Cohen, M. The Challenges and Future Direction for Integrative Medicine in Clinical Practice. Evidence Based Integrative Medicine. 2005 2(3)117-122
The best medical practice involves the integration of the therapies taken from the full range of available healthcare options, applied after considering the circumstances of each individual patient. This requires a knowledge of both conventional and non-conventional therapies along with a consideration of the personal preferences of both the practitioner and the patient in the context of informed consent, the strength of the available scientific evidence, the range of possible alternatives, the associated costs and risks versus the potential benefits of treatment, as well as the availability, accessibility and immediacy of treatment. Effective integration is often difficult to achieve as there are many obstacles to the implementation of complementary and alternative medicine (CAM) in mainstream practice. These include the credentialing and regulation of complementary therapists, the development of appropriate funding models for supporting the delivery of CAM services within the mainstream health system, along with obstacles around the production, dissemination and use of evidence about CAM, as the hurdles for producing and evaluating evidence are often placed considerably higher for CAM than for conventional medicine. A further obstacle to integration relates to interdisciplinary collaboration that is hampered by differences in philosophy and nomenclature between disciplines, few interdisciplinary associations or forums where interdisciplinary issues can be discussed, along with competition for clients and unequal status and access to public funding. Despite these obstacles, progress is being made. The research base for CAM is continually expanding, there is a growing recognition of the need for cross-training of conventional and complementary practitioners, and complementary therapies such as yoga, massage, meditation and hypnosis appear to be widely accepted in mainstream general practice. However, this acceptance may be based on the perception that these therapies are relatively safe and do not threaten to usurp the role of the general practitioner rather than scientific evidence of their efficacy and safety. Collaboration requires an environment of shared understanding, mutual respect and trust. The fostering of interdisciplinary collaboration therefore requires open communication between patients, conventional medical practitioners and complementary therapists along with appropriate education and training programmes. As the practice of medicine is also intricately linked with the socio-political and cultural environment, the successful implementation of integrative medicine will also require a cultural shift across the public and private sector that creates an imperative for all health professionals to work together for the benefit of their patients and the wider community.