Commentary: alternative medicine: is it a reflection of the continued emergence of the biopsychosocial paradigm?

The possibility is presented that the current collaborative versus conventional medical debate may be a consumer-driven continuation of the biomedical versus biopsychosocial controversy first proposed by George Engel 25 years ago. If true, we may all be actors in a genuine Kuhnian paradigmatic shift destined to occur whether we appreciate our roles therein or approve of the ultimate outcome. At the very least, however, it is important to recognize the evidence that at least some patients suffering from chronic conditions may be choosing collaborative therapies for different reasons than for those for which they seek conventional medical care. For these patients, at least, it is important that the quality of the collaborative care they receive be judged on outcomes capable of reflecting these alternative objectives. Finally, whether we are in the midst of a paradigmatic shift in medicine or not, it is essential that we all, as providers of clinical care or as investigators of clinical efficacy, adopt a collaborative role to ensure the provision of both good medicine and good science.