Integrative medicine 整合医学

翻译| 杜琦琦 审校| 高淑媛

Integrative medicine, which is also called integrated medicine and integrative health in the United Kingdom, combines alternative medicine with evidence-based medicine. Proponents claim that it treats the "whole person," focuses on wellness and health rather than on treating disease, and emphasizes the patient-physician relationship.

Integrative medicine has been criticized for compromising the effectiveness of mainstream medicine through inclusion of ineffective alternative remedies,and for claiming it is distinctive in taking a rounded view of a person's health.

整合医学,在英国又称整体医学(integrated medicine)和整合健康integrative health,是一门结合了替代医学和循证医学的学科。支持者认为整体医学的研究对象是“整个人体”,以人的健康而不是疾病治疗为中心,强调医患关系的重要性。

但是,整合医学也因无效的替代疗法的介入而削弱了主流药物的作用以及自称全面关照病人健康而备受诟病。

Contents 目录
1 Definition 基本介绍
2 History 发展历史
3 Impetus 推动力
4 Reception 社会反响

Definition

基本介绍

David Gorski has written that the term "integrative medicine" has become the currently preferred term for non-science based medicine.

David Gorski 认为无科学依据医学现在更常被称作整合医学。

The Consortium of Academic Health Centers for Integrative Medicine defines it as "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, healthcare professionals and disciplines to achieve optimal health and healing". Proponents say integrative medicine is not the same as complementary and alternative medicine nor is it simply the combination of conventional medicine with complementary and alternative medicine.They say instead that it "emphasizes wellness and healing of the entire person (bio-psycho-socio-spiritual dimensions) as primary goals, drawing on both conventional and CAM approaches in the context of a supportive and effective physician-patient relationship".
Critics of integrative medicine see it as being synonymous with complementary medicine, or as "woo".

整合医学学术研究健康中心联合会认为整合医学是一项重申医患关系重要性,重视人的整体性,循证治疗,最大限度利用合适的治疗手段、医疗专业人员和医疗原则从而达到预期治疗目、达到最佳将抗状态的医学实践。支持者认为整合医学不等同于补充与替代医学也不仅是传统医学和补充与替代医学的简单结合,整合医学强调的是个体整体(包括生理、心理、社会、精神多方面)的健康和康复,同时在相互合作,有效沟通的医患关系下兼顾传统医学治疗方法和替代医学的治疗方法。批评者则认为整合医学就是替代医学换了一种说法而已或者说只是一种更吸引人的名称。

History

发展历史

In the 1990s physicians in the United States became increasingly interested in integrating alternative approaches into their medical practice, as shown by a 1995 survey in which 80% of family practice physicians expressed an interest in receiving training in acupuncture, hypnotherapy, and massage therapy.In the mid-1990s hospitals in the United States began opening integrative medicine clinics, which numbered 27 by 2001. The term "integrative medicine" was increasingly popularized by, among others, Deepak Chopra, Andrew Weil, and Prince Charles. The Consortium of Academic Health Centers for Integrative Medicine was founded in 1999 and by 2014 included 57 members, such as Johns Hopkins University School of Medicine, Duke University School of Medicine, Georgetown University School of Medicine, and Mayo Clinic. The goal of the Consortium is to advance the practice of integrative medicine by bringing together medical colleges that include integrative medicine in their medical education. The American Board of Physician Specialties, which awards board certification to medical doctors in the U.S., announced in June 2013 that in 2014 it will begin accrediting doctors in integrative medicine.

自二十世纪九十年代起,越来越多的美国医生对在医疗实践中运用整合替代疗法感兴趣,1995年的一个调查显示80%的家庭医生乐于接受有关针灸、催眠、推拿等方面的培训。二十世纪九十年代中期,整合医学门诊开始出现,截止2001年,全美共有27个整合医学门诊。整合医学这一术语也被越来越多的人包括Deepak Chopra、Andre Weil、Prince Charles所接受。整合医学学术研究健康中心联合会由成立于1999年,截止到2014年有57个成员组织,例如约翰霍普金斯大学医学院、杜克大学医学院、乔治大学医学院、梅约医学中心等。联合会旨在通过联合开设整合医学学科的大学从而推动整合医学的发展。美国专业医师委员会(向全美医生授予资格证书的机构)在2013年六月宣布,从2014年开始,它会提供整合医学的有关资格证明。

Impetus

出现的动因

Medical professor John McLachlan has written in the BMJ that the reason for the creation of integrative medicine was as a rebranding exercise, and that the term is a replacement for the increasingly discredited one of "complementary and alternative medicine". McLachlan writes that it is an "insult" that integrative medical practitioners claim unto themselves the unique distinction of taking into account "their patients' individuality, autonomy, and views", since these are intrinsic aspects of mainstream practice.

医学教授John McLachan 曾在英国医学杂志上发表了一篇文章,该文章称整合医学这一术语的出现其实是一个重命名的过程,整合医学实际是日益受人质疑的替代医学的新名字。鉴于整合医学工作者向来声称他们对病人个体性、自主性和自主观点的关注是独一无二的,McLachlan认为这是一种侮辱,因为主流医疗也不乏对病人个体性、自主性和自主观点的关注。

Proponents of integrative medicine say that the impetus for the adoption of integrative medicine stems in part from the fact that an increasing percentage of the population is consulting complementary medicine practitioners. Some medical professionals feel a need to learn more about complementary medicine so they can better advise their patients which treatments may be useful and which are "ridiculous". In addition, they say that some doctors and patients are unsatisfied with what they perceive as a focus on using pharmaceuticals to treat or suppress a specific disease rather than on helping a patient to become healthy. They take the view that it is important to go beyond the specific complaint and draw upon a combination of conventional and alternative approaches to help create a state of health that is more than the absence of disease. Proponents further suggest that physicians have become so specialized that their traditional role of comprehensive caregiver who focuses on healing and wellness has been neglected. In addition, some patients may seek help from outside the medical mainstream for difficult-to-treat clinical conditions, such as fibromyalgia and irritable bowel syndrome.

支持者认为,整合医学被大众接受的一大促力就是越来越多的人愿意找补充医学的医生看病。一些医学工作者感觉有必要去了解更多关于补充医学的有关知识,以便更好的向病人推荐一些看起来荒谬但是有效的治疗方式。另外他们也谈到把治疗中心放在治疗特定的一种疾病而不是促进病人的康复的这一做法让一些医生和病人不是很满意。他们认为打破治疗某种特定疾病的限制,把传统方法和替代疗法相结合,使病人达到一个健康的状态而不仅仅是没有疾病,具有重要意义。支持者还认为,医生变得越来越专于一科,而他们传统的职责——力求病人整体的康复——却被日渐忽视。另外,对于一些难治的临床表现如神经肌肉痛、刺激性肠综合征等,一些病人从主流医学之外寻求治疗方法。

Reception

社会反响

Integrative medicine is sometimes lumped together with alternative medicine, which has received criticism and has been called "snake oil." A primary issue is whether alternative practices have been objectively tested. In a 1998 article in The New Republic, Arnold S. Relman, a former editor of The New England Journal of Medicine stated that "There are not two kinds of medicine, one conventional and the other unconventional, that can be practiced jointly in a new kind of ‘integrative medicine.' Nor, as Andrew Weil and his friends also would have us believe, are there two kinds of thinking, or two ways to find out which treatments work and which do not. In the best kind of medical practice, all proposed treatments must be tested objectively. In the end, there will only be treatments that pass that test and those that do not, those that are proven worthwhile and those that are not".

整合医学有时会和所谓“万能”的却备受诟病的替代医学混为一谈。主要问题在于替代医疗实践是否已经通过了客观的测试.1998年,前新英格兰医学杂志编辑Arnold S.Relman 在新共和杂志发表文章称:世上不存在传统医学和非传统医学两种医学,也不存在所谓的结合两种医学的整合医学。也不是Andrew Weil和他的朋友试图让我们相信的那样,世上同样也不存在两种思路来判断治疗是否有效。最好的医学实践是治疗者提出的所有治疗方法都进行客观的测试,最后,只有通过测试的治疗方法和没有通过测试的治疗方法,经证明有效的方法和无效的方法。

In order to objectively test alternative medicine treatments, in 1991 the U.S. government established the Office of Alternative Medicine, which in 1998 was re-established as the National Center for Complementary and Alternative Medicine (NCCAM) as one of the National Institutes of Health. However, skeptic Steven Novella, a neurologist at Yale School of Medicine, said that NCCAM's activities are "used to lend an appearance of legitimacy to treatments that are not legitimate". The NCCAM website states that there is "emerging evidence that some of the perceived benefits are real or meaningful". NCCAM also says that "the scientific evidence is limited" and "In many instances, a lack of reliable data makes it difficult for people to make informed decisions about using integrative health care".

为了对替代医学疗法进行客观的测试,美国政府于1991年创建了替代医学办公室,1998年,该办公室更名为美国国家替代医学研究中心,为美国国家健康研究所的下属机构。但是耶鲁大学医学院的神经病学家Steve Novella对此却持怀疑态度,他认为美国国家替代医学研究中心只是“为那些不合法的治疗方式披上了一层合法的外衣”。美国国家替代医学研究中心网站称“新的证据表明已证的疗效是真实并且可靠的”,但同时“这些科学证据也具有局限性,在多数情况下,数据的缺乏使人们难以决定是否接受替代疗法。”

A 2001 editorial in BMJ said that integrative medicine was less recognized in the UK than in the United States. The universities of Buckingham and Westminster had offered courses in integrative medicine, for which they were criticized. In the UK organizations such as The Prince's Foundation for Integrated Health, The College of Medicine and The Sunflower Jam advocate or raise money for integrative medicine.

2001年,英国医学杂志的一篇社论表示整相较于美国,整合医学在英国更加不受大众的认可。白金汉大学和威斯敏斯特大学因为开设整合医学课程而备受责难。英国的一些慈善组织如整合医学基金等为整合医学募集资金。

In 2003 Michael H. Cohen argued that integrative medicine creates a “liability paradox,” in that the greater the cross-disciplinary integration among providers, the greater the risk of shared liability among them; thus, “information sharing may expand liability but ultimately reduce risk to the patient; yet maintaining sharp boundaries between providers may decrease risk of shared liability but ultimately increase risk to the patient.”

2003年,Michael H.Cohen 表示整合医学导致了一个“责任悖论”,即医疗人员跨学科的整合度越高,他们共有的风险度也就越高,因此“信息共享可能在放大责任的同时减少病人的风险而医疗人员界限的清晰划分可能在减小共有责任的同时增大病人的风险。”

Steven Salzberg has criticized the teaching of integrative medicine in medical schools, especially the inclusion of pseudoscientific subjects such as homeopathy. In Salzberg's view in offering an integrative medicine course, the University of Maryland Medical School was "mis-training medical students".

Steven Salzberg曾批评医学院校的整合医学教育,特别是那些包含有伪科学如顺势疗法的整合医学教育,在他看来,就提供整合医学课程这一点,马里兰大学医学院是在“误导医学生”。

以上英文来源于:维基百科

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