Integrative oncology: really the best of both worlds?

Journal name:
Nature Reviews Cancer
Year published:
Published online


Over the past two decades there has been a growing acceptance of 'integrative oncology', also known as complementary and alternative medicine (CAM), in cancer care and research at academic medical centres and medical schools. Proponents of integrative oncology argue that it is based in science and provides the 'best of both worlds' by combining science-based treatments and 'holistic' medicine. However, a close examination of the methodologies indicates that, from a standpoint of basic science, the vast majority of 'integrative' treatments are supported by little, if any, scientific evidence. What are the consequences of this integration? Is there any harm? Are there any potential benefits?


  1. Glymour, C. & Stalker, D. Sounding board. Engineers, cranks, physicians, magicians. N. Engl. J. Med. 308, 960964 (1983).
  2. Wechsler, M. E. et al. Active albuterol or placebo, sham acupuncture, or no intervention in asthma. N. Engl. J. Med. 365, 119126 (2011).
  3. Wang, C. et al. A randomized trial of tai chi for fibromyalgia. N. Engl. J. Med. 363, 743754 (2010).
  4. Berman, B. M., Langevin, H. M., Witt, C. M. & Dubner, R. Acupuncture for chronic low back pain. N. Engl. J. Med. 363, 454461 (2010).
  5. Berman, B. M. Integrative approaches to pain management: how to get the best of both worlds. BMJ 326, 13201321 (2003).
  6. Cramer, H., Cohen, L., Dobos, G. & Witt, C. M. Integrative oncology: best of both worlds-theoretical, practical, and research issues. Evid. Based Complement. Alternat. Med. 2013, 383142 (2013).
  7. Kiser, K. Integrative oncology. The best of both worlds. Minn. Med. 93 8, 10 (2010).
  8. Sagar, S. M. & Leis, A. M. Integrative oncology: a Canadian and international perspective. Curr. Oncol. 15 (Suppl. 2), s71s73 (2008).
  9. Seely, D. M., Weeks, L. C. & Young, S. A systematic review of integrative oncology programs. Curr. Oncol. 19, e436461 (2012).
  10. What's the Alternative? NBC Nightly News With Brian Williams. (NBC; 15 and 16 October, 2012).
  11. Ernst, E. Acupuncture—a critical analysis. J. Intern. Med. 259, 125137 (2006).
  12. Kim, J. I., Lee, M. S., Kang, J. W., Choi do, Y. & Ernst, E. Reflexology for the symptomatic treatment of breast cancer: a systematic review. Integr. Cancer Ther. 9, 326330 (2010).
  13. Reddy, S. A. Top hospital opens up to chinese herbs as medicines. Wall Street Journal [online] (April 21, 2014)
  14. Mease, M. R. Reiki at University Medical Center, Tucson, Arizona, a magnet hospital: Mega, R. Mease is interviewed by William Lee Rand. Holist Nurs. Pract. 25, 233237 (2011).
  15. Rosa, L., Rosa, E., Sarner, L. & Barrett, S. A close look at therapeutic touch. JAMA 279, 10051010 (1998).
  16. Ernst, E. Is reflexology an effective intervention? A systematic review of randomised controlled trials. Med. J. Aust. 191, 263266 (2009).
  17. White, A. R., Williamson, J., Hart, A. & Ernst, E. A blinded investigation into the accuracy of reflexology charts. Complement Ther. Med. 8, 166172 (2000).
  18. Ernst, E. Acupuncture. Lancet Oncol. 11, 20 (2010).
  19. Colquhoun, D. & Novella, S. P. Acupuncture is theatrical placebo. Anesth. Analg. 116, 13601363 (2013).
  20. Smith, K. Against homeopathy—a utilitarian perspective. Bioethics 26, 398409 (2012).
  21. Smith, K. Homeopathy is unscientific and unethical. Bioethics 26, 508512 (2012).
  22. Atwood, K. C. Naturopathy, pseudoscience, and medicine: myths and fallacies versus truth. MedGenMed 6, 33 (2004).
  23. Abrams, D. I. An overview of integrative oncology. Clin. Adv. Hematol. Oncol. 5, 4547 (2007).
  24. Barton, D. & Bauer-Wu, S. The emerging discipline of integrative oncology. Oncol. (Williston Park) 23, 4649 (2009).
  25. Berk, L. B. Primer on integrative oncology. Hematol. Oncol. Clin. North Am. 20, 213231 (2006).
  26. Pineda, M. J. & Singh, D. K. What is integrative oncology and can it help my patients? Obstet. Gynecol. Clin. North Am. 39, 285312 (2012).
  27. Standish, L. J., Sweet, E., Naydis, E. & Andersen, M. R. Can we demonstrate that breast cancer “integrative oncology” is effective? A methodology to evaluate the effectiveness of integrative oncology offered in community clinics. Integr. Cancer Ther. 12, 126135 (2013).
  28. Cassileth, B. R. & Vickers, A. J. High prevalence of complementary and alternative medicine use among cancer patients: implications for research and clinical care. J. Clin. Oncol. 23, 25902592 (2005).
  29. Marcus, D. M. & Grollman, A. P. Science and government. Review for NCCAM is overdue. Science 313, 301302 (2006).
  30. Mielczarek, E. V. & Engler, B. D. Measuring mythology: Startling concepts in NCCAM grants. Skeptical Inquirer 36, 3643 (2012).
  31. Mielczarek, E. V. & Engler, B. D. Selling pseudoscience: a rent in the fabric of American medicine. Skeptical Inquirer 38, 4451 (2014).
  32. NCCAM. Facts-at-a-glance and mission access date, [online] (August 11 2014).
  33. Boyle, E. W. The politics of alternative medicine at the National Institutes of Health. Federal Hist. 1, 1632 (2011).
  34. Block, B. NCCAM reaches out to scientists and general public. Altern. Ther. Health Med. 8, 2426 (2002).
  35. Ernst, E. & Posadzki, P. An independent review of NCCAM-funded studies of chiropractic. Clin. Rheumatol 30, 593600 (2011).
  36. Folkman, S. et al. Debating the worth of NCCAM research. Science 314, 10831084; author reply 10831084 (2006).
  37. Straus, S. E. & Chesney, M. A. Science and government. Enhanced: in defense of NCCAM. Science 313, 303304 (2006).
  38. Muscat, M. National Cancer Institute's OCCAM partners with NCCAM to expand research on unconventional cancer treatments. Altern. Ther. Health Med. 5, 2630 (1999).
  39. Office of Cancer Complementary and Alternative Medicine. Annual report on complementary and alternative medicine. [online] (2011).
  40. National Institutes of Health. What is complementary and alternative, medicine? [online] (U. S. Department of Health and Human Services, 2012).
  41. National Institutes of Health. What is complementary and alternative medicine? [online] (U. S. Department of Health and Human Services, 2007).
  42. NCCAM.Complementary, Alternative, or Integrative Health: What's In a Name? [online] (2008).
  43. Tomlinson, D., Diorio, C., Beyene, J. & Sung, L. Effect of exercise on cancer-related fatigue: a meta-analysis. Am. J. Phys. Med. Rehabil. 93, 675686 (2014).
  44. Zeng, Y., Huang, M., Cheng, A. S., Zhou, Y. & So, W. K. Meta-analysis of the effects of exercise intervention on quality of life in breast cancer survivors. Breast Cancer 21, 262274 (2014).
  45. Zou, L. Y., Yang, L., He, X. L., Sun, M. & Xu, J. J. Effects of aerobic exercise on cancer-related fatigue in breast cancer patients receiving chemotherapy: a meta-analysis. Tumour Biol. 35, 56595667 (2014).
  46. Grosso, G. et al. Mediterranean diet and cancer: epidemiological evidence and mechanism of selected aspects. BMC Surg. 13(Suppl. 2), S14 (2013).
  47. Reedy, J. et al. Higher Diet Quality Is Associated with Decreased Risk of All-Cause, Cardiovascular Disease, and Cancer Mortality among Older Adults. J. Nutr. 144, 881889 (2014).
  48. Lynton, H., Kligler, B. & Shiflett, S. Yoga in stroke rehabilitation: a systematic review and results of a pilot study. Top. Stroke Rehabil. 14, 18 (2007).
  49. American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care 37 (Suppl. 1), S1480 (2014).
  50. Chang, C. & Gershwin, M. E. Integrative medicine in allergy and immunology. Clin. Rev. Allergy Immunol. 44, 208228 (2013).
  51. Cooper, E. L. & Hirabayashi, K. Origin of innate immune responses: revelation of food and medicinal applications. J. Tradit Complement. Med. 3, 204212 (2013).
  52. DeBusk, R., Sierpina, V. S. & Kreitzer, M. J. Applying functional nutrition for chronic disease prevention and management: bridging nutrition and functional medicine in 21st century healthcare. Explore 7, 5557 (2011).
  53. NCCAM National, Center for Complementary and Alternative Medicine Third Strategic Plan 2011-2015: Exploring the Science of Complementary and Alternative Medicine [online] (U. S. Department of Health and Human Services, 2011).
  54. [no authors listed] Questionable methods of cancer management: 'nutritional' therapies. CA Cancer J. Clin. 43, 309319 (1993).
  55. [no authors listed] Unproven methods of cancer management: Gerson, Method. CA Cancer J. Clin. 40, 252256 (1990).
  56. Benson, H. et al. Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. Am. Heart J. 151, 934942 (2006).
  57. da Rosa, M. I. et al. A randomized clinical trial on the effects of remote intercessory prayer in the adverse outcomes of pregnancies. Cien. Saude Colet. 18, 23792384 (2013).
  58. Masters, K. S., Spielmans, G. I. & Goodson, J. T. Are there demonstrable effects of distant intercessory prayer? A meta-analytic review. Ann. Behav. Med. 32, 2126 (2006).
  59. Baldwin, A. L. & Hammerschlag, R. Biofield-based therapies: a systematic review of physiological effects on practitioners during healing. Explore 10, 150161 (2014).
  60. Ernst, E. The truth about homeopathy. Br. J. Clin. Pharmacol. 65, 163164 (2008).
  61. Ernst, E. Homeopathy, a “helpful placebo” or an unethical intervention? Trends Pharmacol. Sci. 31, 1 (2010).
  62. Atwood, K. C. Naturopathy: a critical appraisal. MedGenMed 5, 39 (2003).
  63. Cassileth, B. R. & Yarett, I. R. Cancer quackery: the persistent popularity of useless, irrational 'alternative' treatments. Oncology (Williston Park) 26, 754758 (2012).
  64. [no authors listed] Questionable methods of cancer management: Cancell/Entelev. CA Cancer J. Clin. 43, 5762 (1993).
  65. [no authors listed] Unproven methods of cancer management. Laetrile. CA Cancer J. Clin. 41, 187192 (1991).
  66. Lerner, I. J. Laetrile: a lesson in cancer quackery. CA Cancer J. Clin. 31, 9195 (1981).
  67. Moertel, C. G. et al. A clinical trial of amygdalin (Laetrile) in the treatment of human cancer. N. Engl. J. Med. 306, 201206 (1982).
  68. Deng, G. & Cassileth, B. Complementary or alternative medicine in cancer care-myths and realities. Nature Rev. Clin. Oncol. 10, 656664 (2013).
  69. Dobos, G., Cramer, H., Anant, S., Witt, C. M. & Cohen, L. Integrative oncology. Evid. Based Complement. Alternat. Med. 2013, 124032 (2013).
  70. Smyth, J. F. Integrative oncology—what's in a name? Eur. J. Cancer 42, 572573 (2006).
  71. Ning, A. M. How 'alternative' is CAM? Rethinking conventional dichotomies between biomedicine and complementary/alternative medicine. Health (Lond.) 17, 135158 (2013).
  72. Morange, M. The recent evolution of the question “What is life”? Hist. Philos. Life Sci. 34, 425436; discussion 436438 (2012).
  73. Lee, M. S., Pittler, M. H. & Ernst, E. Effects of reiki in clinical practice: a systematic review of randomised clinical trials. Int. J. Clin. Pract. 62, 947954 (2008).
  74. White, A. & Ernst, E. A brief history of acupuncture. Rheumatology 43, 662663 (2004).
  75. Ernst, E. Chiropractic: a critical evaluation. J. Pain Symptom Manage. 35, 544562 (2008).
  76. Green, C., Martin, C. W., Bassett, K. & Kazanjian, A. A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complement Ther. Med. 7, 201207 (1999).
  77. Ernst, E. Craniosacral therapy: A systematic review of the clinical evidence. FACT 17, 197201 (2012).
  78. Ernst, E., Posadzki, P. & Lee, M. S. Reflexology: an update of a systematic review of randomised clinical trials. Maturitas 68, 116120 (2011).
  79. Anastasi, J. K., Currie, L. M. & Kim, G. H. Understanding diagnostic reasoning in TCM practice: tongue diagnosis. Altern Ther. Health Med. 15, 1828 (2009).
  80. Chan, K. Progress in traditional Chinese medicine. Trends Pharmacol. Sci. 16, 182187 (1995).
  81. Cheng, J. T. Review: drug therapy in Chinese traditional medicine. J. Clin. Pharmacol. 40, 445450 (2000).
  82. Yapijakis, C. Hippocrates of Kos, the father of clinical medicine, and Asclepiades of Bithynia, the father of molecular medicine. Review. In Vivo 23, 507514 (2009).
  83. Sakorafas, G. H. & Safioleas, M. Breast cancer surgery: an historical narrative. Part, I. From prehistoric times to Renaissance. Eur. J. Cancer Care 18, 530544 (2009).
  84. Ernst, E. Homeopathy: what does the “best” evidence tell us? Med. J. Aust. 192, 458460 (2010).
  85. Tonelli, M. R. The limits of evidence-based medicine. Respir. Care 46, 14351440; discussion 14401441 (2001).
  86. Tonelli, M. R. & Callahan, T. C. Why alternative medicine cannot be evidence-based. Acad. Med. 76, 12131220 (2001).
  87. Miles, A. On a medicine of the whole person: away from scientistic reductionism and towards the embrace of the complex in clinical practice. J. Eval. Clin. Pract. 15, 941949 (2009).
  88. Vickers, A. J. Message to complementary and alternative medicine: evidence is a better friend than power. BMC Complement Altern Med. 1, 1 (2001).
  89. Seshia, S. S. & Young, G. B. The evidence-based medicine paradigm: where are we 20 years later? Part 2. Can. J. Neurol. Sci. 40, 475481 (2013).
  90. Seshia, S. S. & Young, G. B. The evidence-based medicine paradigm: where are we 20 years later? Part 1. Can. J. Neurol. Sci. 40, 465474 (2013).
  91. DeVita, V. T. Jr & Chu, E. A history of cancer chemotherapy. Cancer Res. 68, 86438653 (2008).
  92. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100 000 women in 123 randomised trials. Lancet 379, 432444 (2011).
  93. Shang, A. et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 366, 726732 (2005).
  94. Altunc, U., Pittler, M. H. & Ernst, E. Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials. Mayo Clin. Proc. 82, 6975 (2007).
  95. Ernst, E. A systematic review of systematic reviews of homeopathy. Br. J. Clin. Pharmacol. 54, 577582 (2002).
  96. McCarney, R. W., Linde, K. & Lasserson, T. J. Homeopathy for chronic asthma. Cochrane Database Syst. Rev. CD000353 (2004).
  97. Goodman, S. N. Toward evidence-based medical statistics. 2: The Bayes factor. Ann. Intern. Med. 130, 10051013 (1999).
  98. Ioannidis, J. P. Why most published research findings are false. PLoS Med. 2, e124 (2005).
  99. Ioannidis, J. P. Biomarker Failures. Clin. Chem. 59, 202204 (2012).
  100. Ioannidis, J. P. & Khoury, M. J. Improving validation practices in “omics” research. Science 334, 12301232 (2011).
  101. Gorski, D. H. & Novella, S. P. Clinical trials of integrative medicine: testing whether magic works? Trends Mol. Med. 20, 473476 (2014).
  102. Linde, K. et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 350, 834843 (1997).
  103. Ludtke, R. & Rutten, A. L. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. J. Clin. Epidemiol. 61, 11971204 (2008).
  104. Ernst, E. & Pittler, M. H. Re-analysis of previous meta-analysis of clinical trials of homeopathy. J. Clin. Epidemiol. 53, 1188 (2000).
  105. Linde, K. et al. Impact of study quality on outcome in placebo-controlled trials of homeopathy. J. Clin. Epidemiol. 52, 631636 (1999).
  106. Kassab, S., Cummings, M., Berkovitz, S., van Haselen, R. & Fisher, P. Homeopathic medicines for adverse effects of cancer treatments. Cochrane Database Syst. Rev. CD004845 (2009).
  107. Oberbaum, M. et al. A randomized, controlled clinical trial of the homeopathic medication TRAUMEEL S in the treatment of chemotherapy-induced stomatitis in children undergoing stem cell transplantation. Cancer 92, 684690 (2001).
  108. Pommier, P. et al. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J. Clin. Oncol. 22, 14471453 (2004).
  109. Vinceti, M. et al. Selenium for preventing cancer. Cochrane Database Syst. Rev. 3, CD005195 (2014).
  110. Klein, E. A. et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 306, 15491556 (2011).
  111. The Alpha-Tocopherol Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and β carotene on the incidence of lung cancer and other cancers in male smokers. The α-Tocopherol, β Carotene Cancer Prevention Study Group. N. Engl. J. Med. 330, 10291035 (1994).
  112. Virtamo, J. et al. Incidence of cancer and mortality following α-tocopherol and β-carotene supplementation: a postintervention follow-up. JAMA 290, 476485 (2003).
  113. Chen, Q. et al. Pharmacologic doses of ascorbate act as a prooxidant and decrease growth of aggressive tumor xenografts in mice. Proc. Natl Acad. Sci. USA 105, 1110511109 (2008).
  114. Espey, M. G. et al. Pharmacologic ascorbate synergizes with gemcitabine in preclinical models of pancreatic cancer. Free Radic. Biol. Med. 50, 16101619 (2011).
  115. Ma, Y. et al. High-dose parenteral ascorbate enhanced chemosensitivity of ovarian cancer and reduced toxicity of chemotherapy. Sci. Transl. Med. 6, 222ra18 (2014).
  116. Junio, H. A. et al. Synergy-directed fractionation of botanical medicines: a case study with goldenseal (Hydrastis canadensis). J. Nature Prod. 74, 16211629 (2011).
  117. Yang, Y. et al. Synergy effects of herb extracts: pharmacokinetics and pharmacodynamic basis. Fitoterapia 92, 133147 (2014).
  118. Wu, J. J. et al. Interactions between phytochemicals from traditional Chinese medicines and human cytochrome P450 enzymes. Curr. Drug Metab. 13, 599614 (2012).
  119. Worthley, L. I. & Holt, A. W. Digoxin in the critically ill patient. Crit. Care Resusc 1, 252264 (1999).
  120. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310, 21912194 (2013).
  121. Goldman, N. et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neurosci. 13, 883888 (2010).
  122. Hurt, J. K. & Zylka, M. J. PAPupuncture has localized and long-lasting antinociceptive effects in mouse models of acute and chronic pain. Mol. Pain 8, 28 (2012).
  123. Garcia, M. K. et al. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J. Clin. Oncol. 31, 952960 (2013).
  124. Cho, S. H., Lee, H. & Ernst, E. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 117, 907920 (2010).
  125. Ernst, E. Are the effects of acupuncture specific or nonspecific? Pain 152, 952 (2011).
  126. Ernst, E., Lee, M. S. & Choi, T. Y. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain 152, 755764 (2011).
  127. Gilby, A. Y., Ernst, E. & Tani, K. A systematic review of reviews of systematic reviews of acupuncture. FACT 18, 818 (2013).
  128. Posadzki, P. et al. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care Cancer, 21, 20672073 (2013).
  129. Street, R. L. Jr., Cox, V., Kallen, M. A. & Suarez-Almazor, M. E. Exploring communication pathways to better health: clinician communication of expectations for acupuncture effectiveness. Patient Educ. Couns. 89, 245251 (2012).
  130. White, P. et al. Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain 153, 455462 (2012).
  131. Dodin, S. et al. Acupuncture for menopausal hot flushes. Cochrane Database Syst. Rev. 7, CD007410 (2013).
  132. Franconi, G., Manni, L., Schroder, S., Marchetti, P. & Robinson, N. A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy. Evid. Based Complement Alternat. Med. 2013, 516916 (2013).
  133. O'Sullivan, E. M. & Higginson, I. J. Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupunct Med. 28, 191199 (2010).
  134. Cheuk, D. K. & Wong, V. Acupuncture for epilepsy. Cochrane Database Syst. Rev. 5, CD005062 (2014).
  135. Kim, T. H. et al. Acupuncture for treating acute ankle sprains in adults. Cochrane Database Syst. Rev. 6, CD009065 (2014).
  136. White, A. R., Rampes, H., Liu, J. P., Stead, L. F. & Campbell, J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst. Rev. 1, CD000009 (2014).
  137. Chiu, H. Y., Pan, C. H., Shyu, Y. K., Han, B. C. & Tsai, P. S. Effects of acupuncture on menopause-related symptoms and quality of life in women on natural menopause: a meta-analysis of randomized controlled trials. Menopause (2014).
  138. Cherkin, D. C. et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch. Intern. Med. 169, 858866 (2009).
  139. Linde, K. et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA 293, 21182125 (2005).
  140. Pastore, L. M., Williams, C. D., Jenkins, J. & Patrie, J. T. True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 96, 31433150 (2011).
  141. Manheimer, E. et al. The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis. Hum. Reprod. Update 19, 696713 (2013).
  142. Bao, T. et al. Patient-reported outcomes in women with breast cancer enrolled in a dual-center, double-blind, randomized controlled trial assessing the effect of acupuncture in reducing aromatase inhibitor-induced musculoskeletal symptoms. Cancer 120, 381389 (2014).
  143. Goldman, R. H. et al. Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial. Clin. J. Pain 24, 211218 (2008).
  144. Vickers, A. J. et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch. Intern. Med. 172, 14441453 (2012).
  145. Stauffer, M. E., Taylor, S. D., Watson, D. J., Peloso, P. M. & Morrison, A. Definition of nonresponse to analgesic treatment of arthritic pain: an analytical literature review of the smallest detectable difference, the minimal detectable change, and the minimal clinically important difference on the pain visual analog scale. Int. J. Inflam. 2011, 231926 (2011).
  146. Tubach, F. et al. Minimum clinically important improvement and patient acceptable symptom state in pain and function in rheumatoid arthritis, ankylosing spondylitis, chronic back pain, hand osteoarthritis, and hip and knee osteoarthritis: Results from a prospective multinational study. Arthritis Care Res. 64, 16991707 (2012).
  147. Atwood, K. C., Woeckner, E., Baratz, R. S. & Sampson, W. I. Why the NIH Trial to Assess Chelation Therapy (TACT) should be abandoned. Medscape J. Med. 10, 115 (2008).
  148. Nissen, S. E. Concerns about reliability in the Trial to Assess Chelation Therapy (TACT). JAMA 309, 12931294 (2013).
  149. Chabot, J. A. et al. Pancreatic proteolytic enzyme therapy compared with gemcitabine-based chemotherapy for the treatment of pancreatic cancer. J. Clin. Oncol. 28, 20582063 (2010).
  150. Vitale, A. Introduction for “Reiki at University Medical Center, Tucson, Arizona, a magnet hospital”: Mega, R. Mease is interviewed by William Lee Rand. Holist Nurs. Pract. 25, 231232 (2011).
  151. Paley, C. A., Johnson, M. I., Tashani, O. A. & Bagnall, A. M. Acupuncture for cancer pain in adults. Cochrane Database Syst. Rev. CD007753 (2011).
  152. Paley, C. A., Tashani, O. A., Bagnall, A. M. & Johnson, M. I. A. Cochrane systematic review of acupuncture for cancer pain in adults. BMJ Support Palliat Care 1, 5155 (2011).
  153. Moerman, D. E. Meaningful placebos—controlling the uncontrollable. N. Engl. J. Med. 365, 171172 (2011).
  154. Kaptchuk, T. J. et al. Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PLoS ONE 5, e15591 (2010).
  155. Spiegel, D., Bloom, J. R., Kraemer, H. C. & Gottheil, E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 2, 888891 (1989).
  156. Andersen, B. L. et al. Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer 113, 34503458 (2008).
  157. Boesen, E. H. & Johansen, C. Impact of psychotherapy on cancer survival: time to move on? Curr. Opin. Oncol. 20, 372377 (2008).
  158. Young, D. C. & Hade, E. M. Holidays, birthdays, and postponement of cancer death. JAMA 292, 30123016 (2004).
  159. Pearson, N. J. & Chesney, M. A. The CAM Education Program of the National Center for Complementary and Alternative Medicine: an overview. Acad. Med. 82, 921926 (2007).
  160. Caspi, O., Bell, I. R., Rychener, D., Gaudet, T. W. & Weil, A. T. The Tower of Babel: communication and medicine: An essay on medical education and complementary-alternative medicine. Arch. Intern. Med. 160, 31933195 (2000).
  161. Amri, H., Haramati, A., Sierpina, V. S. & Kreitzer, M. J. Georgetown University's graduate program in complementary and alternative medicine: training future practitioners of integrative healthcare. Explore 8, 258261 (2012).
  162. Smith, K. R. Factors influencing the inclusion of complementary and alternative medicine (CAM) in undergraduate medical education. BMJ Open 1, e000074 (2011).
  163. Dossett, M. L. et al. A medical student elective promoting humanism, communication skills, complementary and alternative medicine and physician self-care: an evaluation of the HEART program. Explore 9, 292298 (2013).
  164. Locke, A. B., Gordon, A., Guerrera, M. P., Gardiner, P. & Lebensohn, P. Recommended integrative medicine competencies for family medicine residents. Explore 9, 308313 (2013).
  165. Marcus, D. M. & McCullough, L. An evaluation of the evidence in “evidence-based” integrative medicine programs. Acad. Med. 84, 12291234 (2009).
  166. Brokaw, J. J., Tunnicliff, G., Raess, B. U. & Saxon, D. W. The teaching of complementary and alternative medicine in U. S. medical schools: a survey of course directors. Acad. Med. 77, 876881 (2002).
  167. Eyigor, S. & Kanyilmaz, S. Exercise in patients coping with breast cancer: An overview. World J. Clin. Oncol. 5, 406411 (2014).

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  1. Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, 3990 John R St., Suite 400, Detroit, Michigan 48201, USA; and the Molecular Therapeutics Program and Department of Oncology, Barbara Ann Karmanos Cancer Institute, 4100 John R St., Detroit, Michigan 48201, USA.

    • David H. Gorski

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The corresponding author is the chair of the board of directors of the Society for Science-Based Medicine (, an organization dedicated to promoting a strong scientific basis for medicine, and the managing editor of the Science-Based Medicine weblog (

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