The bridge between patient and doctor: the shift from CAM to integrative medicine

Exploration of Why Alaskans Use Complementary Medicine: A Focus Group Study

PURPOSE

To explore why Alaskans choose to pursue complementary medicine as a health care option.

DESIGN

Qualitative descriptive.

METHOD

A purposive convenient recruitment methodology was used to recruit project participants. Focus groups were conducted to collect the research data.

FINDINGS

Five themes were identified that highlighted why participants use complementary medicine: dissatisfaction, effective, holistic, relationship focused, and a personal journey.

Corporate culture assessments in integrative oncology: a qualitative case study of two integrative oncology centers

The offer of "integrative oncology" is one option for clinics to provide safe and evidence-based complementary medicine treatments to cancer patients. As known from merger theories, corporate culture and integration models have a strong influence on the success of such integration. To identify relevant corporate culture aspects that might influence the success in two highly visible integrative oncology clinics, we interviewed physicians, nurses, practitioners, and managers. All interviews (11 in a German breast cancer clinic and 9 in an integrative medicine cancer service in the USA) were audio-recorded, transcribed and analyzed with content analysis. According to the theoretical framework of mergers, each clinic selected a different integration type ("best of both worlds" and "linking"). Nonetheless, each developed a similar corporate culture that has a strong focus on research and safe and evidence-based treatments, and fosters a holistic and patient-centered approach. Structured communication within the team and with other departments had high relevance. Research was highlighted as a way to open doors and to facilitate a more general acceptance within the hospital. Conventional physicians felt unburdened by the provision of integrative medicine service but also saw problems in the time required for scheduled treatments, which often resulted in long waiting lists.

A foot in both worlds: education and the transformation of Chinese medicine in the United States

Although insufficiently studied, schools of complementary and alternative medicine (CAM) provide substantial insight into the transformation of medicine in the United States. Scholars have suggested that the increasing acceptance of CAM is due to its alignment with biomedical models of professionalization, education, research, and practice. At West Coast University, students of acupuncture and Oriental medicine learn to straddle both Western and Eastern medical worlds through an increasingly science-oriented curriculum and the inculcation of professional values associated with West Coast University's emphasis upon integration with Western medicine as a means of achieving professional status and legitimacy vis-à-vis the dominant biomedical paradigm. The implications of integration with biomedicine for the identity of Chinese medicine are discussed: from the perspective of critical medical anthropology, integration reproduces biomedical hegemony; paving the way toward co-optation of Chinese medicine, the subordination of its practitioners, and, ultimately, the constraint of medical pluralism in the United States.

Complementary therapy systems and their integrative evaluation

Complementary and alternative medicine (CAM) is becoming an integral part of modern medicine. Complementary and alternative medicine therapy systems include natural medicinal products, nonpharmacological treatments, and counselling on health and lifestyle issues. Complementary and alternative medicine concepts are often elaborate, transcending biophysical models and employing the principles of salutogenesis. Evaluations of CAM therapy systems need to be integrative and cover the dimensions of: (1) therapeutic professionalism; (2) patient perspective and public demand; (3) conceptuality; (4) safety, effectiveness, and costs. Complex research strategies are required, which reverse the phases of conventional drug assessment. The predominant use of randomized trials would introduce structural bias and create an artificial picture. Important are evaluations of the whole system in real-world conditions, and surveys on component evaluations. Systemic CAM assessments should consist of a broad array of high-quality research methods: well-conducted randomized and nonrandomized studies, cohort studies, qualitative research, high-quality case reports and case series, studies on patient perspective, safety analyses, economic analyses, etc. Good clinical judgement, a core epistemic element of medicine based on nonstochastic principles, should also be integrated and could reflect routine patient care.