1.

The patient and practitioner are partners in the healing process, and that we recognize and honor the expertise of
each. Individuals’ goals can vary widely. One person may come to me and say, “I really want to work on weight loss”; for
another, weight is off-limits, but managing stress is open to discussion. I honor my patients’ decisions and preferences
about their lives and bodies.

2. All factors that influence health, wellness, and disease are taken into consideration. By taking an extensive history,
and listening to my patient’s full story, a healing path often emerges. For instance, I have been struck by the frequency
with which a careful dietary history has detected food intolerance that were the subtle culprits causing disease. Time
and again, a trial off dairy for three weeks has lead to resolution of sinus symptoms, heartburn, and bloating; other
common food triggers are wheat, eggs, soy, and citrus. Inadequate sleep can be the root cause for symptoms as broad
as irritability, joint pain, body aches, weight gain, and depression. A freshly painted office may explain the new onset of
headaches, nausea, and fatigue.

3. Use conventional and alternative methods appropriately to facilitate the body’s innate healing response. Many
strategies can be used to enhance health and well-being. In addition to lifestyle measures such as nutrition,
supplements, and mind-body interactions, acupuncture, Ayurveda, energy practices, and ritual might be used. Discerning
which to use, in what combination, and in what order is at the heart of the art of integrative medicine; it is influenced by
the available scientific evidence; the desires, beliefs, and intuitions of the patient; and the doctor’s clinical experience.

4. Use natural and less invasive interventions whenever possible. Modern medicine can be miraculous.  Still, there are
risks and benefits to all interventions and so whenever possible, I recommend that we begin with lifestyle changes and
the lowest doses of medication necessary.
Also, keep emotional well-being in mind.  We can suffer greatly from loneliness, a sense of failure, and other emotional
struggles.  Guy Winch PhD has a thought provoking TED talk on the topic.

4. Integrative medicine neither rejects conventional medicine nor accepts alternative medicine uncritically. We must be
discerning; there are practices in alternative medicine that I never recommend. Just as we don’t always jump to
conventional medicine, we don’t leap to alternative, either. Working with an integrative doctor can be helpful here, so that
you don’t have to sort it out all on your own.

6. Good medicine is based in good science; it is inquiry-driven and open to new paradigms. Unfortunately, many
physicians still say, “There is no evidence for integrative medicine,” without actually examining the scientific literature. Or
they say, “Alternative medicine is dangerous,” when many of the practices bear significantly lower risk than Western
medicine.
I believe that physicians need to be open-minded skeptics. We bear an obligation to our patients to explore the existing
evidence before rejecting a practice. And sometimes a lack of evidence doesn’t mean that a practice or remedy doesn’t
work; it could be that adequate studies haven’t been done yet. There’s a difference between something that has been
proven not to work and something that hasn’t been adequately studied.

7. The seventh principle of integrative medicine places health promotion and prevention alongside treatment. Do all that
you can to be as healthy as possible.  Clean up your diet, get regular exercise, develop a regular centering practice and
get a good night’s sleep.
Prevention has garnered a tremendous amount of attention during this era of health care reform.  It is important to
consider what prevention means – is it lifestyle change? immunizations? screening tests for cancer?  Also, we
sometimes believe that chemoprevention (using medications to prevent disease) is more effective than it is.  The
Number Needed to Treat (when available) can be very useful in clarifying how effective a prevention recommendation or
treatment actually is.

8. Practitioners of integrative medicine should exemplify its principles and commit themselves to self-exploration and
self-development. This means that we need to “walk our talk” and commit to living the same lifestyle we advise to
others.

Pharmacists from the University of Macau in Macau, China have assembled a meta-analysis of studies that look at the
community pharmacist responsibilities in terms of traditional and complementary and alternative medicines. Published
in Research in Social and Administrative Pharmacy, this study finds that 3 factors influence the pharmacists’
responsibilities: the breadth of medication use, pharmacists' objectives, and stakeholders' perspectives.
Barriers to understanding CAM use include a lack of information about their use in organ impairment, poor data about
the true incidence of adverse drug reactions associated with CAM, and the wide variety of locations where patients can
purchase CAM.

Evidence indicates that the pharmacist's role should expand to include CAM. Literature published in the last 15 years to
determine exactly where pharmacists need to intervene is extensive. Here's what researchers have concluded:
 Pharmacists have a professional responsibility to acknowledge and seek out information about patients' CAM use.
 Pharmacists need to increase their knowledge base about CAM so they have a basic understanding of what various
products do and what their risks are.
 Pharmacists can and must help patients use CAM appropriately and safely.
 Pharmacists should have knowledge of when patients who use CAM experience adverse drug events, and report
them appropriately.
 Pharmacists need to educate patients about CAM and its potential benefits and risks.
 Pharmacists approach to CAM needs to be collaborative in nature, and they need to work with health care
professionals so that they are aware that the patient is taking CAM and it's documented in the medical record.

Pharmacists can start by understanding the scope of the problem and defining CAM. It's especially important to know
what patients tend to use in specific geographic areas. In addition, pharmacists need to ask patients about CAM use. If
patients are using CAM, it's critical for pharmacists to ask them why, how it's working, and if they're having any
difficulties.