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Edzard Ernst: The “integrated medicine” straw-man

28 Jun, 12 | by BMJ

Proponents of integrated medicine want us to believe that they are offering “the best of both worlds” to their patients and claim that using a combination of alternative plus conventional medicine is preferable to conventional medicine alone. This approach allegedly extends our therapeutic options, respects patient choice, and provides compassion in healthcare.

Alternative practitioners, they say, have the ability and time to listen, offer understanding, empathy, sympathy, and compassion. They postulate that these qualities, once called “the art of medicine,” have been lost in modern healthcare which tragically has become de-humanised, technical, heartless, and uncaring. Modern medicine is in a deep crisis, they insist, and integrative medicine offers a way out of the predicament.

This argument is a classic straw-man: it deliberately exaggerates the weaknesses of modern medicine and proposes that its defects can be repaired by adding unproven or disproven treatments to the system—after all, alternative practitioners may well have time, empathy, and compassion, but they also employ treatments that are not evidence-based, implausible, or bogus.

Few people can deny that mainstream medicine is imperfect. All too often, its limitations are nothing but obvious. Therefore, a growing army of experts has been recruited for doing their utmost to improve it. As a result, we have better healthcare today than ever before in the history of medicine.

Compassion has by no means left mainstream medicine and, where it is being neglected, it must be revived not outside but within the system. If modern medicine needs to be reminded of the importance of the art of medicine, this should not be achieved at the expense of the science in medicine. Integrating unproven or disproven treatments into our clinical routine would not improve but can only worsen the situation. The art and the science are not mutually exclusive. In fact, good medicine will always consist of both elements.

The notion that only those who preach the gospel of integrated medicine are able to perform the art of medicine is as ridiculous as it is insulting to everyone in healthcare who does his/her best to meet the needs of their patients. The assumption that unproven or disproven treatments become acceptable simply because they are often administered in a kind and caring fashion is quite simply not true.

The current drive for integrated medicine is illogical and potentially harmful. It should be a concern to anyone with a real interest in improving tomorrow’s healthcare.

Edzard Ernst is a professor of complementary medicine at the Peninsula Medical School, Exeter.

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  • Bendy

    I’ve ended up going to alternative practitioners because I have found there’s a gap in conventional medicine. I have a connective tissue disorder and have had physio on pretty much all the major joints of my body (neck, hip, shoulder, feet, back and so on) at different times and other tiresome complications. What I need is lifestyle tactics for dealing with my entire body and posture, and that was just nonexistent in mainstream medicine. Anti-inflammatories and some physio massage seem to be the limits.

    I found a lot of useful stuff in the Grinberg Method but also a raft of woo-woo that didn’t help at all, and though cranio-sacral massage was also great, it didn’t provide any long-term solutions.

    There are plenty of conditions that require real, evidence-based holistic treatment from mainstream medics who need the freedom to think outside the box – by which I don’t mean talking chakras or prescribing sugar pills. I’m not sure if the NHS is structured in a way that would allow that.

  • Notactualsize

    Ah, ‘integrated’… clever marketing, that. No one could possibly be against ‘integration’, could they? Oh, the power of words…

  • Cdupont

    madam I quite agree – diluting evidence based medicine with  alternative complementary is futile          .never better summarised than in “Suckers – How Alternative Medicine Makes fools of uis all ”      Rose Shapiro  – Harvill Secker 2008

  • roblob

    Couldn’t agree more. Keep up the good work Edzard.

  • James May

    Healthcare has always been about caring before it has been about curing – in the past, before modern medicine, very little curing was possible – people still cared. But it was a caring thing to do to find out how to cure people. To find out if our medicine actually makes a difference and cures we need scientific evidence. You can care for people without science, but you can care better with it. Curing therefore is a subset of caring – EBM is a way of caring for people. Ignoring evidence is not caring. Integrative medicine (which seems to mean EBM + woo) is therefore not caring but deceitful, and would be better called disintegrative medicine.

  • Cdupont

    i quite agree diluting evidence based medicine with alternative complementary is futile never better summarised than in “Suckers   how alternative medicine makes fools of us all Rose Shapiro Harvill Secker 2008

  • http://www.cme-internalmedicine.com/ Carol

    I think illnesses and diseases can be treated by using alternative medicine, though it is not yet 100% proven but a lot of people indulge to it whenever they have no hope in conventional medicines.

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