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Ali M. Seven Core Priciples of Integrative Medicine
J Integrative Medicine 1998;3:77-81

Seven core principles of integrative medicine

    Seven core principles of integrative medicine, proposed individually by the author previously,^1-7 are brought together to create a conceptual framework for the clinical practice of integrative medicine. This will also address the issue of Whither Integrative Medicine? raised recently in The Journal of Integrative Medicine.⁸ Those seven principles are: (1) the principle of empiricism; (2) the principle of integration; (3) the principle of integrity of cellular and tissue ecologic relationships; (4) the principle of physician-patient reciprocity; (5) the principle of spontaneity of oxidation; (6) the principle of spontaneity of healing; and (7) the principle of spiritual surrender.

1. The Principle of Empiricism
    What is empiricism in medicine? It is a scientific discipline that concerns itself with purity of clinical observations concerning the sick. Medical empiricism properly recognizes the absence of experimental validation for its observations when such is the case, but without suffering doubt about the validity of its observation. It should be acknowledged that clinical associations in medicine have mostly preceded the establishment of experimental evidence for the principles that underlie them, just as theorists generally worked out the principles of electromagnetism after the inventors' work was completed in the nineteenth and early twentieth centuries. However, experimental science does catch up with the science of empiricism. I illustrate this principle with three simple examples:

    First, many African tribes empirically recognized association between malaria and mosquitoes long before the Italians and the English insisted it was caused by bad air (mal aire) of Italian swamps.⁹ And that was long before the malarial parasite was identified.

    Second, for decades all over the world, general practitioners empirically administered injections of vitamin B12 (but not of vitamins C or D) for their recognized value in relieving fatigue despite the ridicule of academics. A spate of recent studies have conclusively demonstrated the value of this vitamin for a variety of neuropsychiatric and disorders associated with fatigue.^10-13 At the Institute, the author and his colleagues have observed greater benefits with larger doses of this vitamin (up to 20,000 mcg) in patients with fibromyalgia, CFS, chemical sensitivity, Alzh-eimer's disease, and dementia who suffer from severe cognitive difficulties.

    Third, the efficacy of intravenously administered hydrogen peroxide was empirically recognized.¹⁴ The author refrained from using this therapy for his patients with fibromyalgia and chronic fatigue syndrome on the ground that hydrogen peroxide is a potent oxidant and that ample clinical and experimental evidence clearly established those syndromes to be related to accelerated oxidative molecular injury.¹⁵ However, his recent high-resolution, phase-contrast studies of freshly prepared peripheral blood samples led him to recognize the paradox of an in vitro oxidant serving as an in vivo antioxidant.¹⁶ Now, the author and colleagues frequently employ hydrogen peroxide therapy with good clinical results in a host of patients with accelerated oxidative molecular injury.

2. The Principle of Integration
    In clinical medicine, the principle of integration requires that the practitioner integrate in the care of the patient all that is safe and effective without subservience to one or more schools of medical thought. It is one of the profound ironies of our time that the truth and relevance of this simple - and all too self-evident - principle has escaped the main physician body for so many decades. This principle holds that all outcome studies must assess the efficacy of integrated protocols in their entirety and not of individual therapies. This is a point of crucial importance. Empirical experience clearly demonstrates that clinical outcomes are far superior when the benefits of individual therapies are complemented by other therapies. The true benefits of integrated protocols far exceed the sum of the components therapies.

    In the United States, the principle of integration has largely been ignored at an enormous cost to the sick. A critical issue never addressed in the prevailing pharmacologic model is the inappropriateness of prescribing four, five, or more drugs concurrently, and for years, when the drug combinations used have not been evaluated even for months. No one can testify to the safety of such drug regimens in their entirety.

Two recent studies are cited below to define the magnitude of that problem.

    The first study reported the clinical efficacy of an integrated program for managing patients with advanced coronary artery disease. The program emphasized the role of all elements that improve rheologic characteristics of blood and reduce or prevent oxidative coagulopathy in circulating blood, including self-regulation for stress control, optimal food choices to prevent sugar overload and consequent hyperinsulinemic state, ample supplementation with antioxidant nutrients, herbs to restore damage to the bowel-blood-liver ecosystems, noncompetitive exercise, and EDTA chelation therapy. In a series of 26 patients with failed coronary bypass surgery, angioplasty and multiple drug therapies, complete control of symptoms and discontinuance of all drugs was achieved in 61%. In another 17%, symptom control and drug dose reduction of over 75% was reported.¹⁷ In the second study, by contrast, a non-integrative management plan focusing on coronary bypass surgery and angioplasty for patients hospitalized for acute coronary syndromes actually showed that such procedures increase the odds of death as compared to conservative management.¹⁸ Consider the following quote from the editorial published in the New England Journal of Medicine commenting on that study:

    With remarkable clarity and consistency, all four studies show that routine angiography and revascularization do not reduce the incidence of nonfatal reinfarction or death as compared with the more conservative, ischemia-guided approach. In fact, in the VANQWISH study of patients with non-Q-wave infarction, the aggressive strategy [which these investigators call "invasive"] was associated with increased mortality during hospitalization, at one month, and at one year.¹⁹

3. The Principle of Integrity of Cellular and Tissue Ecologic Relationships
    A macroecologic tissue-organ model of the health-disease continuum (the Pyramid of Trios of Human Ecosystems) based on a microecologic cellular model of illness (the ORPEC state) was recently proposed.¹⁶ In this model, the central roles of oxidative coagulopathy involving all elements of the circulating blood and accelerated oxidative injury to 3M ecologies (membrane-matrix-mitochondria) in the pathogenesis of diverse chronic nutritional, autoimmune, ecologic, degenerative, and malignant disorders. That clinical model is especially pertinent to such entities as fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivity syndrome, Gulf War syndrome, and severe but hard-to-define and indolent autoimmune disorders. It was proposed that the common denominator among all such clinical states is accelerated oxidative molecular injury which results in oxidative damage to enzymes involved in oxygenative, redox, acid-base, and detox pathways.

    The essential strength of the Pyramid of Trios is that it focuses on: (1) a need for ecologic thinking that extends far beyond the limited notions of diseases as defined by microscopic study of tissues after they have been injured; (2) a model of living ecosystems that emphasizes relatedness among the various body ecologies; and (3) the essential role of the base trio of the bowel, blood and liver in the integrity of human defenses. The clinical validity of this schematic model has been demonstrated.^17,20

^{Seven Core Principles 1 2}

Index of Article Authors
Majid Ali, MD
Omar Ali, MD
Mary Ann Carroll, RN
Alfred Fayemi, MD
C.Grieder-Brandenburger, RN
Judy Juco, MD
Tsuneo Kobayashi MD
Jean A. Monro, MB, BS
(This index is incomplete and will be completed shortly)

Past and
Current Editors
Omar Ali, M.D.
Robert Atkins, M.D.
Robert Bradford, D.Sc
Paul Cheney, M.D., Ph.D.
Steven Davies, M.D.
Alfred O. Fayemi, M.D.
Claus Hanke, M.D.
Doug Hutto, N.D.
Judy Juco, M.D.
Paris Kidd, Ph.D.
Oscar Kruesi, M.D.
Derrick Lonsdale, M.D.
D. Vijen Poleszynski, B.S.
Christine Radulescu, Ph.D.
Ray Russamono, M.D.
Susan Test, Ph.D.
Lowell Weiner, D.D.S.
John C. Williams, M.D.

The Journal of Integrative Medicine shall not be held responsible for statements of the contributing authors. The views and opinions expressed are those of the submitting authors and do not necessarily reflect those of The Journal of Integrative Medicine, The American Academy of Integrative Medicine,
The American Academy of Preventive Medicine, any advertisers or staff members of The Journal of Integrative Medicine
 

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The Journal of Integrative Medicine shall not be held responsible for statements of the contributing authors. The views and opinions expressed are those of the submitting authors and do not necessarily reflect those of The Journal of Integrative Medicine, The American Academy of Integrative Medicine, The American Academy of Preventive Medicine, any advertisers or staff members of The Journal of Integrative Medicine