Integrative Care
Policy News

OP/ED: 200 Years of Integrative Medicine in Sweden

15 October, 2013 by Tobias Sundberg

Tobias_Sundberg_3059This year it is 200 years since Per Henrik Ling founded the Royal Gymnastics Central Institute in Stockholm, Sweden. Ling´s extensive gymnastic system integrated physical activity, training and manual treatments for health promotion and health care. It became a Swedish success story and a strong “export product” all over the world. 

Internationally, many actors – among them we at I C – continue to research, evaluate and develop integrative health care models. In common with a lot of other stakeholders, we at I C believe that this is the right way to proceed in promoting health and wellbeing and contributing to materializing the health care system of tomorrow.  

At the recent 6th European Congress for Integrative Medicine in Berlin featuring the theme “future health care” (ECIM 2013), the prevailing trend was clear. The concept of integration is alive and strong among many actors, from health caregivers to patients, from researchers to decision-makers.

Prioritizing a Challenge
It is just as interesting to investigate what possible effects there might be of integrative care, as it is challenging to select which research questions and perspectives to prioritize. What is most important:

  • effective treatments?
  • affordable health care?
  • patients´ wellbeing?
  • working conditions which don´t cause burnout in students and health professionals?
  • studies of the biological mechanisms behind various treatment effects?
  • the preventive perspective with integrated health promotive measures in schools and at the workplace, measures which can allow people to feel better and work longer without having to go on sick leave?

Or is the integration of conventional and complementary methods simply a lot of nonsense, costing much too much money for already strained health care budgets?

Are there paths we can follow in accordance with one or several of the above perspectives?

In his day, Ling often discussed with contemporary proponents of surgical and “chemical” interventions (corresponding to today´s pharmaceuticals). Similarly, one of today´s challenges lies in uniting the unique competencies and resources of various stakeholders to jointly shape the best possible future health care.

Already Being Promoted
This may seem like a huge hurdle, but there are already proactive decision-makers who formulate national health care guidelines, advocating the integration of selected complementary treatment methods, taking into account the current state of evidence and clinical experience. This is e.g., true for manual therapies and mindfulness in the care of chronic and costly ailments such as certain kinds of chronic pain and depression (NICE 2009).

Such guidelines are in turn completely compatible with global recommendations from the WHO (WHO 2009). New research, some of which was presented in Berlin, indicates nascent evidence that integrative care can contribute towards using less of some health care resources such as drugs and costs for this compared to conventional medical strategies for certain diagnostic groups (ECIM 2013).

Focus on Patient Perspective
Some time ago, I was invited as an expert to an international research and policy meeting at the RAND think tank in Los Angeles. The meeting dealt with health economic evaluation of complex health care interventions, including tracks for alternative, complementary and integrative medicine. Some of the results were recently presented in the form of a scientific article (Coulter et al. 2013).

Simply put, in all healthcare, it is extremely important to achieve common frames of reference in order to be able to do comparative evaluations. Since many patients themselves seek out (self-referral) complementary treatments, often using their own resources, and without having a dialogue with their allopathic caregivers, evaluations need to focus particularly hard on the patient perspective, in addition to applying customary research methodology.

As integrative care in addition often has a preventive objective, this should also be reflected in research and evaluation. This might e.g.,  imply considering a broad spectrum of outcomes rather than a specific symptom or illness scale. Similarly, comparative effects of integrative care should be reflected in comparisons of total health care costs, including costs saved, instead of only prioritizing illness-specific costs. 

Different forms of self-care may also be representative of integrative care, which probably has a lot to do with how people relate to and handle their ailments and their health. We have previously shown that integrative care of patients with chronic back and neck pain may contribute to patients using various self-help strategies compared to conventional treatment (Andersson, Sundberg et al 2012).

As Effective as Drugs
Current research now also demonstrates that physical activity and exercise, i.e., methods easily integrated as self-care, may potentially be equivalent, and in some cases perhaps even superior to treatment using pharmaceuticals, in so called secondary prevention, i.e., preventing recurring coronary disease, stroke, heart failure and diabetes leading to death (Naci and Ioannidis 2013).

Already in his day, Ling knew that physical activity and exercise are good for one´s health. Now, direct comparisons between physical activity and drug treatment in terms of mortality in common diseases are novel and controversial.  And that is just an example.

Following in Ling´s footsteps, we at I C believe that integrating methods and treatments may be a strategic path forward. Join us on this exciting journey. We welcome a dialogue with county councils, health care groups, patient organisations or training coordinators interested in these issues!

Tobias Sundberg, PhD, Senior researcher, I C


ECIM.  6th European Congress for Integrative Medicine 2013.  Available at:

NICE. CG88 Low back pain: NICE guideline. 2009. Available at:

NICE. CG90 Depression in adults: NICE guidance. 2009.  Available at:

WHO. 62nd World Health Assembly Resolutions on Traditional Medicine. 2009. Available at:

Coulter ID, Herman PM, Nataraj S. Economic analysis of complementary, alternative, and integrative medicine: considerations raised by an expert panel. BMC Complement Altern Med. 2013;13:191.

Andersson S, Sundberg T, Johansson E, Falkenberg T. Patients’ experiences and perceptions of integrative care for back and neck pain. Altern Ther Health Med. 2012 Jun; 18(3):25–32.

Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ. 2013 Oct 1; 347:f5577–f5577.



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