Integrated – or not?

Usually you go along in your life, being who you are and doing what you do, not thinking too much about it. But every now and then, you hear or see something that rocks these foundations – causing you to ask, Is this really how others see me? What is my true identity?

So it was the other night as I sat in a seminar on hip replacement surgery. The doctor had given his talk, and now the orthopedic program manager was discussing aftercare. There was an emphasis on getting the patient moving as early as possible, with physical therapy the key. Standard care was detailed on a PowerPoint slide. Below that was a bullet point labeled “Integrative Care”. The manager explained this included a range of options, including Reiki, healing touch, and meditation. She said all this was done by volunteers, at no fee to the patients.

Acupuncture was not on the list (and sadly, does not appear to be anywhere on Sharp HealthCare’s menu of treatment options for hip replacement patients, despite having been shown in a recent meta-analysis to significantly decrease pain, opioid use, and opioid side effects in post-operative patients). Acupuncture is, though, commonly found under the heading “Integrative Medicine”. There it is lumped with massage, meditation, music and art therapy, etc. – and, like these other activities, may be provided gratis by volunteers.

What is integrative medicine? I looked up some definitions. From the Duke Integrative Medicine department of Duke University:

Integrative medicine is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health. Employing a personalized strategy that considers the patient’s unique conditions, needs and circumstances, it uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimum health.

And from the University of Arizona’s Arizona Center for Integrative Medicine:

The Center defines integrative medicine (IM) as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.

I believe these are two reputable institutions. Both, incidentally, make clear (the italics are mine) that integrative medicine practices are based in science and evidence. To be crystal clear, in healthcare jargon, to be based in or informed by evidence means there are peer-reviewed, published studies that show the practice has outperformed usual care and/or placebo in randomized, controlled scientific trials. Now, if this is the case, then why are we giving it away for free?

I’m not up to date with the evidence for Reiki or art therapy, but I do know something about acupuncture research. It has provided a multitude of evidence that acupuncture improves outcomes in people with different types of pain, including osteoarthritis, low back pain, and post-surgical pain. There is also good evidence – and M.D. Anderson Cancer Center is a major researcher in this area – that acupuncture reduces side effects of cancer treatment, including nausea, hot flashes, and persistent dry mouth. Yet, at the cancer treatment center where I have (yes) volunteered, the acupuncture department was almost hermetically sealed off from the rest of the hospital. At one point, automatic locks were installed on the doors, meaning you needed a security pass just to go from the waiting room to the treatment area. The only décor in our check-in area was a large sign proclaiming: “Integrative Medicine”.  The administrators, having thoroughly segregated us, seemed immune to the irony.

So, what is my profession, with its thousands-year-old history, its full place in medical teaching hospitals in China, its stacks of modern research literature which in sum provide a very strong evidence base for its effectiveness against a range of conditions which continue to plague Western medicine? We are not integrated – not yet. As of now, despite the hopeful name, we remain segregated from the mainstream of hospitals and doctors’ offices, sometimes not even deemed worthy of asking for financial compensation.

Perhaps I should point out here that acupuncturists in the U.S. go through a four-year master’s program with clinical residency, and an increasing number are obtaining doctorates after an additional two years of study and producing original research. All must pass rigorous licensing exams and carry malpractice/liability insurance. We bill many of our private patients through their insurance plans. This is not art therapy (which no doubt has its place). It is medicine, but we still have a long road to hoe before can truly say we have been integrated into Western medicine.

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