'Integrated medicine" is the new buzzword in healthcare, aiming to combine the best of conventional and alternative medicine. Even the royals have got in on the act: Prince Charles has just launched a campaign encouraging GPs to prescribe more alternative treatments to NHS patients.
But integrated medicine is not a synonym for complementary medicine. While the latter refers to treatments that may be used as adjuncts to conventional treatment, the former is wider in scope, concentrating on health and healing rather than disease and treatment. Writing in the British Medical Journal, Rees and Weil explain: "It views patients as whole people with minds and spirits as well as bodies [...] It also involves patients and doctors paying attention to lifestyle factors such as diet, exercise, rest and relationships."
The latest UK development in integrated medicine is an initiative by the Prince of Wales' Foundation for Integrated Health to recruit GPs as "associates". Each member is expected "to offer a wide range of herbal and other alternative treatments to their patients". By October 2005, the foundation hopes to have enlisted 150 GPs.
And why not? My professional life is dedicated to identifying what works in complementary medicine and, of course, I am in favour of using proven therapies. But probing beneath the surface of the UK initiatives for integrated medicine, one quickly finds problems.
Dr Michael Dixon, a trustee of the foundation, recently gave an example of integrated medicine. A patient with shoulder pain, he said, need not resort to physiotherapy or surgery: "Devil's claw, a shrub found in the Kalahari, and acupuncture are also proven to work."
Devil's claw is a good example of where this approach goes wrong. It is indeed an effective herbal medicine. It is a painkiller much like paracetamol. There is no evidence, however, that it is any better. The idea of substituting a synthetic drug with a herbal remedy sounds ethical, but on closer inspection it is far from green. The growing popularity of devil's claw has led to the plant being overharvested, which has brought it to the brink of extinction.
But the most obvious lunacy of advocating devil's claw under the banner of integrated medicine lies elsewhere: the herb is much more expensive than paracetamol, and could be unsafe. Only recently, anti-inflammatory drugs called COX2 inhibitors were banned because they seemed to cause cardiovascular problems. Devil's claw also works by COX2 inhibition, and so might cause the same problems as the banned drugs. In addition, devil's claw seems to interact with a range of pharmaceutical treatments, including those taken for heart conditions and blood thinning. So far, there is little hard evidence, but this could simply be because we haven't yet done our homework properly.
This little tale exposes the shortfalls of embracing integrated medicine uncritically. As currently promoted in the UK, it could mean the routine adoption of unproven treatments. This is asking for trouble. Unproven therapies such as devil's claw should not be integrated; they should be researched. Only when sufficient evidence is on the table should we decide whether to use them routinely. This concept is called evidence-based medicine, and is a universally accepted strategy. If we deviate from common sense and science, we allow double standards where none must exist. And this will do nobody any favours - least of all the consumer.
· Edzard Ernst is professor of complementary medicine at the Peninsula medical school at the universities of Exeter and Plymouth.