42 Complementary Medicine
National dialogue and legislative action occurred in 2010 that addressed health care reform. This reform focused largely on who would pay for health care, how much it would cost, services covered, who would have health care, and the role of insurance companies as a vehicle for accessing much of it. Less visible was the conversation taking place in health care clinics among providers and their patients, and among academicians, researchers, and economists. This dialogue is not new; it is gaining momentum and causing a paradigm shift. It is about the underlying clinical, academic, and philosophical foundations that drive conventional Western medicine, and it is causing the institutionalization of what was once regarded to be unconventional therapy into the mainstream education and practices of nursing and medicine.
The realization that change was needed is eloquently described by many conventional practitioners: “What we have now is a ‘sick care’ system that is reactive to problems. The integrative approach flips the system on its head and puts the patient at the center, addressing not just symptoms, but the real causes of illness. It is care that is preventive, predictive, and personalized” (Snyderman, 2010). For example, the health care system must “take account of the insufficiency of science and technology alone to shape the ideal practice of medicine” (Snyderman and Weil, 2002, p 5). “If clinicians understand this concept, they will recognize that they must start their relationship with their patient from an entirely new place” (Gaudet, 2010, p 29).
What follows will bring the reader to a better understanding of how the health care system model may be changing as a “gathering” of human wisdom endeavors to join rather than continue to divide a patient into small pieces.
Use of Complementary Therapies
It is estimated that in some Asian and African countries, 80% of the population rely on non-Western or indigenous traditional medicine for primary health care. In many developed countries, 70% to 80% of individuals have used some form of alternative or complementary treatment (World Health Organization [WHO], 2008). According to an analysis of the 2007 U.S. National Health Interview Survey (NHIS) (Barnes et al, 2008), 38% of adults and 12% of children younger than the age of 18 years (with or without congruent conventional medicine) reported using some form of complementary or alternative medicine (CAM) within the prior 6 months. Vitamins and minerals were not included in these statistics. It is surmised that the reported rates in children may be higher in immigrant communities, where cultures using nontraditional medicine regard such practices as mainstream rather than “alternative” (Lazar, 2008). Birdee and colleagues (2010) found that nearly five times as many children used CAM if a parent also reported using CAM.
Complementary Medicine Use in Children
For the first time, the 2007 NHIS elicited information regarding CAM use by specific age groups younger than the age of 18 years. Results revealed use rates at 7.6% in those birth to 4 years old; 10.7% for 5- to 11-year-olds; and 16.4% of those 12 to 17 years. For those between 18 and 29 years, CAM use was 36%. In those less than 18 years the most commonly used therapies were natural products (most commonly echinacea, fish oil/omega 3, combination herb pills, and flaxseed oil/pills), chiropractics, deep breathing, yoga, homeopathic treatment, traditional healers, massage, meditation, diet-based therapies, and progressive relaxation. CAM therapies were used predominantly for back and neck pain; head or chest colds; anxiety and stress; other musculoskeletal conditions; attention-deficit/hyperactivity disorder (ADHD); and insomnia. Mind-body therapies were most commonly used for anxiety and stress, insomnia, and nausea and vomiting; biologically based therapies were used for symptoms of fever, insomnia, reflex, and sinusitis; and manipulation/body-work was used for abdominal pain, musculoskeletal conditions, and nausea and vomiting. Additional common medical conditions or symptoms for which CAM was used included allergies, asthma, dermatological conditions, developmental disorders, gastrointestinal (GI) conditions, headaches, insomnia, learning disabilities, overweight, and psychological conditions. These treatment modalities were not broken down by age group.
Further analysis of the 2007 NHIS led to a more complete description of the child population using CAM. Use was higher among adolescents, non-Hispanic Caucasians, and those living in households earning more than $65,000, who had a college-educated parent, and who lived in states other than the South. Use was higher in those with private medical insurance and in those who also took prescription medicines in the last 3 months. The chosen therapies were used not only to treat illness but also to prevent it. CAM use in children was often predicated on difficulties accessing medical care; also they experienced higher school absenteeism because of illness. The higher the number of health conditions and clinic visits in the past year, the more likely the child was to seek CAM treatment. There was little difference between CAM use and gender or race except when biologically based and manipulation/bodywork therapies were chosen (Birdee et al, 2010).
A literature review by Kemper and colleagues found that approximately 20% to 40% of general pediatric patients had used CAM therapies. The number increased to 50% for children with chronic, recurrent, and incurable conditions (Kemper et al, 2008a); to 64% for children with special needs, as defined by the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services (Sanders et al, 2003); up to 79% for adolescents (Wilson et al, 2006); and up to 70% for homeless adolescents (Kemper et al, 2008a). The use of dietary supplements (multivitamins, minerals, iron, ergogenic agents) by young children was greater than 50% and from 27% to 30% by adolescents (Gardiner et al, 2004; 2008).
Little has been known about the use of homeopathic products (HP) remedies in children. Notable is a study that was administered to the same cohort of children at seven different times from their birth to 8.5 years of age. Slightly less than 12% used HP, with the most common time for administration around 7 years of age. Parents were self-treating children with HP 46% of the time versus having the remedy prescribed by a general practitioner (10%). Ten percent of the parents voiced uncertainty in the definition of HP. Chamomilla for teething and colic and arnica for soft-tissue bruising or cuts were the most commonly used products (Thompson et al, 2010).
Adolescents and their CAM use patterns have received some focus. Reznik and coworkers (2002) revealed that 80% of adolescents reported using CAM therapies for asthma. Wilson and colleagues (2006) showed a correlation between being female, having a positive attitude about CAM use, and being 16 to 17 years of age. Ginseng, zinc, echinacea, ginkgo, weight loss supplements, and creatine were commonly cited supplements in use, with 9% being taken at the same time as prescription medicines in the previous month. A desire to alter body shape was linked with the use of weight loss products and creatine. Those who suffered from chronic headaches reported increased use rates; those reporting fair or poor health status were less likely to use supplements (Gardiner et al, 2008).
Reasons cited by parents for choosing an array of CAM therapies for their children include the following (Barnes et al, 2008; Gardiner et al, 2004):
• Maintenance of health and prevention of diseases
• Limited access to or dissatisfaction with traditional care; ready access to CAM practitioners
• Failure of traditional medicine to have an effect on chronic conditions (six or more concurrent health conditions are associated with higher CAM use) (Barnes et al, 2008)
• Awareness of complications and side effects produced by pharmaceuticals
• Discomfort associated with invasive procedures or diagnostics
• Belief that alternative practices are more natural, less harmful, and more effective
• Belief that by combining conventional and nonconventional treatment a more effective approach to health care is achieved than either practice alone affords
• Awareness of the mind-body connection to affect the immune system response
• Desire for more parental, active participation in their child’s treatment
History of Complementary Medical Practices in The United States
Before 1910, many different medical and apprenticeship schools allowed graduates to be licensed and referred to as “doctors.” With acceptance of the 1910 Flexner report, all medical training, licensure, and regulation in the U.S. became standardized with “approved” medical education based on science and research. Only medical training schools that could meet the rigorous Flexner standards were accredited; graduates were recognized as legitimate medical doctors. Although these standards effectively put many charlatans and snake oil medical practitioners out of work, many other nonconventional medical practitioners were also disqualified or their practices severely limited. The philosophies and practices of chiropractic, naturopathy, osteopathy, homeopathy, herbal treatments, and others fell into the unaccredited category. By excluding these disciplines, the medical community failed to consider the efficacy, benefits, and applications of the healing and treatment theories that these other practices had to offer. Rapid advances in immunology, pathology, and the seduction of technology solidly secured the dominance of the rational-empirical approach, which became known as Western, allopathic, conventional, biomedical, scientific, rational, regular, orthodox, or mainstream medicine. All ailments were expected to fit within a scientific conceptual framework (Janiger and Goldberg, 1993).
In the 1960s a number of doctors and patients began to express disillusionment with the strict limitations of accepted medical practices. The “holistic” health care movement of the 1970s evolved as patients and disaffected medical providers began to refocus health care toward healing, prevention, and the spiritual and environmental factors that affect health. From these contexts, the current trend toward combining the best of Western and nontraditional medicine grew.
Certain basic principles are common to all nonconventional treatment modalities (Micozzi, 1997). These principles include the following:
• A focus on wellness, that, in turn, prevents illness
• Self-healing—focusing external manipulations that stimulate the body’s internal healing processes
• Bioenergy—ensuring that the body’s energy forces are balanced
• Nutrition, plants, and other natural products—obtaining nutrients from natural food sources to maintain or return to health
• Individuality—recognition and use of the individual’s unique constitution, inner resources, and so forth to achieve health
Moving Towards an Integrated Health Care Model
Various phrases have been used to describe health practices that are not fully embraced by conventional Western medicine practices. These terms include alternative, complementary, contemporary, holistic, integrative, folk, irregular, mind-body medicine, natural, New Age, new medicine, nonconventional, nontraditional, quackery, and vernacular medicine. Representatives of both the dominant and nondominant medical practices more routinely use the terms complementary and integrative instead of alternative. Dr. Wayne Jonas, the first Director of the Office of Alternative Medicine at the National Institutes of Health (NIH), observed that these terms represented “practices that aren’t part of the politically dominant medical system of a country” (Wysocki, 1997, p 4). To be acknowledged as a component of the dominant medical system, a particular medical practice must be taught in medical schools, be available in hospitals or conventional health clinics, and be reimbursable by third-party payers (Wysocki, 1997). A Bravewell Collaborative report summarizes the position of integrative medicine practitioners and educators: “Integrative health care is derived from lessons integrated across scientific disciplines and it requires scientific processes that cross domains. The most important influences on health, for individuals and society, are not the factors at play within any single-domain genetics, behavior, social or economic circumstances, physical environment, health care—but the dynamics and synergies across domains. Medical and basic science research tend to examine these influences in isolation, which can distort interpretation of the results” (Bravewell Collaborative, 2010, p 27).
The integrative approach is not without its critics. Cassileth summed up the criticism by stating that “not all mainstream physicians are pleased with CAM, with current efforts to integrate CAM into mainstream medicine, or with a separate NIH research entity for ‘alternative’ medicine” (Cassileth, 1999, p 365).
The most effective treatment may involve using therapeutic applications from several different approaches. Successful primary health care providers benefit from moving between paradigms without prejudice, gleaning what is of value, and knowing when referral to a complementary medical practitioner is appropriate. Table 42-1 lists many of the complementary therapies in use. (Specific applications to pediatric or adolescent diagnoses are discussed at the end of the chapter in Table 42-5.)
TABLE 42-1 Complementary Therapies and Their Applications
| Nonconventional Therapy | Theory Behind Use | Treatment Applications∗ |
|---|---|---|
| Acupressure | Similar principle as acupuncture but uses fingertips instead of needles to apply pressure (see Acupuncture)Also incorporates breathing techniques to aid healing by balancing mind-body-spirit | Muscle tension, targeting a specific organ or glandular systemsUsually more acceptable to children than acupuncture |
| Acupuncture | Hair-thin needles inserted at specific anatomical points to mobilize a limbic-paralimbic-neocortical network and its anticorrelated sensorimotor/paralimbic network at multiple levels of the brainThe hemodynamic response is influenced by the psychophysical response (Hui et al, 2010)Blockages in energy flow patterns are altered along “meridians” and stimulate body to produce pain-relieving and mood-lifting chemicals or antiinflammatory substances (sterile, disposable needles should always be used) (University of California, Berkeley, 1998). | Morning sickness of pregnancyPostoperative dental painChronic pain (including headaches)AllergiesAsthmaNausea and vomiting (including chemotherapy induced and postsurgical)Menstrual crampsMigraine headachesLow back painAddictions (e.g., smoking)Musculoskeletal pain (e.g., arthritis, fibromyalgia, carpal tunnel syndrome, tendinitis) |
| Aromatherapy | Uses pure, essential, volatile oils containing oxygenated molecules to transport nutrients to cells of the bodyBelieved to promote immunity and create a cellular environment in which disease-causing bacteria, fungi, and viruses cannot liveAromas of essential oils are either inhaled or absorbed through the skin. When inhaled, believed to activate the brain’s amygdala (associated with memory and emotions).Taught in medical schools in France; used in Japanese in factories to increase productivity (Krebs, 2006). | Stress, anxiety, depression, agitationFatigueImmune disordersAcute and chronic painInsomniaIntrapartum: strengthens contractions |
| Ayurvedic medicine | The traditional form of medicine practiced in Indian culturesTreats imbalances or “dosnas” within body that cause illness by using diet changes, herbal remedies, breath work, physical exercise, hatha yoga, meditation, and rejuvenation or detoxification programsFocuses on preventing disease by enhancing the mind-body connection. | For primary health care disorders involving GI systems, GYN, respiratory tract, bones and muscles, circulation (including cardiovascular), emotional, and psychological, addictions, ENT |
| Balneotherapy | Therapy focuses on the beneficial effects of medicinal waters and involves bathing in water of various types (e.g., in reduced-sulfurous mineral water). | Low back pain, muscle spasm, stress, promotion of healing (Balogh et al, 2005) |
| Biofeedback | Empowers the mind to take control of conscious and autonomic processes (Frishberg, 1998); relaxation is focused on one muscle or function rather than on the whole body. | Chronic pain, HTNInsomnia, circulationTension and migraine headachesIncontinence (urine and fecal)Stroke rehabilitationPTSD and depressionChronic tinnitusChronic facial nerve palsyTorticollisIn children: chronic pain (e.g., sickle cell crises), JRA, RAP, functional voice disorders, improve sphincter control associated with urinary and fecal incontinence, postural training for scoliosis, ADHD (Allen, 2004) |
| Chelation | Involves IV injections of binding (chelating) agents that attach to toxic metals and wastes in the body that are then excreted in the urineDiffers from detoxification that uses diet or liquids to “cleanse” bodily systems such as the liver, colon | Lead poisoningArteriosclerosisAutism (experimental) |
| Chiropractic (contraindications: malignancies, bone or joint infections, acute fractures, arthropathies) | Regards the spinal column as the center of body’s well-beingUses manipulation and massage of spinal vertebrae to restore proper flow of nerve impulses. | Musculoskeletal pain, including chronic low back pain, headachesTorticollisWhiplash following MVA |
| Chromotherapy (color or light therapy) | Uses human sensitivity to color to identify energy pattern imbalances. Each of the seven colors used is regarded as having healing energies (e.g., blue is sedating). | Stress, depressionFatigue |
| Craniosacral mobilization | Manipulates craniosacral mechanisms to free the flow of cerebrospinal fluid pathways that surround brain and spinal cord; flow can be inhibited by injury to the brain, spinal cord, skull, sacrum, and related membranes | TMJHeadachesSkull injuries with resultant chronic painPoorly fitting denturesColic, vomiting, hypertonicity, tremor, irritability in infancyObstetrically complicated delivery for infantADHD |
| Deep breathing | Helps quiet the mind; involves taking slow, deep inhalations through the nose while counting to 10, then slowly and completely exhaling for another count of 10. This is repeated 5 to 10 times, a few times a day. | Stress and/or tension, anxietyInsomniaHTN, headaches |
| Diet (e.g., vegetarian, macrobiotic, Atkins, Ornish, Pritikin, Zone) | Desired effects achieved by eliminating calories, increasing fiber, decreasing fat, restricting fluids, or altering body’s metabolism by manipulating production of key hormones | Weight lossPrevention of heart disease and arteriosclerosis, HTN, diabetes, to enhance athletic performance |
| Folk medicine (e.g., curanderismo, Native American healing, shamanism) | Form of healing embedded in many cultures; administered by folk healers who are often believed to have a gift passed down through generationsPractices may involve prayer, healing touch, charms, herbal teas, tinctures, and magic rituals. | Maladies treated run the gamut of those seen in primary health care; many symptoms culturally based or have culturally based interpretation of disease |
| Guided imagery | Involves relaxation followed by visualization of calming images; technique practiced 20 to 30 minutes, several times a week | Chronic conditions including headaches, stress, HTN, anxiety; adjunct to cancer treatment |
| Herbalism (many phytomedicinals are not recommended for use in children (see Box 42-4) | Natural herbs are used over pharmaceutical derivatives; practitioners believe them to be as efficacious, gentler, and less toxic; used extensively by naturopathic, homeopathic, and holistic practitioners; appropriate preparation (tea, capsule, topical) of the herb important; the dried or extract form of the plant may be used. | Used in place of many pharmaceuticals to treat a myriad of primary health care entities, including PMS, cardiovascular, insomnia, stress, menopause, GI, respiratory, immunity, energy, and memory (see Table 42-5) |
| Hippotherapy | Uses the unique movements of a horse to achieve therapeutic benefits | Balance, fear, anxiety, lack of confidence, motor (may also improve energy expenditure during walking in those who have CP) and social delays in childrenMental illness |
| Homeopathy | Stimulates a healing response by introducing a substance that is either the same as or similar to the patient’s diseaseInfinitesimal doses of plants, minerals, and animal matter are usedMedicinal products are prescribed on the basis of the “law of similars”—the medicine used is “homeopathic” to the symptoms presented. | Used by many for wide range of primary care illnesses (e.g., respiratory ailments, headaches, diarrhea, teething, toothaches, arthritis, dermatology problems, GI ailments, depression, and anxiety) |
| Hypnosis | Uses an altered state of consciousness to access various levels of the mind to effect changesCan be self-learned; usually practiced by a hypnotist or hypnotherapist | Weight loss, drug addictions, smoking cessation, insomnia, pain and stress reduction, phobias |
| Magnets, electromagnetic therapy (contraindications: pacemakers, defibrillators, acute injuries to bone and muscles, first-trimester pregnancy). Not to be confused with static magnetic therapy (sold as pads, shoe inserts, jewelry). | The use of magnetic field or biofields purport to produce vascular responses by releasing chemicals in response to injury and inflammation. The resulting vasodilation increases blood flow and directs it more quickly to stressed or injured areas, aiding the healing process; may interfere with electric impulses triggering pain or stimulate release of natural body painkillers (endorphins). Mechanism not clear (Miller, 2004). | Musculoskeletal painHeadachesNauseaOsteoarthritis of knee and cervical spineNeck painChronic pelvic painFracture therapy, soft tissue injuryParkinson disease (experimental) |
| Massage therapy (contraindications: clotting tendencies or communicable skin condition) | Hands-on bodywork techniques that knead and manipulate muscles, soft tissues, and connective tissues of the bodyUsed to promote healing and relaxation, relieve sore and injured muscles, and improve one’s overall sense of well-being and health | Premature infants, low birthweightCocaine- and HIV-exposed infantsColic in infantsInfants with disturbed sleep patternsAutistic childrenDiabetic children to help normalize glucose levelsAsthmaArthritisHIV patientsChronic fatigue syndromeStress-induced maladiesAcute and chronic painDigestive disordersCirculatory problems, lymphedemaMusculoskeletal injuriesHeadaches |
| Meditation | A deep relaxation technique that can take many forms, from repeating a mantra to Sufi dancing | Stress-induced maladiesChronic illnesses |
| Megavitamin or high-dose vitamins | Use of vitamins beyond the RDACan produce adverse and/or toxic effects | Prevention and treatment of a myriad of illnesses (e.g., cancer, heart disease, schizophrenia, viral infections) |
| Music therapy | Music used to provide rhythmic cues to stimulate brain’s motor systems to help build and strengthen connections among nerve cells in the cerebral cortexBoosts immune function in children | Physical rehabilitation of stroke, cerebral palsy, Alzheimer, Parkinson, ADHD, learning disabilities, Down syndrome, depression and anxiety, hypertensionPain relief (surgical, during labor)Premature infants (increases weight gain in premature infants [Lubetzky et al, 2010]) |
| Naturopathy | Natural remedies used to help restore health and balance in the body (e.g., diet, herbal medicine, hydrotherapy, acupuncture, homeopathy, and therapeutic massage)Practitioners often use similar diagnostic and testing procedures as Western medicine practitioners | Used by many for most primary health care issues (see Table 42-5) |
| Nutrition | Stresses wisdom of following healthy, balanced diet to affect diet-related health issuesAdvocates the food pyramid or FoodPlate guidelines | Weight lossFood allergiesVitamin and mineral deficienciesNonpathological GI conditions (e.g., constipation)Chronic diseases |
| Osteopathy | Remobilization of joints and tissues to restore them to normal, structural positions and mobility, thus releasing tension in muscles and ligaments. | Musculoskeletal pain, including chronic back pain and headachesTorticollisWhiplash following MVA |
| Pet therapy | Therapy uses dogs, cats, and birds to help those with psychological issues. | Anxiety, social isolation, poor sense of well-being, antipathy |
| Pilates | Works on mind-body connection with exercise techniquesRelies on exercising with firm support and stretching without straining to improve overall body flexibility and fitness | Restricted body flexibility |
| Prayer | Works on mind-body connection by using the strongly held belief of the connection between the self and a higher power.The most commonly relied on healing practice by people of all cultures and religious beliefs | All forms of health, illness, disease, and disability |
| Progressive relaxation | Successive tensing and relaxing each of the 15 major muscle groups, starting from the head; often used with deep breathing | Stress, tension, insomnia, anxiety, pain, HTN |
| Qi gong | Ancient Chinese practice combining gentle physical movements, mental focus, and deep breathing. Believed to integrate mind, body, spirit, and stimulate movement of vital life energy (qi). A learned series of movements—often organ specific—done 2+ times a week for 30 minutes. | Asthma, arthritis, stress, lower back pain, allergies, diabetes, headaches, CVD, HTN, chronic pain, autism (Silva et al, 2009) |
| Reflexology (use with caution in patients with deep vein thrombosis, leg ulcers, phlebitis in lower extremities, pregnancy, pacemakers; avoid renal reflexes in patients with suspected renal calculi; avoid kidney and gallbladder reflexes in patients with gallstones) | Massage technique based on the principle that proprioceptive nerve receptors in hands and feet correspond to all parts of the body, including organs and glands. Use thumb and fingers to massage reflex areas to detect diseases and to rebalance vital energy. | Stress and anxietyPromote circulationColic, irritability and reflux in infantsHeadachesLow back painSome allergic responsesSome dermatology conditionsGI tract disordersMenstrual problemsArthritis and sciatica |
| Reiki (aka energy healing therapy) | A bodywork technique to stimulate healing energy within body | Musculoskeletal maladiesLow blood hemoglobin levelsPain control (including from cancer, fractured bones)Stress and grief |
| Tai chi | Stimulates and balances flow of chi or vital energy along acupuncture meridians | Restricted body flexibility, fitness, stamina and energy, stress |
| Traditional Oriental (Chinese) medicine | Combines practices and beliefs of acupuncture, acupressure, herbal remedies, massage, dietary changes, and bodywork, such as tai chi, breathing, and meditation, to stimulate vital body energy to rebalance life force | Used by one fourth of world’s population for primary health care disorders involving GI systems, GYN, respiratory tract, ENT, bones and muscles, circulation (including cardiovascular), emotions and psychology addictions |
| Touch, therapeutic or healing | Based on autonomic nervous system effects using the subtle energy fields, vibration field, nonlinear electromagnetic energy, spirit or vital forceLowers heart rate; leads to relaxation, reduces anxiety, pain and enhances sense of well-beingSimilar to qi gong, Reiki | In children reduces anxiety, worry; insomnia, asthma, fatigue, isolation, pain (Kemper et al, 2009), abdominal, arthritis, backache, burn, bruises, cancer, fibromyalgia, headache, postoperative pain (Kemper and Kelly, 2004) |
| Yoga | Works on breathing, body alignment, and posture to improve health; preventive | Chronic musculoskeletal ailmentsStress-related maladiesImproving overall body flexibility, fitness, stamina, mental healthAsthmaHypertension |
ADHD, Attention-deficit/hyperactivity disorder; CP, cerebral palsy; CVD, cardiovascular disease; ENT, ears, nose, and throat; GI, gastrointestinal; GYN, gynecology; HIV, human immunodeficiency virus; HTN, hypertension; JRA, juvenile rheumatoid arthritis; MVA, motor vehicle accident; PMS, premenstrual syndrome; RAP, recurrent abdominal pain; RDA, recommended dietary allowance (established by the National Academy of Science); TMJ, temporomandibular joint.
∗ These applications may or may not be supported by scientific research; the listing of these therapies does not imply endorsement of proven efficacy.
Some data from Gasalberti D: Alternative therapies for children and youth with special health care needs, J Pediatr Health Care 20(2):133-136, 2006.
The Role of Primary Health Care Providers in an Integrated Health Care System
Medicine needs to return to an “art of healing,” for “dependence on the ‘quick fix’ has made us less self-reliant regarding matters of health. The focus in medicine should be on creating an environment in which the body needs as few of these fixes as possible, and people become less dependent on the medical system, not more” (Rakel, 2003, p 8). The Bravewell Collaborative offers a Patient’s Bill of Rights for delineating what individuals should expect from their health care system and providers (Box 42-1). The updated “role” of the clinician who uses the integrative medicine model focuses on the patient as a unique individual, looks at the complex phenomenon of health and disease, appreciates the concept of inherent healing capacity, and uses scientific research (Stumpf et al, 2008). Patients are seen as the primary agents influencing the status of their own health; the practitioner helps mobilize the interplay between biology, behavior, psychosocial factors, and environment. One practitioner describes the effort as one of augmenting host resistance (enhancing the overall immune response or constitutional state) rather than one of attacking the disease (treating, controlling, and suppressing symptoms) (Schoch, 1999).
BOX 42-1 Patient’s Bill of Rights
As an Individual, You Have:
• The right to person-centered care
• The right to receive health care that addresses the wholeness of who you are—body, mind, and spirit in the context of community
• The right to a health care system that focuses on prevention and wellness
• The right to be empowered as the responsible central actor in your own healing
• The right to education about self-care that includes access to scientifically based nutrition, exercise, and mind-body interventions
• The right to a healing relationship with your health care provider that is grounded in humanism, compassion, and caring
• The right to speak openly and honestly with your health care providers and in return, to experience honest and supportive communications from all members of the health care community
• The right to a health care environment that recognizes that to be healing and empowering, health care providers themselves must seek to be restored and whole
• The right to embrace the spiritual dimension in the context of your health care
• The right to health care providers who understand that integrity and spiritual qualities are as important as medical knowledge and technical skills in the process of healing
• The right to a truly integrative medicine that is supported by rigorous scientific research, maintains the highest standards of excellence, and offers a full and complete array of care modalities
• The right to healing even when there is no cure
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