Alternative vs Complementary vs Integrative Medicine: What’s the Difference?
Rehabilitation professionals don’t “cure” people of their diseases, but they do provide treatments and recommendations for people with cancer, HIV, arthritis, lupus, heart disease, diabetes, lupus, etc. that help people reduce and manage their pain, improve their function and enhance their quality of life.
As long as there are conditions and diseases that have no cure, people will seek remedies and interventions that help them feel as good and function as optimally possible. Some interventions are grounded in scientific studies of safety and efficacy, whereas other treatments have NOT withstood the test of scientific inquiry. Nevertheless, these types of treatments are often characterized negatively as alternative or complementary, even though most times, there is no claim that a treatment such as acupuncture for post-chemotherapy nausea will cure cancer. Rather, it will improve the quality of life of someone who is being treated for cancer.
Unfortunately, distinctions between alternative, complementary and integrative medicine and/or therapies are not always accurate. This has the potential to create situations in which people avoid certain types of treatments or care because they fear ridicule for seeking help outside of the “proven” treatments of Western medicine.
Enter the New York Times article, Alternative Cancer Treatments May Be Bad for Your Health with the subtitle, People who used herbs, acupuncture and other complementary treatments tended to die earlier than those who didn’t. On the surface, this seems to be an alarming and outrageous statement, and indeed it is.
Let’s start dissecting the title and subtitle by understanding “alternative” and “complementary”. The National Center for Complementary and Integrative Health (NCCIH) explains that these terms mean very different things. If a non-mainstream practice, (i.e., an intervention that doesn’t have scientific evidence or approval) is used in place of conventional medicine, it’s deemed “alternative”. We know these as any number of treatments that have no published articles on its safety and efficacy, requires cash payments, and promise a cure.
A non-mainstream practice that’s used together with conventional medicine is considered “complementary”. The NCCIH uses the term “integrative health” when complementary health approaches such as natural products, yoga, meditation, deep breathing, etc. are incorporated into mainstream health care. In fact, the NCCIH is helping to fund research on integrative approaches for symptom management in patients with cancer and survivors. Their funded studies have suggested that:
people with cancer who receive integrative therapies while in the hospital have less pain and anxiety
massage therapy may lead to short-term improvements in pain and mood in patients with advanced cancer
yoga may relieve persistent fatigue that some women experience after breast cancer treatment
Now let’s come back to the NYT article, which is based on the paper published in JAMA Oncology. It appears the definition of “complementary” was confounded with “alternative”, meaning that people who chose to refuse conventional medicine were mixed in with the people who chose an integrative health approach of combining complementary therapies with conventional treatment.
The merits and conclusions of the paper are also challenged by the fact that complementary medicine was defined as “other-unproven: cancer treatments administered by non-medical personnel”. Certainly, this does not include all the modalities applied in an evidence-informed manner by licensed rehabilitation professionals who are helping patients navigate through pain, fatigue, depression, physical impairments and activity limitations.
And finally, a warning flag should be raised over the JAMA Oncology article because it reported on 258 patients in the complementary therapy group while there were 1,901,557 people in the conventional cancer treatment group. This breakdown of groups makes no sense when multiple surveys have found that 50% to 88% of people with cancer use complementary approaches. That would mean that there should have been anywhere from 836,000 to 1.6 million people in the complementary therapy group.
So what should we take away from this?
#1 Don’t believe the headlines
#2 Read and critically appraise the primary source of information, in this case the article in JAMA Oncology, not the New York Times
#3 Language and words matter. Know what terms mean!
#4 People are living with chronic diseases and conditions that have no cure, yet the interventions provided by rehabilitation professionals, yoga therapists, psychologists, mental health counselors, nurses, etc. can have powerful and positive effects on people’s lives.