Foreword
As I write these words in early February 2010, I am returning from my first trip to India. The purpose of my visit was to lead a delegation of six prominent leaders in Complementary and Integrative Medicine from prestigious academic medical centers in the United States at the invitation of the Ministry of Health in India, Department of AYUSH (Ayurveda, Yoga, Unani, Siddah, and Homeopathy). The expressed goal of the Indian Government was to inform our delegation about the evidence-base for Ayurvedic Medicine, and to give us first-hand exposure to the use of traditional Indian medicine in clinical practice and in education, and to explore potential research projects in this area. My own specific objective was to determine whether anything we saw or heard about Traditional Indian Medicine should eventually be included in the curriculum for physicians and other health professionals in the United States.
What struck me during this intense 7-day visit, was the chasm that exists, even in India, between those trained in traditional medical practices and those trained in Western allopathic medicine. Many of the traditionalists feel that centuries of continued practice provides sufficient rationale for the use of various medical approaches (what in Europe constitutes “historic use” in terms of regulatory approval), irrespective of whether these therapies have been “proven” by modern scientific means, whereas most of those conventionally trained express a healthy skepticism and demand clear and unambiguous data to support the use of any therapy or medicinal plant.
This tension is very familiar to me. A decade ago, I helped launch a public lecture series on complementary and alternative medicine (CAM) at Georgetown University School of Medicine. At that time, a fellow colleague and I established a “mini-medical school” series at Georgetown University aimed at informing the public about the advances in medical science and health. For several years, over 200 men, women, and young adults, ranging in age from 16 to 83 years, would come to the medical center on 8 Tuesday nights in the Fall and Spring semesters to hear some of our finest faculty teachers lecture on a myriad of medical issues. In response to our surveys inviting suggestions for future topics, many participants kept requesting lectures on CAM. Initially, we did not know what to make of these requests, but eventually we invited our fellow faculty member, Dr. Hakima Amri, to develop an eight-lecture series on CAM.
Thus began my education into this field, and I quickly realized that the public was eager to learn more about these treatment approaches and ancient medical systems. In contrast, the academic medical community was, in general, wary of venturing into areas many deemed unproven and unscientific. Our purpose in offering the public lecture series on CAM was to provide the best evidence available for what was harmful, what was safe and beneficial, and what aspects of CAM were simply unknown or untested.
This initial foray into a rather controversial field bore fruit. In December 1999, in an effort that demonstrated considerable courage, the leadership at the National Center for Complementary and Alternative Medicine at the National Institutes of Health issued a call for grant proposals from allopathic schools (conventional medicine and nursing) to develop curricular modules that would integrate CAM into the conventional training of physicians and other health professionals. The initiative led to important interactions between like-minded academic leaders of Integrative Medicine who were interested in determining, in an objective fashion, what aspects of CAM ought to be part of a medical curriculum. Those initial efforts led to a landmark series of articles that were published in the October 2007 issue of Academic Medicine, which addressed such topics as rationale for CAM education in health professions training programs, what should students learn about CAM, and instructional strategies for integrating CAM into the medical curriculum.
At Georgetown University School of Medicine, in addition to introducing CAM-relevant material into the medical and nursing curricula, our faculty in the Department of Physiology and Biophysics created an innovative graduate degree program of study in CAM. The mission of the program is to provide advanced study in the science and philosophy of predominant CAM therapies and disciplines and to train students to objectively assess the safety and efficacy of various CAM modalities. The program seeks to understand the mechanistic basis for CAM therapies such as acupuncture, massage, herbs and supplements, and mind-body interactions. By embedding CAM principles and paradigms firmly into a conventional basic/clinical sciences context, our intent is to prepare a new generation of health care providers, educators, and researchers for the challenging task of delivering the health care of the future; namely, a multidisciplinary approach to improved wellness emphasizing health maintenance and disease prevention.
However, literacy in CAM, for students and faculty in our program, as well as for others around the nation, depends on an authoritative, comprehensive textbook that can provide the basic information regarding the philosophy and science for many of the CAM therapies. Fortunately, Dr. Marc Micozzi has done the field a great service by producing an outstanding text, entitled, Fundamentals of Complementary and Alternative Medicine. Joined by a list of distinguished experts in the field of complementary and integrative medicine, Dr. Micozzi introduces the reader to the foundations of CAM, the contexts for the use of CAM, and thorough, evidence-based descriptions of the predominant CAM therapies and traditional medical systems. The writing is easy to understand and the focus is sharp. Each chapter is referenced appropriately, and the reader is directed to several suggested additional readings. For the past few years, my colleagues at Georgetown have relied on this excellent work and have made it required reading for our program. In the new fourth edition, Dr. Micozzi has made significant additions to the scope of the textbook, including a new and important section on mind-body-spirit.
It is essential that the health care practitioner of the future, either in the United States or elsewhere in the world, be able to bridge the current chasm between conventional and traditional medicine. Recently, the Consortium of Academic Health Centers for Integrative Medicine (www.imconsortium.org) defined Integrative Medicine as “the practice of medicine that 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 approaches, healthcare professionals and disciplines to achieve optimal health and healing.” If we are to produce practitioners who can truly address the needs of their patients, they must be knowledgeable about all therapeutic approaches, both conventional and those from other traditions, and be willing and interested to develop working relationships with practitioners from various disciplines. This textbook by Dr. Micozzi goes a long way in providing the reader with a fundamental understanding of complementary and integrative medicine. It is a journey worth taking and on which we at Georgetown University have seriously embarked.