Preventive Medicine, Integrative Medicine & the Health of the Public

The responsibility for the content of this paper rests with the authors and does not necessarily represent the views or endorsement of the Institute of Medicine or its committees and convening bodies. The paper is one of several commissioned by the Institute of Medicine. Reflective of the varied range of issues and interpretations related to integra-tive medicine, the papers developed represent a broad range of perspectives. ABSTRACT The fields of preventive medicine and public health share the objectives of promoting general health, preventing specific diseases, and applying the concepts and techniques of epidemiology toward these goals. The purview of preventive medicine as a discipline has traditionally been described to encompass primary, secondary, and tertiary prevention levels. This paper explores the overlap and potential synergies of integrative medicine and preventive medicine in the context of these levels of prevention, acknowledging the relative deficiency of research on the effectiveness of practice-based integrative care. The holistic approach of integrative medicine overcomes the traditional wall of silence between complementary and alternative medicine (CAM) and conventional practice, reducing the risk of adverse interactions or gaps in care. At the level of primary prevention, an array of integrative modalities can be effective in health promotion, including lifestyle counseling, dietary guidance, stress mitiga-tion techniques, interventions to improve sleep quality, and use of nutriceuticals and herbal supplements for health promotion. At the level of secondary prevention , stress management and nutritional supplementation can reduce risk factors for chronic disease. At the level of tertiary prevention, the full range of CAM modalities pertains to such goals as pain management, symptom control, stress relief , disease management, and risk reduction. Integrative medicine offers knowledgeable guidance to tailored therapies across the full spectrum of both conventional and CAM practice, thereby providing any given patient more op-tions—and more opportunities for success—in the pursuit of personal health. This must be weighed against the inherent risks in making use of therapeutic practices for which the scientific evidence base is often at best incomplete. The goal of integrative medicine should be to make the widest array of appropriate options available to patients, ultimately blurring the boundaries between conventional care and CAM. Both disciplines should be subject to rigorous scientific inquiry so that interventions that work are systematically distinguished from those that do not. The case is made that responsible use of science and responsiveness to the needs of patients that persist when the data from …