Integrative medicine and the quest for humanism in medicine.

The recent issues of this journal have repeatedly presented considerations on the use and appropriateness of the term ‘integrative medicine’ (IM) and its relatives such as ‘complementary medicine’ (CM), ‘complementary and alternative medicine’ (CAM), ‘integrative and complementary medicine’ (CIM). The editorial board has encouraged a broad discussion on the topic; symptomatically, the editors themselves have not yet reached a consistent view on the subject [1]. Internationally, the discussion is not likely to subside in the near future, either. This is not surprising. Even if these terms have first been coined in specific contexts, they have spread globally and are used to designate a large number of quite different non-conventional practices of many cultures and traditions with different forms and degrees of integration into conventional medicine (CON) and health care. This is not only a disadvantage. Certainly, in the wake of internationalization and globalization of CAM, CAM research and CAM regulation we need clear terms for clear communication. For this reason, the plan to develop a consensus-based terminology to describe CAM interventions within the framework of the EU FP7 project CAMbrella is highly welcome [2]. On the other hand, the complexity and openness of the situation and the struggle to clarify the meanings of these terms sharpen the awareness for what is at stake. This is not so much a semantic issue, but a question as to where the present culture of medicine and healthcare is heading. To my knowledge, the term ‘integrative medicine’ was first coined in 1992 by Thilo-Körner [3]. His central tenet was: ‘There is no alternative medicine because we do not know of alternative diseases. There is only one medicine, constantly developing and broadening, and the human with its individual disease. Because of the ongoing worldwide discussion about the future development of our medicine I, therefore, suggest the future oriented concept summarized by the term ‘‘integrative medicine’’’ [4]. This was to include the so-called school or scientific medicine, technical medicine, traditional European medicine (Naturheilkunde), homeopathy, spiritual medicine and complementary medicine in the sense of Heisenberg’s complementarity – a definition of CM, by the way, which was laid at the basis of this journal in 1994 and is characterized by ‘the fact that one and the same phenomenon can sometimes be described by very different, possibly even contradicting images’ [4]. It is noteworthy that Thilo-Körner was not a CAM-practitioner, but professor at the Department of Internal Medicine at a university hospital. This may indicate that, within CON itself, the need to extend the conventional scope of health care and to integrate hitherto unconventional elements has been noticed. This is even more true today. For example, the rapidly growing movement of IM in the USA has mainly been created within academic health care centers; dozens of IM centers have been installed at leading university hospitals, and the often cited definition of IM is the one introduced by the Consortium of Academic Health Centers for Integrative Medicine in 2005: ‘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, health care professionals and disciplines to achieve optimal health and healing’ [5]. This definition does not mention CAM at all, although it (can!) implicitly include it; and the self-understanding that goes with it regards IM as the integration of CAM in the paradigmatic and methodological frame of CON. This is sometimes seen as a threat of CAM by CON [6]. However, debates and definitions are in development, and the awareness seems to grow that profound changes are necessary within CON itself in order to meet patients’ demands. And it could very well be that CON will not just absorb CAM without changing itself, but also learn something from CAM