The most common use of the term integrative medicine is to describe the combination of Western medicine with complementary and alternative medicine (CAM). The problem with this popular definition is that it does not say anything about why or how these therapies should be combined and seems to imply that Western medicine and CAM are somehow fundamentally different (thereby creating an unnecessary tension between them). A more useful definition of integrative medicine would include the philosophic and intellectual rationale for combining differing therapeutic approaches into a seamless, unified approach that is internally cohesive. 

The Why of Integrative Medicine
Comprehensive
To provide comprehensive care for a patient means that their physical, emotional, social and spiritual dimensions are all adequately addressed. Sometimes the word holistic is used to describe this type of medical care. Unfortunately the use and abuse of the term holistic over the years has attached baggage and unwanted connotations to this term in the minds of many. "Comprehensive" is a more neutral term that can convey the same concept without making the hair bristle on the back of many people's necks. There can be no legitimate opposition to the provision of comprehensive care because it is "good medicine." If we were to find ourselves in the unfortunate position of needing medical care we would want comprehensive care for ourselves. The only area of debate around providing comprehensive care nowadays is whether it is cost effective and practical to do so. There are differing views in this debate which ultimately can only be settled by research which has yet to be done and data which has yet to be collected. However, it must be perfectly clear in our minds that the debate on cost effectiveness and practicality has little or no bearing on what constitutes comprehensive care. 

Individualized 
While Western medicine has made remarkable advancements in the treatment of disease, there are still many chronic conditions in which it cannot adequately prevent or relieve suffering. While many of the CAM therapies have been used for millennia with good results, there are many serious conditions that they cannot adequately treat. Therefore, no one therapeutic approach has all of the answers. Whereas Western medicine has undisputed superiority and effectiveness in managing acute medical crises, CAM therapies may be more effective in many chronic conditions. Having an expanded array of therapeutic options allows the clinician to more effectively match the therapy to the clinical situation. Furthermore the availability of increased therapeutic options also gives the patient increased ability to make choices that they are comfortable with. The spectrum of pathology and the diversity of the human condition guarantees that one size will never fit all. Having a broader array of therapeutic avenues to pursue enhances the ability to individualize therapy. 

Evidence
Given that both individuals and society have limited time and resources to expend on health care, the recommendation to use any therapy should be based on evidence that the therapy is safe, effective (improves favorable outcomes) and/or reduces side effects and negative outcomes (improves the margin of safety). There are many types of research that can provide evidence that a particular therapy is worthy of inclusion or exclusion. The lack of randomized clinical trials (often referred to as the "gold standard" of research), showing statistically impressive outcomes, should not necessarily exclude a therapy from consideration. Dramatic (Western medicine) interventions studied in drastic situations can more easily provide unequivocal data than can less-aggressive (CAM) interventions studied in chronic conditions. Recognizing this may allow some CAM therapies to be used in less dangerous conditions in the absence of what some would consider unequivocal data. This is not an excuse to lower the evidentiary bar for CAM, but rather recognition that the aggressiveness of the intervention and the magnitude of the pathology have an undeniable and significant effect on the data collected. Even without ironclad data that inconclusively proves efficacy there should be strong evidence of safety, favorable evidence of efficacy and some plausible mechanism of action. In the absence of these three elements a therapy should be excluded from routine recommendation by clinicians. 

The How of Integrative Medicine
Collaborative and Multidisciplinary
Given the exceedingly broad scope of both Western medicine and CAM it is difficult for any one practitioner to gain mastery in all disciplines. To maintain a certain level of competence there needs to be a degree of specialization. Without specialization there is the danger of being "a Jack of all trades and a master of none." In order to avoid clinical mediocrity, which compromises patient outcomes, it is important for practitioners to recognize the boundaries of their expertise and to be able to collaborate with other practitioners and other disciplines in the best interest of the patient. Collaboration may not always mean that there is entire agreement between all of the involved parties. However, clinical collaboration does mean that all parties and disciplines involved agree that finding ways of working together is vital to improving patient outcomes. 

Patient Empowerment and Responsibility 
The role of lifestyle, including such things as diet, exercise and stress reduction, can have a profound effect on health. To deny this is to ignore an impressive body of research and to provide care that is anything but comprehensive. To only treat patients with interventions and therapies that they must passively submit to, disempowers them, disengages them and compromises outcomes. Western medicine tends to place patients in a more passive role while CAM often encourages a more active role by patients. Integrative medicine recognizes the important role patients play in their own health and attempts to engage patients, whenever possible, to be an active part of the healing process. This engagement can occur more easily through a partnering process rather than through a more traditional and authoritarian model of care. 

Rational and Judicious Selection of Therapies 
The classic stepped-care model of Western medicine guides selection of therapeutic choices in a way that minimizes risk. This is in keeping with the Hippocratic dictum to "above all do no harm." In this model of care less aggressive (less risky and lest costly) strategies are preferred initially unless the clinical situation is more urgent--in which case more aggressive strategies are warranted. The process of taking a history, examining the patient and running any necessary tests allows a clinician to appropriately triage the patient to either less aggressive (non-urgent) or more aggressive (urgent or emergency) interventions. When less aggressive therapies are chosen, then their effectiveness is monitored for a reasonable period of time. If the initial strategy has failed to achieve the desired results then the next "step up" is more aggressive. In this model treatment failure is either a lack of improvement or any evidence of progression/worsening of the condition. Therapies are categorized or ranked according to a hierarchy of steps that range from safe, simple and inexpensive on one end to risky, complicated and expensive on the other. Obviously if safe, simple and inexpensive will do the job this would be preferable. On the other hand if the preferred choice is ineffective then the risk/benefit ratio justifies a change in course. 

The stepped-care model of integrative medicine is essentially the same as that of Western medicine. The main difference is that with the inclusion of (evidence based) CAM the hierarchy of therapeutic choices has been expanded at the lower (less aggressive) steps. The availability of increased options at the lower levels of the hierarchy of clinical interventions may obviate the need to "up the therapeutic ante." The other difference is that the assumed risks and side effects of more aggressive interventions may be reduced or mitigated by the use of CAM strategies along with Western medicine. This, in effect, allows the therapeutic benefit to be "stepped up" (Western medicine) while the risk is "stepped down" (CAM). The expanded stepped-care model of integrative medicine allows practitioners to rationally and judiciously select which therapies are most appropriate based on the risk/benefit ratio in any given clinical situation. It also seeks to favorably alter the risk/benefit ratio of necessary therapies that may be more aggressive. 

Summary/Definition of Integrative Medicine
Integrative medicine is a collaborative, multidisciplinary approach to providing comprehensive and individualized health care that encourages patient participation on the road to wellness. Choices of therapeutic recommendations, from among a continuum of interventions, are guided by evidence of safety and efficacy, with the goal of improving the risk/benefit ratio wherever possible. 

This definition of integrative medicine is neither polarizing nor divisive. This is a philosophy and style of delivering health care that is seamless, internally cohesive and has the best interest of the patient in mind. Integrative medicine, by this definition is simply good medicine.