Integrative Medicine – who and what is integrated how and where to?
By Nora Laubstein
Currently everyone is talking about the term „Integration“: You have to integrate!
If we want to think about integration and naturopathy as one thing, we have to speak verbosely. The keywords associated are: national health system, health economy, USA, university, complementary and alternative medicine (CAM), evidence-based medicine (EBM), and specialization and health professions.
There is a loud call in politics and the media for an urgently needed integration of so far foreign experiences. At the same time it is talked about a so-called dominant culture. We are able to recognize this dominant culture if we transfer this development to the section of health policy: the national health system and the health economy became the measure of all things for the EU-countries with clear rules and regulations.
Everybody is supposed to integrate therein – if they want a part of the public financial support. The liberal health professions like midwifes, naturopaths, nutritionists, private doctors, health pedagogues etc. who are neither working inside of this system nor are part of the state system in Germany including the application procedures. Therefore they are not integrated.
But the commenced conversion of the economic health care system which started after the introduction of the Euro allows the previous hermetically locked up state system to access to the private economy and also the other way around the freelance private health professions gain partial access to the state system.
History and Development
The integration into the medical section is propelled since about ten years. The term of „Integrative Medicine/IM“ was coined in the USA. It describes an interdisciplinary understanding of medicine which sees the human being in his or her individual complexity of mind, soul and body as the centre of diagnostic and therapeutic commitment. The IM is characterized by an unbiased but scientific oriented attitude towards all ethical acceptable therapies – no matter whether it involves methods of the conventional medicine or naturopathic methods.
The IM was founded by US-American doctors who joined together in an academic consortium. This merger is called „Consortium of Academic Health Centers for Integrative Medicine“ www.imconsortium.org and defines IM as follows: Integrative Medicine is “a practice that returns to the importance of the patient/user relation which focuses on the whole person, takes scientific evidence (evidence-based medicine = EBM) into account and uses all appropriate therapeutic approaches, health professions as well as other professions in order to bring about optimal health and healing.“ By now IM became a subject in nearly every renowned university in the USA (e.g. Harvard Medical School, Boston; Duke University, Durham; Mayo Clinic, Rochester and much else).
In Germany IM was introduced and spread by the professors Dr. Dobos (University Duisburg-Essen) and Dr. Michalsen (Charité-Berlin) (book tip: „Chronic Diseases – integrative“, Urban+Fischer-Verlag). This book contains a catchy formula for IM: Mainstream Medicine + EBM-CAM (evaluated naturopathy) + Body & Mind-Therapy (Regulative Therapy) = Integrative Medicine! The two German organisations DAMID and Hufelandgesellschaft assess the importance of IM: „It is shown worldwide that the modern health care system is increasingly oriented towards integration. The demand for medicine that connects conventional and complementary medicine is growing.”
Different Terms
If we look at names like “complementary medicine“, “alternative medicine“, “naturopathy“, “health promotion“ or “traditional medicine“ which are common so far we have to ask ourselves: In which relation to the new term “integrative medicine“ do they stand?
On a political level in Europe all these names are currently still summarized as “CAM” (Complementary and Alternative Medicine). In younger publications the WHO has banned “Alternative” and is using the abbreviation T&CM (Traditional and Complementary Medicine) worldwide. European politics refuse to include CAM or T&CM in their national health programs until today – they remain in private economy and self-adjusting pursuant to their own self-determined dominant culture.
The IM wants to get out of this situation and not be „just“additional complementary anymore! A typical IM-therapy of a chronic gonarthritis with surgery indication for example would happen as follows: After the surgical intervention (conventional medicine) a leech (EBM-study for Indication-CAM) is used and the patient receives a nutrition and exercise therapy (Body and Mind therapy) in addition. This form of treatment has a scientific and clinical focus which is based on a medical specialist education and includes other health professions if necessary.
What are the advantages and disadvantages that occur through the development of integrative medicine for the present situation of naturopathy in Germany? After a closer inspection one can say: “Old wine in new skins“ - the striven networking and collaboration of health professions takes place already, if the patient wants it, that way and provides the financing. The desired introduction of IM to the national financing system holds out the prospect of the development of a “naturopathy-light“which is supposed to be refunded to the patient in the future. There will be more research and studies in the range of naturopathy which is a clear advantage. Gain of knowledge and increasing acceptance of naturopathy can be observed already today.
What do you need to consider?
- Scientific evaluated naturopathy is always indication-based (e.g.“Gonarthritis“ pursuant to diagnosis code ICD-10),
- a single component (e.g. a leech in a humeral therapy) is dissolved out a holistic therapy system and used related to the symptom,
- economic and scientific unappealing CAM-methods are left out and
- the IM is only practiced under medical management and responsibility depending on the legal situation in order to reimburse services of the IM by the GKV.
IM constitutes the newest attempt to find a compromise, to build a bridge into the national system.
Consequences for professions
Of course professional requirements and education are immediately in focus. In times of increasing privatization professional as well as individual possibilities result. The German law about prevention from 2015 has extended this gap even more.
In the last years more and more liberal health professionals tried to integrate therein, e.g. contracts with the national health insurances are negotiated in order to benefit from the tight national budget. Also single professional associations and training institutes are jumping on the bandwagon of scientific recognition and change their educational requirements pursuant to the dominant culture (keyword: more theory, less practice). In tow of medical prescription osteopathy, acupuncture or shiatsu etc. can benefit the panel patient.
Thus the request to integrate signifies a preferably academic specialization which is another important characteristic of the national dominant health culture. The professional hierarchy is a crucial criterion: Who directs, who prescribes and who obeys, who assimilates – because all this meets the national demand for documented safety. The example orthopedics show in which high extend this dominant culture based specialization is happening: doctor for orthopedics, physiotherapist, different joint specialists and surgery robots... and therein chiropractors and osteopaths would like to integrate as an occupational group for their own.
The request is so strong that European expert associations of these therapeutic methods that are originated from whole Europe are going to court and affirm that they want to work legally within the meaning of the mainstream dominant culture. Also German naturopaths are involved in this development: Some are about to integrate eagerly, to study, to acquire diploma or use terms like “Doctor's Office for Integrative Healing Arts” for their doctor's offices name. Others offer integrative medicine classes or merge in institutes for IM.
An interdisciplinary cooperation with other health professions should be frequently equated with IM. The increasing specialization on a single naturopathic method is gaining ground. The danger of losing holistic-additive approaches that are practiced by single users reveals here. Instead many specialized health professions strive for a holistic treatment of the patient. The German umbrella-profession called “Heilpraktiker“ (Naturopath), which is open for an individual professional career, is pressured through the increasing call for specialization, standardization, proof of safety and efficacy proof. So IM could present itself as the financial bird in the hand which is supposed to be better than two in the bush. Transitions get increasingly flowing.
Perspective
There by the philosophical question concerning individual freedom, financial existence, professional solidarity and technical requirement increasingly arises. When German based naturopaths feel belonging to alternative medicine they should decide for themselves what Alternative Medicine defines. A complete integration of the alternative would mean the dissolution of any type of alternative. It is a “hostile embrace” so to speak.
Here it is not the place talking for or against something, but to advertise healthy professional self-confidence. Currently the term “Alternative Medicine” seems to be old fashioned and we could discuss the term “Traditional Medicine” instead. But we should keep in mind that an alternative defines itself inter alia through offering another selectable option, thus to put an alternative treatment range at the patients disposal.
Professor Dr. Walach who is teaching in Frankfurt-Oder at the Europe-University VIADRINA has written an enthralling article some years ago: “Integrative Medicine – the colonisation of different ones and the need of the totally different ones”; you can find this article under: “CAM in Europe” - keyword “Forschung" on the German side of the homepage www.anme-ngo.eu