Abrams Donald - Integrative Oncology

Integrative Oncology

Weil Integrative Medicine Library

Published and Forthcoming Volumes

SERIES EDITOR

ANDREW T. WEIL, MD

Donald I. Abrams and Andrew T. Weil: Integrative Oncology

Karen Olness and Timothy Culbert: Integrative Pediatrics

Gerard Mullin: Integrative Gastroenterology

Victoria Maizes and Tieraona Low Dog: Integrative Womens Health

Randy Horwitz and Daniel Muller: Integrative Rheumatology, Allergy, and Immunology

Bernard Beitman and Daniel A. Monti: Integrative Psychiatry

Stephen DeVries and James Dalen: Integrative Cardiology

EDITED BY

Donald I. Abrams, MD

Chief, Hematology-Oncology

San Francisco General Hospital

Osher Foundation Endowed Director of Clinical Programs
UCSF Osher Center for Integrative Medicine

Professor of Clinical Medicine

University of California San Francisco
San Francisco, California

Andrew T. Weil, MD

Director, Arizona Center for Integrative Medicine
Lovell-Jones Professor of Integrative Rheumatology
Clinical Professor of Medicine

Professor of Public Health

University of Arizona

Tucson, Arizona

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Library of Congress Cataloging-in-Publication Data
Integrative oncology / edited by Donald I. Abrams, Andrew Weil.
p. ; cm.
Includes bibliographical references.
ISBN 978-0-19-530944-7
1. Oncology. 2. CancerAlternative treatment. 3. CancerAdjuvant treatment. 4. Integrative medicine.
[DNLM: 1. Neoplasmstherapy. 2. Complementary Therapies.
QZ 266 I5687 2008] I. Abrams, Donald I. II. Weil, Andrew.
RC254.5.I52 2008
616.99406dc22 2008016137

1 3 5 7 9 8 6 4 2
Printed in the United States of America
on acid-free paper

To Clint for his nurturing, guidance, and inspiration

and

In memory of Sam for his friendship, wisdom, and good cheer

ANDREW T. WEIL, MD

Integrative medicine (IM) is healing-oriented medicine that takes account of the whole person (body, mind, spirit), as well as all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and complementary. IM is not synonymous with alternative medicine or with CAM (complementary and alternative medicine). It neither rejects conventional medicine nor accepts alternative treatments uncritically.

Integrative medicine is a rapidly growing movement in North America. Consumer demand for it has increased steadily over the past decades. Now, as the conventional health-care system collapses because of out-of-control escalation of costs of high-tech medicine, medical institutions are finally taking IM seriously. The Consortium of Academic Health Centers for Integrative Medicine has 41 members; among them are many leading medical schools, whose deans and chancellors recognize the need to move medical education, research, and practice in this direction. A major reason for the new acceptance of IM is awareness that it can lower health-care costs in two ways: (1) by shifting the focus of health care from disease management to health promotion through its attention to lifestyle and the innate healing potentials of the human organism; and (2) by bringing lower-cost treatments into the mainstream that can give outcomes as good as or better than those of pharmaceutical drugs and other conventional therapies.

Practitioners are also increasingly drawn to IM because they recognize its potential to restore core values of medicine that have eroded in the era of profit-driven health care. Yet demand for clinicians trained to practice IM greatly exceeds supply. The Arizona Center for Integrative Medicine that I founded in 1994 has graduated more than 300 physicians (and some nurse practitioners) from comprehensive fellowships, mostly in distributed learning formats. Many of them now direct IM programs at other institutions, some are training others, and some have authored leading textbooks in the field. The Center also trains medical students, pharmacists, and medical residents. One of its major goals is to develop a core curriculum in IM that will become a required, accredited part of all residency training in all medical specialties.

In the meantime, there is an immediate need to organize and make accessible to many more clinicians the basic principles of IM in practical application to common health conditions. It is hoped that the present series of volumes will help fulfill that need. Each volume will cover the relevance of IM to a particular specialty, and each will draw on the editorial expertise of a specialist who is fully trained in IM as well as the advice of senior experts who are open to, but not directly involved with, the IM movement. Each volume will also give detailed protocols for the management of conditions that respond well to integrative treatment and will discuss areas of controversy and uncertainty where further research is needed.

Some physicians may find this information of use in meeting the needs of patients better. Some may use it to determine the best treatments for common conditions. Others may simply want to know more about CAM therapies their patients are using, if only to be able to discuss them intelligently and give advice about possible interactions between, say, conventional drugs and dietary supplements or botanical remedies.

Promoters of IM have been criticized for advocating unscientific or even antiscientific theories and practices. The commitment of all editors involved in this project is to present the evidence base for integrative treatment strategies. Readers should note, however, that IM teaches practitioners to use a sliding scale of evidence in making therapeutic choices: the greater the potential of a treatment to cause harm, the stricter the standard of evidence it should be held to for efficacy. We may recommend therapies that do not yet have a solid evidence base for efficacy if their potential for harm is low. Examples are suggesting therapeutic massage for persons with advanced forms of cancer as a means of improving quality of life or teaching hypertensive patients breathing techniques to increase the tone of the parasympathetic nervous system. All authors have been charged with the task of citing the best available evidence for both safety and efficacy of therapies discussed.