Integrative Medicine

Terms and their first appearances

A textual analysis of literature published between 1975 and 2013, summarised in a 2023 paper on terminology, found first instances of 'alternative medicine' in 1975, 'unconventional medicine' in 1980, 'complementary medicine' in 1984, 'complementary and alternative medicine' in 1994 and 'integrated' or 'integrative medicine' in 1995. These are first appearances in the literature analysed, not evidence of when the underlying ideas or practices began. The paper reports that 'integrative medicine' was the most recent of these terms and that its use has increased slowly each year.

United States institutions from the 1990s

A telephone survey of 1,539 US adults in 1990, published in 1993, found that 34 percent had used at least one of 16 unconventional therapies in the previous year and that 72 percent of those who used unconventional therapy had not told their medical doctor. The authors estimated 425 million visits to providers of unconventional therapy in 1990, more than visits to all US primary care physicians, and advised doctors to ask about such use when taking a medical history.

The timeline of the US National Institutes of Health centre now called NCCIH (National Center for Complementary and Integrative Health) dates the NIH Office of Alternative Medicine to 1991 to 1992, and the 2023 terminology paper gives 1991. The office became an independent centre in 1998 and was renamed NCCIH in 2014. A 2009 review by authors at the Arizona Center for Integrative Medicine describes integrative medicine as initially driven by consumer demand.

The Andrew Weil Center for Integrative Medicine states that it was established in 1994 by Andrew Weil at the University of Arizona. A 2020 news release from a US medical school says the Consortium (formally Academic Consortium for Integrative Medicine and Health) was founded in 1999 and, at that date, included more than 70 academic medical centres and health systems in the United States.

Use of the label outside the United States

Definitions of integrative medicine have also been published by Australian professional bodies, including the Royal Australian College of General Practitioners and the Australasian Integrative Medicine Association, and a 2023 paper from Australia describes growing interest in the practice over recent decades. A 2023 study from Germany describes complementary and integrative medicine as increasingly provided at university outpatient departments there, while noting that scientific evaluation is sparse. The sources reviewed do not trace the history of integrative approaches in other regions in detail.

Complementary, alternative and integrative

NCCIH describes a non-mainstream approach used together with conventional medicine as complementary, and one used in place of conventional medicine as alternative. It describes integrative health as bringing conventional and complementary approaches together in a coordinated way, with an emphasis on multimodal interventions, on treating the whole person and on coordination among providers and institutions. The page was last updated in April 2021 and uses 'integrative health' as its main term.

According to the 2023 terminology paper, the World Health Organization does not separate complementary from alternative medicine and gives no explicit definition of integrative medicine. The paper treats traditional medicine as a separate concept because it refers to a system originating in a region or culture, not to practices defined by their relation to conventional medicine. Its authors note that the terms are often used interchangeably despite differing theoretical definitions.

Definitions from professional bodies

Definitions quoted from Australian bodies describe integrative medicine as blending conventional medicine with evidence-based natural and complementary medicines and therapies and with lifestyle interventions, and state that it does not reject or compete with conventional healthcare. A 2020 news release describes the Academic Consortium's definition as a holistic approach centred on the whole person and the practitioner-patient relationship, using all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines. The qualifier 'evidence-based' is part of these definitions and is not a finding that every approach used has such evidence.

Hunter and colleagues conclude that distinguishing integrative from conventional medicine in general practice is context specific and not always possible, and they propose a category of overlap for items such as preventive health and lifestyle medicine. On that account, the label cannot be read as a fixed list of therapies.

Settings and organisation

The sources reviewed describe integrative care in several settings and do not describe a single standard visit. They include general practice in Australia, where researchers have developed criteria for classifying consultation items as integrative, conventional or both; a German university outpatient department for complementary and integrative medicine; and an inpatient consultation service at a 281-bed hospital in California, whose consultations could include counselling, acupuncture or trigger point injections depending on medical necessity.

A 2009 review by authors at the Arizona Center for Integrative Medicine proposes a model in which a primary health partner who knows the patient coordinates a team of practitioners, and it asks insurers to consider the value of longer office visits. This is a proposal by advocates for how integrative care could be organised, not a description of every clinic. The Andrew Weil Center says its work spans education, clinical care and research.

Patients and records in one university department

In a prospective evaluation at a German university outpatient department, 536 new patients over two years completed paper questionnaires at baseline and after 6 and 12 months, and physicians supplied diagnoses coded to the International Classification of Diseases, 10th revision. Mean age was 49.6 years, 75.7 percent were female, and the most frequent diagnosis groups were neoplasms (18.6 percent) and musculoskeletal diseases (17.9 percent). The study was descriptive, and its authors say the results should be verified in further prospective evaluations.

Reasons people seek unconventional and integrative care

In the 1990 US survey, most respondents who used unconventional therapy did so for chronic, not life-threatening, conditions, and 83 percent of those using it for serious medical conditions also sought treatment for the same condition from a medical doctor. In the German outpatient department, the most frequent diagnoses were neoplasms and musculoskeletal diseases. Neither source measures why a person chooses an integrative service in particular.

How advocates describe the aims

A 2009 review by Arizona Center authors describes integrative medicine as patient centred and healing oriented, emphasising the therapeutic relationship and using approaches from conventional and alternative medicine. It argues that attention to whole persons and to lifestyle change is relevant to chronic disease. The Andrew Weil Center states a mission of training health professionals and empowering individuals through evidence-based, sustainable, integrative approaches. These are advocates' statements of purpose, not research findings.

In cancer care, the Society for Integrative Oncology (SIO) breast cancer guideline addressed symptoms and adverse effects of treatment, including anxiety and stress, mood disorders, fatigue, quality of life, nausea and vomiting, lymphoedema, peripheral neuropathy, pain and sleep disturbance, using mind and body practices, natural products and lifestyle modifications.

Guidelines on individual therapies in cancer care

The SIO guideline on integrative therapies during and after breast cancer treatment, endorsed by the American Society of Clinical Oncology (ASCO) in 2018, drew on systematic reviews of randomised trials published from 1990 to 2015. It recommended music therapy, meditation, stress management and yoga for anxiety and stress, and meditation, relaxation, yoga, massage and music therapy for depression and mood disorders. Acupressure and acupuncture were recommended for chemotherapy-induced nausea and vomiting. It found no strong evidence for ingested dietary supplements and did not recommend acetyl-L-carnitine for preventing neuropathy, citing possible harm.

The 2024 ASCO-SIO update on cancer-related fatigue in adult survivors reviewed 113 randomised trials published from 2013 to 2023. Exercise, cognitive behavioural therapy and mindfulness-based programmes improved fatigue during and after treatment; tai chi, qigong and American ginseng showed benefit during treatment, and yoga, acupressure and moxibustion after it. Other dietary supplements did not improve fatigue. Certainty and quality of evidence were low to moderate.

Evidence on integrative care as a whole

Most research addresses single therapies, not an integrative service as a package. A 2012 systematic review of economic evaluations of complementary and integrative medicine, searching to 2010, identified 338 evaluations; of 114 full evaluations published from 2001 to 2010, 90 percent of these covered single therapies and only one compared usual care with usual care plus access to several licensed practitioners. Of 56 comparisons in the higher-quality studies, 16 (29 percent) showed health improvement with cost savings, and the authors describe the evidence of cost-effectiveness as emerging.

Service-level studies are mostly uncontrolled. A retrospective study of an inpatient consultation service at a Los Angeles hospital compared 165 patients with their own earlier admissions and reported 30-day readmission of 33.0 percent before and 4.6 percent with the consultation (odds ratio 0.10, 95 percent confidence interval 0.06 to 0.17). That design does not allow the effect of the consultation to be separated from other changes between admissions. The German outpatient study reported the severity of the main complaint, on a 0 to 10 scale, falling from 5.2 to 3.9 among 187 patients who returned six-month questionnaires, without a comparison group.

What the sources do not establish

No source reviewed reports a randomised comparison of an integrative medicine clinic, as a complete model of care, with conventional care on patient outcomes. PubMed and Europe PMC searches run for this draft for systematic reviews and trials of integrative medicine clinics did not return one, although those searches were not exhaustive. Findings for a single therapy in one cancer-care setting should not be transferred to other conditions, other therapies or the integrative model generally.

Objections to integration as a model

In a 2005 viewpoint in Academic Medicine, Kaptchuk and Miller compared three possible relationships between mainstream and alternative medicine: opposition, integration and pluralism. They argued that, although advocates speak of evidence-based complementary medicine, integration fosters double standards for validating conventional and unconventional treatments and overlooks differences in the underlying beliefs and practices of the two systems. They favoured pluralism, meaning cooperation without integration, and said physicians should be prepared to disagree with patient choices and urge patients not to forgo medically indicated treatment.

Concerns about legitimacy, harm and cost

A 2018 article in The Surgeon, whose title asks whether integrative medicine is infiltrative pseudoscience, argued that growing use of complementary and alternative medicine at institutions known for evidence-based care risks harm through interactions with evidence-based medicines or through patients forgoing such care, imposes out-of-pocket costs, and legitimises practices not tested rigorously. Its authors treated integrative medicine services as part of that wider field. This is critical commentary; the definitions quoted by professional bodies, by contrast, limit integrative medicine to evidence-based approaches.

Definition and measurement limits

The 2023 terminology paper states that a lack of consistent definitions remains a challenge for researchers, clinicians and organisations, and its operational definition drew on a systematic search that yielded 604 therapies. Hunter and colleagues add that inconsistent operational definitions in primary studies of integrative medicine have hampered systematic comparison between regions. Studies that use the label differently cannot be pooled or compared without care.

Telling every clinician

In the 1990 US survey, 72 percent of respondents who used unconventional therapy had not told their medical doctor, and the authors advised doctors to ask about it. NCCIH advises people with cancer to discuss any complementary approach with their oncology team before using it, even when the reason seems unrelated to the cancer. Coordination across clinicians is part of how integrative health is defined, so what each clinician knows affects how well it can operate.

Supplements, interactions and replacing care

NCCIH states that some herbs may make chemotherapy drugs less effective and that dietary supplements, including antioxidants, might interfere with chemotherapy or other cancer therapies. It advises against using unproven products or practices to replace or delay medical treatment for cancer. The ASCO-SIO guidelines found no strong evidence for ingested supplements for treatment adverse effects and advised against acetyl-L-carnitine in 2018 and L-carnitine in 2024.

A US observational study followed people with non-metastatic breast, prostate, lung or colorectal cancer who chose alternative medicine as their only anticancer treatment, matched 2 to 1 with people who received conventional treatment. Alternative medicine was associated with a higher risk of death (hazard ratio 2.50, 95 percent confidence interval 1.88 to 3.27), and its authors describe such use as rare. The study concerns alternative medicine instead of conventional treatment, which is not what integrative medicine describes, and its observational design leaves room for confounding.

Training and professional standards

A 2025 review by a task force of the Academic Consortium reports that integrative medicine fellowships have grown over the past decade. It revised the field's core competencies after a systematic review of existing competencies and a survey of 23 fellowship programmes (96 percent response), adding health equity, trauma-informed care and interprofessional collaboration. These competencies are set by the field's own academic consortium, and the sources reviewed do not establish a single international training standard; requirements differ by country and by the clinician's own discipline.

Integrative care does not remove the need for conventional assessment. A new or worsening symptom, or a decision about stopping or replacing prescribed treatment, is a matter for the person's treating clinicians.