Respecting science, respecting tradition: evidence- based care in the integrative medicine professions

摘要

Evidence-based medicine (EBM) is seen as integral to modern medical science and practice, yet perceptions persist that there is a direct conflict between evidence-based and complementary and integrative medicine (CIM) models of patient care. Many practitioners fear that application of evidence-based philosophies to clinical practice may encourage therapeutic approaches that are reductionist (rather than holistic) and allopathic (rather than e.g. naturopathic), as well as eroding clinical autonomy by promoting 'cookbook' medicine over individualised care. These fears may be unfounded, as scientific inquiry has always been a core part of CIM practice. Founders of CIM professions highly valued the development and dissemination of research, as well as the development of higher clinical and education standards that evolved the professions. Although this has led to increasing research into CIM, the development of an evidence base for CIM needs to be appropriate, and respectful of the philosophy in which CIM is practiced. Such research suggests it is the traditional elements of practice that demonstrate the most benefit to patients when critically evaluated. Whilst new therapies are not without value, and the incorporation of these remain critical to the development of CIM professions, CIM may work best in an EBM model of healthcare when practice is focused upon tradition and philosophy. This discussion paper draws from a large body of work to highlight that only by truly respecting, valuing and incorporating tradition and philosophy can CIM be EBM, and the full promise of CIM realised.