What in your opinion is the difference between alternative and complementary medicine? If, for example, a 52-year-old woman is supplementing her meals with fresh ginger on the day she is undergoing chemotherapy for breast cancer, should that be considered as alternative, complimentary, traditional or integrative medicine? The 52-year-old woman described who has supplemented her meals with fresh ginger root on the days she's being treated with chemotherapy for breast cancer illustrates the difficulty in defining the different, often conflicting, models of non-conventional medical care. What, in fact, does the term complementary medicine refer to? What differentiates this form of care from those of alternative, traditional or integrative medicine? How do these models of care each differ from conventional medicine? One way to understand these four approaches to non-conventional medical care is to compare them with the context of conventional Western medicine. The 52-year-old patient described was undergoing chemotherapy for breast cancer. Then, conventional treatment she was receiving were being provided within the Conventional Department of Oncology, where the model of care is based on research and established treatment guidelines. It is most likely that our patient was diagnosed initially with breast cancer following a routine screening mammography or else the self-discovery of a breast lump, which led to a biopsy, in which one of a number of types of breast cancer cells were discovered. It is also most likely that a multidisciplinary team of surgeons, oncologists and other health care professionals were involved in the numerous processes of establishing the stage of the disease, receptor status like estrogen and progesterone receptors, HER2, prognostic markers, for example fish one, and risk of recurrence following surgery. The conventional oncology team must have designed a treatment plan which included chemotherapy, neoadjuvant, adjuvant or curative surgery for localized cancer, and endocrine, biological, immunological therapies and radiation. Soon after the diagnosis, a schedule for the chemotherapy regimen was set, as was the case for the other elements of therapy whether surgical, pharmacological or radiotherapeutic. Before beginning chemotherapy, our patient most likely met with the oncology nurses who will be administering the chemotherapy in either the in-patient or out-patient setting, and the social worker who would provide guidance on the social services available, as well as addressing the possibility for psycho-oncology care. In an increasing number of centers, supporting and palliative care is being addressed even before beginning chemotherapy or soon thereafter. This aspect of care will be suggested to the patient by their oncologists, nurse or social worker, and in some centers, by a specially designated palliative care team working within the cancer center. How does all this high-tech conventional state of the art standard of care medical treatment relate to our patients use of ginger as a therapeutic option? Why does she turned to these ancient, simple and inexpensive treatment and with an herbal product which is used primarily to enhance the flavor of cake recipes and not as part of cancer care? One way to understand the patient's interest in ginger is to acknowledge the affinity of patient such as her within the more broad social cultural context of traditional herbal use. The affinity with traditional medicine is especially prevalent in regions such as the Middle East, India and China, where ginger is not only a popular ingredient in cooking and tea, but also considered as a medicinal herb which can significantly reduce the severity of nausea. It would thus be most likely that our patient told her family and friends about the side effects of chemotherapy and they then told her of someone they knew who use ginger and other herbs during chemotherapy which reduce nausea and vomiting, increased energy, lead to a better quality of life, et cetera. In such a scenario, the use of ginger for chemotherapy-induced nausea and vomiting would be defined as complementary medicine, reflecting the use of the non-conventional treatment together or during the same time as the conventional treatment, in this case antiemetic drugs prescribed by the oncologist. The goal of complementary medicine is to supplement the conventional medical treatment, in this case ginger root with conventional antiemetic drugs such as metoclopramide or 5-HT3 antagonist like Ondansetron. We now understand how ginger may be perceived in the context of traditional medicine on the one hand, and complementary medicine on the other. What would be a setting in which the use of ginger would be considered with a framework of alternative medicine? How so with regard to that of integrative medicine? These two approaches of the use of non-conventional treatments, alternative medicine and integrative medicine represent two opposing poles in the paradigm of non-conventional medical care. If our patient would have ignored her oncologist recommendation for chemotherapy, choosing instead to use herbal medicinal such as ginger to treat the cancer, this would be considered as alternative medicine. Alternative medicine is the use of non-conventional medical therapies instead of conventional medicine. The use of herbal medicinals in this context may be chosen with a goal of utilizing what some believe to be powerful anti-cancer effects of these compounds or for their ability to boost the immune system, and since they are perceived by many patients as natural, herbal products are invariably considered to be safe, though this is not always the case. At the other end of the spectrum, we find the concept of integrative medicine. This approach seeks to provide non-conventional therapies within the conventional medicines setting. As such, it will be first and foremost encourage the patient to adhere to the conventional medical treatment regimen, whether chemotherapy or other oncology modalities and does not consider non-conventional therapies such as herbal medicine as an effective alternative to the accepted oncology care. It is within the integrative medicine setting that only those herbal products with research-based evidence supporting their potential effectiveness will be considered. The goal of these practices as part of cancer care will be improving the patient's quality of life, while assuring the safety, risk profile which includes both the potential for adverse effects and negative interactions with conventional treatment such as herbal-drug interactions.
