On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.98 n.3 Cape Town Mar. 2008
PO Box 12602 Die Boord 7613 email@example.com
To the Editor: The editorial entitled 'Why integrative medicine?' (S Afr Med J 2007; 11: 1009 - 1010) has missed the whole point of the integrative process and what is generally recognised as integrative medicine; it implies that the conventional medical process is integrative anyway, so why make a special issue of integrative medicine? You suggest that the conventional model is open to subjecting any treatment or method to scientific scrutiny and, if it is shown to be valuable, will incorporate it into the practice of medicine, and that is integrative.
The model of integrative medicine as developed around the world is, however, very different from this narrow perspective. It is in the end not about diagnosing and then treating a disease, but rather about healing a person. Healing a person is about using modalities and approaches that improve health. It is for this reason that lifestyle changes are emphasised, not only in the prevention but also in the management of ill health. Clearly, the more health, the less ill health; and the more health, the better the body is able to heal itself.
Integrative medicine is firstly about health and supporting health when a person is ill by introducing a health-promoting diet, exercise, stress management, optimising nutrition, developing a more robust immune system, and using other health modalities and techniques. A medical student spent a month with me, and I was surprised at how little she knew about health and the maintenance of health. Drugs interfere with function (anti-histamines, beta-blockers, etc.) and therefore make the system more dysfunctional. Nevertheless, they can play an essential role in the whole programme when used as part of an integrative process.
Secondly, consider the science of integrative medicine. Thousands of articles are published in journals of integrative medicine which are generally not published in journals of conventional medicine, which are supported by pharmaceutical companies. Supporting health is not about using a single product to treat an endpoint (disease) but a whole package of lifestyle approaches and supplements to improve health. Thirdly, supporting health requires compassionate and supportive doctors who give time to their patients. This is holistic - integrative - medicine.
Therefore, to suggest there is only 'one medicine' which is the 'conventional medicine' is a very narrow approach. The real world is so complex that any attempt to rationalise it or expect conventional science to come up with absolute answers will always be fraught with answers that will confuse and contradict, just as weather forecasting remains only a forecast. The 'one medicine' should be a medicine that recognises the power of improving health, supports patients in their process towards health, and uses symptomatic and drug-based medicine as indicated.
Medicine embraces promotion of health, prevention of disease, diagnosis, cure, and if this is not possible, as in end-of-life situations, then care. It is disingenuous to claim that such a comprehensive capacity is unique to 'integrative medicine'. That thousands of articles are published in integrative medicine journals is no proof of their scientific validity. Nor is the implied suggestion that articles must be invalid if supported by pharmaceutical companies. It is in 'developing a more robust immune system, and using other health modalities and techniques' by alternative systems that dubious claims abound. We agree that 'supporting health requires compassionate and supportive doctors who give time to their patients'. - J P van Niekerk (Ed.)