As an integrative/functional medicine physician, I’ve been criticized, like many of my colleagues in the field, of being “anti-science.” In the past five years, many of us within the field have perceived increased and biased scrutiny by the ACCME, the organization tasked with accrediting CME providers. But in the wake of COVID-19, where pharmaceutical interventions were being used in patients care based purely on hypothetical mechanisms of action, the question should be asked: where is the line between an “early adopter” and “unscientific”?
In 1962, social scientist Everett Rogers published the classic text "Diffusion of Innovations" describing how new ideas — which are initially seen as uncertain or even risky — spread. In his framework, he defined five groups by their enthusiasm to embrace novel concepts:
- Innovators are venturesome, not afraid to fail, and often creators of new concepts.
- Early adopters are opinion leaders, often in leadership roles, who embrace change opportunities.
- Early majority are deliberate in their decisions, just ahead of average when accepting new ideas.
- Late majority tend to be skeptical of change to the status quo, and will wait for standard guidelines to guide their practice.
- Laggards are bound by tradition and very conservative.
These categories have been applied to all aspects of modern culture, including the health care industry.
Pharmaceutical companies, device manufacturers, and technology suppliers utilize diffusion theory to sell their products, with the promise of better outcomes, lower costs, and greater revenue. However, the actual translation of research to the bedside typically has a long lag time, and innovations are disseminated broadly at a slow pace.
We’ve certainly progressed from the infamous 264-year period between the discovery that vitamin C-rich produce prevented scurvy and the widespread use of citrus on British ships. But the oft-quoted lag time of 17 years between publication and adoption of research findings at the bedside is confounding, and unacceptable in this age when high-quality information is accessible to health professionals with a few keystrokes, and reputable sites like UpToDate (for biomedicine) and Natural Medicines (for natural products) are doing the work of compiling the relevant info from the more than 3 million scientific articles published per year.
In some areas of medicine, early adoption is applauded. Consider telemedicine: pre-pandemic, the vast majority of clinicians, systems, and insurance companies were slow to incorporate telehealth. However, with the pressure of the pandemic, the pivot happened at a very accelerated pace, increasing from 0.3% of clinician visits in 2019 to 23.6% in 2020. Noteworthy in this was high patient and practitioner satisfaction, possible decreases in health care delivery cost, and increased access for patients in remote locations. I know in my own integrative consult practice, patients rave about the convenience — and we are all thrilled that Illinois is moving to extend telemedicine coverage.
I’d like to propose a shift in how integrative medicine is perceived by those trained in Western biomedicine. A reframing that the majority of health professionals in the relatively newer fields of integrative and functional medicine, especially those operating within the context of academic health centers, are not “quacks” or “unscientific.” Rather, consider that these clinicians are "innovators" and "early adopters" who are choosing to use new concepts to help patients, rather than wait out the gap between availability and incorporation into published guidelines by medical societies.
Examples of “alternative” medical approaches that have become mainstream abound. Biofeedback was considered an esoteric practice when it came onto the medical scene in the 1960s. Now it’s offered in physical therapy clinics, medical centers, and hospitals, and rated as efficacious or probably efficacious for a wide range of conditions. Acupuncture, which came to public awareness in the U.S. in the 1970s (and still called a pseudoscience by some skeptics), is recommended in guidelines from government health institutions, national health system recommendations, and medical specialty groups. And natural products such as omega-3 fatty acids and L-methylfolate are now available as FDA-approved prescriptions for specific conditions, while others are included in guidelines, such as peppermint in the 2021 American College of Gastroenterology guidelines for IBS. Each year sees increasing numbers of research studies published in traditional, integrative, and basic science journals, and the NIH-NCCIH (National Center for Complementary and Integrative Health) 2021–2025 strategic plan aims to increase the integrative research workforce and its impact on individuals, communities, and populations.
To be sure, we need to invest in expanding the evidence base for integrative strategies, particularly those with a higher potential risk to the patient. It’s also imperative that health professionals be transparent in sharing with patients the risks, benefits, and state of evidence for all therapies. And medical trainees should be taught not just what treatments one might find in integrative medicine, but how to assess the data and make referrals to qualified clinicians.
As the nascent fields of integrative and functional medicine gain popularity among patients and practitioners, we need to remain true to the principles of evidence-informed care and the Hippocratic Oath. Just as physicians and patients need to partner in care, I’d like to close by suggesting that our more strictly biomedical colleagues consider a shift in their perspective of the integrative field from that of “charlatans” to “early adopters,” and collaborate in helping patients reach their goals. And who knows? Maybe you can learn something from your early adopter colleagues that can help your patients.
Where do you draw the line between "anti-science" and "early adopter"? Share in the comments.
Dr. Melinda Ring serves as the Director of the Osher Center for Integrative Medicine at Northwestern University, and Clinical Associate Professor in the Departments of Medicine and Medical Social Sciences at the Northwestern University Feinberg School of Medicine. Dr. Ring is board-certified in internal medicine and integrative medicine, and has a special focus in women's health. In her roles at Northwestern, she directs both clinical and faculty fellowships in integrative medicine, teaches the Cooking Up Health culinary medicine course, and researches nutrition and integrative strategies to promote health. She is a 2020–2021 Doximity Op-Med Fellow.