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Special Article |

Integrative Medicine and Systemic Outcomes Research:  Issues in the Emergence of a New Model for Primary Health Care

Iris R. Bell, MD, MD(H), PhD; Opher Caspi, MD; Gary E. R. Schwartz, PhD; Kathryn L. Grant, PharmD; Tracy W. Gaudet, MD; David Rychener, PhD; Victoria Maizes, MD; Andrew Weil, MD
Arch Intern Med. 2002;162(2):133-140. doi:10.1001/archinte.162.2.133.
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Clinicians and researchers are increasingly using the term integrative medicine to refer to the merging of complementary and alternative medicine (CAM) with conventional biomedicine. However, combination medicine (CAM added to conventional) is not integrative. Integrative medicine represents a higher-order system of systems of care that 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. Using the context of integrative medicine, this article outlines the relevance of complex systems theory as an approach to health outcomes research. In this view, health is an emergent property of the person as a complex living system. Within this conceptualization, the whole may exhibit properties that its separate parts do not possess. Thus, unlike biomedical research that typically examines parts of health care and parts of the individual, one at a time, but not the complete system, integrative outcomes research advocates the study of the whole. The whole system includes the patient-provider relationship, multiple conventional and CAM treatments, and the philosophical context of care as the intervention. The systemic outcomes encompass the simultaneous, interactive changes within the whole person.

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Figure 1.

Double selection procedure for research designs testing complementary and alternative medicine (CAM) techniques for treating patients with a given conventional medical diagnosis that meets criteria for one of multiple, different CAM system diagnoses. Reproduced with permission from Vincent C, Furnham A. Complementary Medicine: A Research Perspective. New York, NY: John Wiley & Sons Ltd; 1997.

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Figure 2.

A, Domains for research in conventional biomedicine. The person is the clinical focus, but research examines the subsystems of the person as separate, static units. Reductionism limits the number of variables under study and progressively eliminates consideration of the context (higher-order systems and dynamics) in which the studied subsystem functions. This approach permits optimal understanding of each component part of the person. B, Domains for research in integrative medicine. The person is the clinical focus, but the research examines the person as an intact, complex, dynamic system, composed of lower-order systems and existing within higher-order systems. Integrative research includes multiple variables in interaction and emphasizes the evolving context (higher-order systems and dynamics) in which the person as a system functions. This approach permits optimal understanding of the person as a living system within larger systems.

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