Is integrative medicine right for you? (And what is it, anyway?)

Published: October 2011

When we surveyed 45,601 Consumer Reports subscribers online, we found that three out of four were using some form of alternative therapy for their general health. More than 38 million adults make more than 300 million visits to acupuncturists, chiropractors, massage therapists, and other complementary and alternative practitioners each year in the U.S.

We talked with Joseph Mosquera, M.D., a physician who is board-certified in internal medicine and also trained in integrative medicine, which combines the best of conventional and complementary therapies. He also consults with Consumer Reports on herbal remedies and other dietary supplements, as well as nontraditional health-care treatments including acupuncture and hypnotherapy.

Q. How did you become interested in this approach to health care?
I grew up in a multicultural, inner-city environment in Newark, and after I graduated from medical school, I moved back there to practice medicine. The people I saw would come to me with all the traditions of their homelands—the herbs, the healing foods, the advice from their grandmothers. Instead of dismissing it, I decided to see how it could be incorporated into my practice. The challenge was to distinguish myth from scientific and evidence-based therapies.

Q. What kind of training did you receive?
I started with a continuing-education course at Harvard Medical School taught by Herbert Benson, M.D., who studied how Buddhist meditation, or what he calls the relaxation response, can affect health. Then I enrolled in the University of Arizona's medical program in integrative medicine, a two-year fellowship program started by Dr. Andrew Weil. Finally, I received more in-depth training and certification in three areas: Japanese acupuncture; hypnosis and visual imagery; and nutrition, focusing on diets for good health and for treating specific medical states. Other people who practice integrative medicine might have different focuses—osteopathy and manipulation, for example, or herbal supplements, or expressive art therapy. But they all have the same basic holistic approach to health care.

Q. How is integrative medicine different from conventional medicine?
It's low-tech, high-touch medicine. It focuses on the whole person, not just disease. Its goal is, yes, to cure you or ease symptoms if you're sick, but even more it's to keep you healthy in the first place. It doesn't emphasize any one particular therapy, but rather stresses the importance of using all appropriate therapies. It neither rejects conventional medicine nor uncritically accepts alternative ones. But it does aim to use simpler, safer, and more natural remedies whenever possible. And it applies a sliding scale to the need for evidence: The greater the potential harm of a treatment, the stronger the evidence needs to be. Thus we would expect, say, greater evidence for chemotherapy than for massage.

Q. How does that play out in real life? For example, how would someone trained in integrative medicine treat a patient with arthritis?
It starts with the interview and spending more time with our patients. We don't ask just about the person's medical history but what makes them happy or sad, where do they go for emotional and spiritual support, what do they eat. … We try to get as complete a picture of the person's life as possible. And we empower the person in his or her care, too, since we work together as equal partners. Then, in the case of arthritis, instead of turning first to anti-inflammatory drugs, such as Celebrex or Advil (ibuprofen), or possibly steroids, we would start with changes to their diet, to their activity patterns. We would try to disrupt the underlying inflammatory problems that contribute to the condition.

Q. What kind of evidence is there to support that approach to health care?
No one doubts the importance of a healthy diet or regular exercise in good health, and those are essential components of what we do. And there is a growing body of research supporting the safety and effectiveness of certain particular practices. Mindful meditation, for example, for reducing stress and depression. Manipulation for some kinds of back pain. Certain herbs and supplements. The key is choosing those that seem to work and that make sense for a particular patient. But it is true that for the integrative medicine as a whole, the evidence at this point is mainly anecdotal, though there are plans for studies to measure outcomes in people who are treated this way.

Q. How can consumers find physicians trained in integrative medicine?
It is getting easier. The University of Arizona's Center for Integrative Medicine has established residency training programs at more than 20 medical schools and centers, including at Beth Israel Medical Center in New York City, Carolinas Medical Center in Charlotte, N.C., and Tufts University in Malden, Mass. And the center's website has a directory of physicians who have been trained in it. Integrative health centers are now available throughout the country at places like Scripps Health in San Diego and Beth Israel. It's very important to check qualifications and certifications, as with all specialties.

Editor's Note:

This report was made possible by a grant from the Airborne Cy Pres Fund, which was established through a legal settlement of a national class-action lawsuit (Wilson v. Airborne Health, Inc., et al.) regarding deceptive advertising practices.

Joseph L. Mosquera, M.D.

Medical Adviser

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