Talk:Integrative medicine

At the moment, the article page is in the midst of some merges both of material from other article and talk pages, as well as sources provided directly. Feel free to comment on the talk page, but I would appreciate it if there were no major edits on the article page while it's being constructed. This should be no more than a day or two, but, since the article does use features of clusters, it could not be constructed in a sandbox. Howard C. Berkowitz 04:58, 18 December 2008 (UTC)

Definitions, when not existing, will be the closest term currently in the U.S. National Library of Medicine's Medical Subject Headings vocabulary, which may not always agree with certain traditional terms. Also, wherever there are standard vocabularies, such as the International Classification of Diseases (ICD) from the World Health Organization, their terms will be preferred. Howard C. Berkowitz 05:06, 18 December 2008 (UTC)

Good start, Howard! I especially think the 'table' is useful.Martin Cohen 12:47, 19 December 2008 (UTC)

Temporary commentts

These come from Another Controversial Place. Some may well move into the main article here.

Pat, to some extent, I've tried a new start in integrative medicine. I will, to some extent, defend the problem that people are seeing different practitioners, who could work together, but there is no coordinated care. A conventional physician must know any herbals or dietary supplements the patient is taking, or, variously, a drug could be prescribed and cause a deadly intercation, or laboratory results are completely skewed. If a patient chooses to use an herbal preparation, and the medical prescriber knows it, different choices can be made.

"Complementary" is not, to reasonable practitioners, a bad word. "Alternative" is a problem, when it is seen as a substitute. integrative medicine is a paradigm of cooperation. For example, I've been involved with several multiphysician groups that either have in-house acupuncture, manipulative therapies, or routinely cross-refer. I lost a close relative because an "alternative" practitioner decided that his particular discipline would cure everything, and missed basic signs of major internal bleeding. Pain management clinics are very frequently multidisciplinary, which, perhaps, is another way of saying complementary. Physicians often don't know how to teach visualization, meditation, and other techniques that they agree are worth trying in chronic, or even acute pain. I'm as bioscience oriented as anyone you will find, but if I get a headache, I use some learned visualization techniques first -- and take conventional medications if they don't work in 15-20 minutes. I might decide to take acetaminophen and then use relaxation and visualization.

As a term of art, multidisciplinary tends to involve multiple defined medical specialties and subspecialties, where complementary simply refers to things not in a core medical curriculum. Some of those things, under that definition, are as straightforward as art therapy, therapeutic massage, and manipulation. There are some exciting synergies: certain manipulative therapies can only be done with a patient under anesthesia. That may look like a patient going into an operating room with the anesthesia equipment, then a chiropractor, working with the anesthesiologist, does the manipulation. A friend of mine is a dual-boarded (family and emergency medicine), but also is osteopathically trained and can do the manipulations himself.

Actually, I rather like the couple of paragraphs above, and may take them to integrative medicine. I would like to invite everyone to work in that framework, because the whole idea of integrative medicine is about collaboration. Howard C. Berkowitz 23:51, 26 December 2008 (UTC)

cross linking of articles; what relates to what?

Howard wrote on my talk page: As long as people coming to complementary and alternative medicine can find integrative medicine, no problem. Now I'm going to quibble with that. I think that people ought to be able to read about and think about "alternative medicine" (or whatever you want to call it) without also having to think about the idea that official medicine can be combined with unofficial approaches, and often is. Those are diffirent issues. So I do NOT think that "alternative medicine" needs to link to this article. What probably should link to this article is, maybe, plain old "medicine".

But having said that, although I don't necessarily disagree with what is in this article, I also think that it is essentially an essay rather than an article. Sorry to be so blunt, Howard, because your mind fascinates me, but this would make a great blog. An entire string of complex blog articles! But is it encyclopedic? I'm not so sure. Medicine exists in its official sense. All sorts of unofficial, "unauthorized" healing approaches exists, whether authorized medicine approves or not. I'm not sure we at CZ really ought to wade in any farther than that. But as a blog? Man it has potential...Just my two cents worth.

I guess at most, one might mention that the term "integrative medicine" sometimes get used to encompass the idea of combining official approaches with promising unofficial approaches. But it really isn't a hard and fast term that everyone agrees on. Or at least, I wasn't aware of it. How about moving this to a blog? You've obviously thought and read and studied a lot about it, and your life experience has as much value as anyones.Pat Palmer 00:32, 27 December 2008 (UTC)

Pat, most of the content here is a paraphrase and merge of material from actual integrative medicine programs: Columbia, Duke, Hopkins, Mayo Clinic and others. One of the things that makes this "official" is that they are, possibly with the exception of Columbia, directed by physicians whose legal authority makes what they do "official".

A parallel example: the Food and Drug Administration approves drugs only for the indications that are spelled out in the New Drug Application process. With some narrow exceptions, however, it is within the discretion of a licensed physician to order a prescription drug for use in conditions not in the indications, but that, in his or her professional judgment, will help a specific patient. This is a more, not less, widespread pattern with the advent of molecular pharmacology. No longer does one prescribe because drug A is good for disease Z. One prescribes a drug to modulate a chemical interaction that happens in disease Z, but that the physician knows takes place in diseases Y and X. An extreme example: thalidomide, everyone's poster child of a horror drug, was approved for a specific indication in inflammatory leprosy. This is totally different than its original purpose, and there are incredibly stringent warnings to prevent birth defects. We know that the mode of action of thalidomide is that it blocks the action of a particular chemical messenger in the body, tumor necrosis factor alpha. as well as some other chemicals. Overexpression of TNF-A is not just a problem in leprosy, but in Behcet's syndrome, graft-vs-host disease (think transplant rejection), quite possibly multiple sclerosis, etc. Other TNF-a blockers such as etanercept, approved for rheumatoid arthritis, work in a different way. Last time I looked, there was no approved indication for thalidomide in Behcet's, but it's fairly standard treatment because a physician prescribes it.

Various jurisdictions regulate "scope of practice". For example, you must be a physician to perform acupuncture in Virginia. In Maryland, one can perform it with a degree/certificate from an approved program; I'm not sure if a prescription is required. In many states, physical therapy and medical laboratory tests can be done only with a physician's prescription.

So, acupuncture done in Virginia is "official", because it's restricted to physicians, presumably with additional training. By having it physician-directed, integrative medicine is official. That doesn't mean a physician can't face professional discipline or malpractice for ordering a complementary therapy that gets a patient in trouble -- but so can ordering an utterly conventional treatment.

Look at [1], and note the distinction between "whole systems"/alternative and complementary therapies. You can't get much more official than the National Institutes of Health. So, no, integrative medicine is medicine, just as much as is coronary bypass or penicillin. Perhaps the first truly integrative form is what is called osteopathic medicine in the U.S., which is quite different than osteopathy in the U.K. In the U.S., an osteopathic physician with a DO degree goes through the same training as an MD, but also learns osteopathic manipulative techniques. In the UK, osteopaths manipulate, but, AFAIK, cannot prescribe drugs, do surgery, or any of a variety of things thought part of the scope of practice of medicine. In the U.S. Army, a dental officer isn't usually going to be asked to fix a shattered leg, but she may very well do the anesthesia if no anesthesiologist is available -- dentists get anesthesia training comparable to surgeons. Howard C. Berkowitz 01:32, 27 December 2008 (UTC)