In Name and Concept: The Global Uptake of the Movement for Integrative Medicine and Health.

A curious and somewhat ironic multicultural loop in the global world of integrative health and medicine goes like this. The United States imported traditional Chinese medicine. In the 1980s, the field of acupuncture—then considered “alternative medicine”—began a process of significant professional formation in the United States. Schools were founded. State licensing was initiated and expanded to more and more of the nation's 50 states. Consumer use rose.[1]

With evidence of an increase in use by their prospective patients, conventional institutions in the United States became interested. Supportive healthcare professionals viewed the phrase alternative medicine as sending the wrong message. Surveys found that the vast majority who favored “alternative” practices also used “regular” medicine.[2] The kinder and gentler term complementary was first imported from England to describe acupuncture and several other therapies, modalities, and professions. By the late 1990s, academically-based healthcare providers in the United States guiding these new practices through the resistance of their colleagues introduced their own attempt at accurate language. They began to replace “complementary and alternative” with the new concept of “integrative medicine.” The term indicated, above all, the merging of industrial medicine with multiple traditional practices that make a reasonable evidentiary grade with a focus on health and healing. Some consider integrative health a broader and more inclusive term.[3]

The global loop is closed with the export of “integrative medicine” back into the very countries that provide most of the distinctive components of the integrative concept. In these countries, previously imported industrial medicine tends to dominate formal medical training, government-backed and nongovernmental organization–backed services. Now proponents of traditional practices use the term and the movement it signifies as useful leverage in re-elevating the value of the host country's traditional practices. One strategic investment in this influence came in 2010 when a delegation of 6 leaders of the US Academic Consortium for Integrative Medicine and Health were invited to India to meet with Indian officials (personal communication via email with Aviad Haramati, July 9, 2015). Wrapped in integrative medicine's new clothing, new stature for traditional practices may be gained with leaders of regular medicine.

I have repeatedly observed this uroborus-like activity while writing The Global Integrator Blog for this journal's web portal.[4] The spiraling interconnectivity poses the question of what might be achieved if these linkages were engaged with greater intentionality. How might diverse parties go about forging additional ties? What are the elements of a global movement for integrative health and medicine? What might be reasonably accomplished?

These questions are the stuff of summit meetings, debate, flip charts, whiteboards, and white papers. Issues relating to cultural hegemony would certainly surface and wind through. While I plan to help corral if not answer some of these question in future writing here, this particular column focuses on the richness of the rapidly percolating global integrative landscape.

Late last year, the Hong Kong Jockey Club Charities Trust announced plans to donate $10.45 million HK to set up the Hong Kong Institute of Integrative Medicine. The facility would be “the first of its kind in the city.” The plan is to “incorporate Chinese and Western integrative medical treatment, education and research under one roof.”[5] On the mainland, the Beijing Traditional Chinese Medicine and Western Medicine Cardiac Rehabilitation Center was recently established as “the first of its kind in China.”[6]

In Singapore, a division of a public corporation called Eu Yan Sang Integrative Health has quickly grown to more than 26 clinic sites.[7] The firm declares its intention: “From a unique heritage in Traditional Chinese Medicine (TCM), Eu Yan Sang is setting its vision to be a global integrative health and wellness company.”[8] Nearby, the Thai government backed a “healthy city and community lifestyle event aiming to raise the community's confidence in services of health-care institutes in Thailand, and to increase the economic value of Thai and integrative medicine.”[9]

The activity in India has been especially robust since Prime Minister Narendra Modi established a formal agency dedicated to advancing the role of the nation's traditional medicine disciplines.[10] A department of integrative oncology was launched at India's Mazumdar Cancer Centre in the influential Narayana Health City.[11] The fact that “some modern hospitals are additionally offering Ayurveda in the name of integrative medicine” was used by the president of the All Indian Ayurvedic Conference to build the case for more uptake of the practices he represents. He urges “greater collaboration between Ayurvedic and allopathic researchers to widen the database of treatment protocols and successful medical practices.” Meanwhile, for a popular twist, an Indian entertainer who is also a medical doctor, Parth Oza, tells his fans that “while music and art are my passions, I am currently doing research on music therapy and integrative medicine.”[12]

Similar movement is visible in the Middle East. The Weill Cornell Medical College of Qatar hosted a symposium that the local media headlined as “looking forward to the new era of integrative medicine.” Scotland-based integrative physician and homeopath David Reilly, MD, was the keynote speaker.[13] In Dubai, the huge annual Arab Health Conference featured a day on “Alternative, Complementary and Integrative Medicine” at its January 2015 meeting. Featured were medical and Asian medicine practitioners from Europe and the United States including Global Advances in Health and Medicine founding editor David Riley, MD. This followed prior consulting by Riley for Dubai Healthcare City on rules, based on Western norms, for credentialing new kinds of integrative health and medicine practitioners. Pakistani medical school faculty held a mid–April 2015 forum to promote a “true health reform” that would put what an article on the meeting called “integrated medicine” in all medical education. Speakers noted that the movement “was spreading fast throughout the world and was playing an important role in the treatment of many ailments.”[14]

To pull the loop in even more tightly, back in the United States, the Puyallup tribe of indigenous peoples in the western state of Washington announced plans for the first ever tribally-owned integrative oncology center in what will be an 8200–square foot facility. The tribal chair explains that “as the indigenous keepers of the Puyallup Tribe Indian Reservation, we have a strong ancestral bond with nature and creation. We believe that natural healing through traditional roots, berries, herbs, and traditional healing can blend with modern oncology practices.”[15] And in a direct form of strategic cross-fertilization, the George Family Foundation, one of the leading philanthropic agents in integrative medicine in the United States, granted funds to a women's center in a Minnesota tribe so its leaders could gain education in the mind-body therapies developed by integrative medicine pioneer James Gordon, MD. An article in the Minneapolis StarTribune on the grants is subheaded “the path to healing comes full circle for two Indian elders bringing mind-body medicine to their community.”[16]

Full circle indeed. The cycling spheres of influence revolve in multiple directions. The government of India as part of its growing campaign to export Indian medicine announces a memorandum of understanding with Mauritius.[17] An Iranian delegation to Tajikistan is promoting exchange “in modern and traditional medicine.”[18] The first traditional Chinese medicine clinic is opened in Palestine.[19] In Czechoslovakia, with backing from the Chinese government, a joint effort is creating the “first centre of traditional Chinese medicine in Central and Eastern Europe.”[20] The campaign of the Chinese government to export its medicine was a controversial part of a new trade agreement with Australia.[21] On a grander scale, the China–European Union 2020 Strategic Agenda for Cooperation announced the International Cancer Centre of Asia that will focus “especially on the combination of traditional Chinese medicine (TCM) and Western medical treatments in treating cancer.”[22]

Meanwhile, robust movement is underway in multiple other nations to lay down the regulatory infrastructure for traditional medicine practices and products. This standard-setting and clarification of roles is a necessary precursor to robust integrative health and medicine engagement. Activity is particularly robust in Africa as I seek to document in the monthly “Quick Links to Global News in Traditional, Alternative, and Integrative Health and Medicine” in the Global Integrator Blog.[23] The list of nations is long: Nigeria, Ghana, Gambia, South Africa, Uganda, Zanzibar, Zimbabwe, and moves off-continent to Turkey, Myanmar, Malaysia, Paraguay, Cuba, and Thailand, as just a few examples. Much of this work is under the guidance of the World Health Organization Traditional Medicine Strategy 2014-2023.[24] At the same time, new regulation of traditional practices continues in Europe and North America. An additional US state is licensing acupuncturists and another gave a thumbs-up to traditional midwifery. More Canadian provinces now recognize naturopathic medicine and homeopathy. Switzerland has announced recognition of 4 new fields, including Ayurvedic medicine.[25]

The picture is clearly one of growing momentum. As a writer whose first interest is less in the word itself than what one's words can help to accomplish, my instinct is to ask how and in what ways this flourishing of integrative care might be advanced. I plan to return to this theme in this column. Please feel free to contact me with your ideas and guidance: johnweeks@theintegratorblog.com.