Integrative Care
Policy News

Examples of Promising Integrative Care

31 May, 2013 by Johanna Hök

For three days in April 2013, 500 researchers from all over the world gathered in London for the 8th international congress on complementary and alternative medicine research (ICCMR). As a participant and co-organiser, I C’s Johanna Hök reflects about the congress and it’s contributions including some of her favourite examples of research: a study on yoga for depression, a diet intervention and, patients’ experiences of manual therapies within the National Health Care System in the UK.

It is clear that the scientific presentations and discussions at this congress were no longer questioning if the field of complementary and alternative medicine (CAM) has anything to offer healthcare systems around the world. Rather the question is how CAM can contribute to health for all according to the WHO millennium goals.

This is not to say however, that all CAM should be embraced uncritically by national health care systems. Rather, the scientific contributions and its audience at this congress are all about trying to figure out how science can help policymakers make wise and evidence-informed decisions in this field.

Finding  sustainable solutions
The main questions at the congress were:

  • How can CAM and integrative care help meet the needs of persons with long-term conditions?
  • How can we develop sustainable solutions to healthcare ills?

Judging from the list of congress delegates, there is a diverse and multi-professional crowd trying to answer these questions.

Diversity of scientific disciplines
As part of the congress committee, I was proud to see a diversity of high quality contributions from the fields of pharmacology, pharmacognosy, medicine, nursing, psychology, sociology, and health economics represented.

Clearly, CAM has become a multi-disciplinary field where multiple research methods are used to explore future possibilities of integrative care, a trend that is also seen in our results from the European project CAMbrella (see publications from CAMbrella), which mapped out the future needs of CAM research in Europe.

Almost 3000 reviews published
One step towards finding a solution for a sustainable future of CAM research and information worldwide was demonstrated by the keynote lecture given by Professor Brian Berman, University of Maryland School of Medicine, Center for Integrative Medicine.

Professor Berman spoke, together with his colleague Eric Manheimer, about the work of Cochrane Collaboration’s CAM field and its reviews of CAM trials. Since 1996, the Cochrane CAM field has identified published clinical trials in the field of CAM, summarized these into rigorous scientific reviews and disseminated these to the general public.

As of April 2013, the group had published almost three thousand (2 738) Cochrane Reviews related to the field of CAM in a number of health areas. The group is also working to develop methodology and to train more researchers and CAM practitioners in the methods of conducting systematic reviews. Learn more about the work of the Cochrane CAM field, or the Cochrane reviews.

Limitations of Cochrane reviews
One should however note, that most congress participants, including myself, seem to agree that although important, Cochrane reviews have their limitations. That means they must be interpreted with care and supplemented by other kinds of research such as cost-effectiveness research, safety research and qualitative studies.

The importance of the recognition of multiple research methods was also a key element in the CAMbrella recommendations to the EU regarding future research actions in the field (see publications from CAMbrella). Read more about this complex issue in a previous IC article by David Finer (in Swedish) here.

My three favourite examples
The congress contributions presented a range of ideas regarding how CAM and integrative care may present sustainable solutions for chronic illness (or not when for example there may be issues around the safety of a certain method).

While it is beyond the scope of this brief report to mention all the important contributions, I have selected three of my favourite examples from different stages in the research process.

1. Healthy doctors – healthy patients
Professor David Eisenberg, Associate Professor of Nutrition at the Harvard School of Public Health and Executive Vice President for Health Research and Education at the Samueli Institute, addressed the problem of unhealthy dietary habits among patients with diabetes.

He presented on-going work using a nutritional and culinary intervention with the long-term aims to increase health care providers’ success in advising their patients about a healthy lifestyle.  The idea was to improve health care providers’ own lifestyles in terms of a healthier diet and to see how this in turn could trickle down to the lifestyle of their patients.

Despite the small material of 219 providers, completing a 4-day course in nutrition and culinary skills, combining theory and practice, Eisenberg and his co-authors conclude that this may be enough to alter providers personal and professional nutritional-related behaviours.

2. Manual therapies for low back pain
Low back pain is also a widespread chronic illness problem. Dr. Felicity Bishop presented qualitative results regarding patients’ preferences and reasoning in response to the NICE (UK’s National Institute of Health and Care Excellence) guidelines for low back pain from 2009. One of the frontline recommendations is for providers to consider “offering a course of manual therapy, including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks.”

Dr. Bishop had conducted 13 focus group discussions with 75 patients receiving care at the NHS since the guidelines were implemented. She addressed the diversity of opinions regarding all the different treatment options recommended by NICE. Her results show that people are willing to try many things as long as they think they might improve their pain.

On the other hand, the findings also shows that people have concerns about all treatment options, pharmacological treatments as well as manual therapies, although these concerns differ in nature.

When it comes to manual therapies, people are mainly concerned about feeling sore after manipulation, the possible cause of further damage due to the manipulation itself and ‘cracking’ bones. Dr Bishop concludes that it is important for providers to consider people’s willingness to try different methods, as well as their concerns about these methods.

3. Yoga may relieve depression
The third example I want to raise is the work by Dr. Holger Cramer and colleagues. They have conducted a systematic review of publications on yoga for depression., including 11 randomized controlled trails (RCTs) with a total of 527 participants. They conclude that there is moderate support for short-term improvement of depressive symptoms among people practicing yoga. Moreover, they found this association to be strongest for meditation-based yoga types.

A recommendation for future yoga trials is, according to Dr. Cramer, to also include or mention data around safety. None of the included trials in this review mentioned safety aspects.

CAM teaches us a lot
Last but not least, the congress featured many significant contributions about the patient-provider relationship, the placebo effect (or as I prefer to call it, the ‘meaning response’) and the importance of contextual factors, such as the physical environment, in the therapeutic encounter.

The impact of  these contributions on the congress is perhaps the most important trend of all. A trend that focuses less on specific methods and more on what integrative care and CAM can teach us about healing. It seems to be a lot. A glimpse of the large realm of what remains to be discovered is discussed at the symposium “Using and receiving placebos in clinical practice: patients’ and doctors perspectives” organised by Professor George Lewith, Jeremy Howick, Felicity Bishop and Michael Hyland from University of Southampton, University of Oxford and, University of Plymouth. In a recent publication in PLOSOne, Howick and colleagues (2013) conclude that Placebos and treatments often have similar effect sizes. Placebos with comparatively powerful effects can benefit patients either alone or as part of a therapeutic regime, and trials involving such placebos must be adequately blinded.” This raises a very interesting discussion that deserves a separate text to come.

Johanna Hök



Published articles referred to in the text

Eisenberg, David M., et al. “Enhancing Medical Education to Address Obesity:“See One. Taste One. Cook One. Teach One.”.” JAMA internal medicine (2013): 1-3.

Howick, Jeremy, et al. “Are Treatments More Effective than Placebos? A Systematic Review and Meta-Analysis.” PloS one 8.5 (2013): e62599.

Link to all ICCMR 2013 congress abstracts









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