Guide
Integrative medicine: what the evidence says (and doesn't)
Integrative medicine combines conventional medical care with complementary approaches, such as acupuncture or yoga, in a coordinated way. Whether it is "evidence based" depends on the specific therapy and the specific condition. A few have moderate evidence for particular uses. Many have weak or negative evidence. Homeopathy has no reliable evidence of effectiveness for any condition.
This is information about reading evidence, not medical advice. Talk to your doctor or pharmacist before changing anything. Before starting any complementary therapy, tell your doctor, and never stop or delay a prescribed treatment without talking to them.
The terms, separated
The US National Center for Complementary and Integrative Health (NCCIH) draws a line that is worth keeping:
- Complementary: a non-mainstream approach "used together with conventional medicine."
- Alternative: a non-mainstream approach "used in place of conventional medicine."
- Integrative health: "brings conventional and complementary approaches together in a coordinated way," with an emphasis on treating the whole person.
Holistic medicine has no single formal definition. It is commonly used to mean care that considers the whole person (body, mind and circumstances) rather than one organ. Good conventional care aims to do that too. The label tells you nothing about whether a particular treatment works.
Functional medicine is a branded model of care that its proponents describe as focused on root causes of chronic disease. The main published comparison is a 2019 retrospective cohort study at the Cleveland Clinic (Beidelschies and colleagues, JAMA Network Open). It found a small improvement in patient-reported physical health at 6 months compared with matched primary care patients, which was not significant at 12 months in the main comparison. The authors said prospective studies "are warranted to confirm these findings." Observational, single-centre, and not randomised: that is early evidence, not proof.
The distinction that matters most is complementary vs alternative. Using something alongside effective treatment is a different risk from using it instead.
How to read the evidence below
The summaries below come from Cochrane systematic reviews where they exist. Cochrane rates the certainty of evidence (high, moderate, low, very low) using the GRADE approach. "Low certainty" means the true effect may be substantially different from the estimate. A "sham" comparison (for example, needles placed at non-acupuncture points or not inserted) is the test of whether a specific effect exists beyond expectation and attention.
What the systematic reviews found
| Approach and condition | Review | What it found | Certainty |
|---|---|---|---|
| Acupuncture to prevent episodic migraine | Cochrane, Linde et al. 2016 (22 trials, 4,985 people) | Fewer headaches than no acupuncture. An effect over sham, "but this effect is small." May be similar to preventive drugs. No long-term studies over a year. | Moderate |
| Acupuncture to prevent tension-type headache | Cochrane, Linde et al. 2016 (12 trials, 2,349 people) | 51% vs 43% had at least a halving of headache frequency compared with sham. Authors call for more trials comparing it with other treatments. | Moderate to low |
| Acupuncture for chronic low back pain | Cochrane, Mu et al. 2020 (33 studies, 8,270 people) | "May not play a more clinically meaningful role than sham" for immediate pain relief or short-term quality of life. Better than no treatment in some comparisons. | Moderate to very low |
| Yoga for chronic low back pain | Cochrane, Wieland et al. 2022 (21 trials, 2,223 people) | Compared with no exercise, "small and clinically unimportant improvements" in function and pain. Probably little or no difference from other back exercise. More adverse events (mainly back pain) than no exercise. | Low to moderate |
| Echinacea for the common cold | Cochrane, Karsch-Völk et al. 2014 (24 trials, 4,631 people) | "Not here been shown to provide benefits for treating colds"; a weak benefit from some products is possible, of "questionable clinical relevance." | Mixed; products vary |
| Homeopathy, any condition | NHMRC (Australia) 2015 | "No health conditions for which there is reliable evidence that homeopathy is effective." | Overview of systematic reviews |
Two honest readings of this table:
- Some complementary approaches have real, modest effects for specific uses. Acupuncture for headache prevention is the clearest example here.
- "Natural" or "traditional" is not evidence. Several popular approaches show little or no benefit beyond sham or placebo for the conditions studied, and some carry their own risks.
Homeopathy: the Australian finding
In 2015 Australia's National Health and Medical Research Council (NHMRC) assessed 57 systematic reviews, containing 176 studies, that searched for research on homeopathy for 68 health conditions. Its conclusion was direct:
"There are no health conditions for which there is reliable evidence that homeopathy is effective."
NHMRC added that homeopathy "should not be used to treat health conditions that are chronic, serious, or could become serious," that people who choose it "may put their health at risk if they reject or delay treatments for which there is good evidence," and that anyone considering it should first get advice from a registered health practitioner and keep taking prescribed treatments.
Integrative oncology: complement, never replace
Integrative oncology means using complementary approaches alongside standard cancer treatment, usually for symptoms such as anxiety, fatigue or pain. Professional bodies now publish guidance on this. For example, the Society for Integrative Oncology and the American Society of Clinical Oncology issued a joint guideline in 2023 on integrative care for symptoms of anxiety and depression in adults with cancer (Carlson et al., JCO Oncology Practice). Those recommendations concern symptoms and quality of life, not treating the cancer itself.
The risk of using alternatives instead of treatment is measurable. A 2018 study in the Journal of the National Cancer Institute (Johnson et al.) followed people with non-metastatic breast, prostate, lung or colorectal cancer who chose alternative medicine alone. Compared with matched patients who had conventional treatment, they had a higher risk of death (hazard ratio 2.50, 95% CI 1.88 to 3.27). It is an observational study, but the direction and size of the effect are hard to ignore.
If you have cancer and want to use a complementary therapy, discuss it with your oncology team first. Some herbs and supplements can interact with cancer treatments.
How to judge a claim you read
- Is there a systematic review? Check the Cochrane Library first.
- What was it compared with? "Better than nothing" is not the same as "better than sham" or "as good as standard treatment."
- How certain is the evidence? Low or very low certainty means the next good trial could change the answer.
- Who is selling it? Treat claims from practitioners or product sellers with extra care.
- Is it being offered instead of effective care? That is the point at which the risk rises sharply.
Where MIA fits
MIA is for clinicians, researchers and medico-legal professionals who need to read a specific paper carefully: a trial, a review, or a study cited in a report. Put the paper on the desk and the working separates what it shows, what may be drawn from it, and what it does not establish. Clinical Conservative is the default, so investigational claims stay apart from standard of care, and thin evidence is named as thin. MIA is not a clinician, does not recommend any therapy, and gives no dosing.
Read a trial or review with MIA: 150 free credits, no card.
FAQ
Is integrative medicine evidence based? It depends on the therapy and the condition. Some approaches, such as acupuncture for headache prevention, have moderate-certainty evidence of modest benefit. Others have little or no evidence. Integrative medicine should complement, never replace, effective conventional care.
What is the difference between integrative and alternative medicine? Complementary or integrative approaches are used together with conventional medicine. Alternative approaches are used in place of it. Using an approach instead of effective treatment carries much higher risk.
Does acupuncture work? Cochrane reviews found moderate-certainty evidence that acupuncture reduces the frequency of migraine and tension-type headaches, with a small effect over sham. For chronic low back pain, it may not be more clinically meaningful than sham for immediate pain relief.
Does homeopathy work? Australia's NHMRC concluded in 2015 that there are no health conditions for which there is reliable evidence that homeopathy is effective.
This is information about reading evidence, not medical advice. Talk to your doctor or pharmacist before changing anything. See your clinician before starting, stopping or combining any treatment.
Sources
- NCCIH. Complementary, Alternative, or Integrative Health: What's In a Name? https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name - National Health and Medical Research Council. NHMRC Statement on Homeopathy and NHMRC Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions. Canberra: NHMRC; March 2015 (ref. CAM02). https://www.nhmrc.gov.au/about-us/publications/homeopathy - Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016;(6):CD001218. doi:10.1002/14651858.CD001218.pub3 - Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev. 2016;(4):CD007587. - Mu J, Furlan AD, Lam WY, et al. Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev. 2020;(12):CD013814. - Wieland LS, Skoetz N, Pilkington K, et al. Yoga for chronic non-specific low back pain. Cochrane Database Syst Rev. 2022;(11):CD010671. - Karsch-Völk M, Barrett B, Kiefer D, et al. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2014;(2):CD000530. - Beidelschies M, Alejandro-Rodriguez M, Ji X, et al. Association of the functional medicine model of care with patient-reported health-related quality-of-life outcomes. JAMA Netw Open. 2019;2(10):e1914017. - Carlson LE, Ismaila N, Addington EL, et al. Integrative oncology care of symptoms of anxiety and depression in adults with cancer: SIO-ASCO guideline summary and Q&A. JCO Oncol Pract. 2023;19(10):847-851. - Johnson SB, Park HS, Gross CP, Yu JB. Use of alternative medicine for cancer and its impact on survival. J Natl Cancer Inst. 2018;110(1). doi:10.1093/jnci/djx145 - Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-926.