beneficial and what is not beneficial to provide practitioners and patients the information they need to make informed decisions about medical care.
The field of integrative oncology continues its ascent as medicine shifts toward a more personalized care model. Delivering many common and accepted modalities such as diet, exercise and stress management using a patient-centered, comprehensive approach is what distinguishes integrative medicine from reductionist and fragmented models of care. As more and more cancer survivors proactively participate in a patient-centered wellness approach, integrative oncology practitioners will continue to grow in numbers to meet this demand.