Understanding Complementary and Integrative Medicine

Definition of complementary medicine (modified) from the Cochrane Collaboration¹

Complementary medicine (CM) is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CM and between the CM domain and that of the dominant system are not always sharp or fixed.

We use the term complementary medicine synonymously with the terms "complementary therapies" and "complementary and alternative medicine" found in other texts, according to the definition used by the Cochrane Collaboration.

The Therapeutic Goods Administration definition of complementary medicines²

In Australia, medicinal products containing such ingredients as herbs, vitamins, minerals, nutritional supplements, homoeopathic and certain aromatherapy preparations including essential oils, traditional Chinese medicine and Ayurvedic (traditional Indian) medicines are referred to as 'complementary medicines' and are regulated as medicines under the Therapeutic Goods Act 1989 (opens in new window) (the Act).  

Definition of complementary medicine from the World Health Organization (WHO)³

Traditional medicine (TM):
Traditional medicine has a long history. It is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.⁴

Complementary medicine (CM):
The terms "complementary medicine" or "alternative medicine" refer to a broad set of healthcare practices that are not part of that country's own tradition or conventional medicine and are not fully integrated into the dominant healthcare system. They are used interchangeably with traditional medicine in some countries.⁴

Traditional and complementary medicine (T&CM):
T&CM merges the the terms TM and CM, encompassing products, practices and practitioners.

Integrative Medicine

There are many definitions of "integrative" healthcare, but all involve bringing conventional and complementary approaches together in a coordinated way.

Integrative medicine and health reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing.

Most complementary health approaches fall into one of two subgroups—natural products or mind and body practices.

Natural Product

This group includes a variety of products, such as herbs (also known as botanicals), vitamins and minerals, and probiotics. They are widely marketed, readily available to consumers, and often sold as dietary supplements.

Researchers have done large, rigorous studies on a few natural products, with variable result. While there are indications that some may be helpful, more needs to be learned about the effects of these products in the human body and about their safety and potential interactions with medicines and other natural products.

Mind and Body Practices

Mind and body practices include a large and diverse group of procedures or techniques administered or taught by a trained practitioner or teacher. In 2012, yoga, chiropractic and osteopathic manipulation, meditation, and massage therapy were among the most popular mind and body practices used by U.S. adults. The popularity of yoga has grown dramatically in recent years, with almost twice as many U.S. adults practicing yoga in 2012 as in 2002.

Other mind and body practices include acupuncture, relaxation techniques (such as breathing exercises, guided imagery, and progressive muscle relaxation), tai chi, qi gong, healing touch, hypnotherapy, and movement therapies (such as Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, and Trager psychophysical integration).

The amount of research on mind and body approaches varies widely depending on the practice. For example, researchers have done many studies on acupuncture, yoga, spinal manipulation, and meditation, but there have been fewer studies on some other practices.

Complementary medicines have a long history of use. Some 2,500 years ago, the Chinese were using treatments made of mouldy soybean curd to treat infections. Only in 1942 did Howard Florey and Ernst Chain develop the manufacturing process for penicillin, enabling the first antibiotics to be sold as drugs.

Many modern pharmaceuticals are derived from plants used in complementary medicine. Common examples include aspirin (from willow bark), the cardiac drug digoxin (from foxglove), quinine (from cinchona bark) and ephedrine (from ma huang, a widely used Chinese medicine).

At least three out of four Australians use some form of complementary medicine,⁵ with rates as high as 87 per cent among specific patient groups, such as those with breast cancer.⁶

Australians invest heavily in complementary medicines, spending over $3.5 billion each year on complementary medicines and therapies.⁷

Consumers use them as part of their self-care approach and seek better information to support their healthcare choices.⁸

Australians spent $2 billion in out of pocket expenses on complementary medicines in 2010–11. This is more than the out of pocket contribution to pharmaceuticals of $1.6 billion.⁹

Evidence has shown many complementary medicines to have excellent safety and efficacy profiles, providing advantages over available treatment, and offering treatment options where none currently exists.
Example include:

• Acupuncture for relief of chronic lower back pain¹⁰
• Omega 3 fatty acids (DHA, EPA) for secondary prevention of heart disease in Australia¹¹ and mood disorders¹²
• St John's wort for mild to moderate depression¹³

Complementary medicines represent a substantial, growing industry with manufacturing jobs and export potential in Asia. Industry revenue is currently $3.6 billion and is expected to grow to $4.6 billion by 2027-28.¹⁴ Over this period, employment is anticipated to rise to 40,000.¹⁵

Australian companies export around $200m in complementary medicines to more than 20 countries in Southeast Asia, Europe and the Americas and this continues to grow at higher rates than domestic consumption. There is enormous growth potential for the export market.¹⁶

Australian Government support for complementary medicine research is minimal. NHMRC funding for complementary medicine has been 0.2 per cent of total funding from 2003-2012, despite high levels of usage by the Australian public and despite being acknowledged as a major health issue in successive NHMRC Strategic Plans. In 2012, funding for complementary medicines fell to 0.14 per cent of total funding or $1.24m out of a total of $780m.

References

^1. Zollman C, Vickers A. What is complementary medicine? BMJ. 1999;319(7211):693-6. DOI: 10.1136/bmj.319.7211.693.

^2. Therapeutic Goods Administration. Complementary medicines overview. Available from: https://www.tga.gov.au/complementary-medicines-overview

^3. World Health Organization (WHO). WHO traditional medicine strategy: 2014-2023. Geneva, Switzerland 2013. Available from https://apps.who.int/iris/handle/10665/92455

^4. World Health Organization (WHO). (n.d.).Traditional, complementary and integrative medicine. https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_1

^5.Complementary Medicines Australia. (2022). CMA Industry Audit & Trends 2022. Complementary Medicines Australia, Canberra

^6. Kremser T, Evans A, Moore A, Luxford K, Begbie S, Bensoussan A, et al. Use of complementary therapies by Australian women with breast cancer. Breast. 2008;17(4):387-94. DOI: 10.1016/j. breast.2007.12.006.

^7. Access Economics. Cost effectiveness of complementary medicines, Report to the National Institute of Complementary Medicine, Sydney, Australia. 2010.

^8. National Prescribing Service, Information Use and Needs of Complementary Medicines Users, December 2008.

^9. Australia Institute of Health and Welfare. Health expenditure Australia 2010-2011. (Health and welfare expenditure series no. 47. Cat. no. HWE 56). 2012.

^10. Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, Irnich D, Witt CM, Linde K. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain. 2018;19(5):455-74. DOI: 10.1016/j.jpain.2017.11.005.

^11. Access Economics. Cost effectiveness of complementary medicines, Report to the National Institute of Complementary Medicine, Sydney, Australia. 2010.

^12. Access Economics. (2010, August). Cost-effectiveness of complementary medicines. Access Economics, Sydney.

^13. Black Dog Institute. (2020, April). Omega-3 & Mood Disorders. [Fact Sheet]. Black Dog Institute, Sydney.

^14. Richardson, A. (2022, August 16). Alternative Health Therapies in Australia: Industry Report X0015. IBISWorld, Melbourne.

^15. Richardson, A. (2022, August 16). Alternative Health Therapies in Australia: Industry Report X0015. IBISWorld, Melbourne.

^16. CHC Industry Audit May 2011.