The analysis of the materials revealed that the interviewees perceive the terminology debate from different perspectives: 1) from the perspective of medical practice, 2) from the perspective of research, 3) from the perspective of public relations, and finally, 4) from the perspective of health care delivery. If interviewees argued from the perspective of practice or research, they overall favored integrative medicine (IM). If they looked at the terminology debate from a public relations perspective, they perceived complementary and alternative medicine (CAM) as easier to understand for those outside the field. Finally, some were not happy with any of the umbrella terms and were seeking out new terms altogether that encompassed the entire medical health care system.
1)The perspective from medical practice
Most of the interviewees considered IM the best term because it portrayed the integration of the practice of CAM into conventional medical institutions. IM was seen as a descriptor of the physician’s role and the activities of conventional medical institutions. From the perspective of patients’ behavior in medical care, both IM and CAM were seen as adequate descriptors because both demonstrated that many patients used conventional medicine and other therapies in complementary or integrative ways.
a)IM as descriptor of a physician’s role
Some of the interviewed medical doctors discussed the terminology question from the perspective of their work. As medical doctors trained in conventional medicine, they regularly considered conventional treatment options as well as treatment options from other medical traditions for their patients. In the opinion of some of the interviewees, this was precisely what IM stood for.
“It’s what we do. When I do my grand rounds, I first think about the patient’s conventional medication and diagnostics, and then I think about the other, it’s really integrative.”(MD, Germany)
Because of this integration of conventional medicine and other medical traditions in their everyday work, some of the MDs did not see CAM as an appropriate umbrella term. The descriptor “complementary” was perceived to limit the practitioner to the complementary part of therapy and neglect the conventional expertise of MDs who practiced both.
“What I don’t like about the term complementary medicine is that this in fact often limits one to complementary medicine. And many of us have a good education in conventional medicine.” (MD, Germany)
b)IM as descriptor of conventional medical institutions
Some interviewees argued from an institutional perspective. Their respective institutions offered conventional medicine and CAM concurrently. Interviewees proclaimed that such offers were important for the institutions because it tied patients to them who may not otherwise come. Such an “integrative” offer provided patients the choices they requested. Thus, from the perspective of conventional medical institutions, integrative medicine seemed the most viable term.
“We do want to offer the full range of choices. But that is (…) happening at medical centers throughout the country, in cancer in particular.”(PhD, USA)
c)CAM and IM as a descriptor of patients’ behaviors
In the views of the interviewees, patients did not choose between CAM therapies and conventional medicine. Normally, they chose from all sorts of medical traditions, including conventional medicine and complementary treatments. Such a behavior was seen to be encompassed by both the term IM and by the term CAM.
Again, IM was seen as the integrated work of CAM and conventional medicine conducted in medical centers. This was seen to reflect patients’ wishes.
“Integrative medicine. In the way that they’re doing it in the U.S. That’s what patients really want, that’s what all our qualitative data on CAM tell us, this is patient-led, this is a uniquely patient-led process.” (MD, UK)
The same argument was used to argue for the term CAM as it stressed the complementary aspect of different medical traditions. Again, it was seen as what patients did. They used different medical traditions to treat a condition.
“Patients don’t go alternative, patients are really going together.” (PhD, USA)
2)The perspective of research and academia: The vagueness of IM
Interestingly, interviewees portrayed the term IM as a vague term that others outside the CAM field did not understand. This vagueness was seen as an advantage of IM.
“Yes, absolutely. Because it’s so vague no one knows what it means and we can all define it. For most, it means integrating conventional with complementary medicine. For others, it conveys the concept of treating people as “whole” individuals, integrating mind, body and spirit. But yes, people do really like the term. And sometimes we’ll say complementary and integrative, but we also do want to offer the full range of choices. But that is happening actually at medical centers throughout the country, for cancer in particular.” (PhD, USA)
Thus, the vagueness meant that it needed to be defined by those shaping the field. Such a term holds the promise to go beyond old debates and worries concerning medical traditions outside conventional medicine, if conventional medicine is seriously part of integrative medicine.
Integrative medicine is an appropriate term because it does not exclude any serious medical approach. The term is somewhat vague on purpose. (…) Integrative medicine should indicate the combination of conventional and complementary medicine indeed. If someday integrative medicine would be considered a simple synonym for alternative medicine then we need to change it.” (MD, Germany)
At the same time, the worry was voiced that the vagueness of the term would discredit the field because others may view it as a “Trojan horse” and would develop even bigger resentments against CAM.
“For the first time it now happened to me that integrative medicine was discussed in a negative way with me. They saw it [IM] as a Trojan horse through which methods that cannot be taken seriously are introduced into medical schools.” (MD, Germany)
To counter worries in conventional medicine about CAM and IM, one interviewee suggested institutionalising IM through the establishment of a medical specialisation in “IM” for MDs. This would protect the field from being undermined by treatments that have not shown to be safe and effective.
However, such an approach was not seen without problems. There was some concern that the effectiveness of CAM and the dichotomy between CAM and conventional medicine had some benefits that were lost under the label of IM.
“Experience shows that if one tries to come into dialogue with conventional medicine, one needs to leave the theoretical underpinnings [of CAM] behind (…), because it cannot be evaluated scientifically (…). However, [the theoretical background] is extremely important. Time and again I have experienced that if you are trying to use only a technique from CAM such as acupuncture it is not as effective (….). I think integrative medicine is good, but we need to find a way to teach integrative medicine and to make it less prone to criticism and I am worried that that will in fact lead to a significant reduction of what CAM has to offer.” (MD, Germany)
The concern was echoed by another interviewee who suggested that the fight between complementary and conventional medicine may be important to improve and bring research forward.
“The question is if integrative medicine also has disadvantages. If the polarisation, the discussion, and maybe the disruption, may be crucial for scientific development.” (MD, Germany)
3)From the perspective of public relations: CAM
Many of the interviewees agreed that IM was a vague term that was not understood by lay people. This was also an argument against the term IM. If one wanted others to understand what one was doing, the term CAM might provide more clarity.
“because people then know what we are talking about. If we wrote, this is a masters in integrative medicine nobody knows what you are saying. So we are using complementary and alternative (…), so people know we are talking about the CAM disciplines.” (PhD, USA)
4)From the perspective of health care delivery
When interviewees discussed the terminology question, they also discussed the type of health care system they envisioned. Such reflections led the interviewees to caution about too narrow a focus on the terminology question. The question of naming was one about influencing and changing medicine. Similarly, interviewees pointed towards a re-orientation of medical care towards healing or patient-centered care.
“I think they’re [the suggested names] all place holders. You know, until you just can get to where … we have influenced enough that medicine sort of gets back to its, some of its holistic roots, and its healing roots.” (MD, US)
“What we need to deliver at the clinic, is what I think we should focus on. Because I think, we can agree on that, and we got real consensus with the patient. I don’t think it matters what you call it. (…) We know what we want to deliver, and we haven’t got a really good way of describing it. But maybe! it’s patient-centred medicine, maybe! we should stop worrying about the complementary medicine, and we should just start talking about our medicine being patient-centred rather than process-driven” (MD, UK)
In line with the cautioning about fixating on terminology, the problem of restricting oneself by a name was also mentioned. This seemed particularly pertinent because disciplinary boundaries change with time and what may currently be perceived as complementary medicine could later become conventional medicine.
I wouldn’t give it, I would, I, I wouldn’t give it a very descriptive name, (…) But complementary medicine isn’t mentioned. (…)I wouldn’t want to be labeled in a particular way, because who knows, how! we’re going to deal with mindfulness in ten years’ time.” (MD, UK)