Introduction.

The fields of complementary and alternative medicine (CAM) and its evolving progeny, integrative medicine (IM), have become highly visible areas in clinical care as well as education and research. Although patient use of alternative therapies has been very high in multiple surveys, physician knowledge in these areas has sometimes lagged. Frankly, evidence in many so-called CAM therapies has in the past been thin or based on suboptimally designed or underpowered studies. This has further fueled physician concerns about safety and efficacy of certain alternative therapies. Another issue is that we as clinicians may sometimes feel "deskilled" when a patient arrives with a sheaf of Internet printouts, books, articles, and so forth about a product or therapy we know little about. This role reversal from expert to partner in decision-making can be challenging in the contemporary medical encounter, as can finding reliable information. Yet, questions on these topic areas now appear on United States Medical Licensing Examinations (USMLE), shelf examinations for students and house staff, and specialty board examinations such as internal medicine and family practice.

As part of the solution to these issues, more than 90 medical schools have introduced content areas in CAM. However, the preferred term is becoming "integrative medicine." (1) The Consortium of Academic Health Centers for Integrative Medicine (2) is a group of 27 medical schools with active programs in integrative medicine, and they have created a suitable definition: "Integrative medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches to achieve optimal health and healing."

Another part of the solution is the increasing quality of peer-reviewed publications regarding CAM/IM therapies. As the field matures, so does the level of evidence and quality of studies published. These are of inestimable value for practicing clinicians who may have had little formal exposure to many of these therapies and approaches. One of the fastest-growing areas of funding for research is now in the CAM/IM domain. The National Center for Complementary and Alternative Medicine and National Institutes of Health agencies funded more than $300 million in research last year in this area.

To address the challenge in finding reliable answers to clinical questions. Dr. Moshe Frenkel and colleagues discuss the context of patients who wish to combine alternative therapies with their cancer care. In addition to specifying some excellent research, they provide a useful algorithm on how to approach patient inquiries in this area. Dr. Julie McKee and her colleague, Dr. Sara Warber, take on the challenge of what to do in the post-Women's Health Initiative study era regarding the rational treatment of menopause. They present a realistic and reasonable approach to managing menopause that holistically embraces a variety of approaches from a patient-centered and evidence-based perspective.

While much attention has been paid in recent years to pain control, including requirements by the Joint Commission on Accreditation of Healthcare Organizations to properly assess and treat pain, the problem still exists in pediatrics. As Dr. Susie Gerik notes, pain is underdiagnosed and undertreated in the pediatric population. In her thoughtful review of the developmental stages of children and the way they process pain neurologically and psychologically, she provides an excellent foundation for sensitivity and understanding in this area. This is followed by a concise, evidence-based summary of helpful, safe, mind-body therapies for pain. Many useful tools and resources are included. Dr. David Rakel and Dr. James Rindfleisch address the increasingly visible role of inflammation in the pathology of disease, particularly vascular disease. Their article addresses the scientific basis of the antiinflammatory diet and gives practical and rational approaches for clinical application of dietary treatment for health promotion, disease prevention, and treatment. This is an area that will be increasingly important as our knowledge of nutrigenomics increases.

Dr. Jamal Islam and Dr. Mona Carter have done a superb job in sifting through the scientific literature about the use of Echinacea for upper respiratory infections. Multiple articles appear in the literature, both pro and con, and they offer the thoughtful clinician a stout overview of the evidence along with some practical guidelines for usage, product selection, indications, and dosing. Finally, Dr. Kathi Kemper and her colleague Dr. Suzanne Danhauer end the series on a fine note by surveying the utility of music and music therapy in the clinical setting. Using an evidence-based approach, their summary offers not only interesting help to the clinician but suggests the need for wider application and research about music as a healing modality.

Thanks to the editorial staff of the Southern Medical Journal, who invited me to be the Guest Editor of this CME special feature on CAM. I trust you will find it useful and that it will stimulate you to pay closer attention to the evolving field of integrative medicine. Note that its application is not about modalities and therapies so much as in treating the whole person, body, mind, and spirit, from a patient-centered, therapeutic relationship that embraces the widest array of scientific healing options, both conventional and alternative. I predict that this is the way that medicine of the future will be practiced. Indeed, it is an approach that excellent physicians already use.

The longer I live the more I see that I am never wrong about anything,
and that all the pains that I have so humbly taken to vertify my notions
have only wasted my time.
--George Bernard Shaw

Accepted December 13, 2004.

References

1. Sierpina V. Teaching integratively: how the next generation of doctors will practice. Integr Cancer Ther 2004;3:202-207.

2. Consortium of Academic Health Centers in Integrative Medicine (CAHCIM) http://www.imconsortium.org.

Victor S. Sierpina, MD

From the University of Texas Medical Branch, Galveston, TX.

Please note that contributors to this series belong to several CAHCIM centers: University of Michigan, Wake Forest University Health Sciences, and University of Texas Medical Branch.

Reprint requests to Dr. Victor S. Sierpina, 301 University Blvd., University of Texas Medical Branch, Galveston, TX 77555-1123. Email: [e-mail]