Integrative, Integrated and Integrated Functional Medicine: Clarifying the Terms

Healthcare vocabulary has a habit of changing faster than practice. Terms that once described a clear idea acquire new meanings, lose old ones and travel between countries where they are understood differently. Nowhere is this more obvious than in the cluster of words around conventional and non conventional care: alternative, complementary, integrative, integrated and holistic. Practitioners who use them loosely risk misunderstanding their patients, their colleagues and the evidence. This article traces where the terms came from and what they are generally taken to mean now.

From alternative to complementary

In the English speaking world, “alternative medicine” became a common umbrella term in the 1970s and 1980s for practices outside mainstream biomedicine. The word carried an implication of replacement: an alternative is chosen instead of something else.

As research and policy attention grew, many institutions preferred “complementary”, implying use alongside conventional care, and the combined acronym CAM, for complementary and alternative medicine, became widespread. In the United States, the government research centre established in the late 1990s was named the National Center for Complementary and Alternative Medicine.

The distinction the 2 words capture remains useful. The same practice can be complementary or alternative depending on how it is used. Acupuncture used alongside a physiotherapy programme for back pain is complementary. A herbal remedy used instead of prescribed treatment for a serious infection is alternative. The practice has not changed; the relationship to conventional care has.

The rise of integrative

From the 1990s, academic medical centres, particularly in North America, began using “integrative medicine” to describe a deliberate combination of conventional care with complementary approaches that had some evidence of benefit, delivered with attention to the whole person and the therapeutic relationship. In 2014 the United States research centre changed its name to the National Center for Complementary and Integrative Health, reflecting this shift.

Academic definitions of integrative medicine and health typically emphasise 4 ideas: the importance of the practitioner and patient relationship; a focus on the whole person; being informed by evidence; and using all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines. The word implies coordination and a commitment to evidence, not simply a menu of therapies.

Integrated care: a different meaning

“Integrated” is used in a separate sense in health services research and policy. The World Health Organization’s framework on integrated, people centred health services describes care that is coordinated around people’s needs across settings, providers and levels of the health system. In this sense, integration is about organisation: a patient with diabetes, depression and heart failure receiving joined up care rather than 3 disconnected services. It has nothing specifically to do with complementary medicine.

In some countries “integrated” carries yet another meaning. In China, integrated Chinese and Western medicine is an established field with its own training and research. In India, the term is used for practice that combines modern medicine with Ayush systems, and the rules governing what different practitioners may do are set by national regulators and courts. A practitioner who uses the word in an international setting should be aware that listeners may hear any of these meanings.

Holistic, and why it is vague

“Holistic” is used across all of these fields to mean attending to the whole person rather than a single organ or symptom. It is a worthwhile aspiration, and good conventional practice is often holistic in exactly this sense. But the word has no precise definition, is used heavily in marketing, and says nothing about evidence or coordination. It is best used sparingly and backed with specifics.

Where Integrated Functional Medicine fits

Integrated Functional Medicine is IIFM’s name for a specific framework. It borrows from each of the traditions above but is not identical to any of them.

• From functional medicine it takes its organising method: the timeline, the matrix, the focus on mechanisms and modifiable mediators.
• From integrative medicine it takes the commitment to the whole person and to evidence informed use of approaches from outside conventional care.
• From integrated care it takes the emphasis on coordination across practitioners and settings.
• It adds an explicit responsibility to understand, evaluate, integrate and coordinate every kind of care a patient uses, with conventional diagnosis and treatment as the foundation.

A working glossary

Why precise language matters clinically

The single most important distinction, clinically, is between alternative and complementary use, because alternative use of an ineffective approach for a serious condition is a recognised cause of harm. Studies of patients with curable cancers who chose alternative medicine alone, for instance, have found substantially worse survival than among those who received conventional treatment. When a patient mentions another form of care, the most useful immediate question is often simply: are you using this together with the treatment your doctor recommended, or instead of it?

Language also shapes the patient relationship. Describing a patient’s tradition as alternative when they use it alongside conventional care can feel dismissive and discourage disclosure. Describing an approach as integrative when it is being used without evidence or coordination can lend it authority it has not earned. Accurate words protect both the patient and the credibility of practitioners who work across boundaries.

Talking with colleagues

When writing to a colleague about a patient’s other care, specifics are more useful than labels. “She takes St John’s wort 300 mg 3 times daily, started 4 months ago” tells the reader far more than “she uses complementary medicine”. Naming the practice, the dose, the practitioner and the dates allows the reader to assess it on its own merits.

Terms will keep changing

The vocabulary will continue to evolve, and practitioners do not need to police every usage. What matters is being clear in one’s own practice about 3 things: whether an approach is being used instead of or alongside conventional care; whether its use is informed by evidence; and whether it is coordinated with the rest of the patient’s care. Any term that helps answer those questions is doing its job.