Complementary and Integrative Medicine – The What, Why, and How – Part 1
More than 1 out of every 10 children use complementary therapies in addition to conventional allopathic medicine. This number drastically increases in children with chronic diseases, such as inflammatory bowel disease, migraine headaches, epilepsy, asthma, and cystic fibrosis, where up to 50% of children affected with these conditions have used complementary therapies. The numbers of adults are even higher where 1 in 3 adults use complementary therapies. These statistics are from the 2012 National Health Interview Survey that looked at complementary therapy use in the preceding year. At the time of writing this article, 13 years after that initial survey, interest in and acceptance of integrative and complementary modalities of healing have only grown.
So, what is complementary and integrative medicine anyways? For this, let’s go through some terminology and definitions:
Allopathic Medicine: This is the conventional, Western approach to diagnosing and managing disease conditions. This approach follows evidence-based clinical guidelines and protocols.
Complementary Therapies: These are also evidence-based approaches, but these developed outside the realm of conventional allopathic medicine. These therapies are used in conjunction with allopathic medicine to supplement and augment the overall disease management plan.
Integrative Health: This is when a practitioner combines complementary and conventional therapies in a holistic patient-centered and evidence-based manner.
Alternative Therapies: These are modalities that are not evidence-based and are used instead of conventional care.
While alternative therapies are not recommended by the author of this article and professional medical societies, complementary and integrative therapies do play a significant role in the evidence-based management of a number of conditions. The focus then, of this article, is to expand your understanding of complementary and integrative therapies as they are practiced here in the United States.
Now that you have a general idea of the technical differentiation of allopathic, complementary, and integrative therapies, let’s dive a little deeper into why understanding this is even important.
As I started off this piece sharing statistics of the significant proportion of adults and children who use complementary therapies, and we know that these rates are higher in those affected with chronic conditions, we also know that the pace of actual use of these modalities is out-running the pace that doctors and other allopathic practitioners are able to keep up with learning about these modalities.
While 72% of pediatricians felt that they should be able to give patients information about complementary therapies, they reported that they simply did not know enough about these therapies to provide additional education and support to their patients. The fact is that training in complementary and integrative therapies is simply not part of the medical education curriculum for the majority of training programs in the U.S. Allopathic medical practitioners who are knowledgeable about complementary and integrative therapies have often sought out this information on their own accord either due to personal use of these therapies or through web-based training resources.
Likely because of this lack of sufficient knowledge and training of the evidence-based risks and benefits of complementary and integrative therapies, many allopathic practitioners don’t even ask patients about their use of these therapies during office visits. This, in addition to patients’ perception of their doctor’s judgements about these therapies, are barriers to open communication and dialogue within the clinical setting. And yet, open discussion of these therapies between patients and their providers is essential to ensuring safety of the overall disease management plan and to monitor for potential risks of confounding negative interactions of the modalities being used.
The takeaway here for patients is this: If you’re considering complementary and integrative therapies, talk to your provider about it to make sure you’re going about it in the safest way possible as it relates to possible interactions with your current allopathic medical regimen.
The takeaway here for providers is this: Ask your patients about their use of complementary and integrative therapies, even if you don’t feel well-versed in these modalities currently. It’s important that you’re aware of your patient’s use of these modalities. The first step to training yourself further in these therapies is having an awareness of which specific complementary and integrative approaches your patient population is curious about and/or actively seeking out.
It's through this bidirectional communication and awareness that, as a medical community, we’ll be able to continue to expand our understanding and application of the most beneficial and impactful ways to augment conventional medical practices with the complementary and integrative therapies that many patients are already using anyways. It’s our responsibility as patients and providers to continue to educate ourselves on the roles of these different modalities of healing and well-being. An excellent resource for patients and providers is the National Center for Complementary and Alternative Medicine https://www.nccih.nih.gov which is a division of the National Institutes of Health.
In Part 2 of this article, you’ll learn about the most common specific modalities of complementary and integrative therapies.
Reference: Hilary McClafferty, Sunita Vohra, Michelle Bailey, Melanie Brown, Anna Esparham, Dana Gerstbacher, Brenda Golianu, Anna-Kaisa Niemi, Erica Sibinga, Joy Weydert, Ann Ming Yeh, SECTION ON INTEGRATIVE MEDICINE, Timothy Culbert, Melanie Gold; Pediatric Integrative Medicine. Pediatrics September 2017; 140 (3): e20171961