“Integrative”—What Is in a Word?
Having just returned from the 2012 International Research Congress on Integrative Medicine and Health, the term “integrative” and its various meanings are very much on my mind.
The legislation that created NCCAM puts a clear emphasis on integration. Here is what the law says:
The Director of the Center shall, as appropriate, study the integration of alternative treatment, diagnostic and prevention systems, modalities and disciplines with the practice of conventional medicine as a complement to such medicine and into health care delivery systems in the United States.
That seems simple enough but there are a lot of rough edges at the interface between conventional medicine on the one hand and use of complementary/alternative health approaches on the other, and “integrative” can get caught in a highly polarized debate. From one end, “integrative medicine” offers a holistic, gentle, patient-centered approach that will solve many our Nation’s most pressing health care problems. At another end, “integrative care” represents an evasive rebranding of modern equivalents of “snake oil” by practitioners who raise unrealistic hopes and promote approaches that are not sensible, supported by evidence, or proven safe.
So what does “integration” mean to NCCAM from our perspective at the NIH? We begin with three very well-documented facts:
- Individuals, their health care providers, and their health care systems are all, on a large scale, incorporating various practices which have origins outside of mainstream medicine into multi-pronged treatment and health promotion approaches.
- This “integrative” trend among providers and health care systems is growing. Driving factors include perceived benefit in health or well-being, emerging evidence in at least some cases that perceived benefits of integrative are real and/or meaningful (e.g., management of chronic pain), and marketing of “integrative care” by health care providers to consumers.
- With few exceptions, data to guide evidence-based decision making about safety and efficacy are at best preliminary.
That’s where NCCAM comes in. We are focusing our resources on building better evidence to clarify whether interventions that are already being widely integrated into the real world of health care and health care systems—and for which there exists a reasonable scientific case for investment of valuable resources—are safe and have efficacy. For example, we are deeply invested in clarifying the role of non-pharmacological approaches as components of pain management.
That is NCCAM’s evolving perspective on the word “integrative.” We think it is a very useful construct because it is simple, pragmatic, and focuses on major trends in twenty-first century health care.
I’m eager to see where this line of investigation takes us and hope you will join our conversation.