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Integrative care is not just a hodge podge, new survey finds

Consumer Reports News: February 23, 2012 09:38 AM

Integrative medicine, which combines conventional care with complementary and alternative therapies, has become an established component of some healthcare systems, hospitals, and medical and nursing schools. This according to a survey of 29 U.S. integrative medicine programs, treating a total of about 19,200 patients each month. The survey was conducted by the Bravewell Collaborative, a nonprofit foundation dedicated to advancing integrative medicine through education, research, and practice.

Allaying concerns that complementary medicine may include a hodge-podge of techniques, the survey revealed that interventions for specific conditions were remarkably consistent among diverse sites. Analysis also showed a strong correlation between the treatments offered for related ailments, such as heart disease and high blood pressure, and fatigue and sleep disorders, suggesting that treatment norms are emerging in integrative care.

“One of the most interesting findings was an analysis showing a lot of similarity in integrative interventions for each condition,” says one of the study authors, Donald Abrams, M.D., chief of Hematology-Oncology at San Francisco General Hospital and an integrative oncologist Osher Center for Integrative Medicine,University of California, San Francisco. “Conditions that are very similar have the same battery of interventions used, but allergies, for example, are definitely treated quite differently than acute pain.”

The interventions most frequently prescribed include dietary approaches and the use of supplements. In the treatment of 20 common health conditions, half or more of the centers reported using nutrition to treat all conditions except pain, and supplements for all conditions except pre-operative care. Other frequently used interventions include acupuncture, massage, meditation, yoga, and herbal and botanical remedies.

The wide variation in the quality of research about these treatments means that patients need to seek out reputable medical centers staffed by highly trained healthcare practitioners, according to Mimi Guarneri, M.D., director of the Scripps Center for Integrative Medicine in La Jolla, California. “Integrative medicine is about knowing what to use, based on the evidence. Not everyone knows how to do this. It’s one of the reasons why integrative medicine is being considered a specialty now.”

But does integrative medicine work to alleviate patients’ problems? One major limitation of the study was that it did not collect objective outcome measures—such as a fewer heart attacks and strokes, or reduction in symptoms or medication use. The survey instead asked centers to indicate the five conditions for which they were having the most clinical success. Although at least two centers reported success for each of the 20 common maladies, some conditions consistently made the top five. The majority of the centers reported having success treating chronic pain (75%), gastrointestinal disorders (59%), depression/ anxiety (55%), cancer (52%), and stress 52%. Conditions for which less than 20 percent of centers reported success included allergies, diabetes, and obesity.

More than 100 million Americans are suffering with pain, according to Abrams and those patients are among the most likely to seek out alternative therapies: “It’s a huge problem that conventional practitioners are not doing as quite as well with as we found reported by our survey respondents.” Some of the top-ranked treatments for chronic pain included medical massage, meditation, relaxation techniques, and yoga.

The integrated medicine centers also reported a high level of success treating gastrointestinal conditions using nutritional approaches, supplements, probiotics, and herbal remedies. “The most heavily prescribed pharmaceuticals in the U.S. are for digestive problems,” points out Abrams. “We know from our centers that lifestyle changes can mean the difference between relief for these patients and hospitalization or chronic use of pharmaceutical therapies.”

Cancer patients were mostly referred from conventional cancer treatment centers. The integrative medicine centers tended to offer emotional and nutritional support, as well as complementary therapies such as acupuncture and massage therapy, to people who are undergoing, or have completed, conventional cancer treatment.

So who pays for all this? The study found that while some aspects of integrative care such as nutritional counseling and psychiatric care are more likely to be covered by insurance, patients are more likely to have to pay themselves for therapies such as acupuncture, massage, and meditation. However, many in the field assert thinking outside the conventional therapy box has the potential to save healthcare dollars.

For example, incorporating integrative therapies for oncology patients at Beth Israel Medical Center in New York resulted in cost savings of $150 daily for each patient due to the reduced need for medications to treat nausea, anxiety, and insomnia according to Benjamin Kligler, M.D., vice chair of the department of integrative medicine at the hospital and professor of family and social medicine at Albert Einstein College of Medicine, Bronx, New York. So it is possible that a system in which conventional medicine works hand-in-hand with alternative therapies could both reduce costs and improve patient health.

Integrative Medicine in America: How Integrative Medicine Is Being Practiced in Clinical Centers Across the United States

Teresa Carr

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