Integrative Medicine: The “Best of Both Worlds”?

In 2006, Brazil launched its National Policy for Integrative and Complementary Practices, known as PICs. This new label officially replaced the older and more popular term “alternative medicine.” It also formalized the inclusion of various alternative practices—now with a more polished name—into Brazil’s public health system, the SUS. But why so many names? What’s the actual difference between alternative, complementary, and integrative medicine?

In reality, there is no substantive difference—only a matter of branding. All three terms refer to a broad collection of practices without a clear definition of what they share, what legitimizes them, or how they can be distinguished from useless or pseudoscientific treatments.

Brazil’s Ministry of Health defines them this way: “Integrative and Complementary Practices (PICs) are treatments based on traditional knowledge, aimed at preventing illnesses such as depression and hypertension. In some cases, they may also be used as palliative treatments for chronic conditions.” Hospital Israelita Albert Einstein describes them as: “A person-centered approach, informed by evidence, making use of all appropriate therapeutic methods, with health professionals from different disciplines, to achieve the best in health and healing. Integrative medicine fosters a partnership between doctor and patient to maintain health.”It adds that this includes traditional practices such as meditation, breathing techniques, relaxation, mindfulness, and herbal remedies, “always based on evidence regarding safety and efficacy.”

The Australasian Integrative Medicine Association defines it as: “A philosophy of healthcare that focuses on the patient as an individual, combining the best of Western medicine with evidence-based complementary therapies.”

The U.S. Academic Consortium for Integrative Medicine and Health says: “A practice that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches and healthcare professionals to achieve optimal health and healing.”

In the United States, the National Center for Complementary and Integrative Health (NCCIH) defines it as: “Integrative health brings together conventional and complementary approaches in a coordinated way. It emphasizes a holistic, patient-centered approach that includes mental, emotional, functional, spiritual, and community aspects—treating the whole person rather than just one system or organ.”

Finally, the World Health Organization (WHO) uses the terms “complementary” or “alternative medicine”: “They refer to a broad set of healthcare practices that are not part of a country’s own tradition or conventional medicine, and are not fully integrated into the dominant health system.” Interpreting the Definitions

Put together, these definitions sound more like vague notes of good intentions than useful or precise descriptions. The common thread seems to be the idea that in order to “treat the whole person,” one must step outside the boundaries of conventional medicine and use “traditional knowledge.” This supposed tension between “traditional” and “conventional” is revealing—especially since neither term is clearly defined.

In Brazil, PICs even include treatments created in the 20th century, like Reiki, flower remedies, ozone therapy, or family constellations. How these could be considered “traditional” is unclear. Another tension lies in the frequent use of phrases like “evidence-based” or “informed by evidence.” But what kind of evidence? If the evidence were strong enough to meet scientific standards of safety and efficacy, these practices would already be part of conventional medicine—no need for the “traditional” label. If the evidence is weak, then invoking tradition is not only irrelevant but potentially dangerous.

It is also false to suggest that conventional medicine cannot treat patients holistically. Any good doctor is, of course, interested in restoring health and supporting overall well-being. Physicians regularly advise patients to stop smoking, exercise, or improve diet—classic holistic strategies. If shortcomings exist in the system (poor training, lack of supplies, or inadequate consultation time), the solution should be to fix the system, not integrate pseudoscientific methods that may offer comfort but waste resources and sometimes encourage harmful beliefs, like downplaying vaccines or claiming all illnesses can be cured through diet and mental discipline. Sorting Wheat from Chaff

PICs are essentially the same old alternative practices, still lacking scientific support. Of the 29 included in SUS—such as apitherapy, family constellation therapy, bioenergetics, geotherapy, chromotherapy, homeopathy, and flower remedies—only yoga, meditation, and some specific uses of herbal medicine have scientific grounding (yoga as exercise, meditation as stress reduction, and certain tested medicinal plants). The rest lack proof, and some—like homeopathy—have already been shown by rigorous science to be ineffective.

So why the name change?

The idea is that by “integrating” scientifically based medicine (which proponents dismissively label as “Western,” “allopathic,” or “hegemonic”), patients supposedly get “the best of both worlds.” The concept sounds appealing—but when one of the worlds is pure fantasy, what’s the point of combining it with reality? And is such integration really harmless?

Calling these practices “complementary” or “integrative” also shifts responsibility. If patients abandon conventional treatments in favor of fantasy, proponents can claim they only meant their therapies to be used alongside real medicine. This framing also creates the illusion that alternative methods stand on equal footing with science-based treatments, especially when both are offered within the same public health system.

John Farley of the University of Nevada illustrated the absurdity of this logic: “Biologists would have to integrate creationism with Darwinian evolution; chemists would integrate alchemy with modern chemistry; geologists would integrate flat-Earth beliefs with modern dating methods; physicists would combine perpetual motion machines with thermodynamics; and astronomers would merge astrology with astronomy. It’s absurd to integrate nonsense with science.” “What’s the Harm?”

Supporters argue that even if PICs don’t cure anything, they at least promote well-being and might prevent serious illnesses, saving healthcare costs. Yet, after 13 years in SUS, there has been no follow-up study to test this claim. In fact, there is no proper regulation of these practices at all.

We do not know if people using homeopathy, Reiki, aromatherapy, or energy healing experience less cancer or hypertension. But based on international studies—and the implausibility of the methods—it’s highly unlikely.

The U.S. has decades of experience with this. In 1992, Congress created the Office of Alternative Medicine (OAM). In 1998, it became the National Center for Complementary and Alternative Medicine (NCCAM) within the NIH, with a $50 million annual budget, which grew to $123 million by 2005. In 2014, it was renamed the NCCIH.

After billions of dollars and hundreds of clinical trials, the results are consistent: no alternative practice has proven effective. Reviews in Scientific Review of Alternative Medicine and Skeptical Inquirer concluded that the center has produced no useful discoveries, only confirmed the ineffectiveness of methods long known not to work. Yet funding continues.

Meanwhile, integrating alternative practices into systems like SUS misleads patients, drains public resources, and risks undermining conventional care. In Brazil, where even basic supplies like gloves, syringes, and contraceptives are scarce, diverting funds to unproven therapies is especially indefensible. What Science Says

There is no need for separate categories of “conventional,” “alternative,” “complementary,” or “integrative” medicine. For evidence-based medicine, origin doesn’t matter. Whether ancient or modern, cultural or molecular, the only test that matters is: does it work?

If a therapy is proven safe and effective through randomized, controlled, placebo-based clinical trials, it will be adopted into mainstream medicine.

The label “integrative” exists only to disguise the fact that these therapies have failed rigorous testing, rely on implausible diagnostic concepts, and conflict with established knowledge in chemistry, physics, and biology.

And so we return to the tension present in all these definitions: tradition versus evidence. If the evidence is strong, tradition doesn’t matter. If the evidence is weak, tradition is nothing more than a smokescreen.

✍️ Natalia Pasternak is a researcher at the Institute of Biomedical Sciences at the University of São Paulo (USP), national coordinator of Pint of Science Brazil, and president of the Instituto Questão de Ciência.