Educating for integration

Nicola Robinson ∗
London South Bank University, UK
Jianping Liu
Beijing University of Chinese Medicine, China
Paolo Roberti di Sarsina
University of Milano-Bicocca, Milan, Italy
Aviad Haramati
Georgetown University School of Medicine, USA
∗ Corresponding author.
E-mail address: nicky.robinson@lsbu.ac.uk (N. Robinson)

European Journal of Integrative Medicine 6 (2014) 1–4

A recent Viewpoint perspective in the British Medical Journal
calls for a re-examination of the integrative medicine curriculums
in the USA [1]. There are over 50 medical and nursing
schools which have integrative medicine centres and in this article
the author states, ‘unfortunately many endorse the use of
complementary and alternative medicine (CAM)’. The arguments
are based on the fact that the systematic reviews have
highlighted problems with methodology and that recent trials
have failed to show ‘evidence of efficacy above placebo’. The
author also concludes that medical curricula are misrepresented
as being evidence based and have not been updated in accordance
with recent evidence. Cost and safety are other issues raised, in
particular to the use of dietary supplements and poor reporting
of adverse events. Further, it is suggested that British and Australian
universities ‘as the result of a campaign to expose the
lack of evidence supporting those practices have discontinued
CAM courses’.
It is tempting to dismiss those comments as the rantings of a
known sceptic who continually maligns members of the faculty
at prestigious institutions by accusing them of forgoing
sound science for funding dollars and advocacy of CAM. But
let’s set that aside and consider the broader question: why have
over a third of US medical schools elected to become members
of the Consortium of Academic Health Centers for Integrative
Medicine and are actively working to advance complementary
and integrative medicine by developing new curricula, exploring
new research questions and creating innovative clinical delivery
models? Clearly, the leaders of these institutions recognize the
importance of expanding the understanding of this field. Indeed,
in a report issued by the Institute of Medicine (IOM) in 2005 on
the use of CAM in the US, there was an unequivocal acknowledgement:
‘CAM is here to stay’ [2]. Data from multiple surveys
consistently indicate that one out of four adults in the US uses
at least one form of CAM yearly to improve their health and
well-being [3], which creates a urgent need for research. It is
important to know which CAM therapies work (and in which
populations) and which do not. It is vital that safety be established
as well as efficacy. And both practitioners and patients
certainly need to know what might be dangerous or might have
serious contraindications. It is for that reason that the Consortium,
which now numbers over 50 leading academic centers
in the US, 3 in Canada and 1 in Mexico, sponsors the largest
international research congress biennially to showcase the best
science from around the world [4]. But the Consortium also
recently sponsored an International Congress for Educators in
CAM and Integrative Medicine [5], because it recognizes the
educational imperative. Academic institutions must train health
professionals with the knowledge, skills and attitudes to meet
the public need. Again, the IOM report was very direct with
its recommendation on education: ‘The committee recommends
that health profession schools (e.g. schools of medicine, nursing,
pharmacy, and allied health) incorporate sufficient information
about CAM into the standard curriculum...to enable licensed
professionals to competently advise their patients about CAM’
[2]. It is essential that we learn about educational initiatives
aimed at incorporating both traditional, native medicine and conventional,
Western medicine and adopt best practices to improve
the literacy of the healthcare workforce about CAM and Integrative
Medicine. There is much to learn from our colleagues
around the world.
For example, in China, Traditional Chinese Medicine (TCM)
education has been incorporated into the conventional medical
education system for the last 30 years. The TCM curricula is
taught to conventional medicine students in their 3rd and 4th
year of medical training. Its content has not changed since the
1980’s and includes TCM theory, TCM pattern differentiation,
Chinese material medica, herbal formulation, acupuncture, and
TCM internal medicine. The curriculum with up to 80 hours
of teaching has as its objective providing TCM education for
conventional medicine practitioners to equip them with basic
knowledge of traditional medicine which aids its integration
into the health care system. China legally implements a parallel
health care system of western conventional medicine and
TCM. The Chinese government has also encouraged integration
of both systems into the health care even prior to the 1950’s. In
addition, 48 medical colleges/universities (including 22 western
medicine and 26 TCM universities) have set integrative
medicine undergraduate education programmes [6]. This option
provides a five-year education, and the graduates can register as
integrative medicine doctors. Postgraduate education for integrative
medicine is also available in some of the TCM or western
medicine universities.
(...)