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Integrative Medicine and Systemic Outcomes Research
Issues in the Emergence of a New Model for Primary Health Care
Iris R. Bell, MD, MD(H), PhD;
Opher Caspi, MD;
Gary E. R. Schwartz, PhD;
Kathryn L. Grant, PharmD;
Tracy W. Gaudet, MD;
David Rychener, PhD;
Victoria Maizes, MD;
Andrew Weil, MD
Arch Intern Med. 2002;162:133-140.
Clinicians and researchers are increasingly using the term integrative medicine to refer to the merging of complementary and alternative
medicine (CAM) with conventional biomedicine. However, combination medicine
(CAM added to conventional) is not integrative. Integrative medicine represents
a higher-order system of systems of care that emphasizes wellness and healing
of the entire person (bio-psycho-socio-spiritual dimensions) as primary goals,
drawing on both conventional and CAM approaches in the context of a supportive
and effective physician-patient relationship. Using the context of integrative
medicine, this article outlines the relevance of complex systems theory as
an approach to health outcomes research. In this view, health is an emergent
property of the person as a complex living system. Within this conceptualization,
the whole may exhibit properties that its separate parts do not possess. Thus,
unlike biomedical research that typically examines parts of health care and
parts of the individual, one at a time, but not the complete system, integrative
outcomes research advocates the study of the whole. The whole system includes
the patient-provider relationship, multiple conventional and CAM treatments,
and the philosophical context of care as the intervention. The systemic outcomes
encompass the simultaneous, interactive changes within the whole person.
From the Program in Integrative Medicine, Departments of Medicine (Drs
Bell, Caspi, Schwartz, Grant, Gaudet, Rychener, Maizes, and Weil), Psychiatry
(Drs Bell and Schwartz), Psychology (Drs Bell, Caspi, and Schwartz), Neurology
(Dr Schwartz), Family & Community Medicine (Drs Bell and Weil), Obstetrics
and Gynecology (Dr Gaudet), and Pharmacy Practice (Dr Grant), The University
of Arizona Colleges of Medicine and Pharmacy, and the Southern Arizona Veterans
Affairs Health Care System (Dr Bell), Tucson. Dr Gaudet is now with Duke University
Center for Integrative Medicine, Durham, NC.
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